Clinical outcomes in patients with chronic congestive heart failure who undergo left ventricular assist device implantation

被引:37
作者
Dang, NC [1 ]
Topkara, VK [1 ]
Kim, BT [1 ]
Mercando, ML [1 ]
Kay, J [1 ]
Naka, Y [1 ]
机构
[1] Columbia Univ Coll Phys & Surg, Dept Surg, Div Cardiothorac Surg, Milstein Hosp, New York, NY 10032 USA
关键词
D O I
10.1016/j.jtcvs.2005.07.017
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: The use of left ventricular assist devices as a bridge to transplantation for patients with chronic congestive heart failure is well accepted. However, few studies have examined outcomes solely for these patients. This study details one center's left ventricular assist device experience with this population. Methods: Two hundred one patients received HeartMate left ventricular assist devices (Thoratec Corp, Pleasanton, Calif) from January 1, 1996, to April 30, 2004. Of these, 119 (59.2%) had chronic congestive heart failure (diagnosis > 6 months) as the primary indication. Outcome parameters included early mortality after left ventricular assist device placement (< 30 days), bridge-to-transplantation rate, and posttransplantation survival. Variables examined included patient demographic data; preoperative pacemaker, internal defibrillator, and balloon pump use; and preoperative laboratory values. Results: Advanced age, female sex, and diabetes were independent predictors of early death (P =.048, odds ratio 1.879 per 10 years of age, 95% confidence interval 1.005-3.515; P =.002, odds ratio 10.029, 95% confidence interval 2.256-44.583; P =.040, odds ratio 3.974, 95% confidence interval 1.063-14.861). Advanced age, female sex, and low preoperative albumin were independent predictors of poor bridge-to-transplantation rate (P=.029, odds ratio 0.135 per 10 years of age, 95% confidence interval 0.022-0.819; P=.002, odds ratio 0.013, 95% confidence interval 0.001-0.197; P =.023, odds ratio 19.178 per 1 g/dL albumin, 95% confidence interval 1.504-244.598). There were no independent predictors of poor posttransplantation survival and prolonged intensive care unit stay. Overall bridge-to-transplantation rate was 81.5%. The 1-, 3, 5, and 7-year posttransplantation survivals were 88.4%, 84.5%, 78.4%, and 76.0%. Conclusion: Among patients with chronic congestive heart failure, advanced age, female sex, diabetes, and low preoperative albumin predict poor clinical course. Careful risk stratification and comprehensive evaluation by care providers should be performed for candidates who are female, are elderly, and have diabetes, and preoperative nutritional optimization should be encouraged to enhance patient outcomes.
引用
收藏
页码:1302 / 1309
页数:8
相关论文
共 32 条
[1]  
BERGER RL, 1979, J THORAC CARDIOV SUR, V78, P626
[2]   Left ventricular assist device performance with long-term circulatory support: Lessons from the REMATCH trial [J].
Dembitsky, WP ;
Tector, AJ ;
Park, S ;
Moskowitz, AJ ;
Gelijns, AC ;
Ronan, NS ;
Piccione, W ;
Holman, WL ;
Furukawa, S ;
Frazier, OH ;
Weinberg, AD ;
Heatley, G ;
Poirier, VL ;
Damme, L ;
Long, JW .
ANNALS OF THORACIC SURGERY, 2004, 78 (06) :2123-2129
[3]  
Deng YB, 2003, ACTA MATH SCI, V23, P1
[4]   Impact of gender on coronary bypass operative mortality [J].
Edwards, FH ;
Carey, JS ;
Grover, FL ;
Bero, JW ;
Hartz, RS .
ANNALS OF THORACIC SURGERY, 1998, 66 (01) :125-131
[5]  
Frazier O H, 2004, Congest Heart Fail, V10, P109, DOI 10.1111/j.1527-5299.2004.03366.x
[6]   Mechanical circulatory support for advanced heart failure - Where does it stand in 2003? [J].
Frazier, OH ;
Delgado, RM .
CIRCULATION, 2003, 108 (25) :3064-3068
[7]   Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation [J].
Frazier, OH ;
Rose, EA ;
Oz, MC ;
Dembitsky, W ;
McCarthy, P ;
Radovancevic, B ;
Poirier, VL ;
Dasse, KA .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2001, 122 (06) :1186-1195
[8]  
Goldstein D J, 2000, Semin Thorac Cardiovasc Surg, V12, P220
[9]   GENDER DIFFERENCES IN MORTALITY-RATES FOR CORONARY-ARTERY BYPASS-SURGERY [J].
HANNAN, EL ;
BERNARD, HR ;
KILBURN, HC ;
ODONNELL, JF .
AMERICAN HEART JOURNAL, 1992, 123 (04) :866-872
[10]   Permanent mechanical circulatory support in patients of advanced age [J].
Jurmann, MJ ;
Weng, Y ;
Drews, T ;
Pasic, M ;
Hennig, E ;
Hetzer, R .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2004, 25 (04) :610-618