Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
Semin Thorac Cardiovasc Surg. 2022 Spring;34(1):148-156. doi: 10.1053/j.semtcvs.2021.02.001. Epub 2021 Feb 17.
Left ventricular assist device implantation without sternotomy (LIS) may simplify heart transplantation (HTX) by avoiding adhesions and eliminating the need for a re-sternotomy. This study investigates the impact of LIS LVAD implantation on HTX outcomes. A retrospective comparison of 46 patients undergoing HTX between 07/13 and 06/19 after conventional LVAD implantation with a full sternotomy (FS) and LIS LVAD implantation (LIS: n = 27 patients, 59%; FS: n = 19 patients, 41%) was performed. Endpoints were perioperative data including blood product use, de-novo formation of donor specific antibodies (DSAs) and survival. Patient demographics (mean age FS: 60.3 ± 9.3 years vs LIS 58.0 ± 7.7 years, P = 0.313; male gender FS: 84% vs LIS: 82%, P = 1.000; urgent HTX FS: 16% vs LIS 18%, P = 1.000) were comparable between LIS and FS patients. The primary finding was a significantly higher risk to develop de novo donor specific antibodies (DSAs) after HTX in patients of the FS group (FS: 36% vs LIS: 4%; P = 0.006). LIS patients had a significant reduction of intraoperative packed red blood cells (PRBCs) use (LIS: 4 (IQR 2-7) Units vs FS: 7 (IQR 4-8) Units; P = 0.045). Other adverse events rates and in-hospital mortality (LIS: 7% vs FS 5%, P = 1.000) were comparable between both groups. LIS LVAD reduces formation of donor specific antibodies after HTX.
经左侧胸廓入路（LIS）植入左心室辅助装置（LVAD）可避免粘连，并避免再次开胸，从而简化心脏移植（HTX）。本研究旨在探讨 LIS 行 LVAD 植入对 HTX 结局的影响。对 2013 年 7 月至 2019 年 6 月间行 HTX 的 46 例患者进行回顾性比较，其中常规 LVAD 植入+完全胸骨切开术（FS）组（n=19，41%）和 LIS 组（n=27，59%）。主要观察终点为围手术期数据，包括血制品使用、供体特异性抗体（DSA）的新发形成和生存率。LIS 和 FS 患者的患者人口统计学特征（FS 组平均年龄 60.3±9.3 岁，LIS 组 58.0±7.7 岁，P=0.313；男性 FS 组 84%，LIS 组 82%，P=1.000；FS 组急诊 HTX 16%，LIS 组 18%，P=1.000）具有可比性。主要发现是 FS 组 HTX 后新发 DSA 的风险显著增加（FS 组 36%，LIS 组 4%，P=0.006）。LIS 组术中使用的浓缩红细胞（PRBC）显著减少（LIS 组 4（IQR 2-7）单位，FS 组 7（IQR 4-8）单位；P=0.045）。两组间其他不良事件发生率和院内死亡率（LIS 组 7%，FS 组 5%，P=1.000）相似。LIS LVAD 可减少 HTX 后供体特异性抗体的形成。
