Nair Nandini, Nguyen Kenny, Du Dongping, Mahesh Aditya, Soleimani Behzad, Mahesh Balakrishnan
Division of Cardiology, Penn State College of Medicine, Hershey, PA, USA.
Division of Cardiothoracic Surgery, Penn State College of Medicine, Hershey, PA, USA.
Int J Artif Organs. 2025 Aug;48(8):566-574. doi: 10.1177/03913988251351116. Epub 2025 Jun 25.
Ongoing donor-organ shortage has limited transplantation making LVADs an effective alternative therapy for patients with end-stage heart failure. When LVAD-associated complications arise device exchange is a feasible and safe alternative. This study addresses the factors that impact survival post-LVAD exchange.
Our decoded database was constructed retrospectively. Surgical details, device features, and re-intervention information were studied. The primary outcome was mortality. Kaplan-Meier estimators were used for post-pump exchange survival analysis. Pairwise log-rank tests compare the survivals between different groups within each variable. -Value <0.05 was considered significant. Backward-stepwise regression was used to construct the multivariable model using a subset of variables, retaining only variables with a -value <0.1. Hazard ratios, their 95% confidence intervals, and p-values of the significant variables were reported.
Analysis of factors impacting survival post-pump exchange study showed a poor survival probability of only primary midline-sternotomy/redo ( = 0.005). Multivariable analysis showed that bridging with ECMO was protective with a hazard ratio of 0.16 (0.03-0.86, = 0.03).
The overall survival probability is 50% at 4 years post-pump exchange. This study highlights the differences in post-exchange outcomes depending on the device types and surgical approaches used. LVAD exchange for device-related complications can be performed in high-risk patients as a viable alternative to heart transplantation in the setting of the current heart allocation prioritization systems.
持续存在的供体器官短缺限制了移植手术，使得左心室辅助装置（LVAD）成为终末期心力衰竭患者的一种有效替代疗法。当出现与LVAD相关的并发症时，装置更换是一种可行且安全的选择。本研究探讨了影响LVAD更换术后生存的因素。
我们的解码数据库是回顾性构建的。研究了手术细节、装置特征和再次干预信息。主要结局是死亡率。采用Kaplan-Meier估计量进行泵更换术后生存分析。成对对数秩检验比较每个变量内不同组之间的生存率。P值<0.05被认为具有统计学意义。采用向后逐步回归法，使用变量子集构建多变量模型，仅保留P值<0.1的变量。报告了显著变量的风险比、其95%置信区间和P值。
泵更换术后生存影响因素分析显示，仅初次正中胸骨切开术/再次手术的生存概率较低（P = 0.005）。多变量分析显示，使用体外膜肺氧合（ECMO）进行桥接具有保护作用，风险比为0.16（0.03 - 0.86，P = 0.03）。
泵更换术后4年的总体生存概率为50%。本研究强调了根据所使用的装置类型和手术方法，更换术后结局存在差异。在当前心脏分配优先系统的背景下，对于与装置相关并发症的LVAD更换可在高危患者中进行，作为心脏移植的可行替代方案。
