Mastroianni Ciro, Nenna Antonio, Lebreton Guillaume, D'Alessandro Cosimo, Greco Salvatore Matteo, Lusini Mario, Leprince Pascal, Chello Massimo
Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Department of Cardiac Surgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, France.
Ann Cardiothorac Surg. 2019 Jan;8(1):99-108. doi: 10.21037/acs.2018.12.08.
Heart transplantation (HTx) is a valuable option in eligible patients with end-stage heart failure. The most significant complication in the immediate post-operative period is early graft failure (EGF), with a mean incidence of 20-25%. EGF is a major risk factor for death and accounts for 40-50% of early mortality after HTx. Despite the use of inotropes, EGF may persist and require temporary mechanical circulatory support. Extracorporeal membrane oxygenation (ECMO) has been investigated over the years and has proved to be a reliable strategy in patients with EGF after HTx. This study aims to review the contemporary literature on this topic. Considering short-term outcomes, 45-80% of patients were discharged alive from hospital. Duration of support is variable, with a mean duration of 4-8 days. Cannulation strategy and device selection have no differences with respect to short-term outcomes. The main causes of death are multi-organ failure, bleeding, heart failure, stroke and sepsis. Considering long-term outcomes, ECMO survivors appear to have similar survival rates to HTx patients who did not experience EGF. Also, ECMO-treated EGF, among survivors, has no detrimental effect for graft function. In conclusion, ECMO is a reliable therapeutic option to support patients with severe graft failure after HTx, providing adequate support with either central or peripheral arteriovenous cannulation. Further studies will be needed to establish the correct threshold for ECMO support and to provide long-term results.
心脏移植（HTx）对于符合条件的终末期心力衰竭患者而言是一种有价值的选择。术后即刻最严重的并发症是早期移植物功能衰竭（EGF），平均发生率为20% - 25%。EGF是死亡的主要危险因素，占HTx术后早期死亡率的40% - 50%。尽管使用了正性肌力药物，EGF仍可能持续存在，并需要临时机械循环支持。多年来一直在研究体外膜肺氧合（ECMO），并且已证明它是HTx术后发生EGF患者的可靠治疗策略。本研究旨在综述关于该主题的当代文献。考虑短期结果，45% - 80%的患者出院时存活。支持时间各不相同，平均时长为4 - 8天。插管策略和设备选择在短期结果方面没有差异。死亡的主要原因是多器官功能衰竭、出血、心力衰竭、中风和败血症。考虑长期结果，ECMO存活者的生存率似乎与未经历EGF的HTx患者相似。此外，在存活者中，经ECMO治疗的EGF对移植物功能没有不利影响。总之，ECMO是支持HTx术后严重移植物功能衰竭患者的可靠治疗选择，通过中心或外周动静脉插管均可提供充分支持。需要进一步研究来确定ECMO支持的正确阈值并提供长期结果。
