From the Advocate Christ Medical Center, Advocate Heart Institute, Heart and Vascular Institute Administration, Oak Lawn, Illinois.
Departments of Cardiac and Thoracic Surgery, University of Michigan Hospitals, 5161 Cardiovascular Center, Ann Arbor, Michigan.
ASAIO J. 2021 Jun 1;67(6):642-649. doi: 10.1097/MAT.0000000000001287.
Hemodynamic support with continuous-flow left ventricular assist device (CF-LVAD) therapy has proven a reliable treatment for advanced heart failure. Although modern LVADs are highly durable, device failure and infection can be resolved with surgical exchange of pump components. In this study, we investigated the incidence and outcomes of LVAD exchange with the HeartMate II and HeartWare HVAD. Data were obtained from 677 patients who underwent CF-LVAD implantation between 2005 and 2016. Patients who underwent a device exchanged were included. The primary outcomes were length of hospital stay and mortality. Of the 677 patients included in this study, 72 (10.6%) required LVAD exchange. Thirty-day and 1-year mortality rates were comparable to primary LVAD implantation: 4.3% vs. 3.49%, p = 0.727 and 20.3% vs. 20.7%, p = 0.989, respectively. Thirty-one patients (4.5%) underwent exchange with ongoing infection. Kaplan-Meier analysis indicated significant differences in survival between groups based on indication for exchange. Patients who underwent exchange after more than 150 days of active infection suffered worse postexchange survival than those who underwent exchanged earlier (P = 0.007). While exchange was required only in 10.6% of patients undergoing LVAD implantation, our results show device exchange may be executed safely and effectively, with long-term outcomes similar to primary LVAD implantation. The indication for device exchange impacts postexchange outcomes, and those exchanged with LVAD infection tend to fare worse than those exchanged for device malfunction or thrombus. Patients who are exchanged with active infection have better postoperative survival if the exchange is performed expeditiously after medical management has failed.
使用连续血流左心室辅助装置（CF-LVAD）进行血流动力学支持已被证明是治疗晚期心力衰竭的可靠方法。尽管现代 LVAD 具有高度耐用性，但可以通过外科交换泵组件来解决设备故障和感染问题。在这项研究中，我们调查了 HeartMate II 和 HeartWare HVAD 进行 LVAD 交换的发生率和结果。数据来自于 2005 年至 2016 年间接受 CF-LVAD 植入的 677 名患者。纳入了需要进行设备更换的患者。主要结局是住院时间和死亡率。在这项研究中，677 名患者中有 72 名（10.6%）需要进行 LVAD 更换。30 天和 1 年死亡率与初次 LVAD 植入相当：4.3%比 3.49%，P=0.727 和 20.3%比 20.7%，P=0.989。31 名患者（4.5%）在持续感染的情况下进行了交换。Kaplan-Meier 分析表明，根据交换的适应证，各组之间的生存率存在显著差异。在感染活动超过 150 天后进行交换的患者的术后生存情况比更早进行交换的患者差（P=0.007）。虽然只有 10.6%的 LVAD 植入患者需要进行交换，但我们的结果表明，设备交换可以安全有效地进行，长期结果与初次 LVAD 植入相似。设备交换的适应证影响交换后的结果，与因设备故障或血栓而进行交换的患者相比，因 LVAD 感染而进行交换的患者预后较差。如果在经过医疗管理后仍未能成功控制感染，而进行积极的感染性疾病交换，患者的术后生存情况会更好。
