连续血流左心室辅助装置的轴突损伤与修复：系统评价。

Driveline damage and repair in continuous-flow left ventricular assist devices: A systematic review.

机构信息

Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.

Division of Cardiac Surgery, Centre Hospitalié de l'Université de Montréal, Montréal, QC, Canada.

出版信息

Artif Organs. 2021 Aug;45(8):819-826. doi: 10.1111/aor.13901. Epub 2021 Feb 22.

DOI:10.1111/aor.13901

PMID:33377216

Abstract

With mounting time on continuous-flow left ventricular assist device (CF-LVAD) support, patients occasionally sustain damage to the device driveline. Outcomes associated with external and internal driveline damage and repair are currently not well documented. We sought to evaluate the outcomes of driveline damage and its repair. Electronic search was performed to identify all relevant studies published over the past 20 years. Fifteen studies were selected for analysis comprising of 55 patients with CF-LVAD dysfunction due to driveline damage. Demographic and perioperative variables along with outcomes including survival rates were extracted and pooled for the systematic review. Most patients (53/55) were supported on HeartMate II LVAD (Abbott Laboratories, Abbott Park, IL). Internal damage was more commonly reported than external damage [69.1% (38/55) vs. 30.9% (17/55), P = .01]. Median time to driveline damage was 1.9 years [IQR 1.0, 2.5]. Most patients presented with a CF-LVAD alarm [94.5% (52/55)] and patients with internal driveline damage had a significantly higher rate of alarm activation compared to that observed for those with external damage [38/38 (100%) vs. 14/17 (82.4%), P = .04]. Patients with internal driveline dysfunction were more likely to experience component wear compared to those with external driveline dysfunction [10/38 (26.3%) vs. 0/17 (0%), P = .05]; 14.5% of patients (8/55) underwent external repair of the driveline, 5.5% (3/55) were treated with rescue tape, and 5.5% (3/55) were placed on an ungrounded cable, indicating a short-to-shield event had occurred. A total of 49.1% of patients (27/55) underwent CF-LVAD exchange, 5.5% (3/55) were weaned off the CF-LVAD to explant, and 5.5% (3/55) underwent emergent heart transplantation. The median length of hospital stay was 12 days [IQR 7, 12] and 30-day mortality rate was 14.5% (8/55). Driveline damage was more commonly reported at an internal location and despite being a well-recognized complication, mortality still appears high.

摘要

随着连续流动左心室辅助装置（CF-LVAD）支持时间的增加，患者偶尔会对设备传动系统造成损害。目前，与外部和内部传动系统损伤及其修复相关的结果尚未得到很好的记录。我们旨在评估传动系统损伤及其修复的结果。通过电子搜索，确定了过去 20 年发表的所有相关研究。选择了 15 项研究进行分析，共纳入 55 例因传动系统损伤导致 CF-LVAD 功能障碍的患者。提取并汇总了人口统计学和围手术期变量以及生存率等结果，进行系统评价。大多数患者（55 例中的 53 例）接受 HeartMate II LVAD（雅培实验室，雅培公园，IL）支持。内部损伤比外部损伤更常见[69.1%（38/55）比 30.9%（17/55），P=0.01]。传动系统损伤的中位时间为 1.9 年[IQR 1.0，2.5]。大多数患者出现 CF-LVAD 报警[94.5%（55/55）]，内部传动系统损伤患者的报警激活率明显高于外部损伤患者[38/38（100%）比 14/17（82.4%），P=0.04]。与外部传动系统损伤相比，内部传动系统功能障碍患者更容易出现部件磨损[10/38（26.3%）比 0/17（0%），P=0.05]；14.5%的患者（55 例中的 8 例）接受了传动系统的外部修复，5.5%（55 例中的 3 例）接受了救援带治疗，5.5%（55 例中的 3 例）接受了未接地电缆治疗，表明发生了短至屏蔽事件。共有 49.1%的患者（55 例中的 27 例）接受了 CF-LVAD 更换，5.5%（55 例中的 3 例）脱机 CF-LVAD 脱机，5.5%（55 例中的 3 例）紧急进行心脏移植。中位住院时间为 12 天[IQR 7，12]，30 天死亡率为 14.5%（55 例中的 8 例）。传动系统损伤更常见于内部位置，尽管这是一种公认的并发症，但死亡率似乎仍然很高。