Bridging cardiogenic shock patients with short-term ventricular support at a community hospital to long-term ventricular support at a tertiary hospital

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• 作者：José ; Gonzá ; lez-Costello ; MD^a ; ^b ; ^{jgcostello@hotmail.com} ; Jonathan Yang ; MD^c ; Daniel B. Sims ; MD^a ; Alexander P. Kossar^c ; Lindsay K. Murray ; BA^a ; Paolo C. Colombo ; MD^a ; Hiroo Takayama ; MD^c ; Donna Mancini ; MD^a ; Yoshifumi Naka ; MD ; PhD^c ; Ulrich P. Jorde ; MD^a ; Nir Uriel ; MD^a
• 关键词：community hospital ; tertiary hospital ; cardiogenic shock ; short-term ventricular assist device ; long-term ventricular assist device
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2012
• 期刊代码：161_10532498
• 类别：med
• 出版时间：June, 2012
• 卷：31
• 期：6
• 页码：618-624
• 文件大小：565 K

摘要

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Background

Patients in cardiogenic shock require immediate circulatory support. Outcomes of patients who underwent short-term ventricular assist device (STVAD) implantation in a community hospital (CH) as a bridge to a long-term VAD (LTVAD) were compared with those who received both implants at the same tertiary hospital (TH).

Methods

Data were retrospectively reviewed for patients with a STVAD who were bridged to a LTVAD in a TH from 1997 to 2010. We studied outcomes and survival censored for cardiac transplantation.

Results

Thirty-seven patients (73%male) were identified. Mean age was 52 卤 16 years, 30%were diabetic, and 65%had intra-aortic balloon pump support. Reasons for STVAD implantation were an acute myocardial infarction, 38%; post-cardiotomy, 38%, decompensated chronic heart failure, 19%; and others, 5%. A STVAD was implanted in a CH in 20 patients (54%), and they had fewer cardiovascular risk factors than those whose STVAD was implanted at the TH. All patients at the CH were at Interagency Registry for Mechanically Assisted Circulatory Support 1 compared with 71%at the TH (p = 0.014). Patients from the CH tended to die sooner after LTVAD implant, although long-term survival was similar. At the 1-year follow-up, 65%from the CH were alive or had received a transplant vs 60%from the TH.

Conclusion

Patients with cardiogenic shock in whom a STVAD was implanted in a CH and then were bridged to a LTVAD in a TH had similar long-term survival as those bridged to LTVAD at the TH.