From the Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Exp Clin Transplant. 2021 May;19(5):473-480. doi: 10.6002/ect.2020.0342. Epub 2021 Apr 16.
Primary graft dysfunction remains a serious problem after heart transplant. Pharmacological treatment with the calcium sensitizer levosimendan may be an additive treatment for primary graft dysfunction.
Patients undergoing heart transplant between 2010 and 2020 were retrospectively reviewed and divided depending on postoperative treatment with (n = 41) or without (n = 109) levosimendan. Recipients who received levosi mendan were further divided with regard to timing of levosimendan application (early group: started ≤48 hours posttransplant [n = 23]; late group: started >48 hours posttransplant [n = 18]).
Patients who received levosimendan treatment displayed a remarkable incidence (87.8%) of postoperative primary graft dysfunction with need for venoarterial extracorporeal membrane oxygenation and therefore often presented with perioperative morbidity. Patient with early application of levosimendan showed significantly decreased duration of venoarterial extracorporeal membrane oxygenation support (5.1 ± 3.5 days vs 12.6 ± 9.3 days in those with late application; P < .01) and decreased mortality during venoarterial extracorporeal membrane oxygenation support (0.0% vs 33.3% in early vs late group; P < .01). In addition, compared with patients with late levosimendan application, patients with early application needed fewer blood transfusions (P < .05), had shorter ventilation times (279 ± 235 vs 428 ± 293 h; P = .03), and showed a trend of reduced incidence of postoperative renal failure (69.6% vs 94.4%; P = .06). Moreover, survival analyses indicated an increased survival for patients with early start of levosimendan therapy within the first 48 hours after heart transplant (P = .09).
Pharmacotherapy with levosimendan may be a promising additive in the treatment of primary graft dysfunction after heart transplant. With administration of levosimendan within the first 48 hours posttransplant, rates of successful weaning from venoarterial extracorporeal membrane oxygenation and outcomes after heart transplant were shown to increase.
心脏移植后原发性移植物功能障碍仍然是一个严重的问题。钙敏剂左西孟旦的药物治疗可能是原发性移植物功能障碍的一种附加治疗方法。
回顾性分析 2010 年至 2020 年间接受心脏移植的患者，并根据术后是否使用（n=41）或不使用（n=109）左西孟旦进行分组。接受左西孟旦治疗的患者进一步根据左西孟旦应用的时间进行分组（早期组：移植后≤48 小时开始[n=23]；晚期组：移植后>48 小时开始[n=18]）。
接受左西孟旦治疗的患者术后原发性移植物功能障碍发生率极高（87.8%），需要静脉-动脉体外膜肺氧合，因此常伴有围手术期并发症。早期应用左西孟旦的患者静脉-动脉体外膜肺氧合支持时间明显缩短（5.1±3.5 天 vs 晚期组 12.6±9.3 天；P<.01），体外膜肺氧合支持期间死亡率降低（0.0% vs 早期 vs 晚期组 33.3%；P<.01）。此外，与晚期应用左西孟旦的患者相比，早期应用左西孟旦的患者需要更少的输血（P<.05），通气时间更短（279±235 小时 vs 428±293 小时；P=0.03），术后肾功能衰竭的发生率呈降低趋势（69.6% vs 94.4%；P=0.06）。此外，生存分析表明，心脏移植后 48 小时内开始左西孟旦治疗的患者生存率增加（P=0.09）。
钙敏剂左西孟旦的药物治疗可能是心脏移植后原发性移植物功能障碍的一种有前途的附加治疗方法。在移植后 48 小时内给予左西孟旦，可提高静脉-动脉体外膜肺氧合的脱机成功率，并改善心脏移植后的结局。
