Department of Medicine, TTUHSC, Lubbock, TX, USA.
Department of Cardiothoracic Surgery, University of Alabama School of Medicine, Birmingham, AL, USA.
Int J Artif Organs. 2021 Oct;44(10):675-680. doi: 10.1177/03913988211035143. Epub 2021 Aug 18.
The effect of type of mechanical circulatory support on stroke risk during the early post-transplant period remains undefined in patients bridged to transplant. This study assesses if the type of circulatory support device affects stroke risk in this population. The study cohort of 4257 adult patients bridged with mechanical support to cardiac transplant were derived from the UNOS transplant registry data. Risk factors assessed were age, gender, ischemic time, diabetes (recipient), durable mechanical support at listing and mechanical ventilation pre-transplant. Descriptive statistics were used to describe characteristics of the study cohort. Univariate logistic regression was used to test if there is a significant association between stroke event and all the potential risk factors. Multivariate logistic regression was used to test such associations while adjusting for all other risk factors. Odds ratios (ORs) and their 95% confidence intervals (CIs) in parenthesis, were calculated. < 0.05 was considered significant. Patients on Extracorporeal membrane oxygenation (ECMO) had the highest risk of stroke immediately post-transplant prior to discharge (OR 3.03, {1.16, 7.95}) followed by Total Artificial Heart (TAH) (OR 2.03, {1.01, 4.07) as compared to those only on a Left Ventricular Assist Device (LVAD). Ischemic time (OR 1.3 {1.09, 1.45}) and diabetes (OR 1.8 {1.29, 2.51}) were significant risk factors. Patients on ECMO and TAH had a 203% and 103% increase respectively in the odds of having a stroke prior to discharge as compared to those only on LVADS.
在接受机械循环支持桥接移植的患者中，早期移植后卒中风险与机械循环支持类型的关系仍不明确。本研究评估了循环支持装置的类型是否会影响该人群的卒中风险。该研究队列包括 4257 名接受机械支持桥接心脏移植的成年患者，来源于 UNOS 移植登记数据。评估的危险因素包括年龄、性别、缺血时间、糖尿病（受者）、列入名单时的耐用机械支持和移植前机械通气。采用描述性统计方法描述研究队列的特征。采用单因素逻辑回归检验卒中事件与所有潜在危险因素之间是否存在显著关联。采用多因素逻辑回归检验在调整所有其他危险因素后，这种关联是否存在。计算比值比（OR）及其 95%置信区间（CI）。 < 0.05 被认为具有统计学意义。在出院前，体外膜肺氧合（ECMO）组的卒中风险最高（OR 3.03，{1.16，7.95}），其次是全人工心脏（TAH）组（OR 2.03，{1.01，4.07}），而仅使用左心室辅助装置（LVAD）组的卒中风险最低。缺血时间（OR 1.3 {1.09，1.45}）和糖尿病（OR 1.8 {1.29，2.51}）是显著的危险因素。与仅使用 LVADS 的患者相比，使用 ECMO 和 TAH 的患者在出院前发生卒中的几率分别增加了 203%和 103%。
