Tenge Theresa, Roth Sebastian, M'Pembele René, Lurati Buse Giovanna, Boenner Florian, Ballázs Christina, Tudorache Igor, Boeken Udo, Lichtenberg Artur, Neukirchen Martin, Huhn Ragnar, Aubin Hug
Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Düsseldorf, Germany.
Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Düsseldorf, Germany.
Life (Basel). 2022 Nov 24;12(12):1966. doi: 10.3390/life12121966.
The two main surgical options to treat end-stage heart failure are heart transplantation (HTx) or left ventricular assist device (LVAD) implantation. In hemodynamically stable patients, the decision for HTx listing with or without LVADs is challenging. We analyzed the impact of both options on days alive and out of hospital (DAOH) and survival. This retrospective study screened all patients with HTx or LVAD implantation between 2010 and 2020. The main inclusion criterion was hemodynamic stability defined as independence of intravenous inotropic/vasoactive support at decision. Propensity score matching (PSM) was performed. The primary endpoint was DAOH within one year after the decision. Secondary endpoints included survival, duration until HTx, and hospitalizations. In total, 187 patients received HTx and 227 patients underwent LVAD implantation. There were 21 bridge-to-transplant (BTT)-LVAD patients (implantation less than a month after HTx listing or listing after implantation) and 44 HTx-waiting patients included. PSM identified 17 matched pairs. Median DAOH at one year was not significantly different between the groups (BTT-LVAD: median 281, IQR 89; HTx waiting: median 329, IQR 74; = 0.448). Secondary endpoints did not differ significantly. Our data suggest that BTT-LVAD implantation may not be favorable in terms of DAOH within one year for hemodynamically stable patients compared to waiting for HTx. Further investigations on quality of life and long-term outcomes are warranted.
治疗终末期心力衰竭的两种主要手术选择是心脏移植（HTx）或植入左心室辅助装置（LVAD）。对于血流动力学稳定的患者，决定是否将其列入心脏移植名单（无论是否使用LVAD）具有挑战性。我们分析了这两种选择对存活天数和出院天数（DAOH）以及生存率的影响。这项回顾性研究筛查了2010年至2020年间所有接受HTx或LVAD植入的患者。主要纳入标准是血流动力学稳定，定义为在决策时无需静脉注射强心/血管活性药物支持。进行了倾向评分匹配（PSM）。主要终点是决策后一年内的DAOH。次要终点包括生存率、直至接受HTx的持续时间和住院情况。共有187例患者接受了HTx，227例患者接受了LVAD植入。有21例桥接至移植（BTT）-LVAD患者（在列入HTx名单后不到一个月植入或植入后列入名单）和44例等待HTx的患者。PSM确定了17对匹配病例。两组之间一年时的DAOH中位数无显著差异（BTT-LVAD：中位数281，四分位间距89；等待HTx：中位数329，四分位间距74；P = 0.448）。次要终点也无显著差异。我们的数据表明，对于血流动力学稳定的患者，与等待HTx相比，在决策后一年内，BTT-LVAD植入在DAOH方面可能并无优势。有必要对生活质量和长期结局进行进一步研究。
