Department of Heart Failure and Transplantation, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France.
Pharmacy Department, Edouard Herriot Hospital, 69002 Lyon; Laboratoire MATEIS, Claude Bernard University, 69622 Villeurbanne, France.
Arch Cardiovasc Dis. 2022 Aug-Sep;115(8-9):426-435. doi: 10.1016/j.acvd.2022.04.009. Epub 2022 Jul 5.
Primary graft dysfunction remains the leading cause of 30-day mortality after heart transplantation. Few data have been published about the clinical outcome of severe primary graft dysfunction treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).
To evaluate the prevalence and outcome of severe primary graft dysfunction requiring VA-ECMO, and to identify factors associated with hospital mortality.
We performed an observational analysis of our institutional database of VA-ECMO for primary graft dysfunction after heart transplantation. Patients with severe primary graft dysfunction, according to the International Society for Heart and Lung Transplantation classification, were included. The primary outcome was survival to hospital discharge. Risk factors for in-hospital mortality were searched with multiple logistic regression analysis using backward stepwise variable elimination.
Of the 397 patients who had heart transplantation between January 2007 and December 2018, 60 (15.1%) developed severe primary graft dysfunction requiring VA-ECMO. The median age was 52 (interquartile range 39-59) years, and 73.3% were male. Thirty-nine (65.0%) patients were weaned after a mean duration of VA-ECMO support of 7.2±6.0 days. Thirty-two (53.3%) patients were alive at hospital discharge. Inotropic support in the recipient before heart transplantation (odds ratio [OR] 3.88, 95% confidence interval [CI] 1.04-14.44; P=0.04), total ischaemic time (OR 0.99, 95% CI 0.99-1.00; P=0.01) and 48-hour total blood transfusion (OR 1.14, 95% CI 1.04-1.26; P=0.01) were independent predictors of in-hospital mortality.
Severe primary graft dysfunction requiring VA-ECMO is frequent after heart transplantation. Survival to hospital discharge after VA-ECMO for severe primary graft dysfunction is satisfactory in such a critically ill population.
原发性移植物功能障碍仍然是心脏移植后 30 天内死亡的主要原因。关于使用静脉-动脉体外膜肺氧合（VA-ECMO）治疗严重原发性移植物功能障碍的临床结果，发表的数据很少。
评估需要 VA-ECMO 治疗的严重原发性移植物功能障碍的发生率和结果，并确定与院内死亡率相关的因素。
我们对我院心脏移植后因原发性移植物功能障碍而使用 VA-ECMO 的机构数据库进行了观察性分析。根据国际心肺移植学会的分类，纳入严重原发性移植物功能障碍患者。主要结局是存活至出院。使用向后逐步变量消除的多变量逻辑回归分析搜索院内死亡率的危险因素。
在 2007 年 1 月至 2018 年 12 月期间进行心脏移植的 397 例患者中，60 例（15.1%）发生需要 VA-ECMO 治疗的严重原发性移植物功能障碍。中位年龄为 52 岁（四分位距 39-59 岁），73.3%为男性。39 例（65.0%）患者在接受 VA-ECMO 支持平均 7.2±6.0 天后脱机。32 例（53.3%）患者在出院时存活。心脏移植前受体的正性肌力支持（比值比[OR]3.88，95%置信区间[CI]1.04-14.44；P=0.04）、总缺血时间（OR 0.99，95%CI 0.99-1.00；P=0.01）和 48 小时总输血（OR 1.14，95%CI 1.04-1.26；P=0.01）是院内死亡率的独立预测因子。
心脏移植后需要 VA-ECMO 的严重原发性移植物功能障碍很常见。在这种危重人群中，VA-ECMO 治疗严重原发性移植物功能障碍后，存活至出院的情况令人满意。
