主动脉球囊反搏在心脏移植桥接治疗中的疗效及对移植预后影响

Research on the efficacy of IABP applied in cardiac transplant bridging treatment and its prognostic impact

目的 主动脉球囊反搏(intra-aortic balloon pumping,IABP)可有效改善终末期心衰患者血流动力学状态,本研究旨在总结中国医学科学院阜外医院使用IABP桥接心脏移植(heart transplantation,HTx)受者的预后。方法 回顾性分析2011年1月至2020年12月中国医学科学院阜外医院单独使用IABP桥接至HTx患者70例与同期术前无器械辅助受者669例的基线资料、实验室检查及血流动力学数据。比较IABP置入后对移植术前状态改善情况,根据供者年龄、体重及冷缺血时间进行1:1倾向性评分匹配(propensity score matching,PSM),比较IABP桥接与无器械辅助患者术后恢复和生存情况差异。结果 HTx术前单独IABP桥接患者(n=70)较无器械组(n=669)的肺动脉平均压[(34.56±11.79) mmHg比(27.6±10.31) mmHg]、血肌酐[111.8(93.82,130.27)μmol/L比90.51(76.13,110.10)μmol/L]、肺动脉楔压[28(17,34) mm Hg比18(11,24)mm Hg]、血总胆红素[26.2(18.3,41.08)μmol/L比22.76(16.09,34.70)]μmol/L更高(P <0.05);IABP辅助后该组与辅助前对比肺动脉平均压(34.56±11.79比24.71±9.68)及肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)[28(17,34)比16(12,28)]显著下降(P <0.01);血肌酐[111.80(93.82,130.27)比101.44(80.22,128.46)]、血总胆红素[26.2(18.30,41.08)比8.465(6.40,11.05)]、乳酸[1.00(0.90,1.53)mmol/L比0.85(0.30,1.50)mmol/L]、Nt-pro BNP[7469.50(3819.25,13411.75)ng/ml比2797(1256.55,5639) ng/ml]明显改善(P <0.01);IABP组的UNOS评分(5.17±1.88比2.85±1.51)更高(P <0.05),经IABP辅助后,该组UNOS评分与无器械组对比(3.84±1.30比2.85±1.51)无差异(P> 0.05);经1:1 PSM后,IABP组与无器械辅助患者院内病死率(5.71%比5.71%,P> 0.05)及移植后长期生存率(包括1年、3年和5年)无显著差异(94.3%比92.8%,94.3%比91.3%,94.3%比91.3%,P> 0.05)。结论 IABP治疗可有效改善HTx受者术前状态,使其与术前状态较好的无器械辅助受者的短期及长期生存率相当。

Objective IABP is currently considered as a mean of bridging patients with end-stage heart failure to HTx,moreover,it is able to effectively improve the hemodynamic status of patients before transplantation.In the study,we summarize the preoperative status and prognostic impact of bridging patients with end-stage heart failure to HTx in our center.Methods We firstly carried out a retrospective analysis of bridging patients with end-stage heart failure to HTx by adopting IABP independently in our center from January 2011 to December 2020.Then,we further compared the improvement before IABP and after transplantation;the 1:1 PSM was realized in accordance with baseline information,donor age and cold ischemia time was used to further compare the differences of clinical profile and postoperative survival between bridging patients with independent IABP and those who had no instrument aid.Results The final analysis was performed in 70 patients with IABP bridging alone before HTx and 669 patients without device assistance during the same period.before IABP assistance,the IABP group had higher mean pulmonary artery pressure〔(34.56±11.79)mmHg vs.(27.6±10.31)mmHg〕,pulmonary artery wedge pressure〔28(17,34)mmHg vs.18(11,24)mmHg〕,creatinine〔111.8(93.82,130.27)μmol/L vs.90.51(76.13,110.1)μmol/L〕,and total bilirubin〔26.2(18.3,41.08)μmol/L vs.22.76(16.09,34.7)〕μmol/L(P<0.05);After IABP placement,mean pulmonary artery pressure〔(34.56±11.79)mmHg vs.(24.71±9.68)mmHg〕and pulmonary artery wedge pressure〔28(17,34)vs.16(12,28)decreased in the IABP group(P<0.01);Creatinine〔111.80(93.82,130.27)vs.101.44(80.22,128.46)〕,total bilirubin〔26.2(18.3,41.08)vs.8.465(6.40,11.05)〕,lactic acid〔1.00(0.90,1.53)mmol/L vs.0.85(0.30,1.50)mmol/L〕and NT-proBNP〔7469.5(3819.25,13411.75)ng/ml vs.2797(1256.55,5639)ng/ml〕were significantly improved(P<0.05);UNOS scores were higher in the IABP group〔5.17±1.88 vs.2.85±1.51,P<0.05〕,and after IABP assistance,there was no difference in UNOS scores in this group compared to the no-device group 3.84±1.30 vs.2.85±1.51(P>0.05);After 1:1 PSM,there was no significant difference in in-hospital mortality(5.71%vs.5.71%,P>0.05)and long-term post-transplant survival(including 1,3 and 5 years)between the IABP group and patients without device assistance(94.3%vs.92.8%,94.3%vs.91.3%,94.3%vs.91.3%,P>0.05).Conclusion IABP treatment is effective in improving the preoperative status of HTx recipients,resulting in short-term and long-term survival rates comparable to those of device-free assisted recipients with better preoperative status.