Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), The Netherlands.
Artif Organs. 2022 Nov;46(11):2293-2303. doi: 10.1111/aor.14333. Epub 2022 Jun 30.
Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score (PS) matching two preoperatively comparable populations of females and males and test if any real sex-related difference exists regarding survival and adverse events after LVAD implantation.
This retrospective single-center observational study investigated patients who received LVAD implantation between 2010 and 2018. PS matching was applied to balance preoperative heterogeneity between males and females. Primary endpoint was survival at follow-up. Secondary endpoints included perioperative outcomes and LVAD-related adverse events.
92 fully comparable females(n = 46) and males(n = 46) were selected after PS matching (median age:57 years, min-max:18-75). 26.1% of patients required preoperative mechanical circulatory support. Females needed more intraoperative fresh frozen plasma (p < 0.001) and platelets transfusions (p = 0.008) compared to males, but postoperative outcomes were comparable between groups. In-hospital, 1 and 2-year survival were 78.3%, 69.6% and 65.2%, respectively, with no differences between groups. Survival probability remained comparable up to 8 years of follow-up (p = 0.35). Overall, females showed a higher rate of strokes (p = 0.039) compared to males in the follow-up time.
After reducing preoperative heterogeneity between females and males, survival after LVAD implantation does not differ based on sex. However, differences might exist in terms of higher transfusions and strokes in females. Reducing preoperative sex disparities and developing intraoperative and anticoagulation strategies which acknowledge sex-related variations might help abolishing differences in LVAD outcomes.
从历史上看，女性在接受左心室辅助装置（LVAD）植入后，其预后比男性更差。然而，女性的术前情况较为特殊，这使得直接与男性进行比较具有挑战性。本研究旨在通过倾向评分（PS）匹配选择两组术前可比的女性和男性人群，并检验 LVAD 植入后生存和不良事件是否存在真正的性别差异。
这是一项回顾性单中心观察性研究，纳入了 2010 年至 2018 年间接受 LVAD 植入的患者。采用 PS 匹配来平衡男性和女性之间的术前异质性。主要终点为随访时的生存情况。次要终点包括围手术期结局和与 LVAD 相关的不良事件。
PS 匹配后，共选择了 92 名完全可比的女性（n=46）和男性（n=46）患者（中位年龄：57 岁，最小-最大：18-75 岁）。26.1%的患者需要术前机械循环支持。与男性相比，女性在术中需要更多的新鲜冷冻血浆（p<0.001）和血小板输注（p=0.008），但术后结局在两组间无差异。住院期间、1 年和 2 年生存率分别为 78.3%、69.6%和 65.2%，组间无差异。随访 8 年时，生存概率仍保持一致（p=0.35）。总体而言，女性在随访期间发生中风的比例高于男性（p=0.039）。
在减少女性和男性术前异质性后，LVAD 植入后的生存情况与性别无关。然而，女性在输血和中风方面可能存在更高的发生率。减少术前性别差异，并制定术中及抗凝策略，承认与性别相关的差异，可能有助于消除 LVAD 结局的差异。
