Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany.
Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany.
J Am Coll Cardiol. 2020 Dec 22;76(25):2956-2964. doi: 10.1016/j.jacc.2020.10.036.
The decision to implant durable mechanical circulatory systems (MCSs) in patients on extracorporeal life support (ECLS) is challenging due to expected poor outcomes in these patients.
The aim of this study was to identify outcome predictors that may facilitate future patient selection and decision making.
The Durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent MCS implantation after ECLS between January 2010 and August 2018 in 11 high-volume European centers. Several perioperative parameters were collected. The primary endpoint was survival at 1 year after durable MCS implantation.
A total of 531 durable MCSs after ECLS were implanted during this period. The average patient age was 53 ± 12 years old. ECLS cannulation was peripheral in 87% of patients and 33% of the patients had history of cardiopulmonary resuscitation before ECLS implantation. The 30-day, 1-year, and 3-year actuarial survival rates were 77%, 53%, and 43%, respectively. The following predictors for 1-year outcome have been observed: age, female sex, lactate value, Model of End-Stage Liver Disease XI score, history of atrial fibrillation, redo surgery, and body mass index >30 kg/m. On the basis of this data, a risk score and an app to estimate 1-year mortality was created.
The outcome in patients receiving durable MCS after ECLS remains limited, yet preoperative factors may allow differentiating futile patients from those with significant survival benefit.
由于这些患者的预期预后较差，因此在接受体外生命支持 (ECLS) 的患者中决定植入耐用型机械循环系统 (MCS) 具有挑战性。
本研究旨在确定可能有助于未来患者选择和决策的预后预测因素。
Durable MCS after ECLS 登记处是一项多中心回顾性研究，该研究收集了 2010 年 1 月至 2018 年 8 月期间在 11 个欧洲大容量中心接受 ECLS 后植入耐用型 MCS 的连续患者的数据。收集了几个围手术期参数。主要终点是植入耐用型 MCS 后 1 年的生存率。
在此期间共植入了 531 例 ECLS 后的耐用型 MCS。患者的平均年龄为 53 ± 12 岁。87%的患者采用外周 ECLS 插管，33%的患者在植入 ECLS 前有过心肺复苏史。30 天、1 年和 3 年的实际生存率分别为 77%、53%和 43%。观察到以下 1 年预后的预测因素：年龄、女性、乳酸值、终末期肝病模型 XI 评分、心房颤动史、再次手术和体重指数 >30kg/m2。基于这些数据，创建了一个风险评分和一个应用程序来估计 1 年死亡率。
接受 ECLS 后植入耐用型 MCS 的患者的预后仍然有限，但术前因素可能有助于区分无效患者和具有显著生存获益的患者。
