Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
Eur J Cardiothorac Surg. 2024 Oct 1;66(4). doi: 10.1093/ejcts/ezae317.
Left ventricular assist device (LVAD) therapy has evolved from a short-term bridge-to-transplant strategy into a long-term and often chronic therapy due to long waiting times for heart transplantation and application as destination therapy. Consequently, patients are at risk of developing complications necessitating LVAD exchange. The aim of this study is to assess patient outcomes after LVAD exchange.
Patients who underwent LVAD exchange between January 2010 and December 2022 were included. Logistic and cox regression analyses were used to identify potential risk factors for short and long-term adverse events, respectively. Survival after exchange was assessed using Kaplan-Meier estimates.
Sixty-one patients underwent a total of 80 LVAD exchanges. Most frequently observed short-term complications were pulmonary infections (16.3%) and right heart failure (16.3%). Exit-site infections (34.7%) and device malfunctions (25.3%) were the most often observed long-term complications. HeartWare ventricular assist device as index device was associated with a higher risk of right heart failure [hazard ratio 6.42, 95% confidence interval (CI) 1.80-22.90] and respiratory failure (hazard ratio 7.81, 95% CI 1.95-31.23) compared to HeartMate II and HeartMate 3. Survival was 83% (95% CI 75.5-95.3%) at 1 year and 67% (95% CI 53.9-84.7%) at 6 years after exchange. After 5 years, 25.0% was transplanted, 23.8% had undergone a re-exchange and 32.5% was alive without new intervention.
Although LVAD exchange can be performed with a relatively low mortality, other post-operative adverse events are common. Patients with the HeartWare ventricular assist device as index device may be at higher risk of developing right heart failure and respiratory failure after exchange.
由于心脏移植等待时间长以及将左心室辅助装置 (LVAD) 作为终末期治疗的应用，LVAD 治疗已从短期桥接移植策略演变为长期甚至慢性治疗。因此，患者有发生需要更换 LVAD 的并发症的风险。本研究旨在评估 LVAD 更换后的患者结局。
纳入 2010 年 1 月至 2022 年 12 月期间接受 LVAD 更换的患者。使用逻辑回归和 Cox 回归分析分别确定短期和长期不良事件的潜在风险因素。使用 Kaplan-Meier 估计评估更换后的生存率。
61 名患者共进行了 80 次 LVAD 更换。最常见的短期并发症是肺部感染 (16.3%) 和右心衰竭 (16.3%)。最常见的长期并发症是出口部位感染 (34.7%) 和设备故障 (25.3%)。作为基准设备的 HeartWare 心室辅助装置与右心衰竭 (风险比 6.42，95%置信区间 [CI] 1.80-22.90) 和呼吸衰竭 (风险比 7.81，95% CI 1.95-31.23) 的风险增加相关与 HeartMate II 和 HeartMate 3 相比。更换后 1 年的生存率为 83% (95% CI 75.5-95.3%)，6 年时为 67% (95% CI 53.9-84.7%)。5 年后，25.0%的患者接受了移植，23.8%的患者进行了再次更换，32.5%的患者在没有新干预的情况下存活。
尽管 LVAD 更换的死亡率相对较低，但其他术后不良事件较为常见。作为基准设备的 HeartWare 心室辅助装置的患者在更换后发生右心衰竭和呼吸衰竭的风险可能更高。
