Outcomes on Continuous Flow Left Ventricular Assist Devices: A Single Institutional 9-Year Experience.

Autor:	Morgan JA; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan. Electronic address: jamorganmd@hotmail.com., Go PH; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan., Xuereb L; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan., Kaur B; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan., Akrawe S; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan., Nemeh HW; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan., Borgi J; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan., Lanfear DE; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan., Williams CT; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan., Paone G; Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2016 Oct; Vol. 102 (4), pp. 1266-73. Date of Electronic Publication: 2016 May 10.
DOI:	10.1016/j.athoracsur.2016.03.026
Abstrakt:	Background: Continuous-flow left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure. The goal of this study was to review our 9-year institutional experience. Methods: From March 2006 through May 2015, 231 patients underwent implantation of 240 CF LVADs, HeartMate II LVAD (Thoratec Corp., Pleasanton, CA; n = 205) or HVAD (HeartWare Inc., Framingham, MA; n = 35). Of these, 127 devices (52.9%) were implanted as bridge to transplantation (BTT) and 113 (47.1%) as destination therapy (DT). Results: Mean age was 51.2 ± 11.9 years for BTT patients and 58.2 ± 11.4 years for DT patients (p < 0.001). There was a higher incidence of preoperative diabetes, renal insufficiency, peripheral vascular disease, and previous cardiac operation in DT patients (p < 0.05). Survival was higher for BTT patients, with 1-, 6-, 12-, and 24-month survivals of 91.0%, 90.0%, 88.5%, and 72.1%, respectively, versus 85.3%, 81.1%, 75.6%, and 59.0%, respectively, for DT patients (p = 0.038). Gastrointestinal bleeding was the most common complication (29.6%), followed by right ventricular failure (22.5%) and stroke (15.0%), with a similar incidence for BTT and DT patients. Preoperative liver biopsy (hazard ratio [HR] 2.27, p = 0.036), mechanical support (HR 1.82, p = 0.025), aspartate transaminase (HR 1.07, p = 0.001), and alanine aminotransferase (HR 0.95, p = 0.024) were severe independent predictors of survival in multivariate analysis. Conclusions: These data indicate excellent survival for BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become a plausible alternative to heart transplantation, we need to further decrease the incidence of postoperative complications. (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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