Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Clin Transplant. 2024 Aug;38(8):e15421. doi: 10.1111/ctr.15421.
Extracorporeal membrane oxygenation (ECMO) has gained traction as a bridge to heart transplantation (HT) but remains associated with increased waitlist mortality. This study explores whether this risk is modified by underlying heart failure (HF) etiology.
Using the Organ Procurement and Transplantation Network registry, we conducted a retrospective review of first-time adult HT candidates from 2018 through 2022. Patients were categorized as "ECMO", if ECMO was utilized during the waitlisting period, or "No ECMO" otherwise. Patients were then stratified according to the following HF etiology: ischemic cardiomyopathy (CMP), dilated nonischemic CMP, restrictive CMP, hypertrophic CMP, and congenital heart disease (CHD). After baseline comparisons, waitlist mortality was characterized for ECMO and HF etiology using the Fine-Gray regression.
A total of 16 143 patients were identified of whom 7.0% (n = 1063) were bridged with ECMO. Compared to No ECMO patients, ECMO patients had shorter waitlist durations (46.3 vs. 185.0 days, p < 0.01) and were more likely to undergo transplantation (75.3% vs. 70.3%, p < 0.01). Outcomes analysis revealed that ECMO was associated with increased mortality risk (subdistribution hazard ratio [SHR]: 3.42, p < 0.01), a risk that persisted in all subgroups and was notably high in CHD (SHR: 4.83, p < 0.01) and hypertrophic CMP (SHR: 9.78, p < 0.01). HF etiology comparison within ECMO patients revealed increased mortality risk with CHD (SHR: 3.22, p < 0.01). Within No ECMO patients, hypertrophic CMP patients had lower mortality risk (SHR: 0.64, p = 0.03).
The increased waitlist mortality risk with ECMO persisted after stratification by HF etiology. These findings can help decision-making surrounding candidacy for cannulation and prognostic evaluation.
体外膜肺氧合（ECMO）作为心脏移植（HT）的桥梁已得到广泛应用，但仍与等待名单死亡率升高相关。本研究旨在探讨这种风险是否受基础心力衰竭（HF）病因的影响。
利用器官获取和移植网络（OPTN）登记处，我们对 2018 年至 2022 年期间首次接受成人 HT 候选者进行了回顾性分析。如果患者在等待名单期间使用 ECMO，则归类为“ECMO”，否则归类为“非 ECMO”。然后，根据以下 HF 病因将患者分层：缺血性心肌病（CMP）、扩张性非缺血性 CMP、限制型 CMP、肥厚性 CMP 和先天性心脏病（CHD）。在基线比较后，使用 Fine-Gray 回归描述 ECMO 和 HF 病因的等待名单死亡率。
共纳入 16143 例患者，其中 7.0%（n=1063）接受 ECMO 桥接治疗。与非 ECMO 患者相比，ECMO 患者的等待时间更短（46.3 天 vs. 185.0 天，p<0.01），更有可能接受移植（75.3% vs. 70.3%，p<0.01）。结果分析显示，ECMO 与死亡率增加相关（亚分布风险比[SHR]：3.42，p<0.01），该风险在所有亚组中持续存在，在 CHD（SHR：4.83，p<0.01）和肥厚性 CMP（SHR：9.78，p<0.01）中尤为显著。在 ECMO 患者中按 HF 病因进行分层分析显示，CHD 患者死亡率增加（SHR：3.22，p<0.01）。在非 ECMO 患者中，肥厚性 CMP 患者的死亡率较低（SHR：0.64，p=0.03）。
在按 HF 病因分层后，ECMO 导致的等待名单死亡率增加的风险仍然存在。这些发现有助于围绕插管候选资格和预后评估做出决策。
