Byrne John G, Leacche Marzia, Paul Subroto, Mihaljevic Tomislav, Rawn James D, Shernan Stanton K, Mudge Gilbert H, Stevenson Lynne W
Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Eur J Cardiothorac Surg. 2004 Mar;25(3):327-32. doi: 10.1016/j.ejcts.2003.11.032.
Vasoplegia syndrome after orthotopic heart transplantation (OHT) is a rare but highly lethal syndrome of unknown etiology, characterized by severe refractory hypotension, metabolic acidosis, and decreased systemic vascular resistance (SVR). The objective of this retrospective study was to identify the risk factors contributing to the development of vasoplegia syndrome after OHT in order to provide potential algorithms for its management.
Between October 1992 and July 2001, 187 consecutive patients underwent OHT. Complete pre- and post-data were available in 147 patients (78%). Mean age was 49+/-11 years, 82% (120/147) were male, and donor ischemic time was 117+/-62 min. Twenty-eight of 147 (19%) developed vasoplegia syndrome, defined as SVR <800 dyns per cm(5) with serum bicarbonate <20 mEq/l.
Patients who developed vasoplegia syndrome demonstrated greater hospital mortality (25 vs. 9%, P=0.031) compared to those who did not. Multivariate logistic regression identified pre-operative use of intravenous heparin (OR 2.8, CI 1-7.4, P=0.039) and body surface area >1.9 m(2) (OR 7, CI 0.98-50, P=0.052) as independent predictors for the development of post-operative vasoplegia syndrome. Pre-operative use of inotropic support conferred protection against the development of post-operative vasoplegia syndrome (OR 0.25, CI 0.08-0.79, P=0.018). Pre-operative use of ACE inhibitors was not associated with increased risk (55 vs. 59%, P=0.441).
Vasoplegia syndrome following OHT is associated with high early mortality. The development of a risk stratification profile may help in patient selection as well as the post-operative management of vasoplegia syndrome following OHT.
原位心脏移植（OHT）后血管麻痹综合征是一种病因不明的罕见但极具致死性的综合征，其特征为严重难治性低血压、代谢性酸中毒和体循环血管阻力（SVR）降低。这项回顾性研究的目的是确定导致OHT后血管麻痹综合征发生的危险因素，以便为其管理提供潜在的方案。
1992年10月至2001年7月期间，187例患者连续接受了OHT。147例患者（78%）有完整的术前和术后数据。平均年龄为49±11岁，82%（120/147）为男性，供体缺血时间为117±62分钟。147例中有28例（19%）发生血管麻痹综合征，定义为SVR<800达因/厘米⁵且血清碳酸氢盐<20毫当量/升。
与未发生血管麻痹综合征的患者相比，发生该综合征的患者住院死亡率更高（25%对9%，P=0.031）。多因素逻辑回归分析确定术前使用静脉肝素（比值比2.8，可信区间1 - 7.4，P=0.039）和体表面积>1.9平方米（比值比7，可信区间0.98 - 50，P=0.052）是术后血管麻痹综合征发生的独立预测因素。术前使用正性肌力药物可预防术后血管麻痹综合征的发生（比值比0.25，可信区间0.08 - 0.79，P=0.018）。术前使用血管紧张素转换酶抑制剂与风险增加无关（55%对59%，P=0.441）。
OHT后血管麻痹综合征与早期高死亡率相关。建立风险分层概况可能有助于OHT后血管麻痹综合征患者的选择及术后管理。
