From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.
Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL.
ASAIO J. 2021 Mar 1;67(3):239-244. doi: 10.1097/MAT.0000000000001238.
Left ventricular assist device (LVAD) implantation in patients with advanced heart failure due to hypertrophic or restrictive cardiomyopathy (HCM/RCM) presents technical and physiologic challenges. We conducted a systematic review of observational studies to evaluate the utilization and clinical outcomes associated with LVAD implantation in patients with HCM/RCM and compared these to patients with dilated or ischemic cardiomyopathy (DCM/ICM). We searched MEDLINE, EMBASE, and Scopus from inception through May 2019 and included appropriate studies describing the use of an LVAD in patients with HCM/RCM. We identified six studies with a total of 2,766 patients with HCM/RCM and advanced heart failure, among whom 338 patients (12.2%) underwent LVAD implantation. In patients listed for transplant, the rate of LVAD implantation was significantly lower in patients with HCM/RCM compared to that in patients with DCM/ICM (4.4% vs. 18.2%, p < 0.001). Adverse clinical outcomes were significantly higher in HCM/RCM than in DCM/ICM, including operative/short-term mortality (14.0% vs. 9.0%), right ventricular failure (50.0% vs. 21.0%), infection (15.5% vs. 11.2%), bleeding (40.2% vs. 12.5%), renal failure (15.0% vs. 5.1%), stroke (5.0% vs. 2.4%), and arrhythmias (18.0% vs. 7.7%) (all p values <0.001).
左心室辅助装置（LVAD）植入术在因肥厚型或限制型心肌病（HCM/RCM）导致的晚期心力衰竭患者中存在技术和生理方面的挑战。我们对观察性研究进行了系统回顾，以评估 LVAD 植入术在 HCM/RCM 患者中的应用及相关临床结局，并与扩张型或缺血性心肌病（DCM/ICM）患者进行了比较。我们检索了 MEDLINE、EMBASE 和 Scopus 数据库，检索时间从建库至 2019 年 5 月，纳入了描述 HCM/RCM 患者使用 LVAD 的适当研究。我们共确定了 6 项研究，共纳入了 2766 例 HCM/RCM 合并晚期心力衰竭患者，其中 338 例（12.2%）患者接受了 LVAD 植入术。在接受移植的患者中，HCM/RCM 患者的 LVAD 植入率明显低于 DCM/ICM 患者（4.4% vs. 18.2%，p < 0.001）。HCM/RCM 患者的不良临床结局发生率明显高于 DCM/ICM 患者，包括手术/短期死亡率（14.0% vs. 9.0%）、右心衰竭（50.0% vs. 21.0%）、感染（15.5% vs. 11.2%）、出血（40.2% vs. 12.5%）、肾功能衰竭（15.0% vs. 5.1%）、卒中（5.0% vs. 2.4%）和心律失常（18.0% vs. 7.7%）（所有 p 值均<0.001）。
