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Sangrado postoperatorio grave tras trasplante de corazón

Alexandre Mansour1, Adrien Bougle2, Marion Turpin3

  • 1Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Univ Rennes, CHU Rennes, CIC 1414 (Centre d'Investigation Clinique de Rennes), Inserm, IRSET, UMR_S 1085, FHU SUPORT, F35000 Rennes, France. ORCID0000-0001-8955-2407.

Anesthesiology
|January 13, 2026
PubMed
Resumen

Las complicaciones graves de sangrado ocurren en el 25% de los receptores de trasplante de corazón, lo que aumenta la mortalidad a un año. El soporte cardíaco mecánico y la duración de la circulación extracorpórea son factores de riesgo clave para el sangrado postrasplante.

Palabras clave:
trasplante de corazónsangradocomplicacionesmortalidadsoporte mecánicocirculación extracorpórea

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Área de la Ciencia:

  • Cardiología
  • Cirugía de Trasplantes
  • Medicina de Cuidados Críticos

Sus antecedentes:

  • El sangrado postoperatorio es una preocupación común en la cirugía cardíaca.
  • Sin embargo, su incidencia, factores de riesgo y consecuencias después del trasplante de corazón no están bien definidos.
  • Las complicaciones hemorrágicas graves impactan significativamente los resultados de los pacientes.

Objetivo del estudio:

  • Determinar la incidencia de complicaciones hemorrágicas graves en receptores adultos de trasplante de corazón.
  • Identificar los factores de riesgo asociados con el sangrado postoperatorio grave.
  • Evaluar el impacto del sangrado grave en la mortalidad a un año.

Principales métodos:

  • Se realizó un estudio observacional en pacientes adultos de trasplante de corazón de 2015 a 2022 en dos centros franceses.
  • El sangrado grave se definió utilizando una puntuación de Definición Universal de Sangrado Perioperatorio (UDPB) ≥ 3.
  • Se utilizaron modelos de regresión logística y de Cox multivariables para identificar factores de riesgo y evaluar el impacto en la mortalidad.

Principales resultados:

  • De 446 pacientes, 112 (25%) experimentaron sangrado grave.
  • Los factores de riesgo incluyeron soporte cardíaco mecánico a largo plazo, hemoglobina preoperatoria baja y mayor duración de la circulación extracorpórea (CEC).
  • El sangrado grave se relacionó con un aumento de la mortalidad a un año (35% frente al 13%, HR ajustada 1,91).

Conclusiones:

  • La incidencia de complicaciones hemorrágicas graves después del trasplante de corazón es alta, especialmente en pacientes con soporte circulatorio mecánico.
  • Estos eventos hemorrágicos aumentan significativamente la morbilidad y mortalidad de los pacientes.
  • Se necesita más investigación para desarrollar estrategias de prevención efectivas para el sangrado postrasplante de corazón.