Midterm Outcomes of Bridge-to-Recovery Patients After Short-Term Mechanical Circulatory Support
Midterm Outcomes of Bridge-to-Recovery Patients After Short-Term Mechanical Circulatory Support
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DOI：
10.1016/j.athoracsur.2019.01.060
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发表时间：
2019-08-01
影响因子：
4.6
通讯作者：
Takeda, Koji
中科院分区：
文献类型：
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作者：
Cheng, Yi-Tso;Garan, Arthur R.;Takeda, Koji
背景短期机械循环支持（ST-MCS）的使用增加了难治性心源性休克。然而，关于过渡到康复的患者的数据很少。我们回顾性分析了2010年至2016年期间接受静脉动脉体外膜肺氧合或临时外科心室辅助装置（ST-MCS）的502例心源性休克患者。有178例患者（35.5%）通过器械置换存活。其中，149例患者（29.7%）存活至出院，并纳入分析。主要结果是未接受心脏置换治疗的中期生存率。在我们的过渡到恢复队列中，101例患者（67.8%）为男性，中位年龄为59岁（四分位距，51至67岁）。心源性休克的病因包括35.6%的患者（n = 53）心切开术后休克，26.8%的患者（n = 40）移植物衰竭，24.2%的患者（n = 36）急性心肌梗死（AMI），14.4%的患者（n = 20）其他急性失代偿性心力衰竭。在中位随访306天（四分位距，58.25 - 916.75天）期间，记录了24例重大事件（16.1%），包括21例死亡和3例接受心脏替代治疗的患者。3年时总体无事件率为74.2%。在亚组分析中，AMI患者的无事件发生率显著更差，为40.4%（p < 0.001）。通过单变量考克斯分析，AMI病因（p = 0.003）、ST段-MCS长度（p = 0.06）、血尿素氮（p = 0.012）和出院时左心室射血分数（p = 0.005）是不良事件的预测因素。除AMI患者外，从ST-MCS中恢复的患者的总体中期结局是有利的。(C)2019年美国胸外科医师协会
Background. The use of short-term mechanical circulatory support (ST-MCS) has increased for refractory cardiogenic shock. However, there are scant data about bridge-to-recovery patients.Methods. We retrospectively reviewed 502 patients with cardiogenic shock who received venoarterial extracorporeal membrane oxygenation or a temporary surgical ventricular assist device as ST-MCS between 2010 and 2016. There were 178 patients (35.5%) who survived through device explantation. Of these, 149 patients (29.7%) survived to discharge and were included for analysis. The primary outcome was midterm survival without undergoing heart replacement therapy.Results. In our bridge-to-recovery cohort, 101 patients (67.8%) were men, and the median age was 59 years (interquartile range, 51 to 67 years). Etiology of cardiogenic shock included postcardiotomy shock in 35.6% of patients (n = 53), allograft failure in 26.8% (n = 40), acute myocardial infarction (AMI) in 24.2% (n = 36), and other acute decompensated heart failure in 14.4% (n = 20). There were 24 major events (16.1%) recorded, including 21 patients who died and 3 patients who received heart replacement therapy during median follow-up of 306 days (interquartile range, 58.25 to 916.75 days). Overall freedom from event at 3 years was 74.2%. In subgroup analysis, AMI patients had a significantly worse freedom-from-event rate at 40.4% (p < 0.001). By univariate Cox analysis, AMI etiology (p = 0.003), length of ST-MCS (p = 0.06), blood urea nitrogen (p = 0.012), and left ventricular ejection fraction (p = 0.005) at discharge were predictors for adverse events.Conclusions. The overall midterm outcome of patients explanted from ST-MCS is favorable except for AMI patients. (C) 2019 by The Society of Thoracic Surgeons