Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Ann Thorac Surg. 2019 Aug;108(2):517-523. doi: 10.1016/j.athoracsur.2019.01.061. Epub 2019 Mar 6.
Few reports have described associations between a bleeding revision and outcomes after implantation of a continuous-flow left ventricular assist device (LVAD).
We retrospectively analyzed all adult recipients of a continuous-flow LVAD who were operated on between January 2006 and December 2016 at the Division of Cardiac Surgery, Medical University of Vienna (N = 257). LVAD types were HeartWare HVAD (Medtronic, Minneapolis, MN), HeartMate II (Abbott [Thoratec], Abbott Park, IL), and HeartMate 3 (Abbott [Thoratec]). The primary outcome variable was survival during LVAD support. Secondary outcome variables were rates of prolonged ventilation, intensive care unit stay, hospital stay, renal replacement therapy, and stroke. We additionally investigated risk factors for a bleeding revision.
Thirty-six patients (14%) underwent surgical revision for bleeding. In a multivariable Cox proportional hazards model, bleeding revision was associated with significantly reduced survival during LVAD support (3 months: hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.20 to 3.48; 6 months: HR, 1.63; 95% CI, 0.95 to 2.82; 12 months: HR, 1.30; 95% CI, 0.69 to 2.46; 24 months: HR, 1.04; 95% CI 0.48 to 2.26; overall p = 0.007). Rates of secondary outcome variables were substantially higher in the revision group compared with patients who survived the hospital stay without a bleeding revision. Concomitant implantation of a temporary right ventricular assist device (p = 0.002) and age (p = 0.028) were independent risk factors for a bleeding revision.
A bleeding revision is associated with significantly reduced survival and substantially increased morbidity during LVAD support. Preoperative, intraoperative, and postoperative prophylactic strategies may help to prevent this life-threatening complication.
鲜有研究报道左心室辅助装置（LVAD）植入术后因出血而进行翻修与结局之间的相关性。
我们回顾性分析了 2006 年 1 月至 2016 年 12 月期间在维也纳医科大学心脏外科接受连续血流 LVAD 植入术的所有成年患者（n=257）。LVAD 类型包括 HeartWare HVAD（美敦力，明尼苏达州明尼阿波利斯）、HeartMate II（雅培 [Thoratec]，伊利诺伊州雅培公园）和 HeartMate 3（雅培 [Thoratec]）。主要结局变量为 LVAD 支持期间的生存率。次要结局变量为延长通气、重症监护病房停留时间、住院时间、肾脏替代治疗和中风的发生率。我们还研究了出血翻修的危险因素。
36 例患者（14%）因出血而行手术翻修。多变量 Cox 比例风险模型显示，出血翻修与 LVAD 支持期间生存率显著降低相关（3 个月：风险比[HR]，2.04；95%置信区间[CI]，1.20 至 3.48；6 个月：HR，1.63；95%CI，0.95 至 2.82；12 个月：HR，1.30；95%CI，0.69 至 2.46；24 个月：HR，1.04；95%CI 0.48 至 2.26；总体 p=0.007）。与未发生出血性翻修且存活至出院的患者相比，翻修组的次要结局变量发生率显著更高。同期植入临时右心室辅助装置（p=0.002）和年龄（p=0.028）是出血性翻修的独立危险因素。
出血性翻修与 LVAD 支持期间生存率显著降低和发病率显著增加显著相关。术前、术中和术后预防性策略可能有助于预防这种危及生命的并发症。
