晚期心力衰竭的机械循环支持：单中心经验
Mechanical circulatory support in advanced heart failure: single-center experience.
作者信息
Loforte A, Montalto A, Lilla della Monica P, Lappa A, Contento C, Menichetti A, Musumeci F
机构信息
Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
出版信息
Transplant Proc. 2014 Jun;46(5):1476-80. doi: 10.1016/j.transproceed.2014.01.016.
BACKGROUND
Currently, ventricular assist device (VAD) or total artificial heart (TAH) mechanical support provides an effective treatment of unstable patients with advanced heart failure. We report our single-center experience with mechanical circulatory support therapy.
METHODS
From March 2002 to December 2012, 107 adult patients (mean age, 56.8 ± 9.9 y; range, 31-76 y) were primarly supported on temporary or long-term VAD or TAH support as treatment for refractory heart failure at our institution. Temporary extracorporeal radial VAD support (group A) was established in 49 patients (45.7%), and long-term paracorporeal and intracorporeal VAD or TAH (group B) in 58 patients (54.2%). Left ventricular (LVAD) support was established in 55 patients (51.4%; n = 33, Heartmate II; n = 6, Heartmate I XVE; n = 4, Heartware HVAD; and n = 12, Centrimag) and biventricular (BVAD/TAH) support (group B) in 28 patients (26.1%; n = 10, Thoratec paracorporeal; n = 2, Heartware HVAD, n = 1, Thoratec implantable; n = 1, Syncardia TAH; and n = 14, Centrimag). The temporary Centrimag was the only device adopted as isolated right ventricular (RVAD) support, and it was inserted in 24 patients (22.4%).
RESULTS
In group A, overall mean support time was 10.2 ± 6.6 days (range, 3-43 d). In group B, LVAD mean support time was 357 ± 352.3 days (range, 1-902 d) and BVAD/TAH support time was 98 ± 82.6 days (range, 8-832 d). In group A, the overall success rate was 55.1% (27 patients). In group B, LVAD overall success rate was 74.4% (32 patients) and BVAD/TAH success rate was 50% (7 patients). Overall heart transplantation rate for both groups was 27.1% (n = 2, group A; n = 27, group B). Overall 1-year and 5-year survivals after heart transplantation were 72.4% (n = 21) and 58.6% (n = 17), respectively.
CONCLUSIONS
Mechanical circulatory support is an effective strategy even in cases of end-stage heart failure according to our experience. Further improvement of VAD and TAH technologies may support their adoption as an encouraging alternative to heart transplantation in the near future.
背景
目前，心室辅助装置（VAD）或全人工心脏（TAH）机械支持为晚期心力衰竭不稳定患者提供了一种有效的治疗方法。我们报告我们在机械循环支持治疗方面的单中心经验。
方法
从2002年3月至2012年12月，107例成年患者（平均年龄56.8±9.9岁；范围31 - 76岁）在我们机构接受临时或长期VAD或TAH支持，作为难治性心力衰竭的治疗方法。49例患者（45.7%）建立了临时体外桡动脉VAD支持（A组），58例患者（54.2%）建立了长期体外和体内VAD或TAH（B组）。55例患者（51.4%）建立了左心室（LVAD）支持（n = 33，Heartmate II；n = 6，Heartmate I XVE；n = 4，Heartware HVAD；n = 12，Centrimag），28例患者（26.1%）建立了双心室（BVAD/TAH）支持（B组）（n = 10，Thoratec体外；n = 2，Heartware HVAD；n = 1，Thoratec可植入；n = 1，Syncardia TAH；n = 14，Centrimag）。临时Centrimag是唯一被用作孤立右心室（RVAD）支持的装置，24例患者（22.4%）植入了该装置。
结果
A组总的平均支持时间为10.2±6.6天（范围3 - 43天）。B组中，LVAD平均支持时间为357±352.3天（范围1 - 902天），BVAD/TAH支持时间为98±82.6天（范围8 - 832天）。A组总的成功率为55.1%（27例患者）。B组中，LVAD总的成功率为74.4%（32例患者），BVAD/TAH成功率为50%（7例患者）。两组总的心脏移植率为27.1%（n = 2，A组；n = 27，B组）。心脏移植后总的1年和5年生存率分别为72.4%（n = 21）和58.6%（n = 17）。
结论
根据我们的经验，即使在终末期心力衰竭病例中，机械循环支持也是一种有效的策略。VAD和TAH技术的进一步改进可能支持它们在不久的将来成为心脏移植的一种令人鼓舞的替代方法。
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