From the Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
ASAIO J. 2020 Jan;66(1):17-22. doi: 10.1097/MAT.0000000000000926.
Left ventricular assist device (LVAD) withdrawal with ventricular recovery represents the optimal outcome for patients previously implanted with an LVAD. The aim of this systematic review was to examine the patient outcomes of device withdrawal via minimally invasive pump decommissioning as compared with reoperation for pump explantation. An electronic search was performed to identify all studies in the English literature assessing LVAD withdrawal. All identified articles were systematically assessed for inclusion and exclusion criteria. Overall, 44 studies (85 patients) were included in the analysis, of whom 20% underwent decommissioning and 80% underwent explantation. The most commonly used LVAD types included the HeartMate II (decommissioning 23.5% vs. explantation 60.3%; p = 0.01) and HeartWare HVAD (decommissioning 76.5% vs. explantation 17.6%; p < 0.001). At median follow-up of 389 days, there were no significant differences in the incidence of cerebrovascular accidents (p = 0.88), infection (p = 0.75), and survival (p = 0.20). However, there was a trend toward a higher recurrence of heart failure in patients who underwent decommissioning as compared with explantation (decommissioning 15.4% vs. explantation 8.2%, cumulative hazard; p = 0.06). Decommissioning appears to be a feasible alternative to LVAD explantation in terms of overall patient outcomes.
左心室辅助装置 (LVAD) 撤机并恢复心室功能是先前植入 LVAD 的患者的最佳结果。本系统评价的目的是研究通过微创泵拆卸与泵取出的再手术相比，设备撤机的患者结局。进行了电子检索以确定评估 LVAD 撤机的所有英文文献中的研究。对所有确定的文章进行系统评估，以确定纳入和排除标准。总体而言，有 44 项研究（85 名患者）纳入分析，其中 20%接受了拆卸，80%接受了取出。最常用的 LVAD 类型包括 HeartMate II（拆卸 23.5%，取出 60.3%；p=0.01）和 HeartWare HVAD（拆卸 76.5%，取出 17.6%；p<0.001）。在中位数为 389 天的随访中，在中风（p=0.88）、感染（p=0.75）和生存率（p=0.20）方面没有显著差异。然而，与取出相比，拆卸的患者心力衰竭复发的趋势更高（拆卸 15.4%，取出 8.2%，累积风险；p=0.06）。就患者整体结局而言，拆卸似乎是 LVAD 取出的可行替代方案。
