Abstract：
BACKGROUND: Real-world outcomes with the HeartMate 3 left ventricular assist device (LVAD) depending on whether it\'s a bridge to transplantation (BTT) or destination therapy (DT) are poorly studied. We aimed to compare the profile and clinical outcomes of patients supported with HeartMate 3 according to a BTT or a DT pre-implantation strategy.
METHODS: All patients consecutively implanted with HeartMate 3 at our centre (University Hospital of Lausanne, Switzerland) in 2015-2022 were analysed in a retrospective observational study. Indications for HeartMate 3 implantation were advanced heart failure despite optimal medical treatment. Patients were treated with a vitamin K antagonist anticoagulant combined with antiplatelet therapy after HeartMate 3 implantation and were followed up monthly at our institution.
RESULTS: Among 71 patients implanted with HeartMate 3 between 2015 and 2022, 51 (71.8%) were implanted as a BTT and 20 (28.2%) as DT. Their median age was 58 (IQR: 52-69) years and 84% of patients were classified as INTERMACS profiles 2-4. The median follow-up duration was 18.3 (IQR: 7.5-33.9) months. Patients in the DT group were older than those in the BTT group (p <0.001) and had more chronic renal failure (p <0.001). They also had a lower 5-year survival rate (mean ± standard error: 87.3 ± 5.6% vs 49.4 ± 15.1%) and more adverse events such as renal dysfunction requiring temporary perioperative dialysis (p = 0.08) or bleeding (p = 0.06).
CONCLUSIONS: Although patients supported with HeartMate 3 have favourable survival, those with LVAD-DT have poorer outcomes. There is a need to better select patients eligible for LVAD-DT in order to limit the burden of adverse events and improve their prognosis.
METHODS: All patients consecutively implanted with HeartMate 3 at our centre (University Hospital of Lausanne, Switzerland) in 2015-2022 were analysed in a retrospective observational study. Indications for HeartMate 3 implantation were advanced heart failure despite optimal medical treatment. Patients were treated with a vitamin K antagonist anticoagulant combined with antiplatelet therapy after HeartMate 3 implantation and were followed up monthly at our institution.
RESULTS: Among 71 patients implanted with HeartMate 3 between 2015 and 2022, 51 (71.8%) were implanted as a BTT and 20 (28.2%) as DT. Their median age was 58 (IQR: 52-69) years and 84% of patients were classified as INTERMACS profiles 2-4. The median follow-up duration was 18.3 (IQR: 7.5-33.9) months. Patients in the DT group were older than those in the BTT group (p <0.001) and had more chronic renal failure (p <0.001). They also had a lower 5-year survival rate (mean ± standard error: 87.3 ± 5.6% vs 49.4 ± 15.1%) and more adverse events such as renal dysfunction requiring temporary perioperative dialysis (p = 0.08) or bleeding (p = 0.06).
CONCLUSIONS: Although patients supported with HeartMate 3 have favourable survival, those with LVAD-DT have poorer outcomes. There is a need to better select patients eligible for LVAD-DT in order to limit the burden of adverse events and improve their prognosis.
摘要：
背景：关于HeartMate3左心室辅助装置（LVAD）的实际结果，取决于它是移植的桥梁（BTT）还是目的地治疗（DT），研究甚少。我们旨在根据BTT或DT植入前策略比较使用HeartMate3支持的患者的概况和临床结果。
方法：所有在我们中心连续植入HeartMate3的患者（洛桑大学医院，瑞士）在2015-2022年的一项回顾性观察研究中进行了分析。尽管进行了最佳的药物治疗，但植入HeartMate3的适应症是晚期心力衰竭。植入HeartMate3后，患者接受维生素K拮抗剂抗凝剂联合抗血小板治疗，并每月在我们机构进行随访。
结果：在2015年至2022年之间植入HeartMate3的71例患者中，51例（71.8％）作为BTT植入，20例（28.2％）作为DT植入。他们的中位年龄为58（IQR：52-69）岁，84％的患者被分类为INTERMACS2-4。中位随访时间为18.3(IQR:7.5-33.9)个月。DT组患者年龄大于BTT组（p<0.001），慢性肾功能衰竭更多（p<0.001）。他们还具有较低的5年生存率（平均值±标准误差：87.3±5.6％vs49.4±15.1％）和更多的不良事件，例如需要临时围手术期透析的肾功能不全（p=0.08）或出血（p=0.06）。
结论：尽管使用HeartMate3支持的患者具有良好的生存率，LVAD-DT患者的预后较差.需要更好地选择符合LVAD-DT的患者，以限制不良事件的负担并改善其预后。
方法：所有在我们中心连续植入HeartMate3的患者（洛桑大学医院，瑞士）在2015-2022年的一项回顾性观察研究中进行了分析。尽管进行了最佳的药物治疗，但植入HeartMate3的适应症是晚期心力衰竭。植入HeartMate3后，患者接受维生素K拮抗剂抗凝剂联合抗血小板治疗，并每月在我们机构进行随访。
结果：在2015年至2022年之间植入HeartMate3的71例患者中，51例（71.8％）作为BTT植入，20例（28.2％）作为DT植入。他们的中位年龄为58（IQR：52-69）岁，84％的患者被分类为INTERMACS2-4。中位随访时间为18.3(IQR:7.5-33.9)个月。DT组患者年龄大于BTT组（p<0.001），慢性肾功能衰竭更多（p<0.001）。他们还具有较低的5年生存率（平均值±标准误差：87.3±5.6％vs49.4±15.1％）和更多的不良事件，例如需要临时围手术期透析的肾功能不全（p=0.08）或出血（p=0.06）。
结论：尽管使用HeartMate3支持的患者具有良好的生存率，LVAD-DT患者的预后较差.需要更好地选择符合LVAD-DT的患者，以限制不良事件的负担并改善其预后。
