Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Artif Organs. 2020 Sep;44(9):926-934. doi: 10.1111/aor.13675. Epub 2020 Mar 10.
In patients with biventricular heart failure or refractory right heart failure following HeartWare HVAD placement, off-label placement of a right-sided HeartWare HVAD has been described both in the right ventricular (RV) and right atrial (RA) positions. We sought to evaluate and compare the outcomes of right-sided HeartWare HVAD using the RA versus RV approach. An electronic search was performed in the English literature to identify all reports of left- and right-heart support with HeartWare HVAD. Of the 1,288 articles identified, 13 articles with 56 cases met inclusion criteria. Patient-level data were extracted and analyzed. The median patient age was 52 years (IQR 33.0-59.0) and 40/50 (80.0%) were male. Overall, 21/56 patients (37.5%) had RA HVAD, while 35/56 (62.5%) had RV HVAD. Most underwent concomitant HVAD placement [RA: 17/21 (81.0%) vs. RV: 31/35 (88.6%), P = .69]. In those who did not, the median time between left and right HVAD was 10 days (IQR 7-14) for RA HVAD and 12 days (IQR 8-30) for RV HVAD (P = .77). The median time of support was 351 days (IQR 136-626) for RA HVAD compared to 135 days (IQR 61-244) for RV HVAD (P = .02). Pump thrombosis occurred at a similar rate [RA: 3/10 (30.0%) vs. RV: 6/20 (30.0%), P = 1], as did GI bleeding [RA: 10/35 (28.6%) vs. RV: 5/21 (23.8%), P = .94] during the follow-up time period. Kaplan-Meier analysis when censored for transplant showed higher survival with RA HVAD compared to RV HVAD (P = .036), with an estimated survival at 1 year of 91.7% (95% CI 77.3-100.0) in RA HVAD versus 66.2% (95% CI 48.9-89.6) for RV HVAD. RA HVAD appears to be a viable option for durable right-sided support with outcomes at least comparable to RV HVAD.
在接受 HeartWare HVAD 心脏辅助装置双心室心力衰竭或难治性右心衰竭的患者中，已经描述了将心脏辅助装置的右心辅助装置在右心室（RV）和右心房（RA）位置进行标签外放置。我们试图评估和比较使用 RA 与 RV 方法的右侧心脏辅助装置的结果。在英文文献中进行了电子检索，以确定所有使用 HeartWare HVAD 的左心和右心支持的报告。在确定的 1288 篇文章中，有 13 篇文章中有 56 例符合纳入标准。提取并分析患者水平数据。中位患者年龄为 52 岁（IQR 33.0-59.0），40/50（80.0%）为男性。总体而言，56 例患者中有 21 例（37.5%）接受了 RA HVAD，而 35 例（62.5%）接受了 RV HVAD。大多数患者接受了 HVAD 联合植入[RA：17/21（81.0%）vs. RV：31/35（88.6%），P=0.69]。在未接受联合植入的患者中，RA HVAD 的左心和右心 HVAD 之间的中位时间为 10 天（IQR 7-14），而 RV HVAD 为 12 天（IQR 8-30）（P=0.77）。RA HVAD 的中位支持时间为 351 天（IQR 136-626），而 RV HVAD 的中位支持时间为 135 天（IQR 61-244）（P=0.02）。血栓形成的发生率相似[RA：3/10（30.0%）vs. RV：6/20（30.0%），P=1]，胃肠道出血的发生率也相似[RA：10/35（28.6%）vs. RV：5/21（23.8%），P=0.94]。在随访期间进行移植校正的 Kaplan-Meier 分析显示，RA HVAD 的存活率高于 RV HVAD（P=0.036），RA HVAD 植入后 1 年的估计生存率为 91.7%（95%CI 77.3-100.0），而 RV HVAD 为 66.2%（95%CI 48.9-89.6）。RA HVAD 似乎是一种可行的选择，可提供持久的右侧支持，其结果至少与 RV HVAD 相当。
