Zhigalov Konstantin, Szczechowicz Marcin, Mashhour Ahmed, Mkalaluh Sabreen, Isaev Maxim, Kadyraliev Bakitbek, Easo Jerry, Ennker Juergen, Eichstaedt Harald, Weymann Alexander
Department of Cardiac Surgery, Klinikum Oldenburg, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.
Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany.
Thorac Cardiovasc Surg. 2019 Apr;67(3):183-190. doi: 10.1055/s-0038-1676841. Epub 2019 Jan 8.
The main purpose of this article is to investigate the impact of previous sternotomy (PS) on the outcome of three different left ventricular assist devices (LVAD).
Between June 2007 and February 2018, a total of 121 patients received HeartMate II (60.3%), HeartWare (12.4%), or HeartMate III (27.3%), with or without previous sternotomy (PS and non-PS groups, respectively). Propensity matching resulted in 44 patient pairs. The primary end point was overall survival at 30 days, 1 year, 2, and 5 years, postoperatively. Secondary end points were adverse events.
The overall cumulative survival rates for the two study groups were significantly different (77, 63, 54, and 38% for non-PS group vs 64, 39, 27, and 24% for PS group, = 0.036). In the PS group, there was a higher need for intraoperative implantation of short-term right ventricular assist device (22.7 vs 6.8%, = 0.034) and a higher incidence of hepatic dysfunction (20.5 vs 4.5%, = 0.025) and acute kidney dysfunction (40.9 vs 20.5%, = 0.032).
PS is a reliable predictor of mortality and morbidity after LVAD implantation.
本文的主要目的是研究既往胸骨切开术（PS）对三种不同左心室辅助装置（LVAD）治疗效果的影响。
2007年6月至2018年2月期间，共有121例患者接受了HeartMate II（60.3%）、HeartWare（12.4%）或HeartMate III（27.3%）治疗，其中有或无既往胸骨切开术（分别为PS组和非PS组）。倾向匹配产生了44对患者。主要终点是术后30天、1年、2年和5年的总生存率。次要终点是不良事件。
两个研究组的总体累积生存率有显著差异（非PS组为77%、63%、54%和38%，PS组为64%、39%、27%和24%，P = 0.036）。在PS组中，术中更需要植入短期右心室辅助装置（22.7%对6.8%，P = 0.034），肝功能障碍发生率更高（20.5%对4.5%，P = 0.025），急性肾功能障碍发生率更高（40.9%对20.5%，P = 0.032）。
PS是LVAD植入术后死亡率和发病率的可靠预测指标。
