瑞士非心脏移植大学医院终末期心力衰竭患者新实施的机械循环支持计划的 5 年结果。

5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital.

机构信息

Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland.

Department of cardiology, University Hospital of Basel, Basel, Switzerland.

出版信息

J Cardiothorac Surg. 2021 Mar 31;16(1):64. doi: 10.1186/s13019-021-01447-5.

DOI:10.1186/s13019-021-01447-5

PMID:33789723

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8011141/

Abstract

BACKGROUND

In Switzerland, long-term circulatory support programs have been limited to heart transplant centers. In 2014, to improve the management of patients with end-stage heart failure not eligible for transplantation, we implemented a left ventricular assist device (LVAD) program for destination therapy at the University Hospital of Basel.

METHODS

We described the program set-up with practical aspects. Patients aged 65 and above with therapy refractory end-stage heart failure without major contraindication for LVAD implantation were included. Younger patients with bridge-to-candidacy profile were also considered. Using the Kaplan-Meier estimate, we retrospectively analyzed the overall survival and freedom from major adverse events after LVAD implantation. We compared our results to internationally reported data.

RESULTS

Between October 2014 and September 2019, 16 patients received an LVAD in our center. The mean age at implantation was 67.1 years. The mean EuroSCORE II was 24.4% and the median INTERMACS level was 4. Thirteen patients received an LVAD as destination therapy and three patients as bridge-to-candidacy. The overall survival was 87.5 and 70% at 1 and 2 years, respectively. Freedom from stroke was 81.3% at 1 and 2 years. Freedom from device infection was 67.7 and 58.7% at 1 and 2 years, respectively. Freedom from gastrointestinal bleeding was 75 and 56.3% at 1 and 2 years, respectively. Freedom from readmission was 50 and 31.3% and at 6 months and 1 year, respectively.

CONCLUSIONS

The Basel experience demonstrated the possible implementation of an LVAD program for destination therapy or bridge-to-candidacy in a non-transplant comprehensive heart-failure center with midterm survival results and freedom from major adverse events comparable to international registries. Patient selection remains crucial.

TRIAL REGISTRATION

This study was registered on the ClinicalTrials.gov database ( NCT04263012 ).

摘要

背景

在瑞士，长期循环支持项目仅限于心脏移植中心。为了改善不符合心脏移植条件的终末期心力衰竭患者的管理，我们于 2014 年在巴塞尔大学医院实施了左心室辅助装置（LVAD）作为终末期心力衰竭的治疗方案。

方法

我们描述了方案的实际设置。纳入年龄 65 岁及以上、因治疗无效且无 LVAD 植入重大禁忌证的终末期心力衰竭患者，也考虑年轻桥接候选患者。使用 Kaplan-Meier 估计，我们回顾性分析了 LVAD 植入后的总体生存率和无重大不良事件发生率。我们将我们的结果与国际报告的数据进行了比较。

结果

2014 年 10 月至 2019 年 9 月，我院中心共 16 例患者接受了 LVAD 治疗。植入时的平均年龄为 67.1 岁。平均 EuroSCORE II 为 24.4%，中位数 INTERMACS 分级为 4 级。13 例患者接受 LVAD 作为终末期心力衰竭的治疗方案，3 例患者接受桥接候选方案。1 年和 2 年的总体生存率分别为 87.5%和 70%。1 年和 2 年的免于中风发生率分别为 81.3%和 70%。1 年和 2 年的免于设备感染发生率分别为 67.7%和 58.7%。1 年和 2 年的免于胃肠道出血发生率分别为 75%和 56.3%。6 个月和 1 年的免于再入院率分别为 50%和 31.3%。