Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida.
Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas.
Clin Transplant. 2019 May;33(5):e13538. doi: 10.1111/ctr.13538. Epub 2019 Apr 14.
Severe primary graft dysfunction (PGD) is the leading cause of early death after heart transplant.
To examine the outcomes of heart transplant recipients who received venoarterial extracorporeal membrane oxygenation (VA-ECMO) for severe PGD.
We reviewed electronic health records of adult patients who underwent heart transplant from November 2005 through June 2015. We defined severe PGD according to International Society for Heart and Lung Transplantation consensus statements.
Of 1030 heart transplant patients, 31 (3%) had severe PGD and required VA-ECMO. The mean (range) age was 59 (43-69) years. Fifteen patients (48%) underwent prior sternotomy and 10 (32%) received a left ventricular assist device as a bridge to transplant. Severe PGD manifested as failure to wean from cardiopulmonary bypass in 20 patients (65%) and as severe hemodynamic instability in the immediate postoperative period in 10 (32%), including cardiac arrest in 3 (10%). Twenty-five patients (81%) were successfully weaned from VA-ECMO, and 19 (61%) were discharged; the other 12 (39%) died.
Although VA-ECMO is a common method for providing mechanical circulatory support to patients with PGD, multicenter studies are needed to assess factors associated with successful outcomes and improved survival of these patients.
严重原发性移植物功能障碍（PGD）是心脏移植后早期死亡的主要原因。
研究接受静脉动脉体外膜肺氧合（VA-ECMO）治疗严重 PGD 的心脏移植受者的结局。
我们回顾了 2005 年 11 月至 2015 年 6 月期间接受心脏移植的成年患者的电子健康记录。我们根据国际心肺移植协会共识声明定义了严重 PGD。
在 1030 例心脏移植患者中，有 31 例（3%）发生严重 PGD，需要 VA-ECMO。平均（范围）年龄为 59（43-69）岁。15 例（48%）患者行前胸骨切开术，10 例（32%）患者接受左心室辅助装置作为移植前的桥接。严重 PGD 的表现为 20 例（65%）患者无法从心肺旁路机中撤离，10 例（32%）患者在术后即刻出现严重的血流动力学不稳定，包括 3 例（10%）患者发生心脏骤停。25 例（81%）患者成功撤离 VA-ECMO，19 例（61%）患者出院；其余 12 例（39%）死亡。
尽管 VA-ECMO 是为 PGD 患者提供机械循环支持的常用方法，但需要多中心研究来评估与这些患者成功结局和生存率提高相关的因素。
