Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Clin Res Cardiol. 2019 Nov;108(11):1197-1207. doi: 10.1007/s00392-019-01451-9. Epub 2019 Mar 16.
Ventricular assist devices (VAD) are increasingly used as long-term treatment for advanced heart failure. However, survival after VAD implantation is still unsatisfactory, and no specific outpatient follow-up algorithms have been formally established. Here, we evaluate the effect of an intensified follow-up protocol (IFUP) on survival rates and VAD-associated complications.
This is a retrospective study of 57 patients who received a VAD at our center between February 2013 and December 2017. Inclusion criteria were discharge home after VAD implantation and follow-up in our VAD outpatient clinic. Patients implanted after October 2015 (n = 30) were monitored according to IFUP. This protocol embodied formalized, multi-disciplinary clinical visits every 4-8 weeks including a cardiologist, a cardiothoracic surgeon and a VAD-coordinator and was characterized by optimized anticoagulation and wound management as well as guideline-directed medical therapy. One-year survival in the IFUP patients was 97%, compared to 74% in the pre-IFUP era (p = 0.01). Implementation of IFUP was associated with a 90% risk-reduction for 1-year mortality (relative risk 0.099; p = 0.048). The rate of complications, e.g., device thrombosis and major bleeding, was significantly reduced, resulting in superior event-free survival in the IFUP group (p = 0.003). Furthermore, by implementation of IFUP, a more stable anticoagulation adjustment was achieved as well as an improved adherence to guideline-directed medical therapy.
Implementation of an IFUP for VAD patients is associated with a significant decrease in 1-year all-cause mortality. This emphasizes the need for more vigilance in the management of VAD patients by a dedicated multi-disciplinary team.
心室辅助装置（VAD）越来越多地被用于治疗晚期心力衰竭的长期治疗方法。然而，VAD 植入后的存活率仍然不尽如人意，也没有正式建立特定的门诊随访算法。在这里，我们评估了强化随访方案（IFUP）对存活率和 VAD 相关并发症的影响。
这是一项对 2013 年 2 月至 2017 年 12 月期间在我们中心接受 VAD 的 57 名患者进行的回顾性研究。纳入标准为 VAD 植入后出院并在我们的 VAD 门诊随访。2015 年 10 月后植入的患者（n=30）根据 IFUP 进行监测。该方案体现了每 4-8 周进行一次正式的多学科临床访视，包括心脏病专家、心胸外科医生和 VAD 协调员，并以优化的抗凝和伤口管理以及指南指导的药物治疗为特色。IFUP 患者的 1 年生存率为 97%，而 IFUP 前时代为 74%（p=0.01）。实施 IFUP 可使 1 年死亡率降低 90%（相对风险 0.099；p=0.048）。并发症（如装置血栓形成和大出血）的发生率显著降低，IFUP 组的无事件生存率更高（p=0.003）。此外，通过实施 IFUP，可以更稳定地调整抗凝治疗，并提高对指南指导的药物治疗的依从性。
为 VAD 患者实施 IFUP 与 1 年全因死亡率的显著降低相关。这强调了需要由专门的多学科团队更密切地管理 VAD 患者。
