目的:在欧洲机械循环支持患者注册(EUROMACS)中,有22%的左心室辅助装置(LVAD)受者出现了早期右侧心力衰竭(RHF)。然而,LVAD后RHF的最佳治疗方法尚不清楚。左西孟旦已被证明对心源性休克患者和终末期心力衰竭患者有效。我们试图评估左西孟旦对LVAD后RHF的疗效以及30天和1年死亡率。
方法:EUROMACS注册用于确定接受术前左西孟旦治疗的主流LVAD植入物的成人与倾向匹配的对照组。
结果:总计,3661例患者接受主流LVAD,其中399例(11%)接受左西孟旦前LVAD治疗。给予左西孟旦的患者有更高的EUROMACSRHF评分[4(2-5.5)vs2(2-4);P<0.001],接受了更多的右心室辅助装置(RVAD)[32(8%)vs178(5.5%);P=0.038],LVAD植入后在重症监护病房停留的时间更长[19(8-35)vs11(5-25);P<0.001].然而,RHF的发生率没有显着差异,30天,或1年死亡率。此外,在匹配的队列中(357名服用左西孟旦的患者与20次插补的平均622名对照相比),我们没有发现术后严重RHF差异的证据,RVAD植入率,重症监护病房住院时间或30天和1年死亡率。
结论:在对EUROMACS注册的分析中,我们没有发现左西孟旦与早期RHF或死亡之间有关联的证据,尽管服用左西孟旦的患者的风险要高得多。为了得出一个明确的结论,一个多中心,随机研究是必要的。
Early right-sided heart failure (RHF) was seen in 22% of recipients of a left ventricular assist device (LVAD) in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). However, the optimal treatment of post-LVAD RHF is not well known. Levosimendan has proven to be effective in patients with cardiogenic shock and in those with end-stage heart failure. We sought to evaluate the efficacy of levosimendan on post-LVAD RHF and 30-day and 1-year mortality.
The EUROMACS Registry was used to identify adults with mainstream continuous-flow LVAD implants who were treated with preoperative levosimendan compared to a propensity matched control cohort.
In total, 3661 patients received mainstream LVAD, of which 399 (11%) were treated with levosimendan pre-LVAD. Patients given levosimendan had a higher EUROMACS RHF score [4 (2- 5.5) vs 2 (2- 4); P < 0.001], received more right ventricular assist devices (RVAD) [32 (8%) vs 178 (5.5%); P = 0.038] and stayed longer in the intensive care unit post-LVAD implant [19 (8-35) vs 11(5-25); P < 0.001]. Yet, there was no significant difference in the rate of RHF, 30-day, or 1-year mortality. Also, in the matched cohort (357 patients taking levosimendan compared to an average of 622 controls across 20 imputations), we found no evidence for a difference in postoperative severe RHF, RVAD implant rate, length of stay in the intensive care unit or 30-day and 1-year mortality.
In this analysis of the EUROMACS registry, we found no evidence for an association between levosimendan and early RHF or death, albeit patients taking levosimendan had much higher risk profiles. For a definitive conclusion, a multicentre, randomized study is warranted.