Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Interact Cardiovasc Thorac Surg. 2022 May 2;34(5):902-908. doi: 10.1093/icvts/ivac012.
Limited data are available for use of the HeartMate 3 (HM 3) left ventricular assist device in patients with a small body surface area (BSA). Because the HM 3 is currently the sole device available worldwide, we conducted a single-centre retrospective study of patients with a small BSA (<1.5 m2) who underwent HM 3 implantation to better understand the operative and postoperative management.
This study enrolled 64 consecutive patients who had undergone HM 3 implantation from August 2018 to July 2021. The patients were divided into 2 groups based on their BSA before the operation: BSA of <1.5 m2 (small BSA group, n = 18) and BSA of ≥1.5 m2 (regular BSA group, n = 46). The primary study endpoint was survival free of events such as disabling stroke and pump failure. The secondary endpoint was the frequency of adverse events.
The average BSA was 1.38 m2 in the small BSA group. The overall event-free survival rate at 12 months was 100% and 86.7% in the small BSA group and regular BSA group, respectively, and no significant difference was found between the 2 groups (log-rank P = 0.2). The number of cumulative adverse events of death, stroke of any severity, driveline infection, pump infection, ventricular arrhythmia, gastrointestinal Haemorrhage and pump failure was similar between the 2 groups.
The HM 3 was safely implanted in patients with a small BSA, and postoperative outcomes were acceptable regardless of BSA. However, further research is needed to confirm the indications for HM 3 implantation in even smaller patients.
在体表面积（BSA）较小的患者中，使用 HeartMate 3（HM 3）左心室辅助装置的数据有限。由于 HM 3 是目前全球唯一可用的设备，我们对接受 HM 3 植入术的 BSA 较小（<1.5m2）的患者进行了单中心回顾性研究，以更好地了解手术和术后管理。
本研究纳入了 2018 年 8 月至 2021 年 7 月期间接受 HM 3 植入术的 64 例连续患者。根据手术前的 BSA 将患者分为两组：BSA<1.5m2（小 BSA 组，n=18）和 BSA≥1.5m2（常规 BSA 组，n=46）。主要研究终点是无残疾性中风和泵衰竭等不良事件的生存情况。次要终点是不良事件的发生率。
小 BSA 组的平均 BSA 为 1.38m2。小 BSA 组和常规 BSA 组 12 个月时的无事件生存率分别为 100%和 86.7%，两组间无显著差异（对数秩检验 P=0.2）。两组间死亡、任何严重程度的中风、导线感染、泵感染、室性心律失常、胃肠道出血和泵衰竭的累积不良事件数量相似。
HM 3 可安全植入 BSA 较小的患者中，无论 BSA 如何，术后结果均可以接受。然而，仍需要进一步的研究来确定 HM 3 植入术在更小患者中的适应证。
