Damman Kevin, Caliskan Kadir, Birim Ozcan, Kuijpers Michiel, Otterspoor Luuk C, Yazdanbakhsh Aria, Palmen Meindert, Ramjankhan Faiz Z, Tops Lauren F, van Laake Linda W
University of Groningen, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Neth Heart J. 2023 May;31(5):189-195. doi: 10.1007/s12471-023-01760-9. Epub 2023 Feb 1.
Left ventricular assist device (LVAD) therapy is an established treatment for advanced heart failure with reduced ejection fraction. We evaluated the characteristics and clinical outcomes of patients implanted with an LVAD in the Netherlands.
Patients implanted with an LVAD in the Netherlands between 2016 and 2020 were included in the analysis. Baseline characteristics entered into this registry, as well as clinical outcomes (death on device, heart transplantation) and major adverse events (device dysfunction, major bleeding, major infection and cerebrovascular event), were evaluated.
A total of 430 patients were implanted with an LVAD; mean age was 55 ± 13 years and 27% were female. The initial device strategy was bridge to transplant (BTT) in 50%, destination therapy (DT) in 29% and bridge to decision (BTD) in the remaining 21%. After a follow-up of 17 months, 97 (23%) patients had died during active LVAD support. Survival was 83% at 1 year, 76% at 2 years and 54% at 5 years. Patients implanted with an LVAD as a BTT had better outcomes compared with DT at all time points (1 year 86% vs 72%, 2 years 83% vs 59% and 5 years 58% vs 33%). Major adverse events were frequently observed, most often major infection, major bleeding and cerebrovascular events (0.84, 0.33 and 0.09 per patient-year at risk, respectively) and were similar across device strategies. Patients supported with HeartMate 3 had a lower incidence of major adverse events.
Long-term survival on durable LVAD support in the Netherlands is over 50% after 5 years. Major adverse events, especially infection and bleeding, are still frequently observed, but decreasing with the contemporary use of HeartMate 3 LVAD.
左心室辅助装置（LVAD）治疗是射血分数降低的晚期心力衰竭的既定治疗方法。我们评估了荷兰植入LVAD患者的特征和临床结局。
纳入2016年至2020年在荷兰植入LVAD的患者进行分析。评估进入该登记系统的基线特征，以及临床结局（装置使用期间死亡、心脏移植）和主要不良事件（装置功能障碍、大出血、严重感染和脑血管事件）。
共有430例患者植入了LVAD；平均年龄为55±13岁，27%为女性。初始装置策略为50%为桥接至移植（BTT），29%为目标治疗（DT），其余21%为桥接至决策（BTD）。随访17个月后，97例（23%）患者在LVAD积极支持期间死亡。1年生存率为83%，2年生存率为76%，5年生存率为54%。与DT相比，BTT植入LVAD的患者在所有时间点的结局更好（1年时为86%对72%，2年时为83%对%59，5年时为58%对33%）。经常观察到主要不良事件，最常见的是严重感染、大出血和脑血管事件（分别为每位患者每年0.84、0.33和0.09次风险），且在不同装置策略中相似。使用HeartMate 3支持的患者主要不良事件发生率较低。
在荷兰，持久LVAD支持下的长期生存率在5年后超过50%。仍然经常观察到主要不良事件，尤其是感染和出血，但随着当代HeartMate 3 LVAD的使用而减少。
