心脏伴侣III型左心室辅助装置的最佳移植前持续时间:当代分析。

Ahmet Bilgili,Iverson E Williams,Omar M Sharaf,Fabian Jimenez,Yuriy Stukov,Giles J Peek,Mark S Bleiweis,Jeffrey P Jacobs,Thomas M Beaver,Eric I Jeng
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引用次数: 0

摘要

本研究评估了移植前心脏伴侣III (HM3)左心室辅助装置(LVAD)支持时间对当代队列移植后生存的影响。方法回顾性分析2019年1月至2023年12月接受HM3 LVAD桥接的成人心脏移植受者的器官共享数据库。我们使用Cox比例风险模型拟合的限制性三次样条,根据风险拐点(2年)将患者分为持续时间组,并比较组间和组间的结果。结果1996例患者中,有35.2%(n=702)、32.2%(n=642)和32.7%(n=652)的支持时间分别为2年。中位支持持续时间为518天[IQR: 289-864]。术后卒中和急性排斥反应的发生率各组间无差异(p>0.05),但术后透析率随着支持时间的增加而显著增加(p>0.001)。桥接2年的患者1年生存率显著高于桥接2年的患者(84.3% [95% CI: 81.4-87.4], 2年(HR: 1.77 [1.32-2.38], p<0.001),其移植后死亡率风险高于桥接<1年的患者。结论:虽然HM3可以延长移植桥接时间,但超过2年的支持时间会导致移植后生存恶化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimal Pre-Transplant Duration with HeartMate III Left Ventricular Assist Device: A Contemporary Analysis.
BACKGROUND This study evaluates the impact of pretransplant HeartMate III (HM3) left ventricular assist device (LVAD) support duration on post-transplant survival in a contemporary cohort. METHODS A retrospective review of the United Network for Organ Sharing database was conducted for adult heart transplant recipients from January 2019 to December 2023 who were bridged with an HM3 LVAD. We utilized a restricted cubic spline fitted to a Cox proportional hazards model to stratify patients into duration groups based on risk inflection points (<1 year, 1-2 years, and >2 years), and outcomes were compared between and across groups. RESULTS Among 1,996 patients, 35.2%(n=702), 32.2%(n=642), and 32.7%(n=652) had support durations of <1 year, 1-2 years, and >2 years, respectively. Median support duration was 518 days [IQR: 289-864]. Postoperative rates of stroke and acute rejection did not vary across groups (p>0.05), however rates of postoperative dialysis significantly increased with increasing support time (p>0.001). One-year survival was significantly higher for patients bridged <1 year (90.7% [95%CI: 88.5-93.0]) compared to those bridged >2 years (84.3% [95% CI: 81.4-87.4], p<0.001) but not for those bridged 1-2 years (89.0% [95% CI: 86.6-91.6], p=0.300). In multivariable analysis, patients supported 1-2 years (HR: 1.34 [1.01-1.79], p=0.045) and >2 years (HR: 1.77 [1.32-2.38], p<0.001) had a higher hazard of post-transplant mortality than those bridged <1 year. CONCLUSIONS While the HM3 enables extended bridging to transplant, durations longer than 2 years of support are linked to worse post-transplant survival.
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