心脏移植和心室辅助装置中心的静脉-动脉体外生命支持。荟萃分析。
Veno-Arterial Extracorporeal Life Support in Heart Transplant and Ventricle Assist Device Centres. Meta-analysis.
作者信息
Kowalewski Mariusz, Zieliński Kamil, Gozdek Mirosław, Raffa Giuseppe Maria, Pilato Michele, Alanazi Musab, Gilbers Martijn, Heuts Sam, Natour Ehsan, Bidar Elham, Schreurs Rick, Delnoij Thijs, Driessen Rob, Sels Jan Willem, van de Poll Marcel, Roekaerts Paul, Pasierski Michał, Meani Paolo, Maessen Jos, Suwalski Piotr, Lorusso Roberto
机构信息
Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Wołoska 137 Str, Warsaw, 02-507, Poland.
Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, Maastricht, The Netherlands.
出版信息
ESC Heart Fail. 2021 Apr;8(2):1064-1075. doi: 10.1002/ehf2.13080. Epub 2020 Dec 18.
AIMS
Because reported mortality on veno-arterial (V-A) extracorporeal life support (ECLS) substantially varies between centres, the aim of the current analysis was to assess the outcomes between units performing heart transplantation and/or implanting ventricular assist device (HTx/VAD) vs. non-HTx/VAD units in patients undergoing V-A ECLS for cardiogenic shock.
METHODS AND RESULTS
Systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed using PubMed/MEDLINE databases until 30 November 2019. Articles reporting in-hospital/30-day mortality and centre's HTx/VAD status were included. In-hospital outcomes and long-term survival were analysed in subgroup meta-analysis. A total of 174 studies enrolling n = 13 308 patients were included with 20 series performed in non-HTx/VAD centres (1016 patients, 7.8%). Majority of patients underwent V-A ECLS for post-cardiotomy shock (44.2%) and acute myocardial infarction (20.7%). Estimated overall in-hospital mortality was 57.2% (54.9-59.4%). Mortality rates were higher in non-HTx/VAD [65.5% (59.8-70.8%)] as compared with HTx/VAD centres [55.8% (53.3-58.2%)], P < 0.001. Estimated late survival was 61.8% (55.7-67.9%) without differences between non-HTx/VAD and HTx/VAD centres: 66.5% (30.3-1.02%) vs. 61.7% (55.5-67.8%), respectively (P = 0.797). No differences were seen with respect to ECLS duration, limb complications, and reoperations for bleeding, kidney injury, and sepsis. Yet, weaning rates were higher in HTx/VAD vs. non-HTx/VAD centres: 58.7% (56.2-61.1%) vs. 48.9% (42.0-55.9%), P = 0.010. Estimated rate of bridge to heart transplant was 6.6% (5.2-8.3%) with numerical, yet not statistically significant, difference between non-HTx/VAD [2.7% (0.8-8.3%)] as compared with HTx/VAD [6.7% (5.3-8.6%)] (P = 0.131).
CONCLUSIONS
Survival after V-A ECLS differed according to centre's HTx/VAD status. Potentially different risk profiles of patients must be taken account for before definite conclusions are drawn.
目的
由于静脉 - 动脉（V - A）体外生命支持（ECLS）的报告死亡率在各中心之间存在显著差异，本分析的目的是评估在因心源性休克接受V - A ECLS治疗的患者中，进行心脏移植和/或植入心室辅助装置（HTx/VAD）的单位与未进行HTx/VAD的单位之间的治疗结果。
方法和结果
根据系统评价和荟萃分析的首选报告项目，使用PubMed/MEDLINE数据库进行系统检索，截至2019年11月30日。纳入报告住院/30天死亡率及中心HTx/VAD状态的文章。在亚组荟萃分析中分析住院结局和长期生存率。共纳入174项研究，涉及n = 13308例患者，其中20个系列在非HTx/VAD中心进行（1016例患者，7.8%）。大多数患者因心脏术后休克（44.2%）和急性心肌梗死（20.7%）接受V - A ECLS治疗。估计总体住院死亡率为57.2%（54.9 - 59.4%）。与HTx/VAD中心[55.8%（53.3 - 58.2%）]相比，非HTx/VAD中心的死亡率更高[65.5%（59.8 - 70.8%）]，P < 0.001。估计晚期生存率为61.8%（55.7 - 67.9%），非HTx/VAD中心和HTx/VAD中心之间无差异：分别为66.5%（30.3 - 1.02%）和61.7%（55.5 - 67.8%）（P = 0.797）。在ECLS持续时间、肢体并发症以及出血、肾损伤和脓毒症的再次手术方面未见差异。然而，HTx/VAD中心的撤机率高于非HTx/VAD中心：58.7%（56.2 - 61.1%）对48.9%（42.0 - 55.9%），P = 0.010。估计过渡到心脏移植的比例为6.6%（5.2 - 8.3%），非HTx/VAD中心[2.7%（0.8 - 8.3%）]与HTx/VAD中心[6.7%（5.3 - 8.6%）]之间存在数值差异，但无统计学意义（P = 0.131）。
结论
V - A ECLS后的生存率因中心的HTx/VAD状态而异。在得出明确结论之前，必须考虑患者潜在的不同风险特征。
Zotero 插件