背景:主动脉内球囊泵(IABP)作为心脏移植(HT)的桥梁,可以在等待合适供体的同时进行活动。由于终末期心力衰竭患者通常在左侧安装植入式心律转复除颤器(ICD),由于两个设备的难以访问和接近的感知,可以避免左AX方法。我们的目的是评估使用左侧AXIABP伴或不伴同侧ICD桥接至HT的患者的预后。
方法:我们回顾性审查了2019年11月至2024年2月在我们机构由左侧腋窝IABP支持的HT候选人,根据存在将其分为两组(ICD组,n=48)或不存在(组号ICD,同侧左侧ICD的N=19)。暴露时间定义为从皮肤切口到Dacron移植物吻合开始的时间。
结果:在100%的队列中取得了技术成功,组间AX通路的中位暴露时间相似(ICD,12[7.8,18.2]vs.没有ICD,11[7,19]分钟;p=0.75)。手术不良事件的发生率,如严重的进入部位出血和同侧肢体缺血,两组之间没有显着差异。装置故障率相当(ICD,29.2%与没有ICD,15.8%;p=0.35)。移植后,住院死亡率,严重的原发性移植物功能障碍,两组的卒中发生率相当.
结论:同侧左侧ICD的存在不会对手术疗效产生不利影响,并发症发生率,或移植后结果左侧AXIABP插入HT候选人。
BACKGROUND: The axillary artery (AX) access for intra-aortic balloon pump (IABP) as a bridge to heart transplant (HT) allows mobility while awaiting a suitable donor. As end-stage heart failure patients often have an implantable cardioverter defibrillator (ICD) on the left side, the left AX approach may be avoided due to the perception of difficult access and proximity of two devices. We aimed to evaluate the outcomes of patients bridged to HT with a left-sided AX IABP with or without ipsilateral ICDs.
METHODS: We retrospectively reviewed HT candidates at our institution supported by left-sided axillary IABP from November 2019 to February 2024, dividing them into two groups based on the presence (Group ICD, n = 48) or absence (Group No-ICD, N = 19) of an ipsilateral left-sided ICD. The exposure time was defined as the time from skin incision to the beginning of anastomoses of a Dacron graft.
RESULTS: Technical success was achieved in 100% of the cohort, with median exposure times for AX access similar between groups (ICD, 12 [7.8, 18.2] vs. No ICD, 11 [7, 19] min; p = 0.75). The rate of procedural adverse events, such as significant access site bleeding and ipsilateral limb ischemia, did not significantly differ between both groups. Device malfunction rates were comparable (ICD, 29.2% vs. No ICD, 15.8%; p = 0.35). Posttransplant, in-hospital mortality, severe primary graft dysfunction, and stroke rates were comparable in both groups.
CONCLUSIONS: The presence of an ipsilateral left-sided ICD does not adversely impact the procedural efficacy, complication rates, or posttransplant outcomes of left-sided AX IABP insertion in HT candidates.