Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia.
Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia.
J Heart Lung Transplant. 2015 Jan;34(1):75-81. doi: 10.1016/j.healun.2014.07.015. Epub 2014 Jul 22.
Device-related complications (DRC) can develop in patients supported with continuous-flow left ventricular assist devices (CF-LVADs). We studied the heart transplant (HTx) outcomes of United Network of Organ Sharing (UNOS) Status 1A patients supported with CF-LVADs with (+) or without (-) DRCs.
UNOS data (2006 to 2012) for patients listed under Status 1A with CF-LVADs at the time of HTx were analyzed. Outcomes were compared between the DRC+ and DRC- groups. The DRC+ group was further analyzed under 5 UNOS categories: B1 to B5.
Of the 6,799 patients who received HTx under 1A listing, 2,113 (31%) were supported with CF-LVADs. From 2006 to 2012, patients supported with CF-LVADs under the 1A listing increased from 11.4% to 41.5% (p = 0.0001). The DRC+ group (45%) compared with the DRC- group (55%) had longer waiting times (330 ± 323 days vs 168 ± 298 days), more patients with blood group O (57% vs 40%), and a higher body mass index (29 ± 5.5 kg/m(2) vs 27 ± 5 kg/m(2)). Most of the DRCs were in the B2 category (54%). Post-HTx survival for the DRC+ group was significantly reduced compared with the DRC- group at 1 year (85.6% vs 89.9%, p = 0.01) and at 3 years (78% vs 82.7%, p = 0.01), primarily due to B2 category.
An increasing number of patients receiving HTx under 1A listing are supported with CF-LVADs. DRCs are steadily increasing, with most of them from the B2 category. Post-HTx survival in DRC+ group is inferior, primarily for the B2 category. The benefits of CF-LVADs for patients awaiting HTx need to be weighed against the development of DRCs with subsequently inferior post-HTx survival.
在接受连续血流左心室辅助装置（CF-LVAD）治疗的患者中，可能会出现器械相关并发症（DRC）。我们研究了在接受 CF-LVAD 治疗的 UNOS 1A 状态患者中，出现（+）或不出现（-）DRC 对心脏移植（HTx）结局的影响。
分析了 2006 年至 2012 年期间，在 HTx 时接受 UNOS 1A 状态 CF-LVAD 治疗的患者的数据。比较 DRC+组和 DRC-组的结局。在 5 个 UNOS 类别下对 DRC+组进行了进一步分析：B1 至 B5。
在 6799 名接受 1A 列表 HTx 的患者中，有 2113 名（31%）接受 CF-LVAD 治疗。2006 年至 2012 年，接受 CF-LVAD 治疗的 1A 列表患者比例从 11.4%增加到 41.5%（p = 0.0001）。与 DRC-组（55%）相比，DRC+组（45%）的等待时间更长（330±323 天比 168±298 天），血型 O 的患者更多（57%比 40%），体重指数（BMI）更高（29±5.5kg/m2比 27±5kg/m2）。大多数 DRC 发生在 B2 类别（54%）。与 DRC-组相比，DRC+组的 HTx 后 1 年（85.6%比 89.9%，p = 0.01）和 3 年（78%比 82.7%，p = 0.01）生存率显著降低，主要是由于 B2 类别。
越来越多的接受 1A 列表 HTx 的患者接受 CF-LVAD 治疗。DRC 持续增加，其中大多数来自 B2 类别。DRC+组的 HTx 后生存率较低，主要是由于 B2 类别。在等待 HTx 的患者中，CF-LVAD 的益处需要与随后较差的 HTx 后生存率相关的 DRC 发展相权衡。
