Shah Manuj M, Rando Hannah, Polanco Antonio R, Kilic Ahmet
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
JHLT Open. 2024 Apr 26;5:100097. doi: 10.1016/j.jhlto.2024.100097. eCollection 2024 Aug.
Revisions to the heart allocation criteria in 2018 motivated an increased use of extracorporeal membrane oxygenation (ECMO) as a bridge to transplantation. Studies have demonstrated inferior post-transplant outcomes in patients bridged with ECMO but do not account for underlying diagnosis. Our objective was to elucidate the differential impact of ECMO on outcomes by heart failure (HF) etiology.
The United Network of Organ Sharing database was queried for adults who underwent isolated heart transplantation after October 2018. Patients were stratified by ECMO utilization at the time of transplantation and then by HF etiology. After baseline statistical comparisons, survival analysis relied on Kaplan-Meier estimates and Cox proportional models.
A total of 13,203 patients were included, of whom 761 (5.8%) were supported with ECMO. ECMO patients were younger (48 vs 54 years, < 0.001), less likely to have diabetes (24% vs 30%, < 0.001), smoke cigarettes (31% vs 41%, < 0.001), or have prior cardiac surgery (29% vs 36%, < 0.001), more likely to require dialysis (20% vs 5%, < 0.001), and spent fewer days on the waitlist (59 vs 190, < 0.001). After adjustment, ECMO was associated with increased mortality (hazard ratio 1.85, < 0.001) in the full cohort. After incorporating HF etiology, this increased mortality risk persisted in all subgroups except restrictive cardiomyopathy and congenital heart disease (CHD).
Our findings illustrate that HF etiology is associated with differing outcomes when bridging with ECMO. ECMO patients with restrictive cardiomyopathy or CHD did not have increased mortality risk. With ECMO utilization increasing, these data are hypothesis-generating and serve as a basis for further studies.
2018年心脏分配标准的修订促使体外膜肺氧合（ECMO）作为移植桥梁的使用增加。研究表明，接受ECMO桥接的患者移植后结局较差，但未考虑潜在诊断。我们的目的是阐明ECMO对不同病因心力衰竭（HF）患者结局的差异影响。
查询器官共享联合网络数据库，纳入2018年10月后接受孤立心脏移植的成年人。患者在移植时按是否使用ECMO分层，然后按HF病因分层。在进行基线统计比较后，生存分析采用Kaplan-Meier估计和Cox比例模型。
共纳入13203例患者，其中761例（5.8%）接受了ECMO支持。接受ECMO的患者更年轻（48岁对54岁，<0.001），患糖尿病的可能性更小（24%对30%，<0.001），吸烟的可能性更小（31%对41%，<0.001），或曾接受心脏手术的可能性更小（29%对36%，<0.001），更有可能需要透析（20%对5%，<0.001），在等待名单上的天数更少（59天对190天，<0.001）。调整后，在整个队列中，ECMO与死亡率增加相关（风险比1.85，<0.001）。纳入HF病因后，除限制性心肌病和先天性心脏病（CHD）外，所有亚组的死亡风险均持续增加。
我们的研究结果表明，在使用ECMO作为桥梁时，HF病因与不同的结局相关。患有限制性心肌病或CHD的ECMO患者死亡风险没有增加。随着ECMO使用的增加，这些数据可生成假设，并为进一步研究提供基础。
