Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA.
Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA.
Clin Transplant. 2022 Nov;36(11):e14781. doi: 10.1111/ctr.14781. Epub 2022 Sep 5.
Data are limited on outcomes after heart transplantation in patients bridged-to-transplantation (BTT) with a total artificial heart (TAH-t).
The UNOS database was used to identify 392 adult patients undergoing heart transplantation after TAH-t BTT between 2005 and 2020. They were compared with 11 014 durable left ventricular assist device (LVAD) BTT patients and 22 348 de novo heart transplants (without any durable VAD or TAH-t BTT) during the same period.
TAH-t BTT patients had increased dialysis dependence compared to LVAD BTT and de novo transplants (24.7% vs. 2.7% vs. 3.8%) and higher levels of baseline creatinine and total bilirubin (all p < .001). After transplantation, TAH-t BTT patients were more likely to die from multiorgan failure in the first year (25.0% vs. 16.1% vs. 16.1%, p = .04). Ten-year survival was inferior in TAH-t BTT patients (TAH-t BTT 53.1%, LVAD BTT 61.8%, De Novo 62.6%, p < .001), while 10-year survival conditional on 1-year survival was similar (TAH-t BTT 66.8%, LVAD BTT 68.7%, De Novo 69.0%, all p > .20). Among TAH-t BTT patients, predictors of 1-year mortality included higher baseline creatinine and total bilirubin, mechanical ventilation, and cumulative center volume <20 cases of heart transplantation involving TAH-t BTT (all p < .05).
Survival after TAH-t BTT is acceptable, and patients who survive the early postoperative phase experience similar hazards of mortality over time compared to de novo transplant patients and durable LVAD BTT patients.
在使用全人工心脏（TAH-t）桥接移植的患者中，心脏移植后的结果数据有限。
使用 UNOS 数据库确定了 2005 年至 2020 年间接受 TAH-t 桥接移植后进行心脏移植的 392 名成年患者。将他们与同期 11014 例耐用型左心室辅助装置（LVAD）桥接移植患者和 22348 例新诊断心脏移植（无任何耐用型 VAD 或 TAH-t 桥接移植）患者进行比较。
与 LVAD 桥接移植和新诊断移植相比，TAH-t 桥接移植患者透析依赖的发生率更高（24.7%比 2.7%比 3.8%），基线肌酐和总胆红素水平也更高（均 p<0.001）。移植后，TAH-t 桥接移植患者在第一年死于多器官衰竭的风险更高（25.0%比 16.1%比 16.1%，p=0.04）。TAH-t 桥接移植患者的 10 年生存率较低（TAH-t 桥接移植 53.1%，LVAD 桥接移植 61.8%，新诊断 62.6%，p<0.001），但 1 年生存率条件下的 10 年生存率相似（TAH-t 桥接移植 66.8%，LVAD 桥接移植 68.7%，新诊断 69.0%，均 p>0.20）。在 TAH-t 桥接移植患者中，1 年死亡率的预测因素包括基线肌酐和总胆红素较高、机械通气以及中心累积 TAH-t 桥接移植量<20 例（均 p<0.05）。
TAH-t 桥接移植后的存活率是可以接受的，并且在早期术后阶段存活下来的患者在随时间推移时，与新诊断的心脏移植患者和耐用型 LVAD 桥接移植患者相比，具有相似的死亡风险。
