82例接受搏动性体外心室辅助装置支持的儿童分析：双心室循环与单心室循环患者的比较
Analysis of 82 Children Supported With Pulsatile Paracorporeal Ventricular Assist Device: Comparison of Patients With Biventricular Versus Univentricular Circulation.
作者信息
Bleiweis Mark S, Stukov Yuriy, Philip Joseph, Peek Giles J, Pitkin Andrew D, Sullivan Kevin J, Neal Dan, Jacobs Jeffrey P
机构信息
Congenital Heart Center, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida..
Congenital Heart Center, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida.
出版信息
Semin Thorac Cardiovasc Surg. 2023 Summer;35(2):367-376. doi: 10.1053/j.semtcvs.2022.05.002. Epub 2022 May 15.
We reviewed outcomes in 82 consecutive children supported with the Berlin Heart pulsatile ventricular assist device (VAD), comparing those with functionally univentricular circulation (n = 34) to those with biventricular circulation (n = 48). The primary outcome was mortality. Kaplan-Meier (KM) methods and log-rank tests were used to assess group differences in long-term survival. T-tests using KM-estimated survival proportions and standard errors were used to compare groups at specific time points. 48 biventricular patients were supported (Age: median = 1.4 years, range = 17 days-17.7 years; Weight [kilograms]: median = 9.4, range = 3.1-112), including 43 BiVAD, 4 LVAD only, and 1 LVAD converted to BiVAD. In biventricular patients, duration of VAD support [days]: median = 97, range = 4-315. Of 48 biventricular patients, 35 underwent heart transplantation, 7 died on VAD, 5 weaned off VAD (1 of whom underwent heart transplantation 334 days after weaning), and 1 is still on VAD. 34 univentricular patients were supported with single VAD (sVAD) (Age: median = 38.5 days, range = 4 days-13.3 years; Weight [kilograms]: median = 3.98, range = 2.4-32.6). In univentricular patients, duration of VAD support [days]: median = 138, range = 4-554. Of 34 univentricular patients, 22 underwent transplantation, 11 died on VAD, and 1 is still on VAD. One-year survival after VAD insertion was 82.7% (95% CI = 72.4-94.4%) in biventricular patients and 59.7% (95% CI = 44.9-79.5%) in univentricular patients, p = 0.026. Five-year survival after VAD insertion was 79.7% (95% CI = 68.6-92.6%) in biventricular patients and 50.5% (95% CI = 35.0-73.0%) in univentricular patients, p = 0.010. Pulsatile VAD facilitates bridge to transplantation in neonates, infants, and children with functionally univentricular circulation; however, survival is worse than in patients with biventricular circulation.
我们回顾了连续82例接受柏林心脏搏动性心室辅助装置（VAD）支持的儿童的治疗结果，将功能单心室循环患儿（n = 34）与双心室循环患儿（n = 48）进行比较。主要结局为死亡率。采用Kaplan-Meier（KM）方法和对数秩检验评估长期生存的组间差异。使用KM估计的生存比例和标准误进行t检验，以比较特定时间点的组间差异。48例双心室患儿接受了支持治疗（年龄：中位数 = 1.4岁，范围 = 17天至17.7岁；体重[千克]：中位数 = 9.4，范围 = 3.1至112），包括43例双心室辅助装置（BiVAD）、4例仅左心室辅助装置（LVAD）和1例从LVAD转换为BiVAD的患儿。在双心室患儿中，VAD支持时间[天]：中位数 = 97，范围 = 4至315。48例双心室患儿中，35例行心脏移植，7例在VAD支持下死亡，5例脱离VAD（其中1例在脱离VAD 334天后行心脏移植），1例仍在接受VAD支持。34例单心室患儿接受单VAD（sVAD）支持（年龄：中位数 = 38.5天，范围 = 4天至13.3岁；体重[千克]：中位数 = 3.98，范围 = 2.4至32.6）。在单心室患儿中，VAD支持时间[天]：中位数 = 138，范围 = 4至554。34例单心室患儿中，22例行移植，11例在VAD支持下死亡，1例仍在接受VAD支持。双心室患儿VAD植入后1年生存率为82.7%（95%CI = 72.4 - 94.4%），单心室患儿为59.7%（95%CI = 44.9 - 79.5%），p = 0.026。VAD植入后5年生存率，双心室患儿为79.7%（95%CI = 68.6 - 92.6%），单心室患儿为50.5%（95%CI = 35.0 - 73.0%），p = 0.010。搏动性VAD有助于功能单心室循环的新生儿、婴儿和儿童过渡到移植；然而，其生存率低于双心室循环患儿。
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