左心室卸载对心脏移植后结果的影响,这些患者与VA-ECMO桥接
Daniel Enríquez-Vázquez1, Eduardo Barge-Caballero1, Francisco González-Vílchez2
1Servicio 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.
Revista espanola de cardiologia (English ed.)
|October 11, 2024
概括
手术前的左心室 (LV) 卸载改善了与静脉脉外体膜氧化 (VA-ECMO) 桥接的心脏移植患者的存活率. LV卸载与移植后1年生存率显著改善有关.
科学领域:
- 心脏病学 心脏病学
- 移植手术 移植手术
- 机械循环支持 机械循环支持
背景情况:
- 静脉外体膜氧化 (VA-ECMO) 用于将患者连接到心脏移植 (HT).
- 在VA-ECMO桥梁患者中,手术前左心室 (LV) 卸载对HT后的结果的影响尚不清楚.
研究的目的:
- 通过VA-ECMO与HT桥接患者的移植后结果进行比较.
- 评估LV减压的不同机械策略对这些结果的影响.
主要方法:
- 在西班牙16个中心,从2010年至2020年,VA-ECMO支持的245名接受高紧急HT患者的回顾性分析.
- 患者被分为分层,分为手术前LV卸载或不卸载的组.
- 主要终点是HT后1年生存期,使用考克斯回归分析.
主要成果:
- 在54.3%的患者中采用了机械LV卸载策略,最常见的是使用大动脉内气球.
- 移植后的一年生存率在LV卸载组 (74.4%) 与对照组 (59.8%) 相比较高 (P=.025).
- 手术前 LV 卸载与1年死亡率降低独立相关 (aHR,0.50;P=.003).
结论:
- 手术前的LV卸载独立地与VA-ECMO桥接的心脏移植接受者的1年生存率改善有关.
- 这种益处在动脉内气球和其他机械卸载策略中都被观察到.
- 两组之间没有发现其他手术后并发症的显著差异.
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