Maynes Elizabeth J, O'Malley Thomas J, Luc Jessica G Y, Weber Matthew P, Horan Dylan P, Choi Jae Hwan, Patel Sinal, Abbas Rizvi Syed-Saif, Morris Rohinton J, Entwistle John W, Massey H Todd, Tchantchaleishvili Vakhtang
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Ann Cardiothorac Surg. 2020 Mar;9(2):69-80. doi: 10.21037/acs.2020.03.07.
The aim of this study was to compare the outcomes of patients undergoing SynCardia total artificial heart (TAH) and biventricular HeartWare ventricular assist device (Bi-HVAD) support for biventricular heart failure (HF).
Electronic search was performed to identify all relevant studies detailing patients who underwent biventricular assist device implantation using Bi-HVAD devices and those who underwent TAH placement for biventricular HF. Twelve studies including 512 patients in the TAH group versus 38 patients in the Bi-HVAD group were pooled for meta-analysis.
Ischemic cardiac etiology was present in 32% (95% CI, 24-47) of TAH 15% (95% CI, 4-44) of Bi-HVAD patients (P=0.21). There was a comparable incidence of stroke [TAH 11% (95% CI, 7-16) Bi-HVAD 13% (95% CI, 2-51), P=0.86] and acute kidney injury [TAH 28% (95% CI, 2-89) Bi-HVAD 27% (95% CI, 9-59), P=0.98]. Overall infection rate was 67% (95% CI, 47-82) in TAH and 36% (95% CI, 10-74) in Bi-HVAD (P=0.16). Driveline infections were comparable between the two groups [TAH 11% (95% CI, 6-19) Bi-HVAD 8% (95% CI, 1-39), P=0.73] and although a higher incidence of mediastinitis was found in the Bi-HVAD group [TAH 4% (95% CI, 2-7) Bi-HVAD 15% (95% CI, 4-45), P=0.07] there was no statistically significant difference between the groups. Postoperative bleeding was present in 42% (95% CI, 28-58) of TAH 23% (95% CI, 8-52) of Bi-HVAD (P=0.22). Patients in the TAH group had shorter duration of support [TAH 71 days (95% CI, 15-127) Bi-HVAD 167 days (95% CI, 116-217), P=0.01]. At the mean follow-up time of 120 days, (95% CI, 83-157) patients in both groups had similar overall mortality [TAH 36% (95% CI, 22-49) Bi-HVAD 26% (95% CI, 6-46), P=0.44] including mortality on device support [TAH 26% (95% CI, 17-36) Bi-HVAD 21% (95% CI, 4-37), P=0.55]. Discharge home on support was achieved in 6% (95% CI, 4-17%) of TAH patients 73% (95% CI, 48-89%) of Bi-HVAD (P<0.01), and 68% (95% CI, 52-84) of TAH patients were transplanted 61% (95% CI, 47-75) in the Bi-HVAD group (P=0.14).
Patients on Bi-HVAD support were more likely to be able to be discharged home on support and had similar overall mortality to TAH, albeit with much longer duration of support.
本研究的目的是比较接受SynCardia全人工心脏（TAH）和双心室HeartWare心室辅助装置（Bi-HVAD）支持治疗双心室心力衰竭（HF）患者的结局。
进行电子检索以识别所有相关研究，这些研究详细描述了使用Bi-HVAD装置接受双心室辅助装置植入的患者以及因双心室HF接受TAH植入的患者。汇总了12项研究，TAH组512例患者，Bi-HVAD组38例患者，进行荟萃分析。
TAH患者中32%（95%CI，24-47）存在缺血性心脏病病因，Bi-HVAD患者中为15%（95%CI，4-44）（P=0.21）。中风发生率相当[TAH为11%（95%CI，7-16），Bi-HVAD为13%（95%CI，2-51），P=0.86]，急性肾损伤发生率也相当[TAH为28%（95%CI，2-89），Bi-HVAD为27%（95%CI，9-59），P=0.98]。TAH的总体感染率为67%（95%CI，47-82），Bi-HVAD为36%（95%CI，10-74）（P=0.16）。两组的导线感染情况相当[TAH为11%（95%CI，6-19），Bi-HVAD为8%（95%CI，1-39），P=0.73]，尽管Bi-HVAD组纵隔炎发生率较高[TAH为4%（95%CI，2-7），Bi-HVAD为15%（95%CI，4-45），P=0.07]，但两组间无统计学显著差异。TAH术后出血发生率为42%（95%CI，28-58），Bi-HVAD为23%（95%CI，8-52）（P=0.22）。TAH组患者的支持时间较短[TAH为71天（95%CI，15-127），Bi-HVAD为167天（95%CI，116-217），P=0.01]。在平均120天（95%CI，83-157）的随访时间，两组患者的总体死亡率相似[TAH为36%（95%CI，22-49），Bi-HVAD为26%（95%CI，6-46），P=0.44]，包括装置支持期间的死亡率[TAH为26%（95%CI，17-36），Bi-HVAD为21%（95%CI，4-37），P=0.55]。TAH患者中有6%（95%CI，4-17%）在支持下出院回家，Bi-HVAD为73%（95%CI，48-89%）（P<0.01），TAH患者中有68%（95%CI，52-84）接受了移植，Bi-HVAD组为61%（95%CI，47-75）（P=0.14）。
接受Bi-HVAD支持的患者更有可能在支持下出院回家，总体死亡率与TAH相似，尽管支持时间长得多。
