Meyer Dan M, Nayak Aditi, Wood Katherine L, Blumer Vanessa, Schettle Sarah, Salerno Chris, Koehl Devin, Cantor Ryan, Kirklin James K, Jacobs Jeffrey P, Cascino Thomas, Pagani Francis D, Kanwar Manreet K
Department of Cardiothoracic Surgery, Baylor Scott & White Health, Baylor University Medical Center, Dallas, Texas.
Center for Advanced Heart and Lung Disease, Baylor Scott & White Health, Baylor University Medical Center, Dallas, Texas.
Ann Thorac Surg. 2025 Jan;119(1):34-58. doi: 10.1016/j.athoracsur.2024.10.003. Epub 2024 Oct 21.
The 15th Annual Report from The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support includes 29,634 continuous-flow left ventricular assist devices from the 10-year period between 2014 and 2024. The outcomes reported here demonstrate continued improved survival in the current era of fully magnetically levitated devices, with a significantly higher 1-year (85.7% vs 78.4%) and 5-year (59.7% vs 43.7%) survival than those receiving non-magnetically levitated devices. Magnetically levitated device recipients are experiencing a lower incidence of adverse events, including freedom from gastrointestinal bleeding (72.6%), device malfunction (82.9%), and stroke (86.7%) at 5 years. Additionally, a focus on a subgroup of patients younger than 50 years of age has demonstrated both superior outcomes in survival (91.6% survival at 1 year and 72.6% survival at 5 years) and decreased incidence of adverse events compared with older recipients. This younger cohort also demonstrated more tolerance to the characteristics of sex, race, ethnicity, and psychosocial indicators that are associated with worse outcomes after heart transplantation. Based upon these data, a potential net prolongation of life may be realized by considering prolonged left ventricular assist device support prior to heart transplantation in this population. These analyses provide preliminary data that could positively influence adoption of left ventricular assist device technology in groups previously not seen as candidates for this therapy, while providing a more responsible donor allocation strategy for advanced heart failure patients.
胸外科医师协会机械辅助循环支持跨机构注册处的第15份年度报告涵盖了2014年至2024年这10年间的29,634例连续血流左心室辅助装置。此处报告的结果表明，在当前全磁悬浮装置时代，生存率持续提高，与接受非磁悬浮装置的患者相比，1年生存率（85.7%对78.4%）和5年生存率（59.7%对43.7%）显著更高。磁悬浮装置接受者不良事件的发生率较低，包括5年时无胃肠道出血（72.6%）、装置故障（82.9%）和中风（86.7%）。此外，对年龄小于50岁的患者亚组的关注表明，与老年接受者相比，其生存率更高（1年生存率为91.6%，5年生存率为72.6%），不良事件发生率降低。这个较年轻的队列对与心脏移植后较差结局相关的性别、种族、族裔和社会心理指标特征也表现出更大的耐受性。基于这些数据，通过考虑在该人群心脏移植前延长左心室辅助装置支持时间，可能实现潜在的生命净延长。这些分析提供了初步数据，可能会积极影响左心室辅助装置技术在以前未被视为该治疗候选人群中的采用，同时为晚期心力衰竭患者提供更合理的供体分配策略。
