Shin Kinam, Cho Won Chul, Shin Nara, Kim Hong Rae, Kim Min-Seok, Chung Cheol Hyun, Jung Sung-Ho
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
J Chest Surg. 2024 Mar 5;57(2):184-194. doi: 10.5090/jcs.23.135. Epub 2024 Feb 16.
Left ventricular assist devices (LVADs) are widely employed as a therapeutic option for end-stage heart failure. We evaluated the outcomes associated with centrifugal-flow LVAD implantation, comparing 2 device models: the Heartmate 3 (HM3) and the Heartware Ventricular Assist Device (HVAD).
Data were collected from patients who underwent LVAD implantation between June 1, 2015 and December 31, 2022. We analyzed overall survival, first rehospitalization, and early, late, and LVAD-related complications.
In total, 74 patients underwent LVAD implantation, with 42 receiving the HM3 and 32 the HVAD. A mild Interagency Registry for Mechanically Assisted Circulatory Support score was more common among HM3 than HVAD recipients (p=0.006), and patients receiving the HM3 exhibited lower rates of preoperative ventilator use (p=0.010) and extracorporeal membrane oxygenation (p=0.039). The overall early mortality rate was 5.4% (4 of 74 patients), with no significant difference between groups. Regarding early right ventricular (RV) failure, HM3 implantation was associated with a lower rate (13 of 42 [31.0%]) than HVAD implantation (18 of 32 [56.2%], p=0.051). The median rehospitalization-free period was longer for HM3 recipients (16.9 months) than HVAD recipients (5.3 months, p=0.013). Furthermore, HM3 recipients displayed a lower incidence of late hemorrhagic stroke (p=0.016). In the multivariable analysis, preoperative use of continuous renal replacement therapy (odds ratio, 22.31; p=0.002) was the only significant predictor of postoperative RV failure.
The LVAD models (HM3 and HVAD) demonstrated comparable overall survival rates. However, the HM3 was associated with a lower risk of late hemorrhagic stroke.
左心室辅助装置（LVADs）被广泛用作终末期心力衰竭的一种治疗选择。我们评估了离心式LVAD植入相关的结局，比较了两种装置型号：Heartmate 3（HM3）和Heartware心室辅助装置（HVAD）。
收集2015年6月1日至2022年12月31日期间接受LVAD植入的患者的数据。我们分析了总生存率、首次再住院情况以及早期、晚期和LVAD相关并发症。
共有74例患者接受了LVAD植入，其中42例接受HM3，32例接受HVAD。与接受HVAD的患者相比，接受HM3的患者中机构间机械辅助循环支持评分较低更为常见（p = 0.006），接受HM3的患者术前使用呼吸机（p = 0.010）和体外膜肺氧合（p = 0.039）的比例较低。总体早期死亡率为5.4%（74例患者中的4例），两组之间无显著差异。关于早期右心室（RV）衰竭，HM3植入的发生率（42例中的13例[31.0%]）低于HVAD植入（32例中的18例[56.2%]，p = 0.051）。HM3接受者的无再住院期中位数（16.9个月）长于HVAD接受者（5.3个月，p = 0.013）。此外，HM3接受者晚期出血性卒中的发生率较低（p = 0.016）。在多变量分析中，术前使用持续肾脏替代治疗（比值比，22.31；p = 0.002）是术后RV衰竭的唯一显著预测因素。
LVAD型号（HM3和HVAD）显示出相当的总生存率。然而，HM3与较低的晚期出血性卒中风险相关。
