Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Clinic of Thoracic and Cardiovascular Surgery, Essen University Hospital, Essen, Germany.
Interact Cardiovasc Thorac Surg. 2022 Aug 3;35(3). doi: 10.1093/icvts/ivac107.
Our goal was to analyse adverse events in adolescent and adult patients with the Berlin Heart EXCOR and to assess the outcome of a subsequent heart transplant (HTX).
From 2006 to 2020, a total of 58 patients (12-64 years old) received a biventricular assist device (BIVAD) at our institution and were included in this study.
The causes of biventricular heart failure were nonischaemic cardiomyopathy (62.1%), ischaemic cardiomyopathy (22.4%) and myocarditis (15.5%). The median INTERMACS score was I (I-III). The median age was 49 years (interquartile range, 34-55 years), and 82.8% were male. Causes of death were multiorgan failure (25.0%), septic shock (17.9%), cerebral haemorrhage (14.3%), bleeding (14.3%) and embolic events (14.3%). Major bleeding was more frequent in the patients who died while on BIVADs (60.7 vs 6.7%, P < 0.001). Wound infections were more prevalent in HTX recipients (n = 21, 70.0%). After BIVAD thrombosis, 104 chamber exchanges were performed in 28 patients (48.3%). HTXs were performed in 52.6% of the patients after a BIVAD support time of 316 ± 240 days. The mean time to follow-up of 30 HTX recipients was 1722 ± 1368 days. One-, 6- and 12-month survival after an HTX were 96.7%, 90.0% and 76.7%, respectively. Long-term survival after 5 and 10 years was 69.7%.
Pump thrombosis, infections and bleeding after receiving a BIVAD did not preclude a successful HTX. Although only 50% of patients with BIVADs were successfully given a transplant, long-term survival after an HTX in patients with BIVAD was noninferior compared to that of other recipients.
我们的目标是分析柏林心脏 EXCOR 在心衰患者（青少年和成年人）中的不良事件，并评估随后心脏移植（HTX）的结果。
2006 年至 2020 年，共有 58 例患者（12-64 岁）在我院接受了双心室辅助装置（BIVAD）治疗，并纳入本研究。
双心室心力衰竭的病因是非缺血性心肌病（62.1%）、缺血性心肌病（22.4%）和心肌炎（15.5%）。INTERMACS 评分中位数为 I 级（I-III 级）。中位年龄为 49 岁（四分位距 34-55 岁），82.8%为男性。死亡原因包括多器官衰竭（25.0%）、感染性休克（17.9%）、脑出血（14.3%）、出血（14.3%）和栓塞事件（14.3%）。在 BIVAD 期间死亡的患者中，主要出血更为常见（60.7%比 6.7%，P<0.001）。BIVAD 接受者中，伤口感染更为常见（n=21，70.0%）。BIVAD 血栓形成后，28 例患者（48.3%）进行了 104 次房室交换。BIVAD 支持时间为 316±240 天后，52.6%的患者进行了 HTX。30 例 HTX 接受者的平均随访时间为 1722±1368 天。HTX 后 1、6 和 12 个月的生存率分别为 96.7%、90.0%和 76.7%。5 年和 10 年后的长期生存率分别为 69.7%。
BIVAD 后发生泵血栓形成、感染和出血并不会妨碍成功进行 HTX。尽管只有 50%的 BIVAD 患者成功接受了移植，但 BIVAD 患者接受 HTX 后的长期生存率与其他接受者无差异。
