Université Pierre et Marie Curie, Paris VI, APHP, Groupe hospitalier Pitié-Salpétrière, Institute of Cardiology, Division of Thoracic and Cardiovascular Surgery, F-75013 Paris, France.
Eur J Cardiothorac Surg. 2010 Feb;37(2):343-9. doi: 10.1016/j.ejcts.2009.05.034. Epub 2009 Jul 17.
Early graft failure (EGF) is a major risk for death after heart transplantation. We studied the impact of an extra-corporeal membrane oxygenation (ECMO) temporary support on the operative mortality and the mean-term survival after EGF.
Between January 2000 and December 2006, 394 patients underwent orthotopic heart transplantation at our institution. EGF was observed in 90 (23%) patients. Fifty-four patients (14%) were treated with ECMO support, eight (2%) with other assisting devices, and 28 (7%) received maximal inotropic drug support only.
The overall mortality was 21% (83 patients). EGF was a major risk for death: 13% (35 patients) without EGF versus 58% (49 patients) with EGF, p<0001. Among patients supported with ECMO, 36 (67%) were weaned from the assisting device and 27 (50%) were discharged from the hospital. Overall survival was 73% at 1 year and 66% at 5 years. Absence of EGF improved long-term survival: 78% at 1 year and 70% at 5 years without EGF versus 37% at 1 year and 35% at 5 years with EGF. Patients treated with ECMO have the same 1-year conditional survival as patients not having suffered EGF: 94% at 3 years.
ECMO support is a reliable therapeutic option in severe EGF after cardiac transplantation; furthermore, patients treated with ECMO have the same 1-year conditional survival as patients not having suffered EGF.
心脏移植后早期移植物失功（EGF）是导致死亡的主要风险。我们研究了体外膜肺氧合（ECMO）临时支持对 EGF 术后手术死亡率和中期生存率的影响。
2000 年 1 月至 2006 年 12 月期间，我院共进行了 394 例原位心脏移植术。90 例（23%）患者出现 EGF。54 例（14%）患者接受 ECMO 支持治疗，8 例（2%）患者接受其他辅助设备治疗，28 例（7%）患者仅接受最大程度的正性肌力药物支持治疗。
总体死亡率为 21%（83 例）。EGF 是死亡的主要危险因素：无 EGF 患者为 13%（35 例），有 EGF 患者为 58%（49 例），p<0001。在接受 ECMO 支持的患者中，36 例（67%）成功脱机，27 例（50%）出院。1 年总体生存率为 73%，5 年生存率为 66%。无 EGF 可改善长期生存率：无 EGF 患者 1 年生存率为 78%，5 年生存率为 70%，有 EGF 患者 1 年生存率为 37%，5 年生存率为 35%。接受 ECMO 治疗的患者与未发生 EGF 的患者 1 年条件生存率相同：3 年时为 94%。
在心脏移植后严重 EGF 情况下，ECMO 支持是一种可靠的治疗选择；此外，接受 ECMO 治疗的患者 1 年条件生存率与未发生 EGF 的患者相同。
