Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
Braz J Cardiovasc Surg. 2021 Jun 1;36(3):308-317. doi: 10.21470/1678-9741-2020-0344.
In heart transplantation (HT) recipients, several factors are critical to promptly adopting appropriate rehabilitation strategies and may be important to predict outcomes way after surgery. This study aimed to determine preoperative patient-related risk factors that could adversely affect the postoperative clinical course of patients undergoing HT.
Twenty-one hospitalized patients with heart failure undergoing HT were evaluated according to respiratory muscle strength and functional capacity before HT. Mechanical ventilation (MV) time, reintubation rate, and intensive care unit (ICU) length of stay were recorded, and assessed postoperatively.
Inspiratory muscle strength as absolute and percentpredicted values were strongly correlated with MV time (r=-0.61 and r=-0.70, respectively, at P<0.001). Concerning ICU length of stay, only maximal inspiratory pressure (MIP) absolute and percent-predicted values were significantly associated. The absolute |MIP| was significantly negatively correlated with ICU length of stay (r=-0.58 at P=0.006) and the percent-predicted MIP was also significantly negatively correlated with ICU length of stay (r=-0.68 at P=0.0007). No associations were observed between preoperative functional capacity, age, sex, and clinical characteristics and MV time and ICU length of stay in the cohort included in this study. Patients with respiratory muscle weakness had a higher prevalence of prolonged MV, reintubation, and delayed ICU length of stay.
An impairment of preoperative MIP was associated with poorer short-term outcomes following HT. As such, inspiratory muscle strength is an important clinical preoperative marker in patients undergoing HT.
在心脏移植（HT）受者中，有几个因素对于及时采取适当的康复策略至关重要，并且可能对手术后的预后具有重要意义。本研究旨在确定术前与患者相关的危险因素，这些因素可能对 HT 术后患者的临床病程产生不利影响。
根据 HT 前呼吸肌力量和功能能力，对 21 例住院心力衰竭行 HT 的患者进行评估。记录机械通气（MV）时间、再插管率和重症监护病房（ICU）住院时间，并进行术后评估。
吸气肌力量的绝对值和百分比预测值与 MV 时间呈强相关（r=-0.61 和 r=-0.70，均 P<0.001）。关于 ICU 住院时间，仅最大吸气压力（MIP）绝对值和百分比预测值与 ICU 住院时间显著相关。绝对值|MIP|与 ICU 住院时间呈显著负相关（r=-0.58，P=0.006），百分比预测的 MIP 也与 ICU 住院时间呈显著负相关（r=-0.68，P=0.0007）。在本研究纳入的队列中，术前功能能力、年龄、性别和临床特征与 MV 时间和 ICU 住院时间之间没有观察到相关性。呼吸肌无力的患者 MV 时间延长、再插管和 ICU 住院时间延长的发生率更高。
术前 MIP 受损与 HT 后短期预后较差相关。因此，吸气肌力量是 HT 患者重要的术前临床标志物。
