Abstract:

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 beforetransplantation. 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 wasused to further compare the differences of clinical profile and postoperative survival between bridging patientswith 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〔（346±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 arterypressure〔（34.56± 11.79）mmHg vs.（24.71±9.68）mmHg〕and pulmonary artery wedge pressure〔28（17，34）vs. 16（12，28）decreased inthe 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 afterIABPassistance，there wasno 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）；After1 ：1 PSM，there was no significant difference in in-hospital mortality（5.71 % vs. 5.71%，P＞0.05）and long-term posttransplant survival（including 1，3 and 5 years）betweenthe IABP groupand 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 iseffective in improving the preoperative status of HTx recipients，resulting in short-term and long-term survival rates comparable to those of devicefree assisted recipients with betterpreoperative status.

Key words:

Heart Transplantation , Intra-aortic balloon pumping , Mechanical Circulatory Support , Bridgeto-transplant

摘要：

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）mmHg 比 18（11，24）mmHg〕、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-proBNP〔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。

关键词:

心脏移植 , 主动脉球囊反搏 , 机械循环支持装置 , 移植前桥接