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心脏移植新时代的静脉-动脉体外膜肺氧合(VA-ECMO)支持

Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support in New Era of Heart Transplant.

作者信息

Giovannico Lorenzo, Fischetti Giuseppe, Parigino Domenico, Savino Luca, Di Bari Nicola, Milano Aldo Domenico, Padalino Massimo, Bottio Tomaso

机构信息

Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy.

出版信息

Transpl Int. 2024 Dec 18;37:12981. doi: 10.3389/ti.2024.12981. eCollection 2024.

Abstract

Heart failure is a serious and challenging medical condition characterized by the inability of the heart to pump blood effectively, leading to reduced blood flow to organs and tissues. Several underlying causes may be linked to this, including coronary artery disease, hypertension, or previous heart attacks. Therefore, it is a chronic condition that requires ongoing management and medical attention. HF affects >64 million individuals worldwide. Heart transplantation remains the gold standard of treatment for patients with end-stage cardiomyopathy. The recruitment of marginal donors may be considered an asset at the age of cardiac donor organ shortage. Primary graft dysfunction (PGD) is becoming increasingly common in the new era of heart transplantations. PGD is the most common cause of death within 30 days of cardiac transplantation. Mechanical Circulatory Support (MCS), particularly venoarterial extracorporeal membrane oxygenation (V-A ECMO), is the only effective treatment for severe PGD. VA-ECMO support ensures organ perfusion and provides the transplanted heart with adequate rest and recovery. In the new era of heart transplantation, early use allows for increased patient survival and careful management reduces complications.

摘要

心力衰竭是一种严重且具有挑战性的医学病症,其特征是心脏无法有效地泵血,导致流向器官和组织的血流量减少。多种潜在病因可能与此相关,包括冠状动脉疾病、高血压或既往心脏病发作。因此,这是一种需要持续管理和医疗关注的慢性病症。心力衰竭在全球影响着超过6400万人。心脏移植仍然是终末期心肌病患者的治疗金标准。在心脏供体器官短缺的时代,招募边缘供体可能被视为一项资产。原发性移植功能障碍(PGD)在心脏移植的新时代正变得越来越普遍。PGD是心脏移植后30天内最常见的死亡原因。机械循环支持(MCS),特别是静脉-动脉体外膜肺氧合(V-A ECMO),是治疗严重PGD的唯一有效方法。VA-ECMO支持可确保器官灌注,并为移植的心脏提供充足的休息和恢复时间。在心脏移植的新时代,早期使用可提高患者生存率,且精心管理可减少并发症。

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