体外膜肺氧合在心脏移植后原发性移植物失功中的应用。

Extracorporeal membrane oxygenation in primary graft failure after heart transplantation.

机构信息

Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, Australia.

出版信息

Ann Thorac Surg. 2010 Nov;90(5):1541-6. doi: 10.1016/j.athoracsur.2010.05.066.

DOI:10.1016/j.athoracsur.2010.05.066

PMID:20971259

Abstract

BACKGROUND

The aim of this review was to analyze our results with extracorporeal membrane oxygenation (ECMO) support for primary graft failure (PGF) in heart transplant recipients.

METHODS

A retrospective review of 239 consecutive patients who underwent heart transplantation between January 2000 and August 2009 was performed. Orthotopic, heterotopic, and heart lung transplants were included in this analysis. Over that time period, 54 patients developed PGF, of whom 39 patients required ECMO support. These 39 patients form the basis of this review.

RESULTS

Thirty-four patients (87%) were successfully weaned from ECMO and 29 (74.3%) survived to hospital discharge. There were no significant differences in wean rates or complications between central and peripheral ECMO. Comparison of survival in the 39 ECMO patients to the non-PGF patients (n = 185) showed a significantly worse survival in the ECMO group (p = 0.007). When those patients who died in the first 30 days were excluded, there was no difference in overall survival between groups (p = 0.73).

CONCLUSIONS

Extracorporeal membrane oxygenation provides excellent circulatory support for patients with PGF after heart transplantation with good wean and survival to discharge rates.

摘要

背景

本研究旨在分析我们在体外膜氧合（ECMO）支持治疗心脏移植后原发性移植物衰竭（PGF）方面的结果。

方法

回顾性分析了 2000 年 1 月至 2009 年 8 月期间连续接受心脏移植的 239 例患者。本分析包括原位、异位和心肺移植。在此期间，54 例患者发生 PGF，其中 39 例需要 ECMO 支持。这 39 例患者是本研究的基础。

结果

34 例患者（87%）成功撤机 ECMO，29 例（74.3%）存活至出院。中心型和外周型 ECMO 的撤机率和并发症无显著差异。与非 PGF 患者（n=185）相比，39 例 ECMO 患者的生存率明显较差（p=0.007）。排除 30 天内死亡的患者后，两组之间的总生存率无差异（p=0.73）。