Seese Laura, Hickey Gavin, Keebler Mary E, Mathier Michael A, Sultan Ibrahim, Gleason Thomas G, Wang Yisi, Kilic Arman
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Card Surg. 2020 Apr;35(4):810-817. doi: 10.1111/jocs.14466. Epub 2020 Feb 24.
To create equitable access to donor organs for the highest mortality patients, the cardiac transplant allocation system now prioritizes patients with surgically implanted temporary left ventricular assist devices (T-LVADs). The outcomes following a direct bridge from a T-LVAD to orthotopic heart transplant (OHT) are not well delineated.
This study investigates the T-LVAD waitlist outcomes and compares the posttransplant outcomes in patients bridged to OHT with surgically implanted T-LVADs to patients bridged with durable continuous-flow left ventricular assist devices (CF-LVADs).
Adults recorded in the United Network for Organ Sharing registry bridged to OHT with a durable CF-LVAD and T-LVADs, with or without temporary right ventricular assist devices (T-RVADs), between 2010 and 2018 were included. Propensity matching and multivariable Cox regression were utilized to compare outcomes.
Of 504 patients waitlisted with T-LVADs, the majority were transplanted (50%), bridged to CF-LVAD (17%), or recovered (9%). A total of 9047 recipients were bridged to OHT during the study period with 8875 CF-LVADs and 172 T-LVADs. Early survival in propensity-matched T-LVAD ± T-RVAD patients was similar to CF-LVAD ± T-RVAD patients but reduced at a 1-year follow-up. This difference in survival at 1-year follow-up was attributable to significantly reduced survival in patients with combined T-LVAD + T-RVAD support when compared with CF-LVAD, isolated T-LVAD and combined CF-LVAD + T-RVAD support (80% vs 90% vs 90% vs 91%; P = .005).
This study demonstrates that most patients waitlisted with a T-LVAD are successfully bridged to durable therapy or recover, and those bridged to OHT have acceptable posttransplant outcomes, particularly when T-RVADs are not required.
为了让死亡率最高的患者能够公平获得供体器官，心脏移植分配系统现在将接受外科植入临时左心室辅助装置（T-LVAD）的患者列为优先对象。从T-LVAD直接过渡到原位心脏移植（OHT）后的结果尚未得到充分描述。
本研究调查了T-LVAD等待名单上的结果，并比较了接受外科植入T-LVAD过渡到OHT的患者与接受耐用的连续血流左心室辅助装置（CF-LVAD）过渡到OHT的患者的移植后结果。
纳入2010年至2018年期间在美国器官共享联合网络登记处登记的、使用耐用CF-LVAD和T-LVAD过渡到OHT的成年人，无论是否使用临时右心室辅助装置（T-RVAD）。采用倾向匹配和多变量Cox回归来比较结果。
在504名等待T-LVAD的患者中，大多数接受了移植（50%），过渡到CF-LVAD（17%），或康复（9%）。在研究期间，共有9047名接受者通过8875个CF-LVAD和172个T-LVAD过渡到OHT。倾向匹配的T-LVAD±T-RVAD患者的早期生存率与CF-LVAD±T-RVAD患者相似，但在1年随访时有所降低。1年随访时生存率的这种差异归因于与CF-LVAD、单独的T-LVAD和联合CF-LVAD+T-RVAD支持相比，联合T-LVAD+T-RVAD支持的患者生存率显著降低（80%对90%对90%对91%；P = 0.005）。
本研究表明，大多数等待T-LVAD的患者成功过渡到了持久治疗或康复阶段，那些过渡到OHT的患者移植后结果尚可，尤其是在不需要T-RVAD的情况下。
