HeartMate 3 左心室辅助装置桥接移植与终点治疗策略支持的临床结局：单中心回顾性队列研究。

Clinical outcomes of HeartMate 3 left ventricular assist device support with a Bridge to Transplant vs a Destination Therapy strategy: a single-centre retrospective cohort.

机构信息

Department of Cardiology, University Hospital, Lausanne, Switzerland.

Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland.

出版信息

Swiss Med Wkly. 2024 Jul 10;154:3529. doi: 10.57187/s.3529.

DOI:10.57187/s.3529

PMID:39137373

Abstract

INTRODUCTION

Real-world outcomes with the HeartMate 3 left ventricular assist device (LVAD) depending on whether it's a bridge to transplantation (BTT) or destination therapy (DT) are poorly studied. We aimed to compare the profile and clinical outcomes of patients supported with HeartMate 3 according to a BTT or a DT pre-implantation strategy.

METHODS

All patients consecutively implanted with HeartMate 3 at our centre (University Hospital of Lausanne, Switzerland) in 2015-2022 were analysed in a retrospective observational study. Indications for HeartMate 3 implantation were advanced heart failure despite optimal medical treatment. Patients were treated with a vitamin K antagonist anticoagulant combined with antiplatelet therapy after HeartMate 3 implantation and were followed up monthly at our institution.

RESULTS

Among 71 patients implanted with HeartMate 3 between 2015 and 2022, 51 (71.8%) were implanted as a BTT and 20 (28.2%) as DT. Their median age was 58 (IQR: 52-69) years and 84% of patients were classified as INTERMACS profiles 2-4. The median follow-up duration was 18.3 (IQR: 7.5-33.9) months. Patients in the DT group were older than those in the BTT group (p <0.001) and had more chronic renal failure (p <0.001). They also had a lower 5-year survival rate (mean ± standard error: 87.3 ± 5.6% vs 49.4 ± 15.1%) and more adverse events such as renal dysfunction requiring temporary perioperative dialysis (p = 0.08) or bleeding (p = 0.06).

CONCLUSION

Although patients supported with HeartMate 3 have favourable survival, those with LVAD-DT have poorer outcomes. There is a need to better select patients eligible for LVAD-DT in order to limit the burden of adverse events and improve their prognosis.

摘要

介绍

根据心脏辅助装置 HeartMate 3 是桥接移植（BTT）还是终末期心衰治疗（DT）的适应证，真实世界中使用 HeartMate 3 的结果研究较少。我们旨在比较根据 BTT 或 DT 植入前策略接受 HeartMate 3 支持的患者的特征和临床结局。

方法

对 2015 年至 2022 年在瑞士洛桑大学医院植入 HeartMate 3 的所有患者进行回顾性观察研究。HeartMate 3 植入的适应证为尽管接受了最佳药物治疗但仍有进展性心衰。HeartMate 3 植入后，患者接受维生素 K 拮抗剂抗凝联合抗血小板治疗，并在我们的机构每月进行随访。

结果

在 2015 年至 2022 年间植入 HeartMate 3 的 71 例患者中，51 例（71.8%）作为 BTT 植入，20 例（28.2%）作为 DT 植入。患者的中位年龄为 58（IQR：52-69）岁，84%的患者被归类为 INTERMACS 分级 2-4。中位随访时间为 18.3（IQR：7.5-33.9）个月。DT 组患者比 BTT 组患者年龄更大（p <0.001），慢性肾功能衰竭发生率更高（p <0.001）。他们的 5 年生存率也较低（平均±标准误差：87.3±5.6% vs 49.4±15.1%），并且发生更多不良事件，如需要临时围手术期透析的肾功能障碍（p = 0.08）或出血（p = 0.06）。