Yoshitake Shuichi, Kinoshita Osamu, Nawata Kan, Hoshino Yasuhiro, Itoda Yoshifumi, Kimura Mitsutoshi, Yamauchi Haruo, Ono Minoru
Department of Cardiac Surgery, Department of Cooperative Unit of Medicine and Engineering Research, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
J Artif Organs. 2018 Dec;21(4):405-411. doi: 10.1007/s10047-018-1053-2. Epub 2018 Jun 25.
Currently, we use the Nipro paracorporeal VAD (p-VAD) for initial short-term ventricular support, as a bridge to decision (BTD) or a bridge to candidacy (BTC) treatment, in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels 1 and 2 patients. However, it is possible that compared to patients with primary implantable-VADs (P-iVAD), the bridge-to-bridge (BTB) patients are more likely to develop complications. This retrospective study used data from 24 consecutive BTB patients who were initially implanted with Nipro p-VAD as BTD or BTC treatments between April 2011 and March 2016, and subsequently underwent conversion to an i-VAD. The data from 72 patients who underwent a primary i-VAD (P-iVAD) procedure were used for comparison. Between the two groups, there was no significant difference in the incidence of infectious events (p = 0.72) or stroke (p = 0.44). Orthotropic heart transplantation was performed in 6 of the 24 patients in the BTB group and in 21 of the 72 patients in the P-iVAD group. The 1- and 2-year survival rates were 95.8% and 95.8% in the BTB group and 91% and 85.8% in the P-iVAD group; these values were not significantly different between groups (p = 0.91). Based on these results we conclude that BTB using Nipro p-VAD is a reasonable strategy for treating patients with severe decompensated end-stage heart failure.
目前，在机构间机械辅助循环支持注册中心（INTERMACS）1级和2级患者中，我们使用日机装体外心室辅助装置（p-VAD）进行初始短期心室支持，作为决策过渡（BTD）或候选过渡（BTC）治疗。然而，与原发性植入式心室辅助装置（P-iVAD）患者相比，桥接过渡（BTB）患者可能更容易出现并发症。这项回顾性研究使用了24例连续BTB患者的数据，这些患者在2011年4月至2016年3月期间最初植入日机装p-VAD作为BTD或BTC治疗，随后转换为i-VAD。72例接受原发性i-VAD（P-iVAD）手术患者的数据用于比较。两组之间，感染事件发生率（p = 0.72）或中风发生率（p = 0.44）无显著差异。BTB组24例患者中有6例接受了原位心脏移植，P-iVAD组72例患者中有21例接受了原位心脏移植。BTB组1年和2年生存率分别为95.8%和95.8%，P-iVAD组分别为91%和85.8%；两组之间这些值无显著差异（p = 0.91）。基于这些结果，我们得出结论，使用日机装p-VAD进行BTB是治疗严重失代偿终末期心力衰竭患者的合理策略。
