连续血流左心室辅助装置植入术中同期心脏瓣膜手术的影响：机械循环支持患者的欧洲登记处（EUROMACS）分析。

Impact of concomitant cardiac valvular surgery during implantation of continuous-flow left ventricular assist devices: A European registry for patients with mechanical circulatory support (EUROMACS) analysis.

机构信息

Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy.

EACTS, EUROMACS, Windsor, UK.

出版信息

Artif Organs. 2022 May;46(5):813-826. doi: 10.1111/aor.14143. Epub 2021 Dec 24.

DOI:10.1111/aor.14143

PMID:34904255

Abstract

BACKGROUND

We investigated the clinical outcomes after cardiac valvular surgery procedures concomitant (CCPs) with left ventricular assist device (LVAD) implantation compared to propensity score (PS) matched controls using the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data.

METHODS

Between 2006 and 2018, 2760 continuous-flow LVAD patients were identified. Of these, 533 underwent a CCP during the LVAD implant.

RESULTS

Cardiopulmonary bypass time (p < 0.001) and time for implant (p < 0.001) were both significantly longer in the LVAD+CCP group. Hospital mortality was comparable between the two groups from the unmatched population (15.7% vs. 14.1%, p = 0.073). Similarly, short-to-mid-term survival was similar in both groups, with 1-year, 3-year, and 5-year survival rates of 67.9%, 48.2%, and 27.7% versus 66.4%, 46.1%, and 26%, respectively (log-rank, p = 0.25). The results were similar in the PS-matched population. Hospital mortality was comparable between the two groups (18.9% vs. 17.4%, p = 0.074). The short-to-mid-term Kaplan-Meier survival analysis was similar for both groups, with 1-year, 3-year, and 5-year survival rates of 63.4%, 49.2%, and 24.7% versus 66.5%, 46%, and 25.1%, respectively (log-rank, p = 0.81). In the unmatched population, LVAD+CCP patients had longer intensive care unit (ICU) stays (p < 0.0001), longer mechanical ventilation time (p = 0.001), a higher rate of temporary right ventricular assist device (RVAD) support (p = 0.033), and a higher rate of renal replacement therapy (n = 35, 6.6% vs. n = 89, 4.0%, p = 0.014). In the PS-matched population, the LVAD+CCP patients had longer ICU stays (p = 0.019) and longer mechanical ventilation time (p = 0.002).

CONCLUSIONS

The effect of additive valvular procedures (CCPs) does not seem to affect short-term survival, significantly, based on our registry data analysis. However, the decision to perform CCPs should be balanced with the projected type of surgery and preoperative characteristics. LVAD+CCP patients remain a delicate population and adverse device-related events should be strictly monitored and managed.

摘要

背景

我们使用欧洲机械循环支持患者登记处（EUROMACS）的数据，调查了与左心室辅助装置（LVAD）植入同时进行心脏瓣膜手术（CCPs）的临床结果与倾向评分（PS）匹配对照的情况。

方法

在 2006 年至 2018 年期间，确定了 2760 例连续流动 LVAD 患者。其中，533 例在 LVAD 植入期间进行了 CCP。

结果

CPB 时间（p<0.001）和植入时间（p<0.001）在 LVAD+CCP 组均显著延长。两组未匹配人群的住院死亡率相当（15.7%比 14.1%，p=0.073）。同样，两组的短期至中期存活率相似，1 年、3 年和 5 年存活率分别为 67.9%、48.2%和 27.7%与 66.4%、46.1%和 26%（对数秩，p=0.25）。PS 匹配人群的结果也相似。两组住院死亡率相当（18.9%比 17.4%，p=0.074）。两组的短期至中期 Kaplan-Meier 生存分析相似，1 年、3 年和 5 年存活率分别为 63.4%、49.2%和 24.7%与 66.5%、46%和 25.1%（对数秩，p=0.81）。在未匹配人群中，LVAD+CCP 患者的 ICU 入住时间更长（p<0.0001），机械通气时间更长（p=0.001），临时右心室辅助装置（RVAD）支持的比例更高（p=0.033），需要肾脏替代治疗的比例更高（n=35，6.6%比 n=89，4.0%，p=0.014）。在 PS 匹配人群中，LVAD+CCP 患者的 ICU 入住时间更长（p=0.019），机械通气时间更长（p=0.002）。