Mariani Silvia, Li Tong, Bounader Karl, Boethig Dietmar, Schöde Alexandra, Hanke Jasmin S, Michaelis Jana, Napp L Christian, Berliner Dominik, Dogan Guenes, Lorusso Roberto, Haverich Axel, Schmitto Jan D
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
Ann Cardiothorac Surg. 2021 Mar;10(2):255-267. doi: 10.21037/acs-2020-cfmcs-21.
Worse outcomes in women compared to men undergoing left ventricular assist device (LVAD) implantation remain an underestimated problem in heart failure (HF) patients. With device miniaturization, less-invasive LVAD implantation techniques have gained relevance, but their impact on outcomes in women is unknown. This study investigates sex-related differences in patients undergoing LVAD implantation through less-invasive procedures.
This retrospective single-center cohort study included patients who underwent isolated LVAD implantation between 2011 and 2018 through less-invasive techniques. Propensity score matching (PSM) was utilized to balance preoperative heterogeneity. Primary endpoint was two-year survival, and secondary endpoints included long-term survival, surgical outcomes and postoperative adverse events.
Baseline analysis of 191 patients (females 18.3%) showed differences in terms of age [female (median, 52; IQR, 47-61); male (median, 58.5; IQR, 49-66); P=0.005], underlying diagnosis (P<0.001), INTERMACS profile (P=0.009), history of previous cardiac surgery (P=0.049) and preoperative creatinine values [female (median, 110; IQR, 71-146); male (median, 126; IQR, 9-168); P=0.049]. Over a follow-up of 460.68 patient-years, Kaplan-Meyer analysis showed better survival in females (P=0.027) and a similar probability of cardiac transplantation (P=0.288). After PSM, females showed higher needs for intraoperative fresh frozen plasma (P=0.044) and platelets (P=0.001) but comparable postoperative outcomes. No sex-related differences were noticed regarding two-year outcomes, long-term survival and adverse events. LVAD-related infections remained the most common complication with males experiencing more pump infections than women (P=0.050).
Patients receiving less-invasive LVAD implantation do not show significant sex-related differences in short and long-term outcomes and survival. Prospective studies are needed to evaluate the role of less-invasive techniques in reducing sex-based disparities after LVAD implantation.
与接受左心室辅助装置（LVAD）植入的男性相比，女性患者预后较差仍是心力衰竭（HF）患者中一个被低估的问题。随着设备小型化，侵入性较小的LVAD植入技术变得越来越重要，但其对女性患者预后的影响尚不清楚。本研究调查了通过侵入性较小的手术接受LVAD植入的患者的性别差异。
这项回顾性单中心队列研究纳入了2011年至2018年间通过侵入性较小的技术接受孤立LVAD植入的患者。采用倾向评分匹配（PSM）来平衡术前异质性。主要终点是两年生存率，次要终点包括长期生存率、手术结果和术后不良事件。
对191例患者（女性占18.3%）的基线分析显示，在年龄方面存在差异[女性（中位数，52岁；四分位数间距，47 - 61岁）；男性（中位数，58.5岁；四分位数间距，49 - 66岁）；P = 0.005]、潜在诊断（P < 0.001）、INTERMACS分型（P = 0.009）、既往心脏手术史（P = 0.049）和术前肌酐值[女性（中位数，110；四分位数间距，71 - 146）；男性（中位数，126；四分位数间距，9 - 168）；P = 0.049]。在460.68患者年的随访中，Kaplan - Meyer分析显示女性生存率更高（P = 0.027），心脏移植概率相似（P = 0.288）。PSM后，女性术中对新鲜冰冻血浆（P = 0.044）和血小板（P = 0.001）的需求更高，但术后结果相当。在两年结局、长期生存率和不良事件方面未发现性别差异。LVAD相关感染仍然是最常见的并发症，男性的泵感染比女性更多（P = 0.050）。
接受侵入性较小的LVAD植入的患者在短期和长期结局及生存率方面未显示出明显性别差异。需要进行前瞻性研究来评估侵入性较小的技术在减少LVAD植入后基于性别的差异方面的作用。
