肥胖患者通过左心室辅助装置桥接进行心脏移植的结果。
Outcomes of Obese Patients Bridged to Heart Transplantation with a Left Ventricular Assist Device.
机构信息
From the Cardiovascular Research Unit, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey.
Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
出版信息
ASAIO J. 2021 Feb 1;67(2):137-143. doi: 10.1097/MAT.0000000000001188.
The current study aims to investigate the impact of left ventricular assist device (LVAD) implantation on weight loss and functional status in obese patients bridged to transplantation (BTT). The United Network for Organ Sharing (UNOS) database was queried to identify patients with body mass index (BMI) ≥ 30 who underwent LVAD implantation as BTT from 2008 to 2018. Patients were divided into three groups based the World Health Organization classification of obesity: obesity class I (BMI, 30.0-34.9 kg/m2), obesity class II (BMI, 35-39.9 kg/m2), and obesity class III (BMI, >40 kg/m2). Patients with incomplete data on BMI were excluded. The primary outcome was a change in BMI while listed. Secondary outcomes included a change in functional status after LVAD implantation and posttransplant morbidity and survival. Out of 14,191 patients who had an LVAD while listed within the study period, 5,354 (37.7%) had a BMI ≥30 kg/m2. Obesity was classified as class I in 3,909 (73%), class II in 1,275 (23.8%), and class III in 170 (3.2%) patients. Among patients with complete data on BMI, 18.9% (n = 394) reported a change in BMI, leading to an improvement in their obesity class, and this was similar for all obesity classes (22% [n = 331], 50% [n = 111], and 60% [n = 43] for classes I, II, and III, respectively). All groups reported an improvement in functional status (65% vs. 62% and 61% for classes I, II, and III, respectively). Posttransplant survival was not significantly different between obese groups (p = 0.787). Compared with classes I and II, the incidence of thrombosis (p = 0.0006) and device malfunction (p = 0.036) was significantly higher in the class III group. About one out of every five obese patients listed for heart transplantation with an LVAD loses weight, leading to a change in their BMI class. Most patients reported a significant improvement in their functional status. Among those successfully BTT, posttransplant survival was similar.
本研究旨在探讨左心室辅助装置（LVAD）植入对肥胖桥接移植（BTT）患者体重减轻和功能状态的影响。从 2008 年至 2018 年，通过美国器官共享联合网络（UNOS）数据库，检索接受 LVAD 植入作为 BTT 的体重指数（BMI）≥30 的患者。根据世界卫生组织（WHO）肥胖分类，将患者分为三组：肥胖 I 类（BMI，30.0-34.9kg/m2）、肥胖 II 类（BMI，35-39.9kg/m2）和肥胖 III 类（BMI，>40kg/m2）。BMI 数据不完整的患者被排除在外。主要结局是列出时 BMI 的变化。次要结局包括 LVAD 植入后功能状态的变化以及移植后发病率和生存率。在研究期间接受 LVAD 植入并列入名单的 14191 名患者中，有 5354 名（37.7%）BMI≥30kg/m2。肥胖被分类为 I 类 3909 例（73%），II 类 1275 例（23.8%），III 类 170 例（3.2%）。在 BMI 数据完整的患者中，18.9%（n=394）报告 BMI 发生变化，导致肥胖分类改善，所有肥胖分类均相似（I 类为 22%[n=331]，II 类为 50%[n=111]，III 类为 60%[n=43]）。所有组的功能状态均有所改善（I、II 和 III 类分别为 65%、62%和 61%）。肥胖组之间的移植后生存率无显著差异（p=0.787）。与 I 类和 II 类相比，III 类的血栓形成（p=0.0006）和设备故障（p=0.036）发生率明显更高。在接受 LVAD 植入作为 BTT 的肥胖患者中，约有五分之一的患者体重减轻，导致 BMI 分类发生变化。大多数患者报告其功能状态显著改善。在成功 BTT 的患者中，移植后的生存率相似。
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