Circulation Journal ( IF 3.3 ) Pub Date : 2020-10-23 , DOI: 10.1253/circj.cj-20-0238 Keiichiro Iwasaki 1, 2 , Koichi Yoshitake 1 , Nobuichiro Yagi 1 , Yasumori Sujino 1 , Eiji Anegawa 1 , Hiroki Mochizuki 1 , Kensuke Kuroda 1 , Seiko Nakajima 1 , Takuya Watanabe 1 , Osamu Seguchi 1 , Masanobu Yanase 1 , Satsuki Fukushima 3 , Tomoyuki Fujita 3 , Junjiro Kobayashi 3 , Hiroshi Ito 2 , Norihide Fukushima 1
Background:Continuous-flow left ventricular assist device (CF-LVAD) substantially improves survival in endstage heart failure patients. However, bleeding complications are common after CF-LVAD implantation and in some cases, re-exploration for bleeding is needed. We aimed to investigate the incidence, timing, and risk factors of bleeding requiring re-exploration after CF-LVAD implantation.
Methods and Results:We retrospectively reviewed 162 consecutive patients (age 43±13 years, 71% men) who underwent CF-LVAD implantation (HeartMateII 119, Jarvik2000 15, HVAD 13, EVAHEART 10, DuraHeart 5) from January 2012 to June 2019. During follow-up [median 662 days, interquartile range (IQR) 364–1,116 days], 35 (21.6%) experienced re-exploration for bleeding. The median timing of re-exploration was 6 (IQR 1–10) days. In the multivariate logistic regression analysis, postoperative platelet count was an independent predictor for re-exploration for bleeding after CF-LVAD implantation (per 104/μL: odds ratio 0.83, 95% confidence interval 0.74–0.93, P=0.002). Patients who experienced re-exploration for bleeding had a significantly worse survival rate than patients who did not (at 4 years, 73.6% vs. 90.1%, P=0.039).
Conclusions:Re-exploration for bleeding is prevalent after CF-LVAD implantation, especially in patients with low postoperative platelet counts. As bleeding requiring re-exploration is associated with poor prognosis, risk stratification using the postoperative platelet count may be beneficial for these patients.
中文翻译：
连续流左心室辅助装置植入后重新探索出血的发生率、因素和预后影响 ― 日本单中心研究 ―
背景：连续流左心室辅助装置 (CF-LVAD) 显着提高了终末期心力衰竭患者的生存率。然而，CF-LVAD 植入后出血并发症很常见，在某些情况下，需要重新探索出血。我们旨在调查 CF-LVAD 植入后需要重新探查出血的发生率、时间和危险因素。
方法和结果：我们回顾性回顾了 2012 年 1 月至 2019 年 6 月接受 CF-LVAD 植入术（HeartMateII 119、Jarvik2000 15、HVAD 13、EVAHEART 10、DuraHeart 5）的 162 名连续患者（年龄 43±13 岁，71% 男性）。在随访期间 [中位数 662 天，四分位距 (IQR) 364–1,116 天]，35 人 (21.6%) 因出血而再次探查。重新探索的中位时间为 6 (IQR 1-10) 天。在多变量逻辑回归分析中，术后血小板计数是 CF-LVAD 植入后重新探查出血的独立预测因子（每 10 4/μL：优势比 0.83，95% 置信区间 0.74–0.93，P=0.002）。因出血而再次探查的患者的生存率明显低于没有再次探查的患者（4 年时，分别为 73.6% 与 90.1%，P=0.039）。
结论： CF-LVAD 植入后再次探查出血是普遍现象，尤其是在术后血小板计数低的患者中。由于需要重新探查的出血与不良预后相关，因此使用术后血小板计数进行风险分层可能对这些患者有益。
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