Salna Michael, Ning Yuming, Kurlansky Paul, Yuzefpolskaya Melana, Colombo Paolo C, Naka Yoshifumi, Takeda Koji
Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
J Chest Surg. 2022 Jun 5;55(3):197-205. doi: 10.5090/jcs.21.148.
The integrated design of the HeartMate 3 (Abbott Laboratories, Chicago, IL, USA) affords flexibility to place the pump within the pericardium or thoracic cavity. We sought to determine whether the presence of a left ventricular assist device (LVAD) in either location has a meaningful impact on overall patient outcomes.
A retrospective cohort study was conducted of all 165 patients who received a HeartMate 3 LVAD via a median sternotomy from November 2014 to August 2019 at our center. Based on operative reports and imaging, patients were divided into intrapleural (n=81) and intrapericardial (n=84) cohorts. The primary outcome of interest was in-hospital mortality, while secondary outcomes included postoperative complications, cumulative readmission incidence, and 3-year survival.
There were no significant between-group differences in baseline demographics, risk factors, or preoperative hemodynamics. The overall in-hospital mortality rate was 6%, with no significant difference between the cohorts (9% vs. 4%, p=0.20). There were no significant differences in the postoperative rates of right ventricular failure, kidney failure requiring hemodialysis, stroke, tracheostomy, or arrhythmias. Over 3 years, despite similar mortality rates, intrapleural patients had significantly more readmissions (n=180 vs. n=117, p<0.01) with the most common reason being infection (n=68/165), predominantly unrelated to the device. Intrapleural patients had significantly more infection-related readmissions, predominantly driven by non-ventricular assist device-related infections (p=0.02), with 41% of these due to respiratory infections compared with 28% of intrapericardial patients.
Compared with intrapericardial placement, insertion of an intrapleural HM3 may be associated with a higher incidence of readmission, especially due to respiratory infection.
HeartMate 3（美国伊利诺伊州芝加哥雅培实验室）的一体化设计使将泵置于心包内或胸腔内具有灵活性。我们试图确定泵在任一位置的存在是否对患者总体预后有显著影响。
对2014年11月至2019年8月在我们中心经正中胸骨切开术接受HeartMate 3左心室辅助装置（LVAD）的所有165例患者进行了一项回顾性队列研究。根据手术报告和影像学检查，将患者分为胸腔内（n = 81）和心包内（n = 84）队列。感兴趣的主要结局是住院死亡率，次要结局包括术后并发症、累积再入院发生率和3年生存率。
两组在基线人口统计学、危险因素或术前血流动力学方面无显著差异。总体住院死亡率为6%，两组之间无显著差异（9%对4%，p = 0.20）。右心室衰竭、需要血液透析的肾衰竭、中风、气管切开术或心律失常的术后发生率无显著差异。在3年期间，尽管死亡率相似，但胸腔内患者的再入院次数明显更多（n = 180对n = 117，p < 0.01），最常见的原因是感染（n = 68/165），主要与装置无关。胸腔内患者的感染相关再入院次数明显更多，主要由非心室辅助装置相关感染驱动（p = 0.02），其中41%是由于呼吸道感染，而心包内患者为28%。
与心包内放置相比，胸腔内植入HM3可能与再入院发生率较高有关，尤其是由于呼吸道感染。
