Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Artif Organs. 2021 Aug;45(8):845-851. doi: 10.1111/aor.13927. Epub 2021 Mar 15.
Implantable cardioverter-defibrillators (ICDs) have been shown to have survival advantage in advanced heart failure patients. Few studies have evaluated the role of ICDs in patients supported with continuous-flow left ventricular assist devices (CFVADs). We aimed to evaluate the impact of ICD and CFVAD on heart transplant (HTx) waiting list survival. We queried the United Network for Organ Sharing (UNOS) thoracic transplant database between years 2007 and 2016 for patients aged ≥ 18 years listed for HTx. Patients receiving devices other than CFVAD were excluded. Patients were divided into groups-with and without CFVAD and further subdivided into groups-with and without ICD use. Kaplan-Meier curves were used to evaluate the survival outcomes. There were 34 860 patients listed for HTx during study period of which 11 481 (32%) had a CFVAD and 26 139 (75%) had an ICD. Within CFVAD group, patients with ICD were older, more likely male, with higher creatinine and listed as UNOS status 1A. In the No-CFVAD group, 1-year waitlist survival was significantly better with ICD use (81% vs. 73%, P < .0001); however, in CFVAD patients, 1-year survival with ICD use was comparable to No-ICD use (95% vs. 94%, P = .1). Use of ICD is associated with significantly better heart transplant waitlist survival in patients not supported by CFVAD. In patients supported with CFVAD, the ICD does not offer additional survival benefit.
植入式心脏复律除颤器（ICD）已被证明可提高晚期心力衰竭患者的生存率。少数研究评估了 ICD 在持续血流左心室辅助装置（CFVAD）支持的患者中的作用。我们旨在评估 ICD 和 CFVAD 对心脏移植（HTx）候补名单生存的影响。我们在 2007 年至 2016 年间查询了美国器官共享联合网络（UNOS）的胸移植数据库，以寻找年龄≥18 岁的 HTx 候补患者。排除接受 CFVAD 以外其他设备的患者。患者分为有和无 CFVAD 两组，并进一步分为有和无 ICD 使用两组。使用 Kaplan-Meier 曲线评估生存结果。在研究期间，有 34860 名患者被列入 HTx 候补名单，其中 11481 名（32%）有 CFVAD，26139 名（75%）有 ICD。在 CFVAD 组中，有 ICD 的患者年龄较大，更可能是男性，肌酐水平较高，列为 UNOS 状态 1A。在无 CFVAD 组中，ICD 组的 1 年候补名单生存率显著更高（81% vs. 73%，P<.0001）；然而，在 CFVAD 患者中，ICD 组和无 ICD 组的 1 年生存率相当（95% vs. 94%，P=.1）。在未接受 CFVAD 支持的患者中，ICD 的使用与 HTx 候补名单生存率的显著提高相关。在接受 CFVAD 支持的患者中，ICD 并不能提供额外的生存获益。
