Henry Ford Hospitals, Detroit, Michigan.
University of Washington, Seattle, Washington.
J Heart Lung Transplant. 2022 Feb;41(2):161-170. doi: 10.1016/j.healun.2021.07.011. Epub 2021 Jul 24.
Preoperative variables can predict short term left ventricular assist device (LVAD) survival, but predictors of extended survival remain insufficiently characterized.
Patients undergoing LVAD implant (2012-2018) in the Intermacs registry were grouped according to time on support: short-term (<1 year, n = 7,483), mid-term (MT, 1-3 years, n = 5,976) and long-term (LT, ≥3 years, n = 3,015). Landmarked hazard analyses (adjusted hazard ratio, HR) were performed to identify correlates of survival after 1 and 3 years of support.
After surviving 1 year of support, additional LVAD survival was less likely in older (HR 1.15 per decade), Caucasian (HR 1.22) and unmarried (HR 1.16) patients (p < 0.05). After 3 years of support, only 3 preoperative characteristics (age, race, and history of bypass surgery, p < 0.05) correlated with extended survival. Postoperative events most negatively influenced achieving LT survival. In those alive at 1 year or 3 years, the occurrence of postoperative renal (creatinine HR MT = 1.09; LT HR = 1.10 per mg/dl) and hepatic dysfunction (AST HR MT = 1.29; LT HR = 1.34 per 100 IU), stroke (MT HR = 1.24; LT HR = 1.42), infection (MT HR = 1.13; LT HR = 1.10), and/or device malfunction (MT HR = 1.22; LT HR = 1.46) reduced extended survival (all p ≤ 0.03).
Success with LVAD therapy hinges on achieving long term survival in more recipients. After 1 year, extended survival is heavily constrained by the occurrence of adverse events and postoperative end-organ dysfunction. The growth of destination therapy intent mandates that future LVAD studies be designed with follow up sufficient for capturing outcomes beyond 24 months.
术前变量可以预测短期左心室辅助装置（LVAD）的存活率，但延长生存时间的预测因素仍未得到充分描述。
根据支持时间将接受 Intermacs 注册中心 LVAD 植入（2012-2018 年）的患者分为三组：短期（<1 年，n=7483）、中期（1-3 年，n=5976）和长期（≥3 年，n=3015）。进行标记危险分析（调整后的危险比，HR），以确定支持 1 年和 3 年后的生存相关因素。
在存活 1 年的支持后，年龄较大（每十年 HR 1.15）、白种人（HR 1.22）和未婚（HR 1.16）的患者不太可能有更多的 LVAD 存活（p<0.05）。在支持 3 年后，只有 3 个术前特征（年龄、种族和旁路手术史，p<0.05）与延长生存时间相关。术后事件对实现长期生存的影响最大。在存活 1 年或 3 年的患者中，术后肾功能不全（肌酐 HR MT=1.09；HR LT=1.10/每毫克/分升）和肝功能障碍（AST HR MT=1.29；HR LT=1.34/每 100IU）、中风（MT HR=1.24；HR LT=1.42）、感染（MT HR=1.13；HR LT=1.10）和/或设备故障（MT HR=1.22；HR LT=1.46）的发生降低了延长生存时间（均 p≤0.03）。
LVAD 治疗的成功取决于更多患者实现长期生存。在 1 年后，延长生存时间受到不良事件和术后终末器官功能障碍的严重限制。心脏移植治疗意图的增长要求未来的 LVAD 研究设计具有足够的随访时间，以捕捉 24 个月以上的结果。
