Department of Pediatrics-Cardiology, Stanford University, Palo Alto, Calif.
Department of Pediatrics-Cardiology, Stanford University, Palo Alto, Calif.
J Thorac Cardiovasc Surg. 2019 Jun;157(6):2433-2440. doi: 10.1016/j.jtcvs.2019.01.100. Epub 2019 Feb 6.
To determine the association between continuous flow ventricular assist devices and the incidence of vasoplegia following orthotopic heart transplant in children. Moreover, to propose a novel clinical definition of vasoplegia for use in pediatric populations.
This is a single-center, retrospective cohort study set in the cardiovascular intensive care unit of a tertiary children's hospital. All patients aged 3 years and older who underwent orthotopic heart transplant at Stanford University between April 1, 2014, and July 31, 2017, were included. Vasoplegia was defined by the use of vasoconstrictive medication, diastolic hypotension, preserved systolic heart function, and absence of infection or right atrial pressure or central venous pressure <5 mm Hg.
Of 44 eligible patients, 21 were supported using a continuous flow ventricular assist device. Following heart transplant, 14 patients (32%) developed vasoplegia by the study definition. Development of vasoplegia was associated with pretransplant use of a continuous flow ventricular assist device (52% vs 13%) with a relative risk of 4.02 (95% confidence interval, 1.30-12.45; P = .009). No other variables were predictive of vasoplegia in univariable analysis. Presence of vasoplegia was not associated with adverse outcomes, although there were trends towards higher incidence of acute kidney injury and increased length of hospital stays.
Children receiving continuous flow ventricular assist device support are at increased risk for vasoplegia following orthotopic heart transplant, using a novel definition of vasoplegia. Anticipation of this complication will allow for prompt intervention, thereby minimizing hemodynamic instability and impact on patient outcomes.
确定儿童原位心脏移植后连续血流心室辅助装置与血管麻痹发生率之间的关系。此外，提出一种新的儿科血管麻痹临床定义。
这是一项单中心、回顾性队列研究，在斯坦福大学三级儿童医院的心血管重症监护病房进行。所有于 2014 年 4 月 1 日至 2017 年 7 月 31 日期间在斯坦福大学接受原位心脏移植的年龄在 3 岁及以上的患者均纳入本研究。血管麻痹的定义为使用血管收缩药物、舒张压低血压、收缩期心脏功能正常且无感染或右心房压或中心静脉压<5mmHg。
在 44 名符合条件的患者中，21 名患者使用连续血流心室辅助装置进行支持。心脏移植后，根据研究定义，14 名患者（32%）发生血管麻痹。血管麻痹的发生与移植前使用连续血流心室辅助装置有关（52% vs 13%），相对风险为 4.02（95%置信区间，1.30-12.45；P=.009）。在单变量分析中，没有其他变量可以预测血管麻痹。血管麻痹的存在与不良结局无关，尽管急性肾损伤发生率较高和住院时间延长的趋势。
接受连续血流心室辅助装置支持的儿童在原位心脏移植后发生血管麻痹的风险增加，采用了一种新的血管麻痹定义。预测这种并发症将有助于及时干预，从而最大限度地减少血流动力学不稳定和对患者结局的影响。
