PDF(Pubmed)
Abstract：
BACKGROUND: Left ventricular assist device (LVAD) therapy is an established treatment for advanced heart failure with reduced ejection fraction. We evaluated the characteristics and clinical outcomes of patients implanted with an LVAD in the Netherlands.
METHODS: Patients implanted with an LVAD in the Netherlands between 2016 and 2020 were included in the analysis. Baseline characteristics entered into this registry, as well as clinical outcomes (death on device, heart transplantation) and major adverse events (device dysfunction, major bleeding, major infection and cerebrovascular event), were evaluated.
RESULTS: A total of 430 patients were implanted with an LVAD; mean age was 55 ± 13 years and 27% were female. The initial device strategy was bridge to transplant (BTT) in 50%, destination therapy (DT) in 29% and bridge to decision (BTD) in the remaining 21%. After a follow-up of 17 months, 97 (23%) patients had died during active LVAD support. Survival was 83% at 1 year, 76% at 2 years and 54% at 5 years. Patients implanted with an LVAD as a BTT had better outcomes compared with DT at all time points (1 year 86% vs 72%, 2 years 83% vs 59% and 5 years 58% vs 33%). Major adverse events were frequently observed, most often major infection, major bleeding and cerebrovascular events (0.84, 0.33 and 0.09 per patient-year at risk, respectively) and were similar across device strategies. Patients supported with HeartMate 3 had a lower incidence of major adverse events.
CONCLUSIONS: Long-term survival on durable LVAD support in the Netherlands is over 50% after 5 years. Major adverse events, especially infection and bleeding, are still frequently observed, but decreasing with the contemporary use of HeartMate 3 LVAD.
METHODS: Patients implanted with an LVAD in the Netherlands between 2016 and 2020 were included in the analysis. Baseline characteristics entered into this registry, as well as clinical outcomes (death on device, heart transplantation) and major adverse events (device dysfunction, major bleeding, major infection and cerebrovascular event), were evaluated.
RESULTS: A total of 430 patients were implanted with an LVAD; mean age was 55 ± 13 years and 27% were female. The initial device strategy was bridge to transplant (BTT) in 50%, destination therapy (DT) in 29% and bridge to decision (BTD) in the remaining 21%. After a follow-up of 17 months, 97 (23%) patients had died during active LVAD support. Survival was 83% at 1 year, 76% at 2 years and 54% at 5 years. Patients implanted with an LVAD as a BTT had better outcomes compared with DT at all time points (1 year 86% vs 72%, 2 years 83% vs 59% and 5 years 58% vs 33%). Major adverse events were frequently observed, most often major infection, major bleeding and cerebrovascular events (0.84, 0.33 and 0.09 per patient-year at risk, respectively) and were similar across device strategies. Patients supported with HeartMate 3 had a lower incidence of major adverse events.
CONCLUSIONS: Long-term survival on durable LVAD support in the Netherlands is over 50% after 5 years. Major adverse events, especially infection and bleeding, are still frequently observed, but decreasing with the contemporary use of HeartMate 3 LVAD.
摘要：
背景：左心室辅助装置（LVAD）治疗是一种用于晚期心力衰竭且射血分数降低的既定治疗方法。我们评估了在荷兰植入LVAD的患者的特征和临床结果。
方法：分析包括2016年至2020年在荷兰植入LVAD的患者。输入到此注册表中的基线特征，以及临床结果(设备死亡，心脏移植)和主要不良事件(装置功能障碍，大出血,主要感染和脑血管事件)，进行了评估。
结果：共有430例患者植入LVAD，平均年龄55±13岁，27%为女性。最初的设备策略是50%的桥接移植(BTT)，29％的目的地治疗（DT），其余21％的桥梁决策（BTD）。经过17个月的随访，97(23%)例患者在主动LVAD支持期间死亡。1年生存率为83%，2年为76%，5年为54%。与所有时间点的DT相比，植入LVAD作为BTT的患者具有更好的结果（1年86％vs72％，2年83%vs59%，5年58%vs33%）。经常观察到主要不良事件，最常见的是严重感染，大出血和脑血管事件（0.84、0.33和0.09/患者年风险，分别)，并且在不同的设备策略中相似。使用HeartMate3支持的患者的主要不良事件发生率较低。
结论：荷兰长期支持LVAD5年后的长期生存率超过50%。主要不良事件,尤其是感染和出血,仍然经常被观察到，但随着HeartMate3LVAD的当代使用而减少。
方法：分析包括2016年至2020年在荷兰植入LVAD的患者。输入到此注册表中的基线特征，以及临床结果(设备死亡，心脏移植)和主要不良事件(装置功能障碍，大出血,主要感染和脑血管事件)，进行了评估。
结果：共有430例患者植入LVAD，平均年龄55±13岁，27%为女性。最初的设备策略是50%的桥接移植(BTT)，29％的目的地治疗（DT），其余21％的桥梁决策（BTD）。经过17个月的随访，97(23%)例患者在主动LVAD支持期间死亡。1年生存率为83%，2年为76%，5年为54%。与所有时间点的DT相比，植入LVAD作为BTT的患者具有更好的结果（1年86％vs72％，2年83%vs59%，5年58%vs33%）。经常观察到主要不良事件，最常见的是严重感染，大出血和脑血管事件（0.84、0.33和0.09/患者年风险，分别)，并且在不同的设备策略中相似。使用HeartMate3支持的患者的主要不良事件发生率较低。
结论：荷兰长期支持LVAD5年后的长期生存率超过50%。主要不良事件,尤其是感染和出血,仍然经常被观察到，但随着HeartMate3LVAD的当代使用而减少。
