From bench to bedside: Can the improvements in left ventricular assist device design mitigate adverse events and increase survival?

被引：13

作者：

Tarzia, Vincenzo ^{[1
]}

Di Giammarco, Gabriele ^{[2
]}

Di Mauro, Michele

Bortolussi, Giacomo ^{[1
]}

Maccherini, Massimo ^{[3
]}

Tursi, Vincenzo ^{[4
]}

Maiani, Massimo ^{[4
]}

Bernazzali, Sonia ^{[3
]}

Marinelli, Daniele ^{[2
]}

Foschi, Massimiliano ^{[2
]}

Buratto, Edward ^{[1
,2
]}

Bejko, Jonida ^{[1
]}

Gregori, Dario ^{[1
]}

Scuri, Silvia ^{[1
]}

Livi, Ugolino ^{[4
]}

Sani, Guido ^{[1
,3
]}

Bottio, Tomaso ^{[1
]}

Gerosa, Gino ^{[1
]}

机构：

[1] Univ Padua, Cardiac Surg, I-35128 Padua, Italy

[2] Univ G dAnnunzio, Cardiac Surg, Chieti, Italy

[3] Univ Siena, Cardiac Surg, I-53100 Siena, Italy

[4] Univ Udine, Cardiac Surg, I-33100 Udine, Italy

来源：

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY | 2016年 / 151卷 / 01期

关键词：

ventricular assist device; LVAD; Jarvik; 2000; bearing system; heart failure; follow-up; MECHANICAL CIRCULATORY SUPPORT; HEMOLYSIS; MODELS; HEART; RISK; PIN;

D O I：

10.1016/j.jtcvs.2015.09.107

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective: In vitro tests demonstrated that the new cone-bearing configuration of the Jarvik 2000 (Jarvik Heart Inc, New York, NY) left ventricular assist device exhibits better hydraulic efficiency than the previous pin-bearing design. We investigated the long-term outcomes of patients who received the Jarvik 2000 left ventricular assist device, depending on bearing design. Methods: A retrospective review of prospectively collected data from 18 centers included in the Italian Registry was performed. From May 2008 to September 2013, 99 patients with end-stage heart failure were enrolled. Patients were divided into 2 groups according to their Jarvik 2000 suspending mechanism: Group pin included patients with pin bearings (May 2008 to June 2010), and group cone included patients with newer cone bearings (July 2010 to September 2013). The 2 groups did not differ significantly in terms of baseline characteristics. Results: A total of 30 of 39 patients (group pin) and 46 of 60 patients (group cone) were discharged. During follow-up, 6 patients underwent transplantation, and in 1 patient the left ventricular assist device was explanted. The cumulative incidence competing risk of the entire cohort for noncardiovascular-related death was 28% (20%-40%); the cumulative incidence competing risk for cardiovascular-related death was 56% (42%-73%): 71% in group pin versus 26% in group cone (P = .034). The multivariate analyses confirmed that the pin-bearing design was a risk factor for cardiovascular death, along with Interagency Registry for Mechanically Assisted Circulatory Support class. Right ventricular failures and ischemic and hemorrhagic strokes were significantly higher in group pin. Conclusions: Patients with the new pump configuration showed a better freedom from cardiovascular death and lower incidence of fatal stroke and right ventricular failure. Further studies are needed to prove the favorable impact of pump-enhanced fluid dynamics on long-term results.

引用

页码：213 / 217

页数：5

共 18 条

[1] Ambient hemolysis and activation of coagulation is different between Heart Mate II and Heart Ware left ventricular assist devices [J].