Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
J Thorac Cardiovasc Surg. 2015 Aug;150(2):333-40. doi: 10.1016/j.jtcvs.2015.02.043. Epub 2015 Feb 28.
The role of extracorporeal life support (ECLS) in primary cardiogenic shock (PCS) is well established. In this study, we evaluated the impact of etiology on outcomes.
Between January 2009 and March 2013, we implanted a total of 249 patients with ECLS; we focused on 64 patients for whom peripheral ECLS was the treatment for PCS. Of these, 37 cases (58%) were "acute" (mostly acute myocardial infarction: 39%); 27 (42%) had an exacerbation of "chronic" heart failure (dilated cardiomyopathy: 30%; post-ischemic cardiomyopathy: 9%; and congenital: 3%).
In the group with chronic etiology, 23 patients were bridged to a left ventricular assist device (52%) or heart transplantation (33%). In the group with acute etiology, ECLS was used as a bridge-to-transplantation in 3 patients (8%), a bridge-to-bridge in 9 (24%), and a bridge-to-recovery in 18 (49%). One patient in each group was bridged to conventional surgery. Recovery of cardiac function was achieved in only the group with acute primary cardiogenic shock (18 vs 0 patients, P = .0001). A mean flow during support of ≤60% of the theoretic flow (body surface area × 2.4) was a predictor of successful weaning (P = .02). Median duration of ECLS support was 7 days (range: 2-11.5 days). Nine patients (14%) died during support; 30-day overall survival was 80% (51 of 64 patients); and 59% of patients were discharged, in whom survival at 48 months was 90%. Thirty-day survival was correlated with duration of ECLS support.
In "chronic" heart failure, ECLS represents a bridge to a ventricular assist device or heart transplantation, whereas in "acute" settings, it offers a considerable chance of recovery, and is often the only required therapy.
体外生命支持（ECLS）在原发性心源性休克（PCS）中的作用已得到充分证实。在这项研究中，我们评估了病因对预后的影响。
2009 年 1 月至 2013 年 3 月，我们共为 249 名患者植入了 ECLS；我们重点关注其中 64 名接受外周 ECLS 治疗 PCS 的患者。其中，37 例（58%）为“急性”（主要为急性心肌梗死：39%）；27 例（42%）为“慢性”心力衰竭恶化（扩张型心肌病：30%；缺血性心肌病：9%；先天性：3%）。
在慢性病因组中，23 例患者接受左心室辅助装置（52%）或心脏移植（33%）桥接治疗。在急性病因组中，3 例患者（8%）将 ECLS 作为移植桥接，9 例患者（24%）作为桥接桥接，18 例患者（49%）作为桥接恢复。每组中有 1 例患者接受了常规手术桥接治疗。只有急性原发性心源性休克组的患者恢复了心功能（18 例 vs 0 例，P=0.0001）。支持期间平均流量≤理论流量的 60%（体表面积×2.4）是成功脱机的预测指标（P=0.02）。ECLS 支持的中位时间为 7 天（范围：2-11.5 天）。9 名患者（14%）在支持期间死亡；30 天总生存率为 80%（64 例中的 51 例）；59%的患者出院，其中 48 个月的生存率为 90%。30 天生存率与 ECLS 支持时间相关。
在“慢性”心力衰竭中，ECLS 代表了心室辅助装置或心脏移植的桥接，而在“急性”情况下，它提供了相当大的恢复机会，通常是唯一需要的治疗方法。
