Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
Artif Organs. 2022 Aug;46(8):1616-1625. doi: 10.1111/aor.14235. Epub 2022 Apr 1.
Hemocompatibility-related adverse events (HRAE) negatively influence survival. However, no study has examined the impact of these events on health-related quality of life (HRQOL) and functional outcomes following continuous-flow left ventricular assist device implantation (CF-LVAD). We assessed the impact of HRAE events on HRQOL and hypothesized that HRAE's adversely impact HRQOL and functional outcomes.
INTERMACS database identified patients undergoing primary CF-LVAD implantation from 2008 to 2017. HRAEs included stroke, non-surgical bleeding, hemolysis, and pump thrombosis and were identified as defined in the literature. HRAEs were further stratified as Tier 1-2 and disabling stroke events. Time-series analysis was executed for HRAE patients with values pre-HRAE, post-HRAE, and closest to 12 months follow up. Local polynomial regression curves modeling individual patients were superimposed into "spaghetti" plots.
All HRQOL and functional metrics improved in patients over time, despite HRAE complications. However, these patient metrics were significantly reduced compared to the non-HRAE cohort. Advanced data visualization techniques noted a decline after experiencing an HRAE with a subsequent recovery to baseline levels or higher. Six-minute walk test (6MWT) was noted to be most affected in the post-HRAE period but recovered similar to other metrics.
The burden of HRAE following CF-LVAD implantation did not negatively impact the quality of life. However, the 6MWT did not increase in the post-HRAE period in all HRAE patients. Improvement of heart failure symptoms after CF-LVAD coupled with optimal management following the HRAE act to preserve the enhanced quality of life.
与血液相容性相关的不良事件（HRAE）会对生存率产生负面影响。然而，尚无研究探讨这些事件对连续血流左心室辅助装置植入（CF-LVAD）后健康相关生活质量（HRQOL）和功能结果的影响。我们评估了 HRAE 事件对 HRQOL 的影响，并假设 HRAE 会对 HRQOL 和功能结果产生不利影响。
INTERMACS 数据库确定了 2008 年至 2017 年期间接受初次 CF-LVAD 植入的患者。HRAE 包括中风、非手术性出血、溶血和泵血栓形成，并按照文献中的定义进行了识别。HRAE 进一步分为 1-2 级和致残性中风事件。对发生 HRAE 的患者进行时间序列分析，其值包括 HRAE 前、HRAE 后和最接近 12 个月随访时的值。将个体患者的局部多项式回归曲线模型叠加到“意大利面条”图中。
尽管发生了 HRAE 并发症，但所有 HRQOL 和功能指标均随时间推移而改善。然而，与非 HRAE 队列相比，这些患者指标显著降低。先进的数据可视化技术注意到在经历 HRAE 后出现下降，随后恢复到基线水平或更高水平。在 HRAE 后期间，6 分钟步行测试（6MWT）受到的影响最大，但恢复情况与其他指标相似。
CF-LVAD 植入后 HRAE 的负担并未对生活质量产生负面影响。然而，并非所有 HRAE 患者在 HRAE 后期间 6MWT 都增加。CF-LVAD 后心力衰竭症状的改善以及 HRAE 后最佳管理有助于维持生活质量的提高。
