BACKGROUND Severe early graft dysfunction (EGD) is defined by mechanical circulatory support (MCS) <24 hours of heart transplantation (HT). We classified severe EGD based on timing of post-HT MCS: ''Immediate'' intra-operative vs ''Delayed'' post-operative MCS (after admission into intensive care unit (ICU) from operating theater). We hypothesized that (1) risk factors and clinical course differ between ''Immediate'' and ''Delayed'' MCS; and (2) diastolic perfusion pressure (DPP=diastolic blood pressure-central venous pressure) and Norepinephrine equivalents (NE=sum of vasopressor doses), as measures of vasoplegia are related to ''Delayed'' MCS. METHODS Two-center study of 216 consecutive patients who underwent HT. Recipient, donor, vasopressor doses and hemodynamic data at T0 and T6 (on admission and 6 hours after admission into ICU) were collected. RESULTS Of the 216 patients, 67 patients had severe EGD (''Immediate'' MCS: n = 43, ''Delayed'' MCS: n = 24). The likelihood of ''immediate'' MCS but not ''delayed'' MCS increased with increasing warm ischemic and cardiopulmonary bypass times on multinomial regression analysis with ''no MCS'' as the referent group. One-year mortality was highest in ''Immediate'' MCS vs ''no MCS'' and ''delayed'' MCS (34.9% vs 3.4% and 8% respectively, p < 0.001). Of the patients who had no immediate post-transplant MCS, DPP and NE at T6 were independently associated with subsequent ''delayed'' MCS. Sensitivity and specificity of NE≥ 0.2 mcg/kg/min for ''Delayed'' MCS were 71% and 81%. Sensitivity and specificity of DPP of ≥40 mmHg for No MCS were 83% and 74%. The discriminatory value of systemic vascular resistance for ''Delayed'' MCS was poor. CONCLUSION Risk factors and 1-year survival differed significantly between ''Immediate'' and ''Delayed'' post-HT MCS. The latter is related to lower DPP and higher NE, which is consistent with vasoplegia as the dominant pathophysiology.

中文翻译：

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心脏移植后严重的早期移植物功能障碍：两种临床轨迹和舒张灌注压作为机械循环支持的预测因子。


背景严重早期移植功能障碍（EGD）的定义是心脏移植（HT）的机械循环支持（MCS）％3C24小时。我们根据 HT 后 MCS 的时间对严重 EGD 进行分类：术中“立即”与术后“延迟”MCS（从手术室进入重症监护室 (ICU) 后）。我们假设 (1) “立即”和“延迟”MCS 的危险因素和临床病程有所不同； (2)舒张灌注压（DPP=舒张压-中心静脉压）和去甲肾上腺素当量（NE=升压药剂量之和），因为血管麻痹的测量与“延迟”MCS有关。方法 对 216 名连续接受 HT 的患者进行两中心研究。收集 T0 和 T6（入院时和进入 ICU 后 6 小时）的受者、供者、升压药剂量和血流动力学数据。结果 在 216 名患者中，67 名患者患有严重 EGD（“立即”MCS：n = 43，“延迟”MCS：n = 24）。在以“无 MCS”为参考组的多项回归分析中，“立即”MCS 而不是“延迟”MCS 的可能性随着热缺血和心肺转流时间的增加而增加。 “立即”MCS 与“无 MCS”和“延迟”MCS 的一年死亡率最高（分别为 34.9% vs 3.4% 和 8%，p < 0.001）。在移植后没有立即出现 MCS 的患者中，T6 时的 DPP 和 NE 与随后的“延迟”MCS 独立相关。 NE≥0.2 mcg/kg/min 对于“延迟”MCS 的敏感性和特异性分别为 71% 和 81%。 DPP ≥40 mmHg 对于无 MCS 的敏感性和特异性分别为 83% 和 74%。全身血管阻力对于“延迟”MCS 的鉴别价值很差。 结论 HT MCS 后“立即”和“延迟”的危险因素和 1 年生存率存在显着差异。后者与较低的 DPP 和较高的 NE 有关，这与血管麻痹作为​​主要病理生理学一致。