Griffith B P, Kormos R L, Nastala C J, Winowich S, Pristas J M
Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
Ann Thorac Surg. 1996 Jan;61(1):396-8; discussion 407. doi: 10.1016/0003-4975(95)01020-3.
There is interest in expanding ventricular assist device use from short-term bridging to transplantation to long-term and permanent support.
We have reviewed the outcome of 162 patients who had as mechanical bridge to transplantation that lasted at least 60 days. Eighty-five patients received the HeartMate, 40 the Novacor, and 37 the Thoratec device.
Of the 162 patients, 125 received transplants, and 115 survived after transplantation (93%). Within the group there were 174 complications including 54 infections of the driveline, 73 other infections, and thromboembolic strokes in 47. Infections of the driveline were considered major in 24 of 54 cases, and other infections were major in 36 of 73 cases. Twenty-seven of those who sustained thromboembolic events had residual effects. Of 11 patients with a major stroke and infection, only 1 survived transplantation. Eighty-two patients were supported between 60 and 100 days, 63 patients between 101 and 200 days, 12 patients between 201 and 300 days, and only 5 patients in excess of 300 days. A greater percentage of candidates died waiting between 101 and 200 days than between 60 and 100 days (25% versus 10%). The incidence of complications also rose in those patients bridged more than 100 days.
The data reinforce the excellent results obtained in the bridge to transplantation trials that reported a shorter duration of support. For those interested in extended bridge to transplantation or permanent use of the currently available devices, the results suggest reasonable success can be anticipated, but the serious infections and strokes tend to be more common with longer duration of support.
人们对将心室辅助装置的使用从短期过渡到移植扩展到长期和永久支持感兴趣。
我们回顾了162例作为移植机械桥接至少持续60天的患者的结果。85例患者接受了HeartMate装置，40例接受了Novacor装置，37例接受了Thoratec装置。
162例患者中，125例接受了移植，115例移植后存活（93%）。该组内有174例并发症，包括54例驱动线感染、73例其他感染和47例血栓栓塞性中风。54例驱动线感染中有24例被视为严重感染，73例其他感染中有36例为严重感染。发生血栓栓塞事件的27例患者有后遗症。11例发生严重中风和感染的患者中，只有1例移植后存活。82例患者接受支持60至100天，63例患者接受支持101至200天，12例患者接受支持201至300天，超过300天的仅5例。等待移植的候选人在101至200天之间死亡的比例高于60至100天之间（25%对10%）。支持时间超过100天的患者并发症发生率也有所上升。
数据强化了在移植桥接试验中获得的良好结果，这些试验报告的支持时间较短。对于那些对延长移植桥接或当前可用装置的永久使用感兴趣的人来说，结果表明可以预期取得合理成功，但随着支持时间延长，严重感染和中风往往更常见。
