PDF(Pubmed)
Abstract：
UNASSIGNED: Heart transplantation is the preferred treatment for end-stage heart failure. This study investigated the intra-operative risk factors affecting post-transplantation mortality.
UNASSIGNED: This single-center retrospective cohort study examined 239 heart transplant patients over eight years, from 2011-2019, at the oldest dedicated cardiovascular center, Shahid Rajaee Hospital (Tehran, Iran). The primary evaluated clinical outcomes were rejection, readmission, and mortality one month and one year after transplantation. For data analysis, univariate logistic regression analyses were conducted.
UNASSIGNED: In this study, 107 patients (43.2%) were adults, and 132 patients (56.8%) were children. Notably, reoperation due to bleeding was a significant predictor of one-month mortality in both children (OR=7.47, P=0.006) and adults (OR=172.12, P<0.001). Moreover, the need for defibrillation significantly increased the risk of one-month mortality in both groups (children: OR=38.00, P<0.001; adults: OR=172.12, P<0.001). Interestingly, readmission had a protective effect against one-month mortality in both children (OR=0.02, P<0.001) and adults (OR=0.004, P<0.001). Regarding one-year mortality, the use of extracorporeal membrane oxygenation (ECMO) was associated with a higher risk in both children (OR=7.64, P=0.001) and adults (OR=12.10, P<0.001). For children, reoperation due to postoperative hemorrhage also increased the risk (OR=5.14, P=0.020), while defibrillation was a significant risk factor in both children and adults (children: OR=22.00, P<0.001; adults: OR=172.12, P<0.001). The median post-surgery survival was 22 months for children and 24 months for adults.
UNASSIGNED: There was no correlation between sex and poorer outcomes. Mortality at one month and one year after transplantation was associated with the following risk factors: the use of ECMO, reoperation for bleeding, defibrillation following cross-clamp removal, and Intensive Care Unit (ICU) stay. Readmission, on the other hand, had a weak protective effect.
UNASSIGNED: This single-center retrospective cohort study examined 239 heart transplant patients over eight years, from 2011-2019, at the oldest dedicated cardiovascular center, Shahid Rajaee Hospital (Tehran, Iran). The primary evaluated clinical outcomes were rejection, readmission, and mortality one month and one year after transplantation. For data analysis, univariate logistic regression analyses were conducted.
UNASSIGNED: In this study, 107 patients (43.2%) were adults, and 132 patients (56.8%) were children. Notably, reoperation due to bleeding was a significant predictor of one-month mortality in both children (OR=7.47, P=0.006) and adults (OR=172.12, P<0.001). Moreover, the need for defibrillation significantly increased the risk of one-month mortality in both groups (children: OR=38.00, P<0.001; adults: OR=172.12, P<0.001). Interestingly, readmission had a protective effect against one-month mortality in both children (OR=0.02, P<0.001) and adults (OR=0.004, P<0.001). Regarding one-year mortality, the use of extracorporeal membrane oxygenation (ECMO) was associated with a higher risk in both children (OR=7.64, P=0.001) and adults (OR=12.10, P<0.001). For children, reoperation due to postoperative hemorrhage also increased the risk (OR=5.14, P=0.020), while defibrillation was a significant risk factor in both children and adults (children: OR=22.00, P<0.001; adults: OR=172.12, P<0.001). The median post-surgery survival was 22 months for children and 24 months for adults.
UNASSIGNED: There was no correlation between sex and poorer outcomes. Mortality at one month and one year after transplantation was associated with the following risk factors: the use of ECMO, reoperation for bleeding, defibrillation following cross-clamp removal, and Intensive Care Unit (ICU) stay. Readmission, on the other hand, had a weak protective effect.
摘要：
■心脏移植是治疗终末期心力衰竭的首选方法。这项研究调查了影响移植后死亡率的术中风险因素。
■这项单中心回顾性队列研究检查了239名心脏移植患者，历时8年。从2011年到2019年，在最古老的专用心血管中心，ShahidRajaee医院（德黑兰，伊朗)。主要评估的临床结果是排斥反应，重新接纳,移植后一个月和一年的死亡率。对于数据分析，进行单因素logistic回归分析.
■在这项研究中，107例（43.2%）为成人，132例(56.8%)为儿童。值得注意的是,在儿童(OR=7.47,P=0.006)和成人(OR=172.12,P<0.001)中,出血导致的再次手术是1个月死亡率的显著预测指标.此外，需要除颤可显著增加两组患者1个月死亡率的风险(儿童:OR=38.00,P<0.001;成人:OR=172.12,P<0.001).有趣的是,再次入院对儿童(OR=0.02,P<0.001)和成人(OR=0.004,P<0.001)1个月死亡率均有保护作用.关于一年死亡率，在儿童(OR=7.64,P=0.001)和成人(OR=12.10,P<0.001)中,使用体外膜氧合(ECMO)的风险较高.对于孩子们来说,术后出血再次手术的风险也增加(OR=5.14,P=0.020),而除颤是儿童和成人的显著危险因素(儿童:OR=22.00,P<0.001;成人:OR=172.12,P<0.001)。儿童术后中位生存期为22个月，成人为24个月。
■性别与不良结局之间没有相关性。移植后一个月和一年的死亡率与以下危险因素有关：使用ECMO，再次手术出血，拆除交叉卡箍后进行除颤,重症监护病房（ICU）入住。再入院,另一方面,有微弱的保护作用。
■这项单中心回顾性队列研究检查了239名心脏移植患者，历时8年。从2011年到2019年，在最古老的专用心血管中心，ShahidRajaee医院（德黑兰，伊朗)。主要评估的临床结果是排斥反应，重新接纳,移植后一个月和一年的死亡率。对于数据分析，进行单因素logistic回归分析.
■在这项研究中，107例（43.2%）为成人，132例(56.8%)为儿童。值得注意的是,在儿童(OR=7.47,P=0.006)和成人(OR=172.12,P<0.001)中,出血导致的再次手术是1个月死亡率的显著预测指标.此外，需要除颤可显著增加两组患者1个月死亡率的风险(儿童:OR=38.00,P<0.001;成人:OR=172.12,P<0.001).有趣的是,再次入院对儿童(OR=0.02,P<0.001)和成人(OR=0.004,P<0.001)1个月死亡率均有保护作用.关于一年死亡率，在儿童(OR=7.64,P=0.001)和成人(OR=12.10,P<0.001)中,使用体外膜氧合(ECMO)的风险较高.对于孩子们来说,术后出血再次手术的风险也增加(OR=5.14,P=0.020),而除颤是儿童和成人的显著危险因素(儿童:OR=22.00,P<0.001;成人:OR=172.12,P<0.001)。儿童术后中位生存期为22个月，成人为24个月。
■性别与不良结局之间没有相关性。移植后一个月和一年的死亡率与以下危险因素有关：使用ECMO，再次手术出血，拆除交叉卡箍后进行除颤,重症监护病房（ICU）入住。再入院,另一方面,有微弱的保护作用。
