Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 2021 Sep;162(3):992-1001. doi: 10.1016/j.jtcvs.2020.10.151. Epub 2020 Dec 1.
To report outcomes in a pilot study of autologous mitochondrial transplantation (MT) in pediatric patients requiring postcardiotomy extracorporeal membrane oxygenation (ECMO) for severe refractory cardiogenic shock after ischemia-reperfusion injury (IRI).
A single-center retrospective study of patients requiring ECMO for postcardiotomy cardiogenic shock following IRI between May 2002 and December 2018 was performed. Postcardiotomy IRI was defined as coronary artery compromise followed by successful revascularization. Patients undergoing revascularization and subsequent MT were compared with those undergoing revascularization alone (Control).
Twenty-four patients were included (MT, n = 10; Control, n = 14). Markers of systemic inflammatory response and organ function measured 1 day before and 7 days following revascularization did not differ between groups. Successful separation from ECMO-defined as freedom from ECMO reinstitution within 1 week after initial separation-was possible for 8 patients in the MT group (80%) and 4 in the Control group (29%) (P = .02). Median circumferential strain immediately following IRI but before therapy was not significantly different between groups. Immediately following separation from ECMO, ventricular strain was significantly better in the MT group (-23.0%; range, -20.0% to -28.8%) compared with the Control group (-16.8%; range, -13.0% to -18.4%) (P = .03). Median time to functional recovery after revascularization was significantly shorter in the MT group (2 days vs 9 days; P = .02). Cardiovascular events were lower in the MT group (20% vs 79%; P < .01). Cox regression analysis showed higher composite estimated risk of cardiovascular events in the Control group (hazard ratio, 4.6; 95% confidence interval, 1.0 to 20.9; P = .04) CONCLUSIONS: In this pilot study, MT was associated with successful separation from ECMO and enhanced ventricular strain in patients requiring postcardiotomy ECMO for severe refractory cardiogenic shock after IRI.
报告自体线粒体移植（MT）在儿科患者中的初步研究结果，这些患者在缺血再灌注损伤（IRI）后需要体外膜肺氧合（ECMO）治疗严重难治性心源性休克。
对 2002 年 5 月至 2018 年 12 月间因 IRI 后心脏手术后心源性休克而行 ECMO 的患者进行单中心回顾性研究。心脏手术后 IRI 定义为冠状动脉阻塞后继发成功的血运重建。比较接受血运重建和随后 MT 的患者与仅接受血运重建的患者（对照组）。
共纳入 24 例患者（MT 组 10 例，对照组 14 例）。血运重建前 1 天和后 7 天两组间全身炎症反应和器官功能的标志物无差异。MT 组有 8 例（80%）患者成功脱离 ECMO（定义为初次分离后 1 周内无需再次重新使用 ECMO），对照组有 4 例（29%）（P=0.02）。MT 组在 IRI 后但在治疗前即刻的圆周应变中位数与对照组无显著差异。MT 组在 ECMO 分离后即刻的心室应变明显优于对照组（-23.0%；范围，-20.0%至-28.8%），而对照组为-16.8%（范围，-13.0%至-18.4%）（P=0.03）。MT 组血运重建后功能恢复的中位时间明显短于对照组（2 天比 9 天；P=0.02）。MT 组心血管事件发生率较低（20%比 79%；P<0.01）。Cox 回归分析显示，对照组心血管事件的复合估计风险较高（危险比，4.6；95%置信区间，1.0 至 20.9；P=0.04）。
在这项初步研究中，MT 与 ECMO 分离成功和增强心室应变相关，在因 IRI 后严重难治性心源性休克而需要心脏手术后 ECMO 的患者中。
