左心室卸载对接受VA-ECMO桥接的心脏移植术后患者结局的影响。

Impact of left ventricular unloading on postheart transplantation outcomes in patients bridged with VA-ECMO.

作者信息

Enríquez-Vázquez Daniel, Barge-Caballero Eduardo, González-Vílchez Francisco, Almenar-Bonet Luis, García-Cosío Carmena María Dolores, González-Costello José, Gómez-Bueno Manuel, Castel-Lavilla María Ángeles, Díaz-Molina Beatriz, Martínez-Sellés Manuel, Mirabet-Pérez Sonia, de la Fuente-Galán Luis, Hervás-Sotomayor Daniela, Rangel-Sousa Diego, Garrido-Bravo Iris P, Blasco-Peiró Teresa, Rábago Juan-Aracil Gregorio, Muñiz Javier, Crespo-Leiro María G

机构信息

Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain. Electronic address: https://twitter.com/@danienriquezv.

出版信息

Rev Esp Cardiol (Engl Ed). 2025 Jun;78(6):494-503. doi: 10.1016/j.rec.2024.09.005. Epub 2024 Oct 9.

DOI:10.1016/j.rec.2024.09.005

PMID:39393768

Abstract

INTRODUCTION AND OBJECTIVES

The impact of preoperative left ventricular (LV) unloading on postoperative outcomes in patients bridged with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to heart transplantation (HT) is unknown. Our aim was to compare posttransplant outcomes in patients bridged to HT with VA-ECMO, with or without the use of different mechanical strategies for LV decompression.

METHODS

We conducted a retrospective analysis of the postoperative outcomes of consecutive HT candidates bridged with VA-ECMO, with or without concomitant LV unloading. Patients were included from 16 Spanish centers from 2010 to 2020. The primary endpoint was 1-year post-HT survival, which was assessed using Cox regression.

RESULTS

Overall, 245 patients underwent high-emergency HT while supported with VA-ECMO. A mechanical strategy for LV unloading was used in 133 (54.3%) patients, with the intra-aortic balloon pump being the most commonly used method (n=112; 84.2%). One-year posttransplant survival was 74.4% in the LV unloading group and 59.8% in the control group (P=.025). In multivariate analyses, preoperative LV unloading was independently associated with lower 1-year mortality (adjusted HR, 0.50; 95%CI, 0.32-0.78; P=.003). This association was observed both in patients managed with an intra-aortic balloon pump alone (adjusted HR, 0.52; 95%CI, 0.32-0.84; P=.007) and with other strategies for mechanical LV unloading (adjusted HR, 0.43; 95%CI, 0.19-0.97; P=.042). No significant differences were found between groups regarding other postoperative complications.

CONCLUSIONS

Preoperative LV unloading was independently associated with increased 1-year posttransplant survival in candidates bridged with VA-ECMO.

摘要

引言与目的

术前左心室（LV）减负对接受静脉-动脉体外膜肺氧合（VA-ECMO）过渡至心脏移植（HT）患者术后结局的影响尚不清楚。我们的目的是比较接受VA-ECMO过渡至HT的患者在使用或不使用不同左心室减压机械策略情况下的移植后结局。

方法

我们对连续接受VA-ECMO过渡的HT候选患者的术后结局进行了回顾性分析，这些患者使用或未使用左心室减负措施。患者纳入自2010年至2020年期间的16个西班牙中心。主要终点为HT术后1年生存率，采用Cox回归进行评估。

结果

总体而言，245例患者在VA-ECMO支持下接受了急诊HT。133例（54.3%）患者采用了左心室减负的机械策略，其中主动脉内球囊泵是最常用的方法（n = 112；84.2%）。左心室减负组术后1年生存率为74.4%，对照组为59.8%（P = 0.025）。在多变量分析中，术前左心室减负与较低的1年死亡率独立相关（校正风险比，0.50；95%置信区间，0.32 - 0.78；P = 0.003）。在仅使用主动脉内球囊泵治疗的患者（校正风险比，0.52；95%置信区间，0.32 - 0.84；P = 0.007）以及采用其他左心室机械减负策略的患者中均观察到这种关联（校正风险比，0.43；95%置信区间，0.19 - 0.97；P = 0.042）。两组在其他术后并发症方面未发现显著差异。