Dokument: Einfluss perioperativer Faktoren auf das Patienten-Outcome nach Implantation eines Linksherzunterstützungssystems
| Titel: | Einfluss perioperativer Faktoren auf das Patienten-Outcome nach Implantation eines Linksherzunterstützungssystems | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=68428 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20250206-141728-8 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Voit, Josephine Amelie Louisa [Autor] | |||||||
| Dateien: |
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| Beitragende: | Univ.-Prof. Dr. med. Aubin, Hug [Gutachter] Prof. Dr. Dr. Huhn-Wientgen, Ragnar [Gutachter] | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Zusammenfassung
Der Einsatz linksventrikulärer Unterstützungssysteme (LVAD), als finale Therapiemaßnahme, sowie auch als überbrückende Option bis zu einer Herztransplantation, gewinnt immer mehr an Relevanz. Vorausgegangene Arbeiten legten den Schwerpunkt der LVAD Untersuchungen auf die Analyse mortalitätsbegünstigender Faktoren. Zuletzt rückten patientenzentrierte Endpunkte jedoch mehr in den Fokus und stellten eine gute Ergänzung zu harten Endpunkten dar. Aktuell ist die Datenlage für patientenzentrierte Endpunkte bei LVAD unzureichend. Diese retrospektive, monozentrische Kohorten Studie identifizierte perioperative Variablen, welche die Therapiebedürftigkeit innerhalb des ersten Jahres nach LVAD Implantation beeinflussten. Dies erfolgte anhand des patientenzentrierten Endpunktes Days Alive and Out of Hospital (DAOH). Zunächst wurde mittels einer univariaten Analyse der Einfluss zehn vorab definierter Variablen auf die DAOH untersucht. Anschließend erfolgte eine multivariate Analyse aller im univariaten Modell signifikanten Variablen. Ergänzend analysierte die Arbeit den Einfluss aller zehn Variablen auf die Ein-Jahres-Mortalität. Die Kohorte umfasste 227 LVAD Patienten. Sechs Variablen, darunter die chronische Nierenerkrankung, die präoperative mechanische Kreislaufunterstützung, ein Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Stadium < 3, die intraoperative Implantation eines rechtsventrikulären Unterstützungssystems, die postoperative Nierenersatztherapie und die Tracheotomie, zeigten in der univariaten Analyse einen signifikanten Einfluss auf die DAOH. Die multivariate Analyse zeigte eine unabhängig voneinander existierende Assoziation von fünf der sechs Variablen mit einer reduzierten Anzahl an DAOH. Die Untersuchung der Ein-Jahres-Mortalität zeigte lediglich für die postoperative Nierenersatztherapie eine Signifikanz. Diese Studie identifiziert Faktoren, welche die Therapiebedürftigkeit nach LVAD Implantation beeinflussen. Ebenfalls zeigte sie eine Diskrepanz zwischen Mortalität und Lebensqualität nach LVAD Implantation. DAOH stellt einen validen, patientenzentrierten Endpunkt dar, welcher zukünftiger Forschung zu einem besseren Vergleich des Outcomes in Bezug auf die Therapiebedürftigkeit als Surrogat-Parameter für die Lebensqualität der Patienten dienen kann.There is a tremendous increase in implantation of LVAD as bridge to transplant or destination therapy. The focus in preceding studies was the investigation of perioperative variables influencing mortality after left ventricular assisted device implantation. During the last years, patient centered endpoints became increasingly important complementing hard endpoints such as mortality analysis. Data concerning patient centered endpoints after LVAD implantation is insufficient. For this reason, it is necessary to identify and analyze perioperative factors influencing patients’ life after surgery. This retrospective single-center cohort study aimed to identify perioperative variables which had an impact on the patients’ quality of life. Therefore, quality of life was measured as DAOH within the first year after LVAD implantation. Initially we conducted an univariate analysis investigating the influence of 10 prespecified variables on DAOH. According to that a multivariate analysis conducting influence on DAOH involving previously significant variables was performed. Additionally, this study examined the impact of all variables on 1-year mortality. The cohort of this study included 227 patients. Regarding univariate analysis, six out of ten variables, including Chronic Kidney Disease (CKD), preoperative Mechanical Circulatory Support (pMCS), INTERMACS < 3, Right Ventricular Assist Device (RVAD) implantation, postoperative dialysis and tracheotomy, showed a significant influence on DAOH. Multivariate analysis showed an independent association with reduced DAOH for five out of six variables. The investigation of 1-year mortality revealed a significance only for postoperative dialysis demonstrating an increased mortality. This study identified numerous factors influencing quality of life after LVAD implantation. Furthermore, it showed discrepancy between mortality and quality of life after LVAD implantation. DAOH illustrates a patient centered endpoint which may contribute to a more comprehensive assessment of outcome concerning the patients’ life impact. | |||||||
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Zurakowski, Quantile Regression and Its Applications: A Primer for Anesthesiologists. Anesth Analg, 2019. 128(4): p. 820-830. | |||||||
| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 06.02.2025 | |||||||
| Dateien geändert am: | 06.02.2025 | |||||||
| Promotionsantrag am: | 05.08.2024 | |||||||
| Datum der Promotion: | 21.01.2025 |
