Department of Transplant Medicine, National Cerebral and Cardiovascular Center.
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences.
Circ J. 2020 Oct 23;84(11):1949-1956. doi: 10.1253/circj.CJ-20-0238. Epub 2020 Sep 30.
Continuous-flow left ventricular assist device (CF-LVAD) substantially improves survival in endstage heart failure patients. However, bleeding complications are common after CF-LVAD implantation and in some cases, re-exploration for bleeding is needed. We aimed to investigate the incidence, timing, and risk factors of bleeding requiring re-exploration after CF-LVAD implantation.
We retrospectively reviewed 162 consecutive patients (age 43±13 years, 71% men) who underwent CF-LVAD implantation (HeartMateII 119, Jarvik2000 15, HVAD 13, EVAHEART 10, DuraHeart 5) from January 2012 to June 2019. During follow-up [median 662 days, interquartile range (IQR) 364-1,116 days], 35 (21.6%) experienced re-exploration for bleeding. The median timing of re-exploration was 6 (IQR 1-10) days. In the multivariate logistic regression analysis, postoperative platelet count was an independent predictor for re-exploration for bleeding after CF-LVAD implantation (per 10/μL: odds ratio 0.83, 95% confidence interval 0.74-0.93, P=0.002). Patients who experienced re-exploration for bleeding had a significantly worse survival rate than patients who did not (at 4 years, 73.6% vs. 90.1%, P=0.039).
Re-exploration for bleeding is prevalent after CF-LVAD implantation, especially in patients with low postoperative platelet counts. As bleeding requiring re-exploration is associated with poor prognosis, risk stratification using the postoperative platelet count may be beneficial for these patients.
连续流左心室辅助装置（CF-LVAD）显著提高了终末期心力衰竭患者的生存率。然而，CF-LVAD 植入后常发生出血并发症，在某些情况下需要再次探查以控制出血。我们旨在研究 CF-LVAD 植入后因出血需要再次探查的发生率、时间和危险因素。
我们回顾性分析了 2012 年 1 月至 2019 年 6 月期间 162 例连续接受 CF-LVAD 植入（HeartMateII119 例，Jarvik200015 例，HVAD13 例，EVAHEART10 例，DuraHeart5 例）的患者（年龄 43±13 岁，71%为男性）。在随访期间[中位数 662 天，四分位距（IQR）364-1116 天]，35 例（21.6%）因出血接受了再次探查。再次探查的中位数时间为 6（IQR 1-10）天。多变量逻辑回归分析显示，术后血小板计数是 CF-LVAD 植入后再次探查出血的独立预测因素（每增加 10/μL：比值比 0.83，95%置信区间 0.74-0.93，P=0.002）。经历再次探查出血的患者生存率明显低于未经历再次探查出血的患者（4 年时，73.6% vs. 90.1%，P=0.039）。
CF-LVAD 植入后再次探查出血较为常见，尤其是术后血小板计数较低的患者。由于再次探查出血与预后不良相关，使用术后血小板计数进行风险分层可能对这些患者有益。
