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性别相关倾向评分匹配分析 ECMO 治疗在冠状动脉搭桥术后心肌梗死后心原性休克患者中的应用。

Gender-related propensity score match analysis of ECMO therapy in postcardiotomy cardiogenic shock in patients after myocardial revascularization.

机构信息

Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany.

出版信息

Perfusion. 2022 Jul;37(5):470-476. doi: 10.1177/02676591211004363. Epub 2021 Mar 29.

Abstract

BACKGROUND

Gender is known to influence the pathophysiology and pathogenesis of the coronary vascular disease. Data on gender-related differences in patients with veno-arterial extracorporeal membrane oxygenation due to postcardiotomy cardiogenic shock is lacking in current literature. We aimed to analyze the impact of gender on intraoperative and short-term outcomes of vaECMO patients after coronary surgery and postcardiotomy cardiogenic shock.

METHODS

Between 2006 and 2017, a total of 92 patients with PCS after CABG underwent vaECMO-implantation at our institution. After a 1:1 propensity score match (PSM) for relevant preoperative data, we identified a cohort of 32 patients, 16 males, and 16 females. Periprocedural and short-term outcome data were analyzed with respect to sex differences.

RESULTS

The mean age was 64 ± 11 years, and 79% ( = 73) were male patients. Clinical outcomes showed a 30-day all-cause mortality of 64% ( = 59). After PSM, male patients showed a significantly smaller number of arterial grafts (0.4 ± 0.53 male vs 1.1 ± 0.7 female; p = 0.037). Thirty-day all-cause mortality did not differ between the groups (56% male vs 75% female; p = 0.262). In general, short-term outcome data were comparable without significant differences for the matched groups.

CONCLUSION

Gender has no impact on patients with vaECMO therapy due to PCS in isolated coronary surgery.

摘要

背景

性别已知会影响冠状动脉疾病的病理生理学和发病机制。目前的文献中缺乏关于体外膜肺氧合(ECMO)治疗因心脏手术后心源性休克的患者中性别相关差异的数据。我们旨在分析性别对冠状动脉搭桥手术后并发心源性休克患者行体外VA-ECMO 治疗的术中及短期结局的影响。

方法

2006 年至 2017 年期间,共有 92 例因 CABG 后并发 PCS 的患者在我院接受 VA-ECMO 植入术。在对相关术前数据进行 1:1 倾向评分匹配(PSM)后,我们确定了一组 32 例患者,其中 16 例为男性,16 例为女性。分析了性别差异与围手术期和短期结局数据。

结果

患者的平均年龄为 64±11 岁,79%(73 例)为男性。临床结局显示 30 天全因死亡率为 64%(59 例)。经 PSM 后,男性患者的动脉移植物数量明显减少(0.4±0.53 例男性 vs 1.1±0.7 例女性;p=0.037)。两组 30 天全因死亡率无差异(56%男性 vs 75%女性;p=0.262)。一般来说,在匹配组中,短期结局数据相当,无显著差异。

结论

在单纯冠状动脉手术中,性别对因心脏手术后心源性休克而行 VA-ECMO 治疗的患者无影响。

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