Lee Jun Ho, Choi Nayeon, Kim Yun Jin, Sung Kiick, Kim Wook Sung, Kim Darae, Yang Jeong Hoon, Jeon Eun-Seok, Shinn Sung Ho, Choi Jin-Oh, Cho Yang Hyun
Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Korea.
Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul 04763, Korea.
J Clin Med. 2021 Jun 8;10(12):2542. doi: 10.3390/jcm10122542.
Although patients receiving extracorporeal life support (ECLS) as a bridge to transplantation have demonstrated worse outcomes than those without ECLS, we investigated the key factors in the improvement of their posttransplant outcome. From December 2003 to December 2018, 257 adult patients who underwent heart transplantation (HTx) at our institution were included. We identified 100 patients (38.9%) who underwent HTx during ECLS (ECLS group). The primary outcome was 30-day mortality after HTx. The median duration of ECLS was 10.0 days. The 30-day mortality rate was 3.9% (9.2% in peripheral ECLS, 2.9% in central ECLS, and 1.9% in non-ECLS). The use of ECLS was not an independent predictor of 30-day and 1-year mortality ( = 0.248 and = 0.882, respectively). Independent predictors of 30-day mortality were found to be higher ejection fraction ( < 0.001), Sequential Organ Failure Assessment score ( < 0.001), and total bilirubin level ( = 0.005). In a subgroup analysis, cannulation type was not a predictor of 30-day mortality ( = 0.275). Early ECLS application to prevent organ failure and sophisticated management of acute heart failure may be important steps in achieving favorable survival after HTx.
尽管接受体外生命支持（ECLS）作为移植桥梁的患者预后比未接受ECLS的患者差，但我们调查了改善其移植后预后的关键因素。2003年12月至2018年12月，纳入了在我们机构接受心脏移植（HTx）的257例成年患者。我们确定了100例在ECLS期间接受HTx的患者（ECLS组）。主要结局是HTx后30天死亡率。ECLS的中位持续时间为10.0天。30天死亡率为3.9%（外周ECLS为9.2%，中心ECLS为2.9%，非ECLS为1.9%）。使用ECLS不是30天和1年死亡率的独立预测因素（分别为 = 0.248和 = 0.882）。发现30天死亡率的独立预测因素为较高的射血分数（ < 0.001）、序贯器官衰竭评估评分（ < 0.001）和总胆红素水平（ = 0.005）。在亚组分析中，插管类型不是30天死亡率的预测因素（ = 0.275）。早期应用ECLS预防器官衰竭和对急性心力衰竭进行精细管理可能是HTx后实现良好生存的重要步骤。
