From the *Faculty of Medicine, University of Sydney, Sydney, Australia; †The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ‡Faculty of Medicine and Dentistry, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; §Department of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota; ¶Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; ‖Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York; and #Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
ASAIO J. 2017 Nov/Dec;63(6):695-703. doi: 10.1097/MAT.0000000000000599.
Graft dysfunction is the main cause of early mortality after heart transplantation. In cases of severe graft dysfunction, temporary mechanical circulatory support (TMCS) may be necessary. The aim of this systematic review was to examine the utilization and outcomes of TMCS in patients with graft dysfunction after heart transplantation. Electronic search was performed to identify all studies in the English literature assessing the use of TMCS for graft dysfunction. All identified articles were systematically assessed for inclusion and exclusion criteria. Of the 5,462 studies identified, 41 studies were included. Among the 11,555 patients undergoing heart transplantation, 695 (6.0%) required TMCS with patients most often supported using venoarterial extracorporeal membrane oxygenation (79.4%) followed by right ventricular assist devices (11.1%), biventricular assist devices (BiVADs) (7.5%), and left ventricular assist devices (LVADs) (2.0%). Patients supported by LVADs were more likely to be supported longer (p = 0.003), have a higher death by cardiac event (p = 0.013) and retransplantation rate (p = 0.015). In contrast, patients supported with BiVAD and LVAD were more likely to be weaned off support (p = 0.020). Overall, no significant difference was found in pooled 30 day survival (p = 0.31), survival to discharge (p = 0.19), and overall survival (p = 0.51) between the subgroups. Temporary mechanical circulatory support is an effective modality to support patients with graft dysfunction after heart transplantation. Further studies are needed to establish the optimal threshold and strategy for TMCS and to augment cardiac recovery and long-term survival.
移植物功能障碍是心脏移植后早期死亡的主要原因。在严重移植物功能障碍的情况下，可能需要临时机械循环支持 (TMCS)。本系统评价的目的是检查 TMCS 在心脏移植后移植物功能障碍患者中的应用和结局。电子检索以确定评估 TMCS 用于移植物功能障碍的所有英文文献研究。对所有确定的文章进行系统评估，以确定纳入和排除标准。在确定的 5462 项研究中，有 41 项研究被纳入。在接受心脏移植的 11555 名患者中，有 695 名 (6.0%) 需要 TMCS 支持，最常使用的是静脉动脉体外膜肺氧合 (79.4%)，其次是右心室辅助装置 (11.1%)、双心室辅助装置 (BiVADs) (7.5%) 和左心室辅助装置 (LVADs) (2.0%)。使用 LVAD 支持的患者更有可能支持时间更长 (p = 0.003)，心脏事件死亡率 (p = 0.013) 和再次移植率 (p = 0.015)更高。相比之下，使用 BiVAD 和 LVAD 支持的患者更有可能脱机 (p = 0.020)。总体而言，亚组间 30 天生存率 (p = 0.31)、出院生存率 (p = 0.19) 和总生存率 (p = 0.51) 无显著差异。TMCS 是支持心脏移植后移植物功能障碍患者的有效方法。需要进一步研究以确定 TMCS 的最佳阈值和策略，并增强心脏恢复和长期生存。
