■据报道,严重的右心室衰竭(RVF)使左心室辅助装置(LVAD)放置复杂化,发生率为10-30%。虽然主要用于左心室衰竭,心室辅助装置(VAD)已用于双心室设置中,以对抗LVAD植入后的右心室衰竭(RVF)。随着连续流LVAD(CF-LVAD)取代其脉动前辈的出现,向CF-双心室辅助装置(CF-BiVAD)的转变,与以往的搏动型BiVAD相比,有望改善预后.我们的目标是回顾文献并确定CF-BiVAD接受者的结果。
■进行了系统评价以确定CF-BiVAD的结果。收集术前人口统计和设备配置数据。评估的主要结果是短期生存率,长期生存,持续时间的支持,和移植的生存。评估的次要结局包括重症监护病房(ICU)和住院时间(ICU-LOS和HLOS,分别),泵血栓形成,泵交换。在适当情况下报告中位数和四分位数范围。一个主要的限制是不同出版物的队列可能重叠,这可能导致了一些选择偏差。
■筛选了1,282个,评估了12种出版物。样本量从4到93个CF-BiVAD接受者,随访6~24个月。平均年龄为34至52岁。45%的CF-BiVAD有右心房(RA-)流入插管,其余为右心室(RV)。30天生存率的中位数为90%(IQR82-97.8%),12个月生存率的中位数为58.5%(IQR47.5-62%)。据报道,泵血栓形成(主要是右VAD)的中位数为31%(IQR14-36%),虽然泵交换只有9%(IQR1.5-12.5%)。
■LVAD植入后的RVF是一种高发病率和死亡率的并发症。当前没有可用的标签上连续流RVAD。因此,用于右心室支持以对抗泵血栓形成的LVAD的修改产生了多种技术.BiVAD接受者主要是移植候选人,等待名单上的泵血栓形成和传动系统感染的并发症是非常重要的。该研究表明需要标签上的CF-BiVAD。
UNASSIGNED: Significant right ventricular failure (RVF) complicating left ventricular assist device (LVAD) placement has been reported at 10-30%. Although primarily indicated for left ventricular failure, ventricular assist devices (VADs) have become utilized in a biventricular setup to combat right ventricular failure (RVF) following LVAD implantation. With the advent of continuous-flow LVADs (CF-LVADs) superseding their pulsatile predecessors, the shift towards CF-biventricular assist devices (CF-BiVADs) come with the prospect of improved outcomes over previous pulsatile BiVADs. We aim to review the literature and determine the outcomes of CF-BiVAD recipients.
UNASSIGNED: A systematic review was performed to determine the outcomes of CF-BiVADs. Pre-operative demographics and device configuration data was collected. Primary outcomes evaluated were short-term survival, long-term survival, duration of support, and survival to transplant. Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (ICU-LOS and HLOS, respectively), pump thrombosis, pump exchange. Median and interquartile range was reported where appropriate. A major limitation was the likely overlap of cohorts across publications, which may have contributed to some selection bias.
UNASSIGNED: Of 1,282 screened, 12 publications were evaluated. Sample size ranged from 4 to 93 CF-BiVAD recipients, and follow-up ranged from 6 to 24 months. Mean age ranged from 34 to 52 years old. Forty-five percent of CF-BiVADs had right atrial (RA-) inflow cannulation, with the remaining being right ventricular (RV). Thirty-day survival was a median of 90% (IQR 82-97.8%) and 12-month survival was a median of 58.5% (IQR 47.5-62%). Where reported, rate of pump thrombosis (predominantly the right VAD) was a median of 31% (IQR 14-36%), although pump exchange was only 9% (IQR 1.5-12.5%).
UNASSIGNED: RVF post-LVAD implantation is a high morbidity and mortality complication. There is no on-label continuous-flow RVAD currently available. Thus, the modifications of LVADs for right ventricular support to combat pump thrombosis has resulted in various techniques. BiVAD recipients are predominantly transplant candidates, and complications of pump thrombosis and driveline infection whilst on wait-list are of great consequence. This study demonstrates the need for an on-label CF-BiVAD.