Dell'Aquila Angelo Maria, Schneider Stefan R B, Risso Paolo, Welp Henryk, Glockner David G, Alles Sebastian, Sindermann Jürgen R, Scherer Mirela
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Münster, Münster, Germany.
Epidemiology and Social Psychiatry Unit, Mario Negri Institute for Pharmacological Research, Milan, Italy.
Artif Organs. 2015 Dec;39(12):998-1004. doi: 10.1111/aor.12501. Epub 2015 May 25.
Poor survival has been demonstrated after ventricular assist device (VAD) implantation for Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 and 2 patients compared with more stable levels. However, risk factors within this high-risk cohort have not been determined so far. The aim of the present study was to identify risk factors associated with this very high mortality rate. Between February 1993 and January 2013, 298 patients underwent VAD implantation in our institution. One hundred nine patients were in INTERMACS level 1 and 49 patients were in INTERMACS level 2 and were therefore defined as hemodynamically critical (overall 158 patients). Assist devices implanted were: HVAD HeartWare n = 18; Incor n = 11; VentrAssist n = 2; DeBakey n = 22; and pulsatile systems n = 105. After cumulative support duration of 815.35 months, Kaplan-Meier analysis revealed a survival of 63.9, 48.8, and 40.3% at 1, 6, and 12 months, respectively. Cox regression analyses identified age > 50 (P = 0.001, odds ratio [OR] 2.48), white blood cell count > 13.000/μL (P = 0.01, OR 2.06), preoperative renal replacement therapy (P = 0.001, OR 2.63), and postcardiotomy failure (P < 0.001, OR 2.79) as independent predictors of mortality. Of note, last generation VADs were not associated with significantly better 6-month survival (P = 0.59). Patients without the aforementioned risk factors could yield a survival of 79.2% at 6 months. This single-center experience shows that VAD implantation in hemodynamically unstable patients generally results in poor early outcome, even in third-generation pumps. However, avoiding the aforementioned risk factors could result in improved outcome.
与病情较为稳定的患者相比，机构间机械辅助循环支持注册研究（INTERMACS）1级和2级患者在植入心室辅助装置（VAD）后生存率较低。然而，目前尚未确定这一高危队列中的危险因素。本研究的目的是确定与这种极高死亡率相关的危险因素。1993年2月至2013年1月期间，298例患者在我院接受了VAD植入术。109例患者为INTERMACS 1级，49例患者为INTERMACS 2级，因此被定义为血流动力学不稳定（共158例患者）。植入的辅助装置包括：HeartWare HVAD（n = 18）；Incor（n = 11）；VentrAssist（n = 2）；DeBakey（n = 22）；以及搏动系统（n = 105）。在累计支持时间达815.35个月后，Kaplan-Meier分析显示1个月、6个月和12个月时的生存率分别为63.9%、48.8%和40.3%。Cox回归分析确定年龄>50岁（P = 0.001，比值比[OR] 2.48）、白细胞计数>13,000/μL（P = 0.01，OR 2.06）、术前肾脏替代治疗（P = 0.001，OR 2.63）以及心脏术后衰竭（P < 0.001，OR 2.79）为死亡的独立预测因素。值得注意的是，最新一代VAD与6个月生存率显著提高无关（P = 0.59）。没有上述危险因素的患者6个月时生存率可达79.2%。这项单中心经验表明，血流动力学不稳定患者植入VAD通常早期预后较差，即使使用第三代泵也是如此。然而，避免上述危险因素可能会改善预后。
