左心室辅助装置相关心内膜炎的管理与结局：一项系统评价
Management and outcomes of left ventricular assist device-associated endocarditis: a systematic review.
作者信息
Patel Sinal, Rizvi Syed Saif Abbas, Choi Jae Hwan, Horan Dylan P, Weber Matthew P, Maynes Elizabeth J, Luc Jessica G Y, Aburjania Nana, Entwistle John W, Morris Rohinton J, Massey Howard T, Tchantchaleishvili Vakhtang
机构信息
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
Ann Cardiothorac Surg. 2019 Nov;8(6):600-609. doi: 10.21037/acs.2019.04.04.
BACKGROUND
Left ventricular assist device (LVAD)-associated endocarditis remains poorly studied, especially in newer continuous-flow LVADs (CF-LVADs). The aim of this review was to assess outcomes of patients with LVAD-associated endocarditis, as stratified by CF-LVAD and pulsatile LVAD (P-LVAD) use as well as by different interventions and pathogen types.
METHODS
An electronic search was performed to identify studies in the English literature on LVAD-associated endocarditis.
RESULTS
Overall, 16 articles with 26 patients were included; seven had CF-LVADs and 19 had P-LVADs; time to development of endocarditis was 91 days (152 65 days, respectively, P=0.05). Eleven of 25 patients were treated with antibiotics only. Remaining 14 patients received antibiotics, however, they also underwent additional surgical intervention. One patient was treated with embolization alone for mycotic aneurysm and was therefore excluded. At a median follow-up time of 344 days post implant, there was no difference in overall mortality between CF-LVAD and P-LVAD-associated endocarditis patients (57.9% 42.9%, P=0.81). Patients who underwent additional surgical intervention had higher overall survival compared to those treated with antibiotics alone (71.4% 27.3%, P=0.07); with no difference in outcomes amongst those who underwent surgical device exchange as compared to heart transplantation (80.0% 66.7%; P=0.23).
CONCLUSIONS
Compared to patients with P-LVADs, CF-LVAD patients appeared to be resistant to early development of LVAD-associated endocarditis. There was a trend towards high survival observed amongst patients who underwent additional surgical intervention as compared to those treated with antibiotics alone, with no difference amongst surgical device exchange as compared to heart transplantation. Advantages of additional surgical intervention medical therapy alone deserves further exploration to determine its applicability in CF-LVADs.
背景
左心室辅助装置（LVAD）相关的心内膜炎研究较少，尤其是在新型连续血流LVAD（CF-LVAD）方面。本综述的目的是评估LVAD相关心内膜炎患者的预后，根据CF-LVAD和搏动性LVAD（P-LVAD）的使用情况以及不同的干预措施和病原体类型进行分层。
方法
进行电子检索以确定英文文献中关于LVAD相关心内膜炎的研究。
结果
总体而言，纳入了16篇文章中的26例患者；7例使用CF-LVAD，19例使用P-LVAD；心内膜炎发生时间分别为91天（152±65天，P=0.05）。25例患者中有11例仅接受抗生素治疗。其余14例患者接受了抗生素治疗，但也接受了额外的手术干预。1例患者因霉菌性动脉瘤仅接受栓塞治疗，因此被排除。植入后中位随访时间为344天，CF-LVAD和P-LVAD相关心内膜炎患者的总体死亡率无差异（57.9%对42.9%，P=0.81）。与仅接受抗生素治疗的患者相比，接受额外手术干预的患者总体生存率更高（71.4%对27.3%，P=0.07）；接受手术装置更换与心脏移植的患者预后无差异（80.0%对66.7%；P=0.23）。
结论
与P-LVAD患者相比，CF-LVAD患者似乎对LVAD相关心内膜炎的早期发生具有抵抗力。与仅接受抗生素治疗的患者相比，接受额外手术干预的患者有较高的生存趋势，接受手术装置更换与心脏移植的患者无差异。额外手术干预相对于单纯药物治疗的优势值得进一步探索，以确定其在CF-LVAD中的适用性。
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