Isath Ameesh, Gregory Vasiliki, Ohira Suguru, Levine Avi, Dhand Abhay, Laskowski Igor, Mateo Romeo, Babu Sateesh, Spielvogel David, Kai Masashi
Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA.
New York Medical College, Valhalla, New York, USA.
Clin Transplant. 2023 Dec;37(12):e15147. doi: 10.1111/ctr.15147. Epub 2023 Sep 27.
The management of complex groin wounds following VA-ECMO after heart transplant (HT) is uncertain due to limited experience. Sartorius muscle flaps (SMF) have been used in vascular surgery for groin wound complications. However, their use in HT recipients with perioperative VA-ECMO is unclear. This study aims to describe characteristics and outcomes of HT patients with groin complications after arterial decannulation for femoral VA-ECMO.
We retrospectively reviewed HT patients who underwent peri-transplant femoral VA-ECMO at our institution from April 2011 to February 2023. Patients were categorized into two groups based on the presence of cannulation-related wound complications.
Among the 34 patients requiring VA-ECMO peri-transplant, 17 (50%) experienced complications at the cannulation site. Baseline characteristics including duration of VA-ECMO support were comparable in both groups. Patients with complications presented mostly with open wounds (41.1%) after a median duration of 22 days post-transplant. Concurrent groin infections were observed in 52.3% of patients, all caused by gram-negative bacteria. Wound complications were managed with 12 (70.6%) undergoing SMF treatment and 5 (31.2%) receiving conventional therapy. Four SMF recipients had preemptive procedures for wound dehiscence, while eight underwent SMF for groin infections. Among the SMF group, 11 patients had favorable outcomes without recurrent complications, except for one patient who developed a groin infection with pseudoaneurysm formation. Conventional therapy with vacuum assisted closure (VAC) and antibiotics were utilized in four patients without infection and one patient with infection. Three patients required additional surgeries with favorable healing of the wound.
Complications related to femoral VA-ECMO are common in HT patients, with infection being the most frequent complication. SMFs can be a useful tool to prevent progression of infection and improve local healing.
由于经验有限，心脏移植（HT）后使用体外膜肺氧合（VA-ECMO）时复杂腹股沟伤口的处理尚不确定。缝匠肌皮瓣（SMF）已用于血管外科治疗腹股沟伤口并发症。然而，其在接受围手术期VA-ECMO的HT受者中的应用尚不清楚。本研究旨在描述因股动脉VA-ECMO拔管后出现腹股沟并发症的HT患者的特征和结局。
我们回顾性分析了2011年4月至2023年2月在我院接受移植期股动脉VA-ECMO的HT患者。根据是否存在与插管相关的伤口并发症将患者分为两组。
在34例移植期需要VA-ECMO的患者中，17例（50%）在插管部位出现并发症。两组的基线特征包括VA-ECMO支持时间相当。出现并发症的患者大多在移植后中位22天出现开放性伤口（41.1%）。52.3%的患者同时出现腹股沟感染，均由革兰氏阴性菌引起。12例（70.6%）伤口并发症患者接受了SMF治疗，5例（31.2%）接受了传统治疗。4例接受SMF治疗的患者因伤口裂开进行了预防性手术，8例因腹股沟感染接受了SMF治疗。在SMF组中，11例患者预后良好，无并发症复发，除1例患者出现腹股沟感染并形成假性动脉瘤。4例无感染患者和1例感染患者采用了负压封闭引流（VAC）和抗生素的传统治疗。3例患者需要额外手术，伤口愈合良好。
与股动脉VA-ECMO相关的并发症在HT患者中很常见，感染是最常见的并发症。SMF可作为预防感染进展和促进局部愈合的有用工具。
