Lee Jae Jun, Kim Young Su, Chung Suryeun, Jeong Dong Seop, Yang Ji-Hyuk, Sung Kiick, Kim Wook Sung, Jun Tae-Gook, Cho Yang Hyun
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Chest Surg. 2021 Apr 5;54(2):99-105. doi: 10.5090/jcs.20.115.
The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLSbridged HTx.
From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach.
The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023).
We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.
心脏移植（HTx）的数量每年都在增加。由于医学和外科支持的进步，心脏移植的结果也在改善。体外循环生命支持（ECLS）为失代偿性心力衰竭患者提供了接受心脏移植的机会。一种涉及不同领域经验丰富专家合作的医学方法应能改善ECLS桥接心脏移植的结果和预后。
2003年12月至2018年12月，1465例患者在三星医疗中心接受了ECLS治疗。我们排除了未接受心脏移植或接受重复移植的患者。排除年龄小于18岁的患者。我们还排除了在心脏移植前接受植入式耐用左心室辅助装置的患者。本研究共纳入91例患者。2013年3月我院开始采用多学科团队方法。根据患者在团队方法实施之前或之后接受治疗，将患者分为两组。
ECLS团队治疗前组的30天死亡率显著高于ECLS团队治疗后组（n = 5，18.5% 对 n = 2，3.1%；p = 0.023）。ECLS团队治疗后组的1年生存率优于ECLS团队治疗前组（n = 57，89.1% 对 n = 19，70.4%；p = 0.023）。
我们发现实施多学科团队方法可改善ECLS桥接心脏移植的结果。进行高风险心脏移植的心脏移植中心应采用基于团队的护理。
