Broda Christopher R, Frankel William C, Nair Ajith P, Dreyer W Jeffrey, Tunuguntla Hari P, Frazier O Howard, Dolgner Stephen J, Anders Marc M, Tume Sebastian C, Qureshi Athar M, Parekh Dhaval R, Hickey Edward J, Adachi Iki, Civitello Andrew B
From the Section of Pediatric and Adult Congenital Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
ASAIO J. 2023 May 1;69(5):429-437. doi: 10.1097/MAT.0000000000001853. Epub 2022 Nov 10.
Heart failure (HF) is common in adult congenital heart disease (ACHD) patients; however, use of continuous-flow ventricular assist devices (CF-VADs) remains rare. We reviewed outcomes of patients with congenital heart disease greater than or equal to 18 years of age at the time of CF-VAD implant at the affiliated pediatric and adult institutions between 2006 and 2020. In total, 18 ACHD patients (15 with great anatomical complexity) received 21 CF-VADs. Six patients (median age 34 years) received seven percutaneous CF-VADs with a median duration of support of 20 days (3-44 days) with all patients survived to hospital discharge and two patients were bridged to durable CF-VADs. Fourteen patients (median age 38 years) received durable CF-VADs. Thirteen patients (93%) survived to hospital discharge and the median duration of support was 25.8 months (6.4-52.1 months). Estimated survival on durable CF-VAD at 1, 3, and 5 years was 84%, 72%, and 36%, respectively. Three patients were successfully bridged to transplantation. Device-related complications include cerebrovascular accident (n = 5), driveline infection (n = 3), device infection requiring chronic antibiotic therapy (n = 4), gastrointestinal bleeding (n = 6), and presumed pump thrombosis (n = 5). These results show percutaneous and durable CF-VADs can support ACHD patients with advanced HF.
心力衰竭（HF）在成人先天性心脏病（ACHD）患者中很常见；然而，连续流心室辅助装置（CF-VADs）的使用仍然很少见。我们回顾了2006年至2020年期间在附属儿科和成人机构接受CF-VAD植入时年龄大于或等于18岁的先天性心脏病患者的治疗结果。共有18例ACHD患者（15例具有高度解剖复杂性）接受了21次CF-VAD植入。6例患者（中位年龄34岁）接受了7次经皮CF-VAD植入，中位支持时间为20天（3-44天），所有患者均存活至出院，2例患者过渡到永久性CF-VAD。14例患者（中位年龄38岁）接受了永久性CF-VAD。13例患者（93%）存活至出院，中位支持时间为25.8个月（6.4-52.1个月）。永久性CF-VAD植入后1年、3年和5年的估计生存率分别为84%、72%和36%。3例患者成功过渡到移植。与装置相关的并发症包括脑血管意外（n = 5）、导线感染（n = 3）、需要长期抗生素治疗的装置感染（n = 4）、胃肠道出血（n = 6）和疑似泵血栓形成（n = 5）。这些结果表明，经皮和永久性CF-VAD可以支持晚期HF的ACHD患者。
