Division of Cardiothoracic Transplant and Assist Devices, Baylor College of Medicine, Houston, Tex; Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Tex.
Division of Cardiothoracic Transplant and Assist Devices, Baylor College of Medicine, Houston, Tex; Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Tex; Department of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2019 Oct;158(4):1083-1089.e1. doi: 10.1016/j.jtcvs.2019.02.040. Epub 2019 Feb 21.
Long-term support with continuous-flow left ventricular assist devices (CF-LVADs) has improved the outcomes of patients with end-stage heart failure. However, valve disease management in patients who undergo CF-LVAD implantation remains controversial. The aim of this study was to assess our single-center experience with patients who underwent a concomitant valve procedure during implantation of a CF-LVAD.
From November 2003 through March 2016, 526 patients underwent primary CF-LVAD implantation with a HeartMate II (St Jude Inc, St Paul, Minn; n = 403) or HeartWare (Medtronic, Minneapolis, Minn; n = 123) device at our center. Of those, 91 underwent a concomitant valve procedure during implantation (CF-LVAD+valve procedure group), whereas 435 did not (CF-LVAD-only group). We compared preoperative characteristics and short-term and mid-term survival rates between these groups.
The concomitant valve procedures performed included 13 tricuspid valve repairs, 19 aortic valve repairs or replacements, 30 mitral valve repairs or replacements, and 29 double valve repairs or replacements. Survival rates at 1 month, 6 months, 12 months, and 24 months were 90.3%, 81.4%, 74.9%, and 67.4%, respectively, for the CF-LVAD-only group and 89.0%, 75.8%, 70.3%, and 65.9%, respectively, for the CF-LVAD+valve procedure group (P = .55). The results of Cox regression multivariable modeling showed that performing a concomitant valve procedure was not an independent predictor of mortality (hazard ratio, 1.29; 95% confidence interval, 0.96-1.74; P = .08).
In our experience, performing a concomitant valve procedure during CF-LVAD implantation was not associated with an increased mortality rate. The decision to perform a concomitant valve procedure should be made primarily on the basis of clinical indications for the procedure.
带连续血流的左心室辅助装置（CF-LVAD）的长期支持改善了终末期心力衰竭患者的预后。然而，CF-LVAD 植入患者的瓣膜疾病管理仍存在争议。本研究旨在评估我们中心在 CF-LVAD 植入时同时进行瓣膜手术的患者的单中心经验。
2003 年 11 月至 2016 年 3 月，我们中心 526 例患者行初次 CF-LVAD 植入，其中 403 例行 HeartMate II（St Jude Inc，明尼苏达州圣保罗；n=403），123 例行 HeartWare（Medtronic，明尼苏达州明尼阿波利斯）。其中 91 例行植入时同时行瓣膜手术（CF-LVAD+瓣膜手术组），435 例行单纯 CF-LVAD 手术（CF-LVAD 组）。比较两组患者的术前特征及短期和中期生存率。
同时进行的瓣膜手术包括 13 例三尖瓣修复术、19 例主动脉瓣修复或置换术、30 例二尖瓣修复或置换术和 29 例双瓣修复或置换术。CF-LVAD 组和 CF-LVAD+瓣膜手术组的 1 个月、6 个月、12 个月和 24 个月生存率分别为 90.3%、81.4%、74.9%和 67.4%，89.0%、75.8%、70.3%和 65.9%（P=0.55）。Cox 回归多变量模型的结果显示，同时进行瓣膜手术不是死亡率的独立预测因素（风险比，1.29；95%置信区间，0.96-1.74；P=0.08）。
根据我们的经验，CF-LVAD 植入时同时进行瓣膜手术与死亡率的增加无关。是否同时进行瓣膜手术的决定应主要根据手术的临床适应证做出。
