Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Thorac Cardiovasc Surg. 2021 Apr;161(4):1453-1464.e4. doi: 10.1016/j.jtcvs.2020.04.163. Epub 2020 May 15.
Not all patients in need of durable mechanical circulatory support are suitable for a continuous-flow left ventricular assist device. We describe patient populations who were treated with the paracorporeal EXCOR, including children with small body sizes, adolescents with complex congenital heart diseases, and adults with biventricular failure.
Information on clinical data, echocardiography, invasive hemodynamic measurements, and surgical procedures were collected retrospectively. Differences between various groups were compared.
Between 2008 and 2018, a total of 50 patients (21 children and 29 adults) received an EXCOR as bridge to heart transplantation or myocardial recovery. The majority of patients had heart failure compatible with Interagency Registry for Mechanically Assisted Circulatory Support profile 1. At year 5, the overall survival probability for children was 90%, and for adults 75% (P = .3). After we pooled data from children and adults, the survival probability between patients supported by a biventricular assist device was similar to those treated with a left ventricular assist device/ right ventricular assist device (94% vs 75%, respectively, P = .2). Patients with dilated cardiomyopathy had a trend toward better survival than those with other heart failure etiologies (92% vs 70%, P = .05) and a greater survival free from stroke (92% vs 64%, P = .01). Pump house exchange was performed in nine patients due to chamber thrombosis (n = 7) and partial membrane rupture (n = 2). There were 14 cases of stroke in eleven patients.
Despite severe illness, patient survival on EXCOR was high, and the long-term overall survival probability following heart transplantation and recovery was advantageous. Treatment safety was satisfactory, although still hampered by thromboembolism, mechanical problems, and infections.
并非所有需要持久机械循环支持的患者都适合连续流动左心室辅助装置。我们描述了接受体外 EXCOR 治疗的患者人群，包括体型较小的儿童、患有复杂先天性心脏病的青少年以及双心室衰竭的成人。
回顾性收集临床数据、超声心动图、有创血流动力学测量和手术程序信息。比较了不同组之间的差异。
在 2008 年至 2018 年间，共有 50 名患者（21 名儿童和 29 名成人）接受 EXCOR 作为心脏移植或心肌恢复的桥接治疗。大多数患者患有与机械辅助循环支持机构间注册中心 1 型心力衰竭一致的心力衰竭。在第 5 年，儿童的总体生存率为 90%，成人的生存率为 75%（P=.3）。在我们将儿童和成人的数据合并后，接受双心室辅助装置支持的患者的生存率与接受左心室辅助装置/右心室辅助装置治疗的患者相似（分别为 94%和 75%，P=.2）。扩张型心肌病患者的生存率好于其他心力衰竭病因患者（92%比 70%，P=.05），且免于中风的生存率更高（92%比 64%，P=.01）。由于腔室血栓形成（n=7）和部分膜破裂（n=2），有 9 名患者进行了泵房交换。11 名患者中有 14 例中风。
尽管病情严重，但 EXCOR 上患者的生存率较高，心脏移植和恢复后的长期总体生存率有利。尽管仍受到血栓栓塞、机械问题和感染的影响，但治疗安全性令人满意。
