Third Annual Report From the ISHLT Mechanically Assisted Circulatory Support Registry: A comparison of centrifugal and axial continuous-flow left ventricular assist devices

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:38

Article

Goldstein, Daniel J.¹  Meyns, Bart²  Xie, Rongbing³  Cowger, Jennifer⁴  Pettit, Stephen⁵  Nakatani, Takeshi⁶  Netuka, Ivan⁷  Shaw, Steven⁸  Yanase, Masanobu⁹  Kirklin, James K.³ 

[1] Montefiore Med Ctr, 111 E 210th St, Bronx, NY 10467 USA

[2] Univ Hosp Leuven, Leuven, Belgium

[3] Univ Alabama Birmingham, Birmingham, AL USA

[4] Herny Ford Hosp, Detroit, MI USA

[5] Royal Papworth Hosp, Papworth Everard, England

[6] Maki Hosp, Osaka, Japan

[7] Inst Clin & Expt Med, Prague, Czech Republic

[8] Wythenshawe Hosp, Manchester, Lancs, England

[9] Natl Cardiovasc Ctr, Suita, Osaka, Japan

关键词: mechanical circulatory support;    IMACS;    International Society for Heart and Lung Transplantation;    continuous-flow left ventricular assist devices;    axial flow;    centrifugal flow;   

DOI  :  10.1016/j.healun.2019.02.004

来源: Elsevier

【 摘 要 】

BACKGROUND: The IMACS Registry compiles and analyzes worldwide data from patients undergoing implantation of durable left ventricular assist devices. METHODS: Data encompassing 16,286 LVAD recipients from 4 collectives and 24 individual hospitals was collected and analyzed. In this 3rd annual report we compare and contrast outcomes, adverse events and risks factors between axial flow and centrifugal flow device recipients. RESULTS: Significant differences were found in the baseline characteristics of axial vs centrifugal flow LVAD recipients. Survival was similar between pump types. INTERMACS profile 1-3 constitute 85% of implants. A survival gap persists in destination therapy compared to bridge patients. RVAD need and delay impact survival dramatically. Centrifugal flow outperforms axial flow recipients in regards to GI bleeding and freedom from hemocompatibility related adverse events. No significant difference in the actuarial freedom from all strokes or either stroke subtype (hemorrhagic or ischemic) was seen among the two types of pumps. New end points to guide decision making are proposed. CONCLUSIONS: We demonstrate a transition from axial to centrifugal flow with four-year survival that approximates 60%. A high frequency of adverse events remains an impediment to the wider adoption of these technologies. In the future, composite study endpoints examining life quality and adverse events beyond survival may help in shared decision making prior to MCS implant, and may provide the requisite data to support extension of MCS therapy into the lesser ill heart failure population. (C) Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free