Tissot Cecile, Buckvold Shannon, Phelps Christina M, Ivy D Dunbar, Campbell David N, Mitchell Max B, da Cruz Suzanne Osorio, Pietra Bill A, Miyamoto Shelley D
Children's Hospital of Denver, Aurora, CO, USA.
J Am Coll Cardiol. 2009 Aug 18;54(8):730-7. doi: 10.1016/j.jacc.2009.04.062.
We sought to analyze the indications and outcome of extracorporeal membrane oxygenation (ECMO) for early primary graft failure and determine its impact on long-term graft function and rejection risk.
Early post-operative graft failure requiring ECMO can complicate heart transplantation.
A retrospective review of all children requiring ECMO in the early period after transplantation from 1990 to 2007 was undertaken.
Twenty-eight (9%) of 310 children who underwent transplantation for cardiomyopathy (n = 5) or congenital heart disease (n = 23) required ECMO support. The total ischemic time was significantly longer for ECMO-rescued recipients compared with our overall transplantation population (276 +/- 86 min vs. 242 +/- 70 min, p < 0.01). The indication for transplantation, for ECMO support, and the timing of cannulation had no impact on survival. Hyperacute rejection was uncommon. Fifteen children were successfully weaned off ECMO and discharged alive (54%). Mean duration of ECMO was 2.8 days for survivors (median 3 days) compared with 4.8 days for nonsurvivors (median 5 days). There was 100% 3-year survival in the ECMO survivor group, with 13 patients (46%) currently alive at a mean follow-up of 8.1 +/- 3.8 years. The graft function was preserved (shortening fraction 36 +/- 7%), despite an increased number of early rejection episodes (1.7 +/- 1.6 vs. 0.7 +/- 1.3, overall transplant population, p < 0.05) and hemodynamically comprising rejection episodes (1.3 +/- 1.9 vs. 0.7 +/- 1.3, overall transplant population, p < 0.05).
Overall survival was 54%, with all patients surviving to at least 3 years after undergoing transplantation. None of the children requiring >4 days of ECMO support survived. Despite an increased number of early and hemodynamically compromising rejections, the long-term graft function is similar to our overall transplantation population.
我们试图分析体外膜肺氧合（ECMO）用于早期原发性移植肺功能衰竭的适应证及治疗结果，并确定其对长期移植肺功能及排斥反应风险的影响。
术后早期需要ECMO支持的移植肺功能衰竭会使心脏移植复杂化。
对1990年至2007年间所有在移植术后早期需要ECMO支持的儿童进行回顾性研究。
310例因心肌病（n = 5）或先天性心脏病（n = 23）接受移植的儿童中有28例（9%）需要ECMO支持。与总体移植人群相比，接受ECMO救治的受者总缺血时间显著延长（276±86分钟 vs. 242±70分钟，p < 0.01）。移植适应证、ECMO支持适应证及插管时机对生存率无影响。超急性排斥反应并不常见。15例儿童成功脱离ECMO并存活出院（54%）。存活者ECMO平均持续时间为2.8天（中位数3天），非存活者为4.8天（中位数5天）。ECMO存活组3年生存率为100%，13例患者（46%）目前仍存活，平均随访时间为8.1±3.8年。尽管早期排斥反应发作次数增加（1.7±1.6次 vs. 0.7±1.3次，总体移植人群，p < 0.05）以及血流动力学不稳定的排斥反应发作次数增加（1.3±1.9次 vs. 0.7±1.3次，总体移植人群，p < 0.05），但移植肺功能得以保留（缩短分数36±7%）。
总体生存率为54%，所有患者移植后至少存活3年。需要ECMO支持超过4天的儿童无一存活。尽管早期及血流动力学不稳定的排斥反应发作次数增加，但长期移植肺功能与总体移植人群相似。
