Haft Jonathan W, Pagani Francis D, Romano Matthew A, Leventhal Christina L, Dyke D Bradley, Matthews Jennifer C
Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Ann Thorac Surg. 2009 Sep;88(3):711-7; discussion 717-8. doi: 10.1016/j.athoracsur.2009.04.007.
Mechanical circulatory support (MCS) with temporary, extracorporeal assist devices restores hemodynamics in patients with refractory cardiogenic shock. These devices are frequently used in community hospitals, with subsequent referral to tertiary care centers. We sought to determine the outcomes of such referrals and identify prognostic variables that may influence management decisions.
We performed a single-institution retrospective review of 59 consecutive patients transferred on temporary, extracorporeal MCS from 1997 to 2008. Demographics, medical history, laboratory data, and clinical status were obtained, with survival determined from the medical record and the Social Security Death Index. Univariable and multivariable analysis were performed and survival estimates were determined using the Kaplan-Meier method.
Median age was 49.6 years (range, 14 to 77 years). Forty-five patients (76%) were supported for postcardiotomy failure, and 34 (58%) required biventricular support. Twenty-five (42%) survived to hospital discharge, 11 after cardiac recovery (44%), 9 with long-term implantable MCS devices (39%), and 5 after heart transplantation (22%). Eight patients discharged with implantable MCS devices underwent heart transplantation and 1 remains alive on long-term implantable MCS support. Survival was 42% +/- 6% at 1 year and 38% +/- 6% at 5 years. Age and renal function were independent predictors of death.
Nearly half of all patients transferred on temporary extracorporeal MCS survive to discharge. Most of the long-term survivors received a heart transplant. Age and renal function were independent predictors of death, suggesting that survival is maximized by considering eligibility for cardiac transplantation.
使用临时体外辅助装置的机械循环支持（MCS）可恢复难治性心源性休克患者的血流动力学。这些装置常用于社区医院，随后转诊至三级护理中心。我们试图确定此类转诊的结果，并识别可能影响管理决策的预后变量。
我们对1997年至2008年期间连续59例接受临时体外MCS治疗后转诊的患者进行了单机构回顾性研究。获取了人口统计学、病史、实验室数据和临床状况信息，通过病历和社会保障死亡指数确定生存率。进行了单变量和多变量分析，并使用Kaplan-Meier方法确定生存估计值。
中位年龄为49.6岁（范围14至77岁）。45例患者（76%）因心脏术后衰竭接受支持治疗，34例（58%）需要双心室支持。25例（42%）存活至出院，11例在心脏功能恢复后存活（44%），9例使用长期可植入MCS装置存活（39%），5例在心脏移植后存活（22%）。8例出院时使用可植入MCS装置的患者接受了心脏移植，1例在长期可植入MCS支持下仍存活。1年生存率为42%±6%，5年生存率为38%±6%。年龄和肾功能是死亡的独立预测因素。
接受临时体外MCS治疗后转诊的患者中近一半存活至出院。大多数长期存活者接受了心脏移植。年龄和肾功能是死亡的独立预测因素，这表明通过考虑心脏移植的适宜性可使生存率最大化。
