Advanced Heart Failure Section, Cardiovascular Division, (R.Y.L.-R., S.L.), Spectrum Health, Grand Rapids, MI.
Division of Cardiothoracic Surgery (T.B., M.L.), Spectrum Health, Grand Rapids, MI.
Circ Heart Fail. 2020 Mar;13(3):e006387. doi: 10.1161/CIRCHEARTFAILURE.119.006387. Epub 2020 Mar 13.
Limited data are available regarding the outcomes of patients supported by extracorporeal membrane oxygenation (ECMO) who undergo durable mechanical circulatory support implantation (dMCS). We analyzed the clinical characteristics, outcomes, and risk factors for mortality in patients who were bridged with ECMO to dMCS.
Adult patients who received dMCS between January 2008 and December 2017 (n=19 824), registered in the Society of Thoracic Surgeons-Interagency Registry for Mechanical Assisted Circulatory Support (STS-INTERMACS) database were included. Baseline characteristics, outcomes, risk factors, and adverse events were compared between ECMO-supported patients (n=933) and INTERMACS profile 1 (IP-1) patients not supported by ECMO (n=2362). A propensity match analysis was performed.
ECMO patients had inferior survival at 12 months (66.1%) than non-ECMO patients (75.4%; <0.0001). The proportion of patients transplanted at 2 years after dMCS was similar between the ECMO (30.8%) and non-ECMO (31.8%) groups (=0.49). A multiphase parametric hazard model identified 2 different periods based on risk of death. ECMO patients had a high hazard for death in the first 6 months after implantation (hazard ratio, 2.18 [1.79-2.66]; <0.001). Multivariable analysis showed that ECMO was an independent risk factor associated with poor outcome during the early phase after dMCS (hazard ratio, 1.69 [1.37-2.09]; <0.0001) but not during the constant phase. ECMO patients had similar outcomes to non-ECMO patients when a propensity matched cohort was analyzed.
ECMO-supported patients before dMCS have lower survival compared with other IP-1 patients. A multivariable analysis showed that ECMO is an independent risk factor of poor outcome after dMCS. However, a propensity matched analysis suggested that when important clinical variables are controlled the outcome of both groups is similar. These data support the implantation of dMCS in carefully selected ECMO patients.
关于接受体外膜肺氧合（ECMO）支持后进行持久机械循环支持植入（dMCS）的患者的结局，相关数据有限。我们分析了通过 ECMO 桥接至 dMCS 的患者的临床特征、结局和死亡风险因素。
纳入 2008 年 1 月至 2017 年 12 月期间在胸外科医师学会-机械循环辅助国际注册处（STS-INTERMACS）数据库中接受 dMCS 的成年患者（n=19824）。比较 ECMO 支持患者（n=933）和未接受 ECMO 支持的 INTERMACS 1 型（IP-1）患者（n=2362）的基线特征、结局、风险因素和不良事件。进行倾向评分匹配分析。
12 个月时，ECMO 患者的生存率（66.1%）低于非 ECMO 患者（75.4%；<0.0001）。dMCS 后 2 年接受移植的患者比例在 ECMO 组（30.8%）和非 ECMO 组（31.8%）之间相似（=0.49）。多阶段参数风险模型根据死亡风险确定了 2 个不同的阶段。ECMO 患者在植入后 6 个月内死亡的风险很高（风险比，2.18 [1.79-2.66]；<0.001）。多变量分析显示，ECMO 是 dMCS 后早期不良结局的独立危险因素（风险比，1.69 [1.37-2.09]；<0.0001），但在恒定期无此作用。当对倾向评分匹配队列进行分析时，ECMO 患者的结局与非 ECMO 患者相似。
dMCS 前接受 ECMO 支持的患者的生存率低于其他 IP-1 患者。多变量分析显示，ECMO 是 dMCS 后不良结局的独立危险因素。然而，倾向评分匹配分析表明，当控制重要的临床变量时，两组的结局相似。这些数据支持在仔细选择的 ECMO 患者中植入 dMCS。
