背景:尽管心脏手术后需要体外生命支持(ECLS)的心源性休克与高死亡率相关,性别对心脏切开术后ECLS结局的影响尚不清楚,文献结果相互矛盾.我们比较患者特征,住院结果,需要心脏切开术后ECLS的女性和男性之间的总生存率。
方法:本回顾性研究,多中心(34个中心),观察性研究纳入了2000~2020年间需要进行心脏切开术后ECLS的成人.术前,程序,和ECLS特性,并发症,比较了女性和男性的生存率。通过混合Cox比例风险模型研究了性别与住院生存率之间的关系。
结果:该分析包括1823例患者[女性:40.8%;中位年龄:66.0(四分位距:56.2-73.0岁)]。女性接受了更多的二尖瓣(女性:38.4%,男性:33.1%,p=0.019)和三尖瓣(女性:18%,男性:12.4%,p<0.001)瓣膜手术,而男性进行了更多的冠状动脉手术(女性:45.9%,男性:52.4%,p=0.007)。ECLS植入在女性手术中更为常见(女性:64.1%,男性:59.1%)和男性术后(女性:35.9%,男性:40.9%,p=0.036)。心室卸载(女性:25.1%,男性:36.2%,p<0.001)和主动脉内球囊反搏(女性:25.8%,男性:36.8%,p<0.001)在男性中最常用。女性术后右心室衰竭更多(女性:24.1%,男性:19.1%,p=0.016)和肢体缺血(女性:12.3%,男性:8.8%,p=0.23)。住院死亡率女性为64.9%,男性为61.9%(p=0.199),5年生存率无差异(女性:20%,95CI:17-23;男性:24%,95CI:21-28;p=0.069)。女性住院死亡率的风险比为1.12(95CI:0.99-1.27,p=0.069),调整后没有变化。
结论:这项研究表明,需要心脏切开术后ECLS的女性和男性具有不同的术前和ECLS特征,以及并发症,在住院和5年生存率方面没有统计学差异。
OBJECTIVE: Although cardiogenic shock requiring extracorporeal life support after cardiac surgery is associated with high mortality, the impact of sex on outcomes of postcardiotomy extracorporeal life support remains unclear with conflicting results in the literature. We compare patient characteristics, in-hospital outcomes, and overall survival between females and males requiring postcardiotomy extracorporeal life support.
METHODS: This retrospective, multicenter (34 centers), observational study included adults requiring postcardiotomy extracorporeal life support between 2000 and 2020. Preoperative, procedural, and extracorporeal life support characteristics, complications, and survival were compared between females and males. Association between sex and in-hospital survival was investigated through mixed Cox proportional hazard models.
RESULTS: This analysis included 1823 patients (female: 40.8%; median age: 66.0 years [interquartile range, 56.2-73.0 years]). Females underwent more mitral valve surgery (females: 38.4%, males: 33.1%, P = .019) and tricuspid valve surgery (feamales: 18%, males: 12.4%, P < .001), whereas males underwent more coronary artery surgery (females: 45.9%, males: 52.4%, P = .007). Extracorporeal life support implantation was more common intraoperatively in feamales (females: 64.1%, females: 59.1%) and postoperatively in males (females: 35.9%, males: 40.9%, P = .036). Ventricular unloading (females: 25.1%, males: 36.2%, P < .001) and intra-aortic balloon pumps (females: 25.8%, males: 36.8%, P < .001) were most frequently used in males. Females had more postoperative right ventricular failure (females: 24.1%, males: 19.1%, P = .016) and limb ischemia (females: 12.3%, males: 8.8%, P = .23). In-hospital mortality was 64.9% in females and 61.9% in males (P = .199) with no differences in 5-year survival (females: 20%, 95% CI, 17-23; males: 24%, 95% CI, 21-28; P = .069). Crude hazard ratio for in-hospital mortality in females was 1.12 (95% CI, 0.99-1.27; P = .069) and did not change after adjustments.
CONCLUSIONS: This study demonstrates that female and male patients requiring postcardiotomy extracorporeal life support have different preoperative and extracorporeal life support characteristics, as well as complications, without a statistical difference in in-hospital and 5-year survivals.