Department of Cardiovascular Medicine (I.M., A.J.S., N.A.H., Z.S.), University of Kansas Health System, University of Kansas School of Medicine, Kansas City.
Division of Cardiothoracic Surgery (J.E.T.), Department of Surgery, University of Utah Health, Salt Lake City.
Circ Heart Fail. 2022 Jan;15(1):e008777. doi: 10.1161/CIRCHEARTFAILURE.121.008777. Epub 2021 Dec 9.
There has been increasing use of extracorporeal membrane oxygenation (ECMO) as bridge to heart transplant (orthotopic heart transplant [OHT]) or left ventricular assist device (LVAD) over the last decade. We aimed to provide insights on the population, outcomes, and predictors for the selection of each therapy.
Using the Extracorporeal Life Support Organization Registry between 2010 and 2019, we compared in-hospital mortality and length of stay, predictors of OHT versus LVAD, and predictors of in-hospital mortality for patients with cardiogenic shock that were bridged with ECMO to OHT or LVAD. One hundred sixty-seven patients underwent LVAD versus 234 patients who underwent OHT.
The overall use of ECMO has increased from 1.7% in 2010 to 22.2% in 2019. Mortality was similar between groups (LVAD: 28.7% versus OHT: 29.1%) while length of stay was longer for OHT (LVAD: 49.6 versus OHT: 59.5 days, =0.05). Factors associated with OHT included prior transplant (odds ratio [OR]=31.26 [CI, 3.84-780.5]), use of a temporary pacemaker (OR=6.5 [CI, 1.39-50.15]), and increased use of inotropes on ECMO (OR=3.77 [CI, 1.39-11.07]), whereas LVAD use was associated with weight (OR=0.98 [CI, 0.97-0.99]), cardiogenic shock presentation (OR=0.40 [CI, 0.21-0.78]), previous LVAD (OR=0.01 [CI, 0.0001-0.22]), respiratory failure (OR=0.28 [CI, 0.11-0.70]), and milrinone infusion (OR=0.32 [CI, 0.15-0.67]). Older age (OR=1.07 [CI, 1.02-1.12]), cannulation bleeding (OR=26.1 [CI, 4.32-221.3]), and surgical bleeding (OR=6.7 [CI, 1.26-39.9]) in patients receiving LVAD and respiratory failure (OR=5 [CI, 1.17-23.1]) and continuous renal replacement therapy (OR=3.82 [CI, 1.28-11.9]) in patients receiving OHT were associated with increased mortality.
ECMO use as a bridge to advanced therapies has increased over time, with more patients undergoing LVAD than OHT. Mortality was equal between the 2 groups while length of stay was longer for OHT.
在过去十年中，体外膜肺氧合（ECMO）作为心脏移植（原位心脏移植[OHT]）或左心室辅助装置（LVAD）的桥接治疗的应用越来越多。我们旨在提供有关人群、结局和选择每种治疗方法的预测因素的见解。
使用体外生命支持组织登记处（2010 年至 2019 年），我们比较了因心源性休克接受 ECMO 桥接 OHT 或 LVAD 的患者中，OHT 与 LVAD 的院内死亡率和住院时间、OHT 与 LVAD 的预测因素以及因心源性休克接受 ECMO 桥接 OHT 或 LVAD 的患者的院内死亡率预测因素。167 例患者接受了 LVAD 治疗，234 例患者接受了 OHT 治疗。
ECMO 的总体使用率从 2010 年的 1.7%增加到 2019 年的 22.2%。两组之间的死亡率相似（LVAD：28.7%与 OHT：29.1%），而 OHT 的住院时间更长（LVAD：49.6 天与 OHT：59.5 天，=0.05）。与 OHT 相关的因素包括先前的移植（优势比[OR]=31.26[CI，3.84-780.5]）、使用临时起搏器（OR=6.5[CI，1.39-50.15]）和 ECMO 上使用更多的正性肌力药物（OR=3.77[CI，1.39-11.07]），而 LVAD 与体重（OR=0.98[CI，0.97-0.99]）、心源性休克表现（OR=0.40[CI，0.21-0.78]）、先前的 LVAD（OR=0.01[CI，0.0001-0.22]）、呼吸衰竭（OR=0.28[CI，0.11-0.70]）和米力农输注（OR=0.32[CI，0.15-0.67]）相关。年龄较大（OR=1.07[CI，1.02-1.12]）、LVAD 置管出血（OR=26.1[CI，4.32-221.3]）和手术出血（OR=6.7[CI，1.26-39.9]）患者接受 LVAD 和呼吸衰竭（OR=5[CI，1.17-23.1]）以及持续肾脏替代治疗（OR=3.82[CI，1.28-11.9]）患者接受 OHT 与死亡率增加相关。
ECMO 作为高级治疗的桥接治疗的应用随着时间的推移而增加，接受 LVAD 治疗的患者多于接受 OHT 治疗的患者。两组之间的死亡率相同，而 OHT 的住院时间更长。
