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单中心经验中使用搏动性左心室辅助装置Polvad MEV与连续性血流Heart Ware和HeartMate II进行机械循环支持的比较

Comparison of Mechanical Circulatory Support by the Use of Pulsatile Left Ventricular Assist Devices Polvad MEV and Continuous Flow Heart Ware and Heart Mate II in a Single-Center Experience.

作者信息

Nadziakiewicz P, Pacholewicz J, Zakliczynski M, Niklewski T, Borkowski J, Hrapkowicz T, Zembala M

机构信息

Department of Cardiac Anaesthesia and Intensive Care, Silesian Centre for Heart Diseases, Zabrze, Poland.

Department of Cardiac Surgery and Transplantation SUM, Silesian Centre for Heart Diseases, Zabrze, Poland.

出版信息

Transplant Proc. 2016 Jun;48(5):1770-4. doi: 10.1016/j.transproceed.2016.01.076.

Abstract

BACKGROUND

Mechanical circulatory support is increasingly used in patients with heart failure as a bridge to transplant or recovery. Results of use the Polish POLVAD MEV pulsatile circulatory support system and its comparison with novel devices never was done. We compared the course of patients with left ventricular circulatory support (left ventricular assist device [LVAD]) supported by POLVAD MEV or continuous flow devices Heart Mate II (HM II) and Heart Ware (HW) in single-center cohort.

METHODS

We retrospectively reviewed 44 patients who underwent Polvad Mev (group P; n = 24 [21M/3F]) or HW or HM II (group C; n = 20 [20M/0F]) implantation between April 2007 and February 2014. Patients were in INTERMACS 1 (6 in group P and 1 in group C) or 2. Preimplant demographics, and perioperative and postoperative clinical outcomes were reviewed between groups. We analyzed baseline signs of heart failure, comorbidities, complications, and the 30- and 90-day results.

RESULTS

Among the groups, age, gender, weight, and cause of heart failure were comparable. Patients in group C suffered more frequently from hypercholesterolemia preoperatively. Patients in group P had more pulmonary complications (7 vs 0) after LVAD implantation and stay longer on intensive care unit than patients in group C (17.61 ± 16.96 vs 9.56 ± 9.42; P = .047). After exclusion, INTERMACS 1 patients it was not significant (14.8 ± 10.8 vs 9.8 ± 9.6 days; P = .065), the 30- and 90-day mortality was comparable.

CONCLUSIONS

Implantation of pulsatile POLVAD MEV and continuous flow devices as LVAD support provides comparable results. A greater number of complications in group P can cause increased mortality over a longer observation period.

摘要

背景

机械循环支持越来越多地用于心力衰竭患者,作为移植或康复的桥梁。波兰POLVAD MEV脉动循环支持系统的使用结果及其与新型设备的比较从未进行过。我们在单中心队列中比较了接受POLVAD MEV支持的左心室循环支持(左心室辅助装置[LVAD])患者与连续流设备Heart Mate II(HM II)和Heart Ware(HW)患者的病程。

方法

我们回顾性分析了2007年4月至2014年2月期间接受Polvad Mev植入术的44例患者(P组;n = 24 [21男/3女])或HW或HM II植入术的患者(C组;n = 20 [20男/0女])。患者处于INTERMACS 1级(P组6例,C组1例)或2级。比较两组患者植入前的人口统计学资料、围手术期和术后临床结果。我们分析了心力衰竭的基线体征、合并症、并发症以及30天和90天的结果。

结果

两组之间,年龄、性别、体重和心力衰竭病因具有可比性。C组患者术前高胆固醇血症的发生率更高。P组患者在LVAD植入后肺部并发症更多(7例 vs 0例),在重症监护病房的停留时间比C组患者更长(17.61±16.96天 vs 9.56±9.42天;P = 0.047)。排除INTERMACS 1级患者后,差异无统计学意义(14.8±10.8天 vs 9.8±9.6天;P = 0.065),30天和90天死亡率具有可比性。

结论

作为LVAD支持,脉动式POLVAD MEV和连续流设备的植入效果相当。P组更多的并发症可能导致更长观察期内死亡率增加。

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