Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Heart Lung Transplant. 2024 Jun;43(6):931-943. doi: 10.1016/j.healun.2024.02.1458. Epub 2024 Feb 28.
Vasoplegic syndrome (VS) is a common occurrence during heart transplantation (HT). It currently lacks a uniform definition between transplant centers, and its pathophysiology and treatment remain enigmatic. This systematic review summarizes the available published clinical data regarding VS during HT.
We searched databases for all published reports on VS during HT. Data collected included the incidence of VS in the HT population, patient and intraoperative characteristics, and postoperative outcomes.
Twenty-two publications were included in this review. The prevalence of VS during HT was 28.72% (95% confidence interval: 27.37%, 30.10%). Factors associated with VS included male sex, higher body mass index, hypothyroidism, pre-HT left ventricular assist device or venoarterial extracorporeal membrane oxygenation (VA-ECMO), pre-HT calcium channel blocker or amiodarone usage, longer cardiopulmonary bypass time, and higher blood product transfusion requirement. Patients who developed VS were more likely to require postoperative VA-ECMO support, renal replacement therapy, reoperation for bleeding, longer mechanical ventilation, and a greater 30-day and 1-year mortality.
The results of our systematic review are an initial step for providing clinicians with data that can help identify high-risk patients and avenues for potential risk mitigation. Establishing guidelines that officially define VS will aid in the precise diagnosis of these patients during HT and guide treatment. Future studies of treatment strategies for refractory VS are needed in this high-risk patient population.
血管扩张性综合征（VS）是心脏移植（HT）过程中的常见现象。目前，移植中心之间缺乏统一的定义，其病理生理学和治疗仍然扑朔迷离。本系统评价总结了目前关于 HT 过程中 VS 的可用临床数据。
我们检索了所有关于 HT 过程中 VS 的已发表报告。收集的数据包括 HT 人群中 VS 的发生率、患者和术中特征以及术后结局。
本综述共纳入 22 篇文献。HT 过程中 VS 的发生率为 28.72%（95%置信区间：27.37%，30.10%）。与 VS 相关的因素包括男性、较高的体重指数、甲状腺功能减退症、HT 前左心室辅助装置或静脉-动脉体外膜肺氧合（VA-ECMO）、HT 前钙通道阻滞剂或胺碘酮使用、较长的体外循环时间和较高的血液制品输注需求。发生 VS 的患者更有可能需要术后 VA-ECMO 支持、肾脏替代治疗、因出血再次手术、更长时间的机械通气以及更高的 30 天和 1 年死亡率。
本系统评价的结果为临床医生提供有助于识别高危患者和潜在风险缓解途径的数据提供了初步依据。制定正式定义 VS 的指南将有助于 HT 期间对这些患者进行准确诊断并指导治疗。在这一高危患者人群中，需要进一步研究难治性 VS 的治疗策略。
