vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2024-1-55-66vtio-1694Research ArticleТрансплантация сердца и вспомогательное кровообращениеHeart Transplantation and Assisted CirculationСтратегия превентивного применения периферической вено-артериальной экстракорпоральной мембранной оксигенации при трансплантации с ожидаемой экстремальной длительной продолжительностью ишемии сердечного трансплантатаStrategy for prophylactic application of peripheral va-ecmo in transplantation involving expected extremely prolonged ischemia timeПопцовВ. Н.PoptsovV. N.

123182, Москва, ул. Щукинская, д. 1

1, Shchukinskaya str., Moscow, 123182

poptsov_vit@mail.ruЗахаревичВ. М.ZakharevichV. M.

123182, Москва, ул. Щукинская, д. 1

1, Shchukinskaya str., Moscow, 123182

СпиринаЕ. А.SpirinaE. A.

123182, Москва, ул. Щукинская, д. 1

1, Shchukinskaya str., Moscow, 123182

СкоковаА. И.SkokovaA. I.

123182, Москва, ул. Щукинская, д. 1

1, Shchukinskaya str., Moscow, 123182

СолодовниковаА. К.SolodovnikovaA. K.

123182, Москва, ул. Щукинская, д. 1

1, Shchukinskaya str., Moscow, 123182

ИгнаткинаА. С.IgnatkinaA. S.

123182, Москва, ул. Щукинская, д. 1

1, Shchukinskaya str., Moscow, 123182

КузнецоваА. А.KuznetsovaA. A.

123182, Москва, ул. Щукинская, д. 1

1, Shchukinskaya str., Moscow, 123182

ГлинкинГ. Б.GlinkinG. B.

123182, Москва, ул. Щукинская, д. 1

1, Shchukinskaya str., Moscow, 123182

ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава РоссииРоссияShumakov National Medical Research Center of Transplantology and Artificial OrgansRussian Federation2024181220232615566Copyright © Попцов В.Н., Захаревич В.М., Спирина Е.А., Скокова А.И., Солодовникова А.К., Игнаткина А.С., Кузнецова А.А., Глинкин Г.Б., 20242024Попцов В.Н., Захаревич В.М., Спирина Е.А., Скокова А.И., Солодовникова А.К., Игнаткина А.С., Кузнецова А.А., Глинкин Г.Б.Poptsov V.N., Zakharevich V.M., Spirina E.A., Skokova A.I., Solodovnikova A.K., Ignatkina A.S., Kuznetsova A.A., Glinkin G.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1694

Трансплантация сердца (ТС) с экстремально (более 6 ч) длительной ишемией донорского сердца сопряжена с риском тяжелой дисфункции сердечного трансплантата. Продемонстрирована высокая эффективность превентивной (предоперационное начало) вено-артериальной экстракорпоральной мембранной оксигенации (ВА ЭКМО) с целью предупреждения тяжелых гемодинамических нарушений при кардиохирургических вмешательствах. Цель исследования: определение влияния превентивной ВА ЭКМО на течение периоперационного периода при ТС с ожидаемой продолжительностью ишемии сердечного трансплантата более 6 ч. Материалы и методы. Обследовали 38 реципиентов – 33 (86,8%) мужчин и 5 (13,2%) женщин, возраст 11–66 лет (44,7 ± 12,0) (медиана 48,0). У 15 (39,5%) реципиентов применили предтрансплантационную механическую поддержку кровообращения (МПК) методом периферической ВА ЭКМО, у 6 из которых по превентивной методике. Реципиенты (n = 38) были разделены на 3 группы: 1) «без ВА ЭКМО» (n = 23); 2) «преТС ВА ЭКМО» (n = 9) – предтрансплантационная ВА ЭКМО как мост к ТС; 3) «превентивная ВА ЭКМО» (n = 6). Результаты. В «превентивная ВА ЭКМО» продолжительность ИК (94,0 [85,5; 102,8] мин) и период реперфузии (20,0 [18,3; 27,6] мин) были короче (p < 0,05) по сравнению с «без ВА ЭКМО» (161,0 [122; 191,5] и 60,0 [55,3; 70,5] мин) и «преТС ВА ЭКМО» (127,0 [117; 150,3] и 35,0 [27,8; 48,8] мин). В «преТС ВА ЭКМО» и «превентивная ВА ЭКМО» вазоактивный/инотропный индекс были меньше (p < 0,05) по сравнению с реципиентами группы «без ВА ЭКМО» – соответственно 12,1 [11,2; 14,0] и 12,5 [11,7; 14,8] против 16,0 [15,0; 18,5]. По частоте развития тяжелой первичной дисфункции группы не отличались. Группы «преТС ВА ЭКМО» и «превентивная ВА ЭКМО» характеризовались меньшей продолжительностью ИВЛ по сравнению с «без ВА ЭКМО» (11,7 [10,0; 16,5] и 12,7 [11,3; 18,4] соответственно против 14,5 [13,0; 19,3]). Группы «без ВА ЭКМО» и «превентивная ВА ЭКМО» не различались по потребности в послеоперационной ЗПТ – соответственно 21,7 и 16,7%. Группы не различались по продолжительности лечения в ОРИТ и госпитальной летальности – 0% («превентивная ВА ЭКМО»), 8,7% («без ВА ЭКМО») и 11,1% («преТС ВА ЭКМО»). Заключение. Превентивная ВА ЭКМО при ТС с экстремально длительной ишемией сердечного трансплантата способствует сокращению продолжительности ИК, периода реперфузии, послеоперационной ИВЛ, снижению потребности в инотропной поддержке.

Heart transplantation (HT) with extremely prolonged (>6 hours) graft ischemia is associated with severe cardiac graft dysfunction. The high efficiency of prophylactic (preoperative initiation) veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to prevent severe hemodynamic disorders during cardiac surgery has been demonstrated. Objective: to determine the effect of prophylactic VA-ECMO on the perioperative period in HT with an expected graft ischemia >6 hours. Materials and methods. Thirty-eight recipients (33 (86.8%) males and 5 (13.2%) females), age 11–66 (44.7 ± 12.0) years (median 48.0 years) were examined. Pre-transplant mechanical circulatory support (MCS) using peripheral VA-ECMO was applied in 15 (39.5%) recipients, in 6 of whom by prophylactic technique. The recipients (n = 38) were divided into 3 groups: 1) «no pre-HT VA-ECMO» (n = 23); 2) «pre-HT VA-ECMO» (n = 9) – pre-transplant VA-ECMO as a bridge to HT; 3) «prophylactic VA-ECMO» (n = 6). Results. In «prophylactic VA-ECMO» group, extracorporeal circulation (ECC) (94.0 [85.5; 102.8] min) and reperfusion time (20.0 [18.3; 27.6] min) were shorter (p < 0.05) compared to «no pre-HT VA-ECMO» (161.0 [122; 191.5] and 60.0 [55.3; 70.5] min) and «pre-HT VA-ECMO» (127.0 [117; 150.3] and 35.0 [27.8; 48.8] min) groups. The vasoactive-inotropic score was lower (p < 0.05) in «pre-HT VA-ECMO» and «prophylactic VAECMO» groups compared to recipients in «no pre-HT VA-ECMO» group, 12.1 [11.2; 14.0] and 12.5 [11.7; 14.8] vs. 16.0 [15.0; 18.5], respectively. The groups did not differ in terms of incidence of severe primary dysfunction. The «pre-HT VA-ECMO» and «prophylactic VA-ECMO» groups were characterized by shorter duration of mechanical ventilation (MV) compared with «no pre-HT VA-ECMO» group (11.7 [10.0; 16.5] and 12.7 [11.3; 18.4], respectively, vs. 14.5 [13.0; 19.3]). The «no pre-HT VA-ECMO» and «prophylactic VA-ECMO» groups did not differ in the need for postoperative MST, 21.7% and 16.7%, respectively. The groups did not differ in terms of length of stay in the intensive care unit (ICU) and in-hospital mortality – 0% («prophylactic VA-ECMO») and 8.7% («no pre-HT VA-ECMO») and 11.1% («pre-HT VA-ECMO»), respectively. Conclusion. Prophylactic VA-ECMO in HT with extremely prolonged cardiac graft ischemia reduces ECC duration, reperfusion period, postoperative mechanical ventilation period, and the need for inotropic therapy.

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The authors declare that there are no conflicts of interest present.