Truby Lauren K, Takeda Koji, Farr Maryjane, Beck James, Yuzefpolskaya Melana, Colombo Paolo C, Topkara Veli K, Mancini Donna, Naka Yoshifumi, Takayama Hiroo
ASAIO J. 2018 Jan/Feb;64(1):43-51. doi: 10.1097/MAT.0000000000000623.
Despite significant advances in the medical management of heart transplant (HT) recipients, perioperative complications, including vasoplegia, remain a significant contributor to morbidity and mortality. This is a retrospective review of patients who received HT at our institution between 2012 and 2015. Mean systemic vascular resistance (SVR) was calculated during the bypass run. Vasoplegia was defined as a mean SVR <800 dynes s/cm despite a high pressor requirement (>1,500 μg neosynephrine bolused). The primary outcome of interest was 30 day post-transplant survival. There were 138 patients included in the current study. A total of 16% (n = 22) patients were identified as having developed on-cardiopulmonary bypass vasoplegia. Vasoplegic patients had a significantly higher body mass index (BMI) (30.1 ± 5.0 vs. 26.5 ± 4.7; p = 0.005) and were more likely to be male (95.5% vs. 66.4%; p = 0.004). Use of continuous-flow left ventricular assist device (CF-LVAD) as bridge-to-transplant (BTT) was prevalent among vasoplegic patients (81.8% vs. 57.8%; p = 0.033). These patients had significantly decreased survival at 30 and 60 days (86.4% vs. 99.1% at 30 days; 77.3% vs. 92.8% at 60 days). Bridge-to-transplant with CF-LVAD was an independent predictor of on-cardiopulmonary bypass (CPB) vasoplegia. On-CPB vasoplegia complicated 16% of HTs in the current study and was associated with increased mortality. Bridge-to-transplant with CF-LVAD was an independent predictor of this phenomenon.
尽管心脏移植（HT）受者的医疗管理取得了重大进展，但围手术期并发症，包括血管麻痹，仍然是发病率和死亡率的重要因素。这是一项对2012年至2015年间在我们机构接受心脏移植的患者的回顾性研究。在体外循环期间计算平均体循环血管阻力（SVR）。血管麻痹定义为尽管需要大量升压药（>1500μg新福林推注），但平均SVR<800达因·秒/厘米。感兴趣的主要结局是移植后30天生存率。本研究共纳入138例患者。共有16%（n = 22）的患者被确定在体外循环期间发生了血管麻痹。血管麻痹患者的体重指数（BMI）显著更高（30.1±5.0 vs. 26.5±4.7；p = 0.005），且更可能为男性（95.5% vs. 66.4%；p = 0.004）。作为过渡到移植（BTT）使用连续流左心室辅助装置（CF-LVAD）在血管麻痹患者中很普遍（81.8% vs. 57.8%；p = 0.033）。这些患者在30天和60天时的生存率显著降低（30天时为86.4% vs. 99.1%；60天时为77.3% vs. 92.8%）。使用CF-LVAD进行过渡到移植是体外循环（CPB）血管麻痹的独立预测因素。在本研究中，CPB血管麻痹使16%的心脏移植手术复杂化，并与死亡率增加相关。使用CF-LVAD进行过渡到移植是这一现象的独立预测因素。
