Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Department of Cardiology, Pulmonology and Angiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Interact Cardiovasc Thorac Surg. 2022 Feb 21;34(3):462-469. doi: 10.1093/icvts/ivab265.
Heart transplantation after left ventricular assist device (LVAD) implantation remains challenging. It is still unclear whether its support duration impacts the outcome after transplantation.
All patients undergoing heart transplantation between 2010 and 2021 at a single department after previous left ventricular assistance were retrospectively reviewed and divided into 4 different study groups with regard to the duration of LVAD support to examine the impact on the postoperative morbidity and mortality.
A total of n = 198 patients were included and assigned to the 4 study groups (group 1: <90 days, n = 14; group 2: 90 days to 1 year, n = 31; group 3: 1-2 years, n = 29; group 4: >2 years, n = 24). Although there were no differences between the 4 groups concerning relevant mismatch between the recipients and donors, the incidence of primary graft dysfunction was numerically increased in patients with the shortest support duration, and also those patients with >1 year of support (group 1: 35.7%, group 2: 25.8%, group 3: 41.4%, group 4: 37.5%, P = 0.63). The incidence of acute graft rejection was by trend increased in patients of group 1 (group 1: 28.6%, group 2: 3.3%, group 3: 7.1%, group 4: 12.5%, P = 0.06). Duration of LVAD support did not impact on perioperative adverse events (infections, P = 0.79; acute kidney injury, P = 0.85; neurological events, P = 0.74; thoracic bleeding, P = 0.61), neither on postoperative survival (1-year survival: group 1: 78.6%, group 2: 66.7%, group 3: 80.0%, group 4: 72.7%, P = 0.74).
We cannot identify a significant impact of the duration of pretransplant LVAD support on postoperative outcome; therefore, we cannot recommend a certain timeframe for transplantation of LVAD patients.
左心室辅助装置（LVAD）植入后的心脏移植仍然具有挑战性。其支持时间是否会影响移植后的结果仍不清楚。
回顾性分析 2010 年至 2021 年期间在一个科室接受心脏移植的所有患者，这些患者在接受左心室辅助前均接受过 LVAD 治疗，将患者分为 4 个不同的研究组，根据 LVAD 支持的时间长短来检查其对术后发病率和死亡率的影响。
共纳入 198 例患者，分为 4 个研究组（组 1：<90 天，n = 14；组 2：90 天至 1 年，n = 31；组 3：1-2 年，n = 29；组 4：>2 年，n = 24）。尽管在受体和供体之间的相关不匹配方面，4 组之间没有差异，但支持时间最短的患者原发性移植物功能障碍的发生率以及支持时间>1 年的患者（组 1：35.7%，组 2：25.8%，组 3：41.4%，组 4：37.5%，P = 0.63）的发生率呈上升趋势。组 1 患者的急性移植物排斥反应发生率呈上升趋势（组 1：28.6%，组 2：3.3%，组 3：7.1%，组 4：12.5%，P = 0.06）。LVAD 支持时间不影响围手术期不良事件（感染，P = 0.79；急性肾损伤，P = 0.85；神经系统事件，P = 0.74；胸出血，P = 0.61），也不影响术后生存率（1 年生存率：组 1：78.6%，组 2：66.7%，组 3：80.0%，组 4：72.7%，P = 0.74）。
我们无法确定移植前 LVAD 支持时间对术后结果的显著影响；因此，我们不能推荐 LVAD 患者进行移植的特定时间范围。
