Department of Cardiovascular Medicine and Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
J Heart Lung Transplant. 2012 Mar;31(3):282-7. doi: 10.1016/j.healun.2011.10.010. Epub 2011 Nov 23.
Patients who underwent orthotopic heart transplant (OHT) can develop vasoplegia, which is associated with high mortality and morbidity. Herein we examine the pre-operative risk in OHT recipients at our institution.
We reviewed peri-operative data from 311 consecutive adult patients who underwent OHT between January 2003 and June 2008. Vasoplegia was defined as persistent low systemic vascular resistance, despite multiple intravenous pressor drugs at high dose, between 6 and 48 hours after surgery.
In our cohort of 311 patients, 35 (11%) patients developed vasoplegia syndrome; these patients were more likely to be UNOS Status 1A, with a higher body surface area (1.8 ± 0.25 vs 1.63 ± 0.36, p = 0.0007), greater history of thyroid disease (38.2% vs 18.5%, p = 0.0075) and a higher rate of previous cardiothoracic surgery (79% vs 48%, p = 0.0006). Pre-operatively, they were more frequently treated with aspirin (73% vs 48%, p = 0.005) and mechanical assist devices (ventricular assist devices [VADs]: 45% vs 17%, p < 0.0001; total artificial hearts: 8.6% vs 0%, p < 0.0001), and less treated with milrinone (14.7% vs 45.8%, p = 0.0005). Bypass time (118 ± 37 vs 142 ± 39 minutes, p = 0.0002) and donor heart ischemic time (191 ± 46 vs 219 ± 51 minutes, p = 0.002) were longer, with higher mortality (3.2% vs 17.1%, p = 0.0003) and morbidity in the first 30 days after transplant. In the multivariate analysis, history of thyroid disease (odds ratio [OR] = 2.7, 95% CI 1.0 to 7.0, p = 0.04) and VAD prior to transplant (OR = 2.8, 95% CI 1.07 to 7.4, p = 0.03) were independent risk factors for development of vasoplegia syndrome.
High body mass index, long cardiopulmonary bypass time, prior cardiothoracic surgery, mechanical support, use of aspirin, and thyroid disease are risk factors associated with development of vasoplegia syndrome.
接受原位心脏移植（OHT）的患者可能会出现血管麻痹，这与高死亡率和发病率有关。在此，我们研究了我们机构 OHT 受者的术前风险。
我们回顾了 2003 年 1 月至 2008 年 6 月期间连续 311 例接受 OHT 的成年患者的围手术期数据。血管麻痹定义为手术后 6 至 48 小时内持续存在低全身血管阻力，尽管使用多种高剂量静脉内升压药物。
在我们的 311 例患者队列中，35 例（11%）患者出现血管麻痹综合征；这些患者更有可能是 UNOS 状态 1A，体表面积更大（1.8±0.25 与 1.63±0.36，p=0.0007），甲状腺疾病史更多（38.2%与 18.5%，p=0.0075），先前心脏手术的比例更高（79%与 48%，p=0.0006）。术前，他们更常接受阿司匹林治疗（73%与 48%，p=0.005）和机械辅助装置治疗（心室辅助装置[VAD]：45%与 17%，p<0.0001；全人工心脏：8.6%与 0%，p<0.0001），米力农治疗更少（14.7%与 45.8%，p=0.0005）。体外循环时间（118±37 与 142±39 分钟，p=0.0002）和供心缺血时间（191±46 与 219±51 分钟，p=0.002）更长，移植后 30 天内死亡率（3.2%与 17.1%，p=0.0003）和发病率更高。在多变量分析中，甲状腺疾病史（比值比[OR] = 2.7，95%置信区间 1.0 至 7.0，p=0.04）和移植前 VAD（OR = 2.8，95%置信区间 1.07 至 7.4，p=0.03）是血管麻痹综合征发生的独立危险因素。
高体重指数、长时间体外循环、先前心脏手术、机械支持、使用阿司匹林和甲状腺疾病是与血管麻痹综合征发生相关的危险因素。
