Chan Joshua L, Kobashigawa Jon A, Aintablian Tamar L, Li Yanqing, Perry Paul A, Patel Jignesh K, Kittleson Michelle M, Czer Lawrence S, Zarrini Parham, Velleca Angela, Rush Jenna, Arabia Francisco A, Trento Alfredo, Esmailian Fardad
Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Interact Cardiovasc Thorac Surg. 2017 Aug 1;25(2):212-217. doi: 10.1093/icvts/ivx081.
Vasoplegia syndrome is a potentially life-threatening condition that can occur following cardiopulmonary bypass. Heart transplantation is a recognized risk factor for developing this vasodilatory state. The objective of this study was to determine the effects of vasoplegia syndrome on 1-year heart transplant outcomes.
A retrospective review of orthotopic heart transplants at a single institution between November 2010 and December 2014 was performed. Of the 347 consecutive adult patients, 107 patients (30.8%) met criteria for vasoplegia syndrome. Preoperative factors and intraoperative variables were collected and compared between vasoplegia and non-vasoplegia cohorts. The incidence of postoperative complications, transplant rejection and patient survival within 1 year were evaluated.
Demographics and preoperative medication profiles were similar in both groups, while mechanical circulatory support device use was associated with vasoplegia syndrome (30.8% vs 20.0%; P = 0.039). Perioperative characteristics such as longer cardiopulmonary bypass [165.0 (interquartile range [IQR] 74) min vs 140.0 (IQR 42.7) min; P < 0.001] and increased blood product usage (24.7 ± 17.2 units vs 17.7 ± 14.3 units; P < 0.001) were associated with vasoplegia. Non-vasoplegia patients were more likely to be extubated [42.9 (IQR 37.3) h vs 66.8 (IQR 50.2) h; P < 0.001] and discharged earlier [10.0 (IQR 6) days vs 14.0 (IQR 11.5) days; P < 0.001]. One-year patient survival (92.0% vs 88.6%; P = 0.338) and any-treated rejection rates (82.7% vs 84.3%; P = 0.569) were not significantly different between groups.
Although vasoplegia syndrome was associated with an increase in perioperative morbidity, including greater mechanical ventilation time and hospital length of stay, no significant differences in survival or allograft rejection at 1 year was demonstrated.
血管麻痹综合征是一种可能危及生命的疾病，可发生在体外循环后。心脏移植是发生这种血管舒张状态的一个公认危险因素。本研究的目的是确定血管麻痹综合征对心脏移植1年预后的影响。
对2010年11月至2014年12月期间在一家机构进行的原位心脏移植进行回顾性研究。在347例连续的成年患者中，107例患者（30.8%）符合血管麻痹综合征的标准。收集血管麻痹组和非血管麻痹组的术前因素和术中变量并进行比较。评估术后并发症、移植排斥反应的发生率以及1年内患者的生存率。
两组患者的人口统计学特征和术前用药情况相似，而使用机械循环支持装置与血管麻痹综合征相关（30.8%对20.0%；P = 0.039）。血管麻痹与一些围手术期特征相关，如体外循环时间延长[165.0（四分位间距[IQR]74）分钟对140.0（IQR 42.7）分钟；P < 0.001]和血液制品使用量增加（平均24.7±17.2单位对17.7±14.3单位；P < 0.001）。非血管麻痹患者更有可能较早拔管[42.9（IQR 37.3）小时对66.8（IQR 50.2）小时；P < 0.001]且出院更早[10.0（IQR 6）天对14.0（IQR 11.5）天；P < 0.001]。两组患者1年的生存率（92.0%对88.6%；P = 0.338）和接受任何治疗的排斥反应率（82.7%对84.3%；P = 0.569）无显著差异。
虽然血管麻痹综合征与围手术期发病率增加相关，包括机械通气时间延长和住院时间延长，但在1年生存率或移植物排斥反应方面未显示出显著差异。
