Impacto de la descarga del ventrículo izquierdo en el resultado tras el trasplante en pacientes asistidos con ECMO-VA

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia Pub Date : 2024-12-12 DOI:10.1016/j.recesp.2024.09.010

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

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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.

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左心室放电对ECMO-VA辅助患者移植后预后的影响

前言和目的术前左心室（LV）卸荷对静脉动脉体外膜氧合（VA-ECMO）心脏移植（HT）患者术后预后的影响尚不清楚。我们的目的是比较采用VA-ECMO桥接HT的患者，使用或不使用不同的左室减压机械策略的移植后结果。方法：回顾性分析连续HT候选者与VA-ECMO桥接，合并或不合并左室卸载的术后结果。从2010年到2020年，患者来自16个西班牙中心。主要终点为ht后1年生存率，采用Cox回归进行评估。结果共有245例患者在VA-ECMO支持下接受了高急诊HT治疗。133例（54.3%）患者采用机械方法卸载左室，其中主动脉内球囊泵是最常用的方法(n = 112；84.2%)。左室卸载组移植后1年生存率为74.4%，对照组为59.8% （P = 0.025）。在多变量分析中，术前左室卸荷与较低的1年死亡率独立相关(校正HR， 0.50；95%置信区间,0.32 - -0.78;p = .003)。在单独使用主动脉内球囊泵的患者中均观察到这种关联(调整后风险比，0.52；95%置信区间,0.32 - -0.84;P = .007)和其他机械卸荷策略(调整后危险度，0.43；95%置信区间,0.19 - -0.97;p = .042)。其他术后并发症组间无明显差异。结论经VA-ECMO桥接的患者术后左室卸载与移植后1年生存率的增加独立相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista espanola de cardiologia 医学-心血管系统

CiteScore

4.20

自引率

13.60%

发文量

257

审稿时长

28 days

期刊介绍： Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.