Цель. Анализ опыта ФГБУ «НМИЦК им. акад. Е.И. Чазова» по отбору пациентов, направленных на имплантацию устройства механической поддержки левого желудочка (left ventricular assist device – LVAD). Материалы и методы. Для отбора кандидатов на имплантацию LVAD проскринирован 901 пациент, чьи документы были направлены в ФГБУ «НМИЦК им. акад. Е.И. Чазова» из региональных лечебно-профилактических учреждений. На I этапе всем пациентам проводили трансторакальную эхокардиографию, выполненную по расширенному протоколу с комплексной оценкой размеров и функции левого и правого желудочков сердца. Пациентам, прошедшим скрининговую процедуру, выполняли дальнейшее обследование, включающее как лабораторные, так и инструментальные методы диагностики. Проанализирована поликлиническая база данных пациентов с диагнозом «хроническая сердечная недостаточность» (ХСН), «дилатационная кардиомиопатия». Результаты. Из 901 скринированного пациента подходящими кандидатами на имплантацию LVAD являлись 7,9%, операция выполнена только 23 (2,6%) пациентам. Среди неподошедших кандидатов на операцию: 208 (29%) пациентов не принимали оптимальную медикаментозную терапию, 15% показаны иные хирургические методы лечения ХСН, 12% имели выраженную правожелудочковую недостаточность, 9,8% – тяжелую сопутствующую патологию, 6,8% пациентов отказались от операции. Заключение. Основными проблемами отбора на имплантацию LVAD явились низкая осведомленность врачей о внедрении новых методик лечения, плохое качество трансторакальной эхокардиографии, большое число больных, не получающих базовую терапию ХСН, несвоевременное направление пациентов на другие виды хирургического лечения.
Ключевые слова: хроническая сердечная недостаточность, устройство механической поддержки левого желудочка, постоянная механическая поддержка кровообращения, LVAD, трансплантация сердца
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Aim. To analyze the experience of Chazov National Medical Research Center of Cardiology in patient selection for left ventricular assist device (LVAD) implantation. Materials and methods. 901 patients, whose documents were sent to Chazov National Medical Research Center of Cardiology from regional medical and prophylactic institutions, were screened as selection for LVAD implantation. Firstly, all patients underwent transthoracic echocardiography performed according to the extended protocol with a comprehensive assessment of the left and right ventricle size and function. Patients who underwent the screening procedure underwent further examination including both laboratory and instrumental diagnostic methods. In addition, the polyclinic database of patients diagnosed with chronic heart failure (CHF) and dilated cardiomyopathy was also analyzed. Results. Among 901 screened patients 7.9% were suitable candidates for LVAD implantation and only 23 (2.6%) patients underwent surgery. Among those not eligible for surgery: 208 (29%) patients were not on optimal medical therapy, 15% of patients had indications for other surgical treatment of CHF, 12% of patients had severe right ventricular failure, 9.8% had severe comorbidities, 6.8% of patients refused surgery. Conclusions. The main problems of selection for LVAD implantation were: low awareness of doctors about the introduction of new treatment methods, poor quality of transthoracic echocardiography, a large percentage of patients not receiving basic therapy for CHF, untimely referral of patients for other types of surgical treatment.
Keywords: chronic heart failure, left ventricular mechanical support device, permanent mechanical circulatory support, LVAD, heart transplantation
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8. McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. DOI:10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021;42(48):4901. DOI:10.1093/eurheartj/ehab670
9. Yuzefpolskaya M, Schroeder SE, Houston BA, et al. The Society of Thoracic Surgeons Intermacs 2022 annual report: Focus on the 2018 heart transplant allocation system. Ann Thorac Surg. 2023;115(2):311-27. DOI:10.1016/j.athoracsur.2022.11.023
10. Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial. JAMA. 2022;328(12):1233-42. DOI:10.1001/jama.2022.16197
11. Mehra MR, Cleveland JC Jr, Uriel N, et al.; MOMENTUM 3 Investigators. Primary results of long-term outcomes in the MOMENTUM 3 pivotal trial and continued access protocol study phase: A study of 2200 HeartMate 3 left ventricular assist device implants. Eur J Heart Fail. 2021;23(8):1392-400. DOI:10.1002/ejhf.2211
12. Masarone D, Houston B, Falco L, et al. How to sel ect patients for left ventricular assist devices? A Guide for Clinical Practice. J Clin Med. 2023;12(16):5216. DOI:10.3390/jcm12165216
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14. Lund LH, Matthews J, Aaronson K. Patient selection for left ventricular assist devices. Eur J Heart Fail. 2010;12(5):434-43. DOI:10.1093/eurjhf/hfq006
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16. Frigerio M. Left ventricular assist device: Indication, timing, and management. Heart Fail Clin. 2021;17(4):619-34. DOI:10.1016/j.hfc.2021.05.007
17. Lund LH, Trochu JN, Meyns B, et al. Screening for heart transplantation and left ventricular assist system: Results fr om the ScrEEning for advanced Heart Failure treatment (SEE-HF) study. Eur J Heart Fail. 2018;20(1):152-60. DOI:10.1002/ejhf.975
18. Lietz K, Miller LW. Patient selection for left-ventricular assist devices. Curr Opin Cardiol. 2009;24(3):246-51. DOI:10.1097/HCO.0b013e32832a0743
19. de By TMMH, Mohacsi P, Gahl B, et al.; EUROMACS members. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio-Thoracic Surgery (EACTS): Second report. Eur J Cardiothorac Surg. 2018;53(2):309-16. DOI:10.1093/ejcts/ezx320
20. Aaronson KD, Patel H, Pagani FD. Patient selection for left ventricular assist device therapy. Ann Thorac Surg. 2003;75(Suppl. 6):S29-35. DOI:10.1016/s0003-4975(03)00461-2
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1. Schlendorf KH, Russell SD. New diagnostic devices in heart failure. Curr Opin Cardiol. 2010;25(3):262-7. DOI:10.1097/HCO.0b013e3283387962
2. Gustafsson F, Rogers JG. Left ventricular assist device therapy in advanced heart failure: Patient selection and outcomes. European Journal of Heart Failure. 2017;19(5):595-602. DOI:10.1002/ejhf.779
3. Safiullina AA, Uskach TM, Dobrovolskaya SV, et al. Myocardial remodeling in patients with chronic heart failure and implanted cardiac contractility modulators. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(12):1443-50 (in Russian). DOI:10.26442/00403660.2021.12.201218
4. Vieira JL, Ventura HO, Mehra MR. Mechanical circulatory support devices in advanced heart failure: 2020 and beyond. Prog Cardiovasc Dis. 2020;63(5):630-9. DOI:10.1016/j.pcad.2020.09.003
5. Michaels A, Cowger J. Patient Selection for Destination LVAD Therapy: Predicting Success in the Short and Long Term. Curr Heart Fail Rep. 2019;16(5):140-9.
DOI:10.1007/s11897-019-00434-1
6. Shahramanova ZhA, Amanatova VA, Narusov OYu, et al. Peculiarities of hemodynamic assessment in patients with centrifugal circulatory assist system. Russian Cardiology Bulletin. 2023;18(3):6-15 (in Russian). DOI:10.17116/Cardiobulletin2023180316
7. Rector TS, Taylor BC, Greer N, et al. Use of left ventricular assist devices as destination therapy in end-stage congestive heart failure: A systematic review. Washington (DC): Department of Veterans Affairs (US), 2012. PMID:22855974
8. McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. DOI:10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021;42(48):4901. DOI:10.1093/eurheartj/ehab670
9. Yuzefpolskaya M, Schroeder SE, Houston BA, et al. The Society of Thoracic Surgeons Intermacs 2022 annual report: Focus on the 2018 heart transplant allocation system. Ann Thorac Surg. 2023;115(2):311-27. DOI:10.1016/j.athoracsur.2022.11.023
10. Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial. JAMA. 2022;328(12):1233-42. DOI:10.1001/jama.2022.16197
11. Mehra MR, Cleveland JC Jr, Uriel N, et al.; MOMENTUM 3 Investigators. Primary results of long-term outcomes in the MOMENTUM 3 pivotal trial and continued access protocol study phase: A study of 2200 HeartMate 3 left ventricular assist device implants. Eur J Heart Fail. 2021;23(8):1392-400. DOI:10.1002/ejhf.2211
12. Masarone D, Houston B, Falco L, et al. How to sel ect patients for left ventricular assist devices? A Guide for Clinical Practice. J Clin Med. 2023;12(16):5216. DOI:10.3390/jcm12165216
13. Varshney AS, DeFilippis EM, Cowger JA, et al. Trends and outcomes of left ventricular assist device therapy: JACC Focus Seminar. J Am Coll Cardiol. 2022;79(11):1092-107. DOI:10.1016/j.jacc.2022.01.017
14. Lund LH, Matthews J, Aaronson K. Patient selection for left ventricular assist devices. Eur J Heart Fail. 2010;12(5):434-43. DOI:10.1093/eurjhf/hfq006
15. Gautier SV, Shevchenko AO, Itkin GP, et al. Artificial heart in Russia: Past, present, and future. Artificial Organs. 2021;45(2):111-4. DOI:10.1111/aor.13860
16. Frigerio M. Left ventricular assist device: Indication, timing, and management. Heart Fail Clin. 2021;17(4):619-34. DOI:10.1016/j.hfc.2021.05.007
17. Lund LH, Trochu JN, Meyns B, et al. Screening for heart transplantation and left ventricular assist system: Results fr om the ScrEEning for advanced Heart Failure treatment (SEE-HF) study. Eur J Heart Fail. 2018;20(1):152-60. DOI:10.1002/ejhf.975
18. Lietz K, Miller LW. Patient selection for left-ventricular assist devices. Curr Opin Cardiol. 2009;24(3):246-51. DOI:10.1097/HCO.0b013e32832a0743
19. de By TMMH, Mohacsi P, Gahl B, et al.; EUROMACS members. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio-Thoracic Surgery (EACTS): Second report. Eur J Cardiothorac Surg. 2018;53(2):309-16. DOI:10.1093/ejcts/ezx320
20. Aaronson KD, Patel H, Pagani FD. Patient selection for left ventricular assist device therapy. Ann Thorac Surg. 2003;75(Suppl. 6):S29-35. DOI:10.1016/s0003-4975(03)00461-2
ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Россия
*Jane-20498@mail.ru
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Oleg Yu. Narusov, Janna A. Shahramanova*, Valeriia A. Amanatova, Aleksei V. Sychev, Yulia F. Osmolovskaya, Kamil G. Ganaev, Andrey А. Shiryaev, Irina А. Merkulova, Dmitry V. Pevzner, Maksim I. Makeev, Marina А. Saidova, Filipp N. Paleev, Renat S. Akchurin, Sergey N. Tereshchenko, Sergey A. Boytsov
Chazov National Medical Research Center of Cardiology, Moscow, Russia
*Jane-20498@mail.ru