PDF(Pubmed)
Abstract：
UNASSIGNED: Vasoplegia after cardiac surgery is associated with adverse outcomes. However, the clinical effects of vasoplegia and the significance of its duration after continuous-flow left ventricular assist device (CF-LVAD) implantation are less known.
UNASSIGNED: This study aimed to identify predictors of and outcomes from transient vs prolonged vasoplegia after CF-LVAD implantation.
UNASSIGNED: The study was a retrospective review of consecutive patients who underwent CF-LVAD implantation between January 1, 2005, and December 31, 2017. Vasoplegia was defined as the presence of all of the following: mean arterial pressure ≤65 mm Hg, vasopressor (epinephrine, norepinephrine, vasopressin, or dopamine) use for >6 hours within the first 24 hours postoperatively, cardiac index ≥2.2 L/min/m2 and systemic vascular resistance <800 dyne/s/cm5, and vasodilatory shock not attributable to other causes. Prolonged vasoplegia was defined as that lasting 12 to 24 hours; transient vasoplegia was that lasting 6 to <12 hours. Patient characteristics, outcomes, and risk factors were analyzed.
UNASSIGNED: Of the 600 patients who underwent CF-LVAD implantation during the study period, 182 (30.3%) developed vasoplegia. Mean patient age was similar between the vasoplegia and no-vasoplegia groups. Prolonged vasoplegia (n = 78; 13.0%), compared with transient vasoplegia (n = 104; 17.3%), was associated with greater 30-day mortality (16.7% vs 5.8%; P = 0.02). Risk factors for prolonged vasoplegia included preoperative dialysis and elevated body mass index.
UNASSIGNED: Compared with vasoplegia overall, prolonged vasoplegia was associated with worse survival after CF-LVAD implantation. Treatment to avoid or minimize progression to prolonged vasoplegia may be warranted.
UNASSIGNED: This study aimed to identify predictors of and outcomes from transient vs prolonged vasoplegia after CF-LVAD implantation.
UNASSIGNED: The study was a retrospective review of consecutive patients who underwent CF-LVAD implantation between January 1, 2005, and December 31, 2017. Vasoplegia was defined as the presence of all of the following: mean arterial pressure ≤65 mm Hg, vasopressor (epinephrine, norepinephrine, vasopressin, or dopamine) use for >6 hours within the first 24 hours postoperatively, cardiac index ≥2.2 L/min/m2 and systemic vascular resistance <800 dyne/s/cm5, and vasodilatory shock not attributable to other causes. Prolonged vasoplegia was defined as that lasting 12 to 24 hours; transient vasoplegia was that lasting 6 to <12 hours. Patient characteristics, outcomes, and risk factors were analyzed.
UNASSIGNED: Of the 600 patients who underwent CF-LVAD implantation during the study period, 182 (30.3%) developed vasoplegia. Mean patient age was similar between the vasoplegia and no-vasoplegia groups. Prolonged vasoplegia (n = 78; 13.0%), compared with transient vasoplegia (n = 104; 17.3%), was associated with greater 30-day mortality (16.7% vs 5.8%; P = 0.02). Risk factors for prolonged vasoplegia included preoperative dialysis and elevated body mass index.
UNASSIGNED: Compared with vasoplegia overall, prolonged vasoplegia was associated with worse survival after CF-LVAD implantation. Treatment to avoid or minimize progression to prolonged vasoplegia may be warranted.
摘要：
■心脏手术后的血管停搏液与不良结局相关。然而,血管停搏液的临床效果及其持续左心室辅助装置(CF-LVAD)植入后持续时间的意义尚不清楚.
■本研究旨在确定CF-LVAD植入后短暂性和延长性血管停搏的预测因素和结果。
■该研究是对2005年1月1日至2017年12月31日期间接受CF-LVAD植入的连续患者的回顾性研究。血管停搏被定义为存在以下所有情况：平均动脉压≤65mmHg，血管加压药（肾上腺素，去甲肾上腺素,血管加压素,或多巴胺)术后前24小时内使用>6小时，心脏指数≥2.2L/min/m2，全身血管阻力<800达因/s/cm5，血管舒张性休克不可归因于其他原因。长时间的血管停搏被定义为持续12至24小时；短暂性血管停搏是持续6至<12小时。患者特征,结果，并对危险因素进行分析。
■在研究期间接受CF-LVAD植入的600名患者中，182例(30.3%)出现血管停搏液。血管停搏组和无血管停搏组的平均患者年龄相似。延长血管停搏液（n=78；13.0%），与短暂性血管麻痹相比（n=104；17.3％），与更高的30天死亡率相关(16.7%vs5.8%;P=0.02)。长时间血管停搏的危险因素包括术前透析和体重指数升高。
■与整体血管停搏液相比，长时间的血管停搏液与CF-LVAD植入后的生存率降低相关.可能需要进行治疗以避免或最大程度地减少长期血管停搏液的进展。
■本研究旨在确定CF-LVAD植入后短暂性和延长性血管停搏的预测因素和结果。
■该研究是对2005年1月1日至2017年12月31日期间接受CF-LVAD植入的连续患者的回顾性研究。血管停搏被定义为存在以下所有情况：平均动脉压≤65mmHg，血管加压药（肾上腺素，去甲肾上腺素,血管加压素,或多巴胺)术后前24小时内使用>6小时，心脏指数≥2.2L/min/m2，全身血管阻力<800达因/s/cm5，血管舒张性休克不可归因于其他原因。长时间的血管停搏被定义为持续12至24小时；短暂性血管停搏是持续6至<12小时。患者特征,结果，并对危险因素进行分析。
■在研究期间接受CF-LVAD植入的600名患者中，182例(30.3%)出现血管停搏液。血管停搏组和无血管停搏组的平均患者年龄相似。延长血管停搏液（n=78；13.0%），与短暂性血管麻痹相比（n=104；17.3％），与更高的30天死亡率相关(16.7%vs5.8%;P=0.02)。长时间血管停搏的危险因素包括术前透析和体重指数升高。
■与整体血管停搏液相比，长时间的血管停搏液与CF-LVAD植入后的生存率降低相关.可能需要进行治疗以避免或最大程度地减少长期血管停搏液的进展。
