Jha Sunita R, Hannu Malin K, Newton Phillip J, Wilhelm Kay, Hayward Christopher S, Jabbour Andrew, Kotlyar Eugene, Keogh Anne, Dhital Kumud, Granger Emily, Connellan Mark, Jansz Paul, Spratt Phillip M, Montgomery Elyn, Smith Angela, Harkess Michelle, Tunicliff Peta, Davidson Patricia M, Macdonald Peter S
Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia.
Centre for Cardiovascular and Chronic Care, Faculty Health, University of Technology Sydney, Australia.
Transplant Direct. 2017 May 30;3(7):e167. doi: 10.1097/TXD.0000000000000690. eCollection 2017 Jul.
We recently reported that frailty is independently predictive of increased mortality in patients with advanced heart failure referred for heart transplantation (HTx). The aim of this study was to assess the impact of frailty on short-term outcomes after bridge-to-transplant ventricular assist device (BTT-VAD) implantation and/or HTx and to determine if frailty is reversible after these procedures.
Between August 2013 and August 2016, 100 of 126 consecutive patients underwent frailty assessment using Fried's Frailty Phenotype before surgical intervention: 40 (21 nonfrail, 19 frail) BTT-VAD and 77 (60 nonfrail, 17 frail) HTx-including 17 of the 40 BTT-VAD supported patients. Postprocedural survival, intubation time, intensive care unit, and hospital length of stay were compared between frail and nonfrail groups. Twenty-six frail patients were reassessed at 2 months or longer postintervention.
Frail patients had lower survival (63 ± 10% vs 94 ± 3% at 1 year, = 0.012) and experienced significantly longer intensive care unit (11 vs 5 days, = 0.002) and hospital (49 vs 25 days, = 0.003) length of stay after surgical intervention compared with nonfrail patients. Twelve of 13 frail patients improved their frailty score after VAD (4.0 ± 0.8 to 1.4 ± 1.1, < 0.001) and 12 of 13 frail patients improved their frailty score after HTx (3.2 ± 0.4 to 0.9 ± 0.9, < 0.001). Handgrip strength and depression improved postintervention. Only a slight improvement in cognitive function was seen postintervention.
Frail patients with advanced heart failure experience increased mortality and morbidity after surgical intervention with BTT-VAD or HTx. Among those who survive frailty is partly or completely reversible underscoring the importance of considering this factor as a dynamic not fixed entity.
我们最近报道，衰弱是晚期心力衰竭患者接受心脏移植（HTx）转诊时死亡率增加的独立预测因素。本研究的目的是评估衰弱对桥接至移植心室辅助装置（BTT-VAD）植入和/或HTx后短期结局的影响，并确定衰弱在这些手术后是否可逆。
2013年8月至2016年8月期间，126例连续患者中有100例在手术干预前使用Fried衰弱表型进行衰弱评估：40例（21例非衰弱，19例衰弱）接受BTT-VAD，77例（60例非衰弱，17例衰弱）接受HTx，其中包括40例接受BTT-VAD支持患者中的17例。比较衰弱组和非衰弱组术后生存率、插管时间、重症监护病房和住院时间。26例衰弱患者在干预后2个月或更长时间进行重新评估。
与非衰弱患者相比，衰弱患者术后生存率较低（1年时为63±10%对94±3%，P=0.012），重症监护病房住院时间（11天对5天，P=0.002）和住院时间（49天对25天，P=0.003）明显更长。13例衰弱患者中有12例在VAD植入后衰弱评分改善（从4.0±0.8降至1.4±1.1，P<0.001），13例衰弱患者中有12例在HTx后衰弱评分改善（从3.2±0.4降至0.9±0.9，P<0.001）。干预后握力和抑郁情况有所改善。干预后认知功能仅略有改善。
晚期心力衰竭的衰弱患者在接受BTT-VAD或HTx手术干预后死亡率和发病率增加。在存活患者中，衰弱部分或完全可逆，这突出了将该因素视为动态而非固定实体的重要性。
