Department of Anesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
ESC Heart Fail. 2022 Feb;9(1):695-703. doi: 10.1002/ehf2.13686. Epub 2021 Nov 4.
Primary graft dysfunction (PGD) is a feared complication after heart transplantation (HTX). HTX patients frequently receive veno-arterial extracorporeal membrane oxygenation (VA-ECMO) until graft recovery. Long-term mortality of patients weaned from VA-ECMO after HTX is comparable with non-ECMO patients. However, impact on quality of life is unknown. This study investigated days alive and out of hospital (DAOH) as patient-centred outcome in HTX patients at 1 year after surgery.
This retrospective single-centre cohort study included patients who underwent HTX at the University Hospital Düsseldorf, Germany, from 2010 to 2020. Main exposure was VA-ECMO due to PGD. VA-ECMO and non-VA-ECMO patients were compared regarding the primary endpoint DAOH at 1 year after HTX. Subgroup analysis for patients weaned from VA-ECMO was performed. In total, 144 patients were included into analysis; 1 year mortality was significantly lower in non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO 34.8% (16/46), adjusted hazard ratio: 0.32, 95% confidence interval: 0.15-0.74; P = 0.002]. Mortality did not differ significantly between patients weaned from VA-ECMO and non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO (weaned) 18.9% (7/37), adjusted hazard ratio: 0.72, 95% confidence interval: 0.27-1.90; P = 0.48]. DAOH were significantly higher in non-ECMO patients compared with VA-ECMO patients and patients weaned from VA-ECMO [non-ECMO vs. VA-ECMO: median 310 (inter-quartile range 277-327) days vs. 243 (0-288) days; P < 0.0001; non-ECMO vs. VA-ECMO (weaned): 310 (277-327) days vs. 253 (208-299) days; P < 0.0001]. These results were still significant after multivariable adjustment with forced entry of predefined covariables.
Despite similar survival rates, VA-ECMO due to PGD has a relevant life impact as defined by DAOH in the first year after HTX. As a more patient-centred endpoint, DAOH may contribute to a more comprehensive assessment of outcome in HTX patients.
原发性移植物功能障碍（PGD）是心脏移植（HTX）后的一种严重并发症。HTX 患者在移植物恢复期间经常接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗。从 HTX 后接受 VA-ECMO 脱机的患者的长期死亡率与非 ECMO 患者相当。然而，其对生活质量的影响尚不清楚。本研究旨在调查 1 年后 HTX 患者的生存天数和出院天数（DAOH），作为以患者为中心的结局指标。
本回顾性单中心队列研究纳入了 2010 年至 2020 年期间在德国杜塞尔多夫大学医院接受 HTX 的患者。主要暴露因素为 PGD 导致的 VA-ECMO。比较了 VA-ECMO 和非 VA-ECMO 患者在 HTX 后 1 年的主要结局 DAOH。对从 VA-ECMO 脱机的患者进行了亚组分析。共纳入 144 例患者进行分析；非 ECMO 患者 1 年死亡率明显较低[非 ECMO 组 14.3%（14/98）与 VA-ECMO 组 34.8%（16/46），调整后的危险比：0.32，95%置信区间：0.15-0.74；P=0.002]。从 VA-ECMO 脱机的患者与非 ECMO 患者的死亡率无显著差异[非 ECMO 组 14.3%（14/98）与 VA-ECMO（脱机）组 18.9%（7/37），调整后的危险比：0.72，95%置信区间：0.27-1.90；P=0.48]。与 VA-ECMO 患者和从 VA-ECMO 脱机的患者相比，非 ECMO 患者的 DAOH 明显更高[非 ECMO 组 310（四分位距 277-327）天与 VA-ECMO 组 243（0-288）天；P<0.0001；非 ECMO 组 310（277-327）天与 VA-ECMO（脱机）组 253（208-299）天；P<0.0001]。在使用预定义协变量强制进入的多变量调整后，这些结果仍然具有统计学意义。
尽管生存率相似，但由于 PGD 导致的 VA-ECMO 在 HTX 后 1 年内对患者的生活质量有明显影响，这可通过 DAOH 来定义。作为一个更以患者为中心的终点，DAOH 可能有助于更全面地评估 HTX 患者的结局。
