虚弱与晚期心力衰竭的不良后果有关。我们研究了脆弱对桥接移植(BTT)耐用机械循环支持(MCS)接受者术后结局的影响。
接受左心室辅助装置(LVAD,n=96)或双心室支持(BiV,n=11),因为BTT接受了虚弱评估。根据蒙特利尔认知评估(MoCA),虚弱被定义为Fried的虚弱表型(FFP)的≥3个物理域或FFP的≥2个物理域加上认知障碍。
在虚弱(n=6/38,15.8%)与非虚弱(n=4/58,6.9%)LVAD支持的患者中,在360天的死亡率没有差异。p=0.19。然而,脆弱的BiV(n=4/5)与非脆弱的BiV(n=0/6)支持的患者相比,死亡率明显过高,p=0.013。在所有患者中,与不虚弱的患者相比,虚弱的患者经历了更长的重症监护病房住院时间,12天vs6天(p<0.0001)和住院时间,48天vs27天(p<0.0001)。血液相容性和感染相关不良事件无差异。大多数(n=22/29,75.9%)的虚弱患者在MCS后变得不虚弱;相反,少数(n=3/42,7.1%)因不虚弱而变得虚弱(p=0.0003)。
虚弱的异常标记在接受BTT-MCS支持的患者中很常见,本文使用的那些标记可预测BiV支持的患者的死亡率。但不是LVAD患者。这些发现可能有助于我们更好地识别将从BiV-BTT治疗中受益最大的患者。
Frailty is associated with adverse outcomes in advanced heart failure. We studied the impact of frailty on postoperative outcomes in bridge to transplant (BTT) durable mechanical circulatory support (MCS) recipients.
Patients undergoing left ventricular assist device (LVAD, n = 96) or biventricular support (BiV, n = 11) as BTT underwent frailty assessment. Frailty was defined as ≥ 3 physical domains of the Fried\'s Frailty Phenotype (FFP) or ≥ 2 physical domains of the FFP plus cognitive impairment on the Montreal Cognitive Assessment (MoCA).
No difference in mortality at 360 days was observed in frail (n = 6/38, 15.8%) vs non-frail (n = 4/58, 6.9%) LVAD supported patients, p = 0.19. However, there was a significant excess mortality in frail BiV (n = 4/5) vs non-frail BiV (n = 0/6) supported patients, p = 0.013. In all patients, frail patients compared to non-frail patients experienced longer intensive care unit stay, 12 vs 6 days (p < 0.0001) and hospital length of stay, 48 vs 27 days (p < 0.0001). There was no difference in hemocompatibility and infection related adverse events. The majority (n = 22/29, 75.9%) of frail patients became non-frail following MCS; contrastingly, a minority (n = 3/42, 7.1%) became frail from being non-frail (p = 0.0003).
Abnormal markers of frailty are common in patients undergoing BTT-MCS support and those used herein predict mortality in BiV-supported patients, but not in LVAD patients. These findings may help us better identify patients who will benefit most from BiV-BTT therapy.