Pellenc Quentin, Girault Antoine, Roussel Arnaud, Aguir Sonia, Cerceau Pierre, Longrois Dan, Mal Hervé, Mordant Pierre, Castier Yves
Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, Bichat Hospital, Paris University, Paris, France.
Département d'Anesthésie-Réanimation, Bichat Hospital, Paris University, Paris, France.
Eur J Cardiothorac Surg. 2020 Aug 1;58(2):371-378. doi: 10.1093/ejcts/ezaa039.
In lung transplantation (LT), femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) usually requires an open approach that may be associated with severe groin wound infection. In endovascular aortic procedures, preclosing of the femoral artery (PFA) with vascular closure devices allows the percutaneous insertion and withdrawal of large-bore cannulae. We sought to evaluate whether this innovative technique could be applied in the specific setting of LT to achieve total percutaneous VA-ECMO and decrease groin wound infection.
We conducted a retrospective study of a prospective database including patients who underwent LT in our centre from January 2011 to December 2017. Patients who underwent peripheral VA-ECMO using the PFA technique after January 2014 (PFA group, n = 106) were compared to those who underwent peripheral VA-ECMO using open cannulation and/or decannulation before January 2014 (non-PFA group, n = 48). The primary end point was the rate of technical success defined as total percutaneous VA-ECMO. Secondary end points included groin wound infections and delayed vascular complications.
The PFA technique was technically successful in 98 patients (92.5%). As compared with the non-PFA group, the PFA group was characterized by a similar rate of vascular complications (16.6% vs 11.3%, P = 0.360) and a decreased rate of groin wound infection (18.9% vs 0%, P < 0.001). In multivariate analysis, risk factors associated with vascular complications following PFA included female sex, peripheral arterial disease and ECMO duration.
In LT patients, PFA is associated with a high rate of total percutaneous VA-ECMO, thus preventing the occurrence of groin wound infection.
在肺移植（LT）中，股动静脉体外膜肺氧合（VA-ECMO）通常需要开放手术入路，这可能会伴有严重的腹股沟伤口感染。在血管腔内主动脉手术中，使用血管闭合装置预先闭合股动脉（PFA）可实现经皮插入和拔出大口径插管。我们试图评估这种创新技术是否可应用于LT的特定情况，以实现完全经皮VA-ECMO并减少腹股沟伤口感染。
我们对一个前瞻性数据库进行了回顾性研究，该数据库包括2011年1月至2017年12月在我们中心接受LT的患者。将2014年1月后采用PFA技术进行外周VA-ECMO的患者（PFA组，n = 106）与2014年1月前采用开放插管和/或拔管进行外周VA-ECMO的患者（非PFA组，n = 48）进行比较。主要终点是定义为完全经皮VA-ECMO的技术成功率。次要终点包括腹股沟伤口感染和延迟性血管并发症。
PFA技术在98例患者（92.5%）中取得技术成功。与非PFA组相比，PFA组的血管并发症发生率相似（16.6%对11.3%，P = 0.360），腹股沟伤口感染率降低（18.9%对0%，P < 0.001）。在多变量分析中，PFA后与血管并发症相关的危险因素包括女性、外周动脉疾病和ECMO持续时间。
在LT患者中，PFA与高比例的完全经皮VA-ECMO相关，从而预防腹股沟伤口感染的发生。
