肺动脉内膜剥脱术后体外生命支持作为恢复或移植的桥梁：来自31例连续患者的经验教训。

Extracorporeal Life Support After Pulmonary Endarterectomy as a Bridge to Recovery or Transplantation: Lessons From 31 Consecutive Patients.

作者信息

Boulate David, Mercier Olaf, Mussot Sacha, Fabre Dominique, Stephan François, Haddad François, Jaïs Xavier, Dartevelle Philippe, Fadel Elie

机构信息

Department of Thoracic, Vascular, and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris South University, France.

出版信息

Ann Thorac Surg. 2016 Jul;102(1):260-8. doi: 10.1016/j.athoracsur.2016.01.103. Epub 2016 Apr 23.

DOI:10.1016/j.athoracsur.2016.01.103

PMID:27112656

Abstract

BACKGROUND

Extracorporeal life support (ECLS) can be used to sustain patients having cardiorespiratory failure after pulmonary endarterectomy (PEA). We aimed to assess outcomes and to identify factors associated with short-term survival among patients who required ECLS after PEA.

METHODS

We reviewed the charts of consecutive patients who required ECLS after PEA between 2005 and 2013 at our institution. Patients with failed PEA were scheduled for heart-lung transplantation, and patients with potentially reversible hemodynamic or respiratory failure were given appropriate supportive care until recovery.

RESULTS

Of the 829 patients who underwent PEA, 31 (3.7%) required postoperative ECLS. Of these, 23 continued to receive support, and 8 were listed for heart-lung transplantation during ECLS. Overall inhospital survival was 48.4% (15 of 31). Of patients listed for transplantation, 2 died while on support; 4 of the 6 patients undergoing transplantation lived to hospital discharge. Of the 23 supportive care patients, 11 (47.8%) were alive at hospital discharge. The factors associated with survival were younger age (p = 0.02), larger post-PEA decrease in mean pulmonary artery pressure (p = 0.020), lower post-PEA total pulmonary resistance (p = 0.008), and pure respiratory failure related to reperfusion edema or airway bleeding (p = 0.003).

CONCLUSIONS

Extracorporeal life support may be useful to support patients with complications after PEA either to recovery or to salvage transplantation.

摘要

背景

体外生命支持（ECLS）可用于维持肺内膜剥脱术（PEA）后出现心肺衰竭的患者生命。我们旨在评估PEA术后需要ECLS的患者的预后，并确定与短期生存相关的因素。

方法

我们回顾了2005年至2013年在我院接受PEA术后需要ECLS的连续患者的病历。PEA手术失败的患者安排进行心肺移植，血流动力学或呼吸功能衰竭可能可逆的患者给予适当的支持治疗直至康复。

结果

在829例行PEA手术的患者中，31例（3.7%）术后需要ECLS。其中，23例继续接受支持治疗，8例在ECLS期间被列入心肺移植名单。总体住院生存率为48.4%（31例中的15例）。列入移植名单的患者中，2例在接受支持治疗时死亡；6例接受移植的患者中有4例存活至出院。在23例接受支持治疗的患者中，11例（47.8%）出院时存活。与生存相关的因素包括年龄较小（p = 0.02）、PEA术后平均肺动脉压下降幅度较大（p = 0.020）、PEA术后总肺阻力较低（p = 0.008）以及与再灌注水肿或气道出血相关的单纯呼吸衰竭（p = 0.003）。