Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
International Thoracic and Cardiovascular Research Association (ITCVR).
Artif Organs. 2021 Jul;45(7):706-716. doi: 10.1111/aor.13897. Epub 2021 Feb 1.
The use of left ventricular assist devices (LVADs) for advanced heart failure is becoming increasingly common. However, optimal timing and patient selection remain controversial. The aim of this study was to investigate outcomes of LVAD implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2). Between August 2010 and January 2020, 207 consecutive patients underwent LVAD implantation. Overall survival, major adverse events, and laboratory parameters were compared between patients in INTERMACS 1-2 (n = 107) and INTERMACS 3-5 (n = 100). Preoperative white blood cells, C-reactive protein, procalcitonin, bilirubin, alanine transaminase, and lactate dehydrogenase were all significantly higher in INTERMACS 1-2 when compared to INTERMACS 3-5 (P < .05). During hospitalization following LVAD implantation, patients in INTERMACS 1-2 were more likely to develop major infections (41.1% vs. 23.0%, P = .005), respiratory failure (57.9% vs. 25.0%, P < .001), mild (20.6% vs. 8.0%, P = .010), and moderate (31.8% vs. 7.0%, P < .001) right heart failure, and acute renal dysfunction (56.1% vs. 6.0%, P < .001). During a median follow-up of 2.00 years (interquartile range (IQR) 0.24-3.39 years), they had a higher incidence of thoracic (15.9% vs. 4.0%, P = .005) and gastrointestinal bleeding (21.5% vs. 11.0%, P = .042), as well as right heart failure (18.7% vs. 1%, P < .001). Risk of death was significantly higher in the INTERMACS 1-2 group (hazards ratio (HR) 1.64, 95% CI 1.12-2.40, P = .011). LVAD implantation in critically ill patients is associated with increased morbidity and mortality. Our results suggest that decision for LVAD should be not be delayed until INTERMACS 1 and 2 levels whenever possible.
左心室辅助装置（LVAD）在晚期心力衰竭中的应用越来越普遍。然而，最佳时机和患者选择仍存在争议。本研究旨在探讨重症患者（INTERMACS 1 和 2）中 LVAD 植入治疗晚期心力衰竭的结果。2010 年 8 月至 2020 年 1 月，连续 207 例患者接受了 LVAD 植入。比较 INTERMACS 1-2（n=107）和 INTERMACS 3-5（n=100）患者的总体生存率、主要不良事件和实验室参数。与 INTERMACS 3-5 相比，INTERMACS 1-2 患者的术前白细胞、C 反应蛋白、降钙素原、胆红素、丙氨酸转氨酶和乳酸脱氢酶均显著升高（P<.05）。LVAD 植入后住院期间，INTERMACS 1-2 组患者更易发生重大感染（41.1%比 23.0%，P=.005）、呼吸衰竭（57.9%比 25.0%，P<.001）、轻度（20.6%比 8.0%，P=.010）和中度（31.8%比 7.0%，P<.001）右心衰竭和急性肾功能不全（56.1%比 6.0%，P<.001）。在中位随访 2.00 年（四分位距（IQR）0.24-3.39 年）期间，INTERMACS 1-2 组患者的胸部（15.9%比 4.0%，P=.005）和胃肠道出血（21.5%比 11.0%，P=.042）及右心衰竭（18.7%比 1.0%，P<.001）发生率更高。INTERMACS 1-2 组死亡风险显著升高（风险比（HR）1.64，95%置信区间（CI）1.12-2.40，P=.011）。在重症患者中植入 LVAD 与发病率和死亡率增加相关。我们的研究结果表明，只要有可能，就不应该等到 INTERMACS 1 和 2 级别再决定植入 LVAD。
