体外生命支持后接受HeartMate 3支持的患者结局：代表体外生命支持后持久机械循环支持研究组。
Outcome of patients supported with the HeartMate 3 after extracorporeal life support: On behalf of the Durable Mechanical Circulatory Support After Extracorporeal Life Support Study Group.
作者信息
Saeed Diyar, Stark Christoffer, Otto Wolfgang, Loforte Antonio, Zimpfer Daniel, Bernhardt Alexander M, Potapov Evgenij, Morshius Michiel, Schibilsky David, Albert Alexander, Raweh Ayman, Riebandt Julia, Pappalardo Federico, Attisani Matteo, Rinaldi Mauro, Haneya Assad, Huenges Katharina, Ramjankhan Faiz, Jorde Ulrich P, Lewin Daniel, Jawad Khalil, Aubin Hug, Ayala Rafael, Reichenspurner Hermann, Lichtenberg Artur, Borger Michael, Gummert Jan
机构信息
Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Department of Cardiac Surgery, Helsinki University Central Hospital, Helsinki, Finland.
出版信息
J Thorac Cardiovasc Surg. 2024 Aug;168(2):569-578.e2. doi: 10.1016/j.jtcvs.2023.08.048. Epub 2023 Sep 7.
OBJECTIVES
The Durable Mechanical Circulatory Support System After Extracorporeal Life Support registry is a multicenter registry of patients who were bridged from extracorporeal life support to a durable mechanical circulatory support system. Although numerous studies have highlighted the favorable outcomes after implantation of the HeartMate 3 (Abbott), the objective of our study is to examine the outcomes of patients who received HeartMate 3 support after extracorporeal life support.
METHODS
Data of patients undergoing HeartMate 3 implantation from January 2016 to April 2022 at 14 centers were collected and evaluated. Inclusion criteria were patients with extracorporeal life support before HeartMate 3 implantation. The outcome was reported and compared with patients receiving other types of pumps.
RESULTS
A total of 337 patients were bridged to durable mechanical circulatory support system after extracorporeal life support in the study period. Of those patients, 140 were supported with the HeartMate 3. The other types of pumps included 170 HeartWare HVADs (Medtronic) (86%), 14 HeartMate II devices (7%), and 13 (7%) other pumps (7%). Major postoperative complications included right heart failure requiring temporary right ventricular assist device in 60 patients (47%). Significantly lower postoperative stroke (16% vs 28%, P = .01) and pump thrombosis (3% vs 8%, P = .02) rates were observed in the patients receiving the HeartMate 3. The 30-day, 1-year, and 3-year survivals in patients receiving the HeartMate 3 were 87%, 73%, and 65%, respectively.
CONCLUSIONS
In this critically ill patient population, the survivals of patients who were transitioned to the HeartMate 3 are deemed acceptable and superior to those observed when extracorporeal life support was bridged to other types of durable mechanical circulatory support systems.
目的
体外膜肺氧合（ECLS）后持久机械循环支持系统注册研究是一项多中心注册研究，纳入了从体外膜肺氧合过渡到持久机械循环支持系统的患者。尽管众多研究强调了植入HeartMate 3（雅培公司）后的良好预后，但我们研究的目的是探讨在体外膜肺氧合后接受HeartMate 3支持的患者的预后情况。
方法
收集并评估了2016年1月至2022年4月期间在14个中心接受HeartMate 3植入术患者的数据。纳入标准为在植入HeartMate 3之前接受过体外膜肺氧合的患者。报告了预后情况，并与接受其他类型血泵的患者进行了比较。
结果
在研究期间，共有337例患者在体外膜肺氧合后过渡到持久机械循环支持系统。其中，140例患者接受了HeartMate 3支持。其他类型的血泵包括170台HeartWare HVAD（美敦力公司）（86%）、14台HeartMate II设备（7%）和13台（7%）其他血泵（7%）。主要术后并发症包括60例患者（47%）出现需要临时右心室辅助装置的右心衰竭。接受HeartMate 3的患者术后中风（16%对28%，P = 0.01）和血泵血栓形成（3%对8%，P = 0.02）发生率显著较低。接受HeartMate 3的患者30天、1年和3年生存率分别为87%、73%和65%。
结论
在这一危重症患者群体中，过渡到HeartMate 3的患者生存率被认为是可接受的，且优于从体外膜肺氧合过渡到其他类型持久机械循环支持系统时观察到的生存率。
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