Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
Interact Cardiovasc Thorac Surg. 2021 Apr 8;32(3):476-482. doi: 10.1093/icvts/ivaa280.
Patients with mechanical circulatory support bridged to a heart transplant (HTx) are at higher risk of postoperative graft dysfunction. In this subset, a mode of graft preservation that shortens graft ischaemia should be beneficial.
The outcomes of 38 patients on mechanical circulatory support (extracorporeal life support, left ventricular assist device and biventricular assist device) who received a HTx between 2015 and 2020 were analysed according to the method of graft preservation: cold storage (CS) group, 24 (63%) or ex vivo perfusion (EVP) group, 14 (37%).
The median age was 57 (range 30-73) vs 64 (35-75) years (P = 0.10); 88% were men (P = 0.28); extracorporeal life support was more frequent in the CS group (54% vs 36%; P = 0.27) versus left ventricular and biventricular assist devices in the EVP group (46% vs 64%; P = 0.27). Clamping time was shorter in the EVP group (P < 0.001) and ischaemic time >4 h was higher in the CS group (P = 0.01). Thirty-day mortality was 13% (0-27%) in the CS group and 0% (P = 0.28) in the EVP group. A significantly lower primary graft failure [7% (0-23%) vs 42% (20-63%); P = 0.03] was observed in the EVP group. Survival at 1 year was 79 ± 8% (63-95%) in the CS group and 84 ± 10% (64-104%) in the EVP group (P = 0.95).
Our results support the use of ex vivo graft perfusion in patients on mechanical circulatory support as a bridge to a HTx. This technique, by shortening graft ischaemic time, seems to improve post-HTx outcomes.
接受机械循环支持桥接心脏移植（HTx）的患者术后移植物功能障碍的风险更高。在这部分患者中，应选择缩短移植物缺血时间的保存方式。
分析了 2015 年至 2020 年间接受 HTx 的 38 例机械循环支持（体外生命支持、左心室辅助装置和双心室辅助装置）患者的结局，根据移植物保存方式进行分组：冷保存（CS）组 24 例（63%）或体外灌注（EVP）组 14 例（37%）。
中位年龄分别为 57 岁（范围 30-73 岁）和 64 岁（35-75 岁）（P=0.10）；88%为男性（P=0.28）；CS 组中体外生命支持更为常见（54%比 36%；P=0.27），EVP 组中左心室和双心室辅助装置更为常见（46%比 64%；P=0.27）。EVP 组的夹闭时间更短（P<0.001），CS 组缺血时间>4 h 的比例更高（P=0.01）。CS 组 30 天死亡率为 13%（0-27%），EVP 组为 0%（P=0.28）。EVP 组原发性移植物功能衰竭发生率明显较低[7%（0-23%）比 42%（20-63%）；P=0.03]。CS 组 1 年生存率为 79±8%（63-95%），EVP 组为 84±10%（64-104%）（P=0.95）。
我们的研究结果支持在接受机械循环支持的患者中使用体外移植物灌注作为 HTx 的桥接方法。这种技术通过缩短移植物缺血时间，似乎改善了 HTx 后的结局。
