초록접수 현황
| 16F-287 | 구연 발표 |
Impact of Preoperative Extracorporeal Membrane Oxygenation Apply on Heart Transplantation
Seung Hyun Lee, M.D, Ph.D, Byung Chul Chang, M.D, Ph.D, Hyun Chel Choo, M.D, Kyung-Jong Yoo, M.D, Ph.D, Sak Lee, M.D, Ph.D, Young-Nam Youn, M.D, Ph.D
Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
Background : Extracorporeal membrane oxygenation (ECMO) has long been the sole means of mechanical support for patients with end-stage cardiac failure during waiting for heart-transplantation in Korea, but has high waitlist mortality and reported survival discharge of less than 50%. This study aimed to evaluate the impact of transplantation as primary therapy on survival in patients on ECMO at listing.
Methods : This was a retrospective analysis of total 119 patients received heart transplant from Nov.1994 to Aug 2016. We compared outcomes of 21 patients (17.7%) on ECMO at listing to outcomes of the comparison (Non ECMO, n=98) group. In the ECMO group, a Cox proportional hazard model with transplantation was used to evaluate the effect of transplantation on survival.
Results : Mean follow-up duration was 32.9±41.9 months. Patients on ECMO had a higher bilirubin, AST, ALT, lactate level and a lower EF, hemoglobin level than comparison. Postoperative ECMO and CRRT support, and 30 days mortality was more common in ECMO group. One-year transplant survival was 57% in the ECMO group and 96% in comparison group (P < 0.01). However, one-year transplant survival excluding in-hospital mortality was 76% in the study group and 92% in comparison group (P=0.33). By using of Cox hazard multivariate analysis, preoperative serum bilirubin (P<0.01, HR=1.075, 95%C.I=1.02-1.13), creatinine (P<0.01, HR=1.97, 95% C.I=1.46-2.66),postoperative lactate(P<0.01, HR=1.45, 95% C.I=1.16-1.81), preoperative ECMO support duration (P<0.01, HR=1.00, 95% C.I=1.00-1.01) were risk factors for mortality.
Conclusion : Posttransplant survival still remains inferior to patients without ECMO. However, if we can reduce in-hospital mortality from adequate candidates selection and well-organized management during ECMO support before surgery, transplantation may be considered to be an acceptable therapy in patients on ECMO
Methods : This was a retrospective analysis of total 119 patients received heart transplant from Nov.1994 to Aug 2016. We compared outcomes of 21 patients (17.7%) on ECMO at listing to outcomes of the comparison (Non ECMO, n=98) group. In the ECMO group, a Cox proportional hazard model with transplantation was used to evaluate the effect of transplantation on survival.
Results : Mean follow-up duration was 32.9±41.9 months. Patients on ECMO had a higher bilirubin, AST, ALT, lactate level and a lower EF, hemoglobin level than comparison. Postoperative ECMO and CRRT support, and 30 days mortality was more common in ECMO group. One-year transplant survival was 57% in the ECMO group and 96% in comparison group (P < 0.01). However, one-year transplant survival excluding in-hospital mortality was 76% in the study group and 92% in comparison group (P=0.33). By using of Cox hazard multivariate analysis, preoperative serum bilirubin (P<0.01, HR=1.075, 95%C.I=1.02-1.13), creatinine (P<0.01, HR=1.97, 95% C.I=1.46-2.66),postoperative lactate(P<0.01, HR=1.45, 95% C.I=1.16-1.81), preoperative ECMO support duration (P<0.01, HR=1.00, 95% C.I=1.00-1.01) were risk factors for mortality.
Conclusion : Posttransplant survival still remains inferior to patients without ECMO. However, if we can reduce in-hospital mortality from adequate candidates selection and well-organized management during ECMO support before surgery, transplantation may be considered to be an acceptable therapy in patients on ECMO
책임저자: Young-Nam Youn
Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
발표자: Young-Nam Youn, E-mail : YNYOUN@yuhs.ac