Pozzi Matteo, Alvau Francesca, Armoiry Xavier, Grinberg Daniel, Hugon-Vallet Elisabeth, Koffel Catherine, Portran Philippe, Scollo Giovanni, Fellahi Jean Luc, Obadia Jean Francois
Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
University of Lyon, School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Lyon University Hospitals, "Edouard Herriot" Hospital, Pharmacy Department, Lyon, France.
J Card Surg. 2019 Feb;34(2):74-81. doi: 10.1111/jocs.13985. Epub 2019 Jan 12.
Extracorporeal life support (ECLS) may be necessary in refractory postcardiotomy cardiogenic shock (PCS) unresponsive to optimal medical treatment. We sought to analyze the results and temporal outcomes of ECLS for PCS.
We performed an observational analysis of our prospective database. In order to analyze the temporal trends of ECLS for PCS, patients were divided into two groups according to the period of ECLS implantation: Group I from January 2007-June 2012, Group II from July 2012-December 2017. The primary endpoint was survival to hospital discharge.
During the study period, 90 patients required ECLS for PCS (Group I n = 29, 32%; Group II n = 61, 68%). Mean age was 57.5 ± 15.0 years with 62% of males. Preoperative characteristics were comparable over the two periods. A high proportion of patients were in NYHA class III/IV (61%) or cardiogenic shock (22%). Group II showed a significantly higher proportion of miscellaneous cardiac surgery operations (23 vs 3%, P = 0.031). Crossclamp and cardiopulmonary bypass times were significantly shorter in Group II (85.4 vs 114.2 min, P = 0.023 and 135.2 vs 184.2 min, P = 0.022, respectively). The complication rate during ECLS support was comparable between both groups. Successful weaning from ECLS could be accomplished in 45 (50%) patients (Group I = 52% vs Group II = 49%, P = 0.822) after a mean support of 6.4 days. Thirty-five (39%) patients survived to hospital discharge (Group I = 41% vs Group II = 38%, P = 0.738).
Outcomes following ECLS remained stable over an 11-year period. ECLS may be limited in patients with severe preoperative cardiac dysfunction. Our data suggest that these patients may be better served with less invasive, percutaneous procedures.
对于经最佳药物治疗仍无反应的难治性心脏术后心源性休克（PCS），体外生命支持（ECLS）可能是必要的。我们试图分析ECLS治疗PCS的结果和时间结局。
我们对前瞻性数据库进行了观察性分析。为了分析ECLS治疗PCS的时间趋势，根据ECLS植入时间将患者分为两组：第一组为2007年1月至2012年6月，第二组为2012年7月至2017年12月。主要终点是存活至出院。
在研究期间，90例PCS患者需要ECLS（第一组n = 29，32%；第二组n = 61，68%）。平均年龄为57.5±15.0岁，男性占62%。两个时期的术前特征具有可比性。高比例患者为纽约心脏协会（NYHA）III/IV级（61%）或心源性休克（22%）。第二组中杂项心脏手术操作的比例显著更高（23%对3%，P = 0.031）。第二组的主动脉阻断和体外循环时间显著更短（分别为85.4对114.2分钟，P = 0.023；135.2对184.2分钟，P = 0.022）。两组在ECLS支持期间的并发症发生率相当。在平均支持6.4天后，45例（50%）患者成功脱离ECLS（第一组 = 52%对第二组 = 49%，P = 0.822）。35例（39%）患者存活至出院（第一组 = 41%对第二组 = 38%，P = 0.738）。
在11年期间，ECLS后的结局保持稳定。对于术前严重心脏功能障碍的患者，ECLS可能有限。我们的数据表明，这些患者可能通过侵入性较小的经皮手术得到更好的治疗。
