Rojas Sebastian V, Hanke Jasmin S, Avsar Murat, Ahrens Philipp R, Deutschmann Ove, Tümler Kirstin A, Uribarri Aitor, Rojas-Hernández Sara, Sánchez Pedro L, González-Santos José M, Haverich Axel, Schmitto Jan D
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Rev Esp Cardiol (Engl Ed). 2018 Jan;71(1):13-17. doi: 10.1016/j.rec.2017.03.023. Epub 2017 Jun 20.
The number of older patients with congestive heart failure has dramatically increased. Because of stagnating cardiac transplantation, there is a need for an alternative therapy, which would solve the problem of insufficient donor organ supply. Left ventricular assist devices (LVADs) have recently become more commonly used as destination therapy (DT). Assuming that older patients show a higher risk-profile for LVAD surgery, it is expected that the increasing use of less invasive surgery (LIS) LVAD implantation will improve postoperative outcomes. Thus, this study aimed to assess the outcomes of LIS-LVAD implantation in DT patients.
We performed a prospective analysis of 2-year outcomes in 46 consecutive end-stage heart failure patients older than 60 years, who underwent LVAD implantation (HVAD, HeartWare) for DT in our institution between 2011 and 2013. The patients were divided into 2 groups according to the surgical implantation technique: LIS (n = 20) vs conventional (n = 26).
There was no statistically significant difference in 2-year survival rates between the 2 groups, but the LIS group showed a tendency to improved patient outcome in 85.0% vs 69.2% (P = .302). Moreover, the incidence of postoperative bleeding was minor in LIS patients (0% in the LIS group vs 26.9% in the conventional surgery group, P < .05), who also showed lower rates of postoperative extended inotropic support (15.0% in the LIS group vs 46.2% in the conventional surgery group, P < .05).
Our data indicate that DT patients with LIS-LVAD implantation showed a lower incidence of postoperative bleeding, a reduced need for inotropic support, and a tendency to lower mortality compared with patients treated with the conventional surgical technique.
老年充血性心力衰竭患者数量急剧增加。由于心脏移植数量停滞不前，需要一种替代疗法来解决供体器官供应不足的问题。左心室辅助装置（LVAD）最近作为终末期治疗（DT）越来越常用。假设老年患者LVAD手术风险更高，预计增加使用微创外科手术（LIS）植入LVAD将改善术后结果。因此，本研究旨在评估DT患者LIS-LVAD植入的结果。
我们对2011年至2013年间在我院接受LVAD（HVAD，HeartWare）植入用于DT的46例连续60岁以上终末期心力衰竭患者进行了为期2年的前瞻性分析。根据手术植入技术将患者分为两组：LIS组（n = 20）与传统组（n = 26）。
两组间2年生存率无统计学显著差异，但LIS组患者结局改善趋势为85.0%，而传统组为69.2%（P = 0.302）。此外，LIS患者术后出血发生率较低（LIS组为0%，传统手术组为26.9%，P < 0.05），术后延长使用正性肌力支持的比例也较低（LIS组为15.0%，传统手术组为46.2%，P < 0.05）。
我们的数据表明，与采用传统手术技术治疗的患者相比，接受LIS-LVAD植入的DT患者术后出血发生率较低，对正性肌力支持的需求减少，且死亡率有降低趋势。
