Aboud Anas, Hüting Felix, Fujita Buntaro, Zittermann Armin, Al-Khalil Riad, Puehler Thomas, Ensminger Stephan, Gummert Jan
Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Luebeck Campus, Lübeck, Germany.
Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
Interdiscip Cardiovasc Thorac Surg. 2024 Sep 4;39(3). doi: 10.1093/icvts/ivae147.
This study aims to analyse the short- and long-term outcomes in patients who received extracorporeal life support for the treatment of perioperative low-output syndrome and identify risk factors for mortality.
All consecutive patients who received extracorporeal life-support system during or after cardiac surgery at a high-volume German cardiac centre between 2008 and 2017 were identified retrospectively and followed up to December 2023. This cohort was characterized, and long-term survival (>10 years) was analysed. Univariate and multivariable regression analyses were performed to identify risk factors for mortality.
Five-hundred and seventy-six patients were included; 21.7% underwent isolated coronary bypass, 16.5% single valve surgery, 34.3% combined cardiac surgery and 13.2% heart transplantation. The system was implanted peripherally in 60.8% of patients. In-hospital and 1-year mortality for all patients was 66.0% and 77.7%, respectively. In the multivariable Cox adjustment, severe aortic valve stenosis, previous cardiac surgery and intra-aortic balloon pump were independent risk factors for in-hospital mortality (P < 0.05). Older age, severe mitral regurgitation and patients on insulin were predictors for long-term mortality (P < 0.05). However, peripheral cannulation significantly reduced mortality. There was no time-dependent interaction of perioperative stroke with mortality. For patients who were discharged alive, the estimated 10-year survival was 32.4%.
Treatment of perioperative low-output syndrome with extracorporeal life-support systems is associated with poor outcome and only 34% of patients could be discharged successfully. Peripheral cannulation is prognostically favourable. Special attention should be paid to these patients because age, insulin therapy and severe mitral regurgitation are strong predictors for mortality after 10 years.
本研究旨在分析接受体外生命支持治疗围手术期低心排血量综合征患者的短期和长期结局，并确定死亡风险因素。
回顾性确定2008年至2017年期间在德国一家大型心脏中心接受心脏手术期间或术后接受体外生命支持系统的所有连续患者，并随访至2023年12月。对该队列进行特征描述，并分析长期生存情况（>10年）。进行单因素和多因素回归分析以确定死亡风险因素。
纳入576例患者；21.7%接受单纯冠状动脉搭桥术，16.5%接受单瓣膜手术，34.3%接受联合心脏手术，13.2%接受心脏移植。60.8%的患者通过外周置入该系统。所有患者的住院死亡率和1年死亡率分别为66.0%和77.7%。在多因素Cox调整中，严重主动脉瓣狭窄、既往心脏手术和主动脉内球囊反搏是住院死亡的独立风险因素（P<0.05）。年龄较大、严重二尖瓣反流和使用胰岛素的患者是长期死亡的预测因素（P<0.05）。然而，外周插管显著降低了死亡率。围手术期卒中与死亡率之间不存在时间依赖性相互作用。对于存活出院的患者，估计10年生存率为32.4%。
体外生命支持系统治疗围手术期低心排血量综合征结局不佳，仅34%的患者能够成功出院。外周插管在预后方面具有优势。应特别关注这些患者，因为年龄、胰岛素治疗和严重二尖瓣反流是10年后死亡的有力预测因素。
