Huckaby Lauren V, Seese Laura M, Hickey Gavin, Sultan Ibrahim, Kilic Arman
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2021 Feb;36(2):449-456. doi: 10.1111/jocs.15188. Epub 2020 Dec 7.
We sought to derive a risk score for 1-year mortality following orthotopic heart transplantation (OHT) in patients bridged with a contemporary centrifugal left ventricular assist device (LVAD).
Adult patients (≥18 years) in the United Network for Organ Sharing database undergoing OHT between 2010 and 2019 who were bridged with a HeartWare or HeartMate III device were included. Derivation and validation cohorts were randomly assigned with a 2:1 ratio. Threshold analysis and multivariable logistic regression were utilized to obtain adjusted odds ratios for 1-year post-OHT mortality. A risk score was generated using these adjusted odds ratios in the derivation cohort and the predictive performance of the composite index was evaluated in the validation set.
A total of 3434 patients were identified. In the derivation cohort, the mean age was 53.5 ± 12.1 years and 1758 (76.8%) were male; 1789 (78.1%) were bridged with a HeartWare device. Multivariable logistic regression revealed that recipient age ≥50 years, bilirubin level ≥2.4 mg/dl, ischemic time ≥4 h, and preoperative hemodialysis predicted 1-year post-transplant mortality. Stratification into risk groups in the validation cohort revealed significant differences in postoperative renal failure, stroke, and short-term mortality. One-year post-transplant mortality was 5%, 6.7%, and 14.8% in the low-, moderate-, and high-risk categories, respectively (p < .001).
Among patients bridged to OHT with newer generation centrifugal LVADs, older age, increasing bilirubin, longer ischemic time, and pre-OHT dialysis independently predicted post-transplant mortality. The composite risk score based on these factors may assist in patient selection and prognostication in those supported with contemporary LVADs.
我们试图为使用当代离心式左心室辅助装置（LVAD）过渡的患者在原位心脏移植（OHT）后1年死亡率推导一个风险评分。
纳入器官共享联合网络数据库中2010年至2019年间接受OHT且使用HeartWare或HeartMate III装置过渡的成年患者（≥18岁）。推导队列和验证队列按2:1的比例随机分配。采用阈值分析和多变量逻辑回归来获得OHT后1年死亡率的调整比值比。在推导队列中使用这些调整后的比值比生成一个风险评分，并在验证集中评估综合指数的预测性能。
共识别出3434例患者。在推导队列中，平均年龄为53.5±12.1岁，男性1758例（76.8%）；1789例（78.1%）使用HeartWare装置过渡。多变量逻辑回归显示，受者年龄≥50岁、胆红素水平≥2.4mg/dl、缺血时间≥4小时和术前血液透析可预测移植后1年死亡率。在验证队列中分层为风险组显示，术后肾衰竭、中风和短期死亡率存在显著差异。低、中、高风险类别移植后1年死亡率分别为5%、6.7%和14.8%（p<0.001）。
在使用新一代离心式LVAD过渡到OHT的患者中，年龄较大、胆红素升高、缺血时间延长和OHT前透析独立预测移植后死亡率。基于这些因素的综合风险评分可能有助于当代LVAD支持患者的选择和预后评估。
