目的 回顾性分析静脉-动脉模式体外膜肺氧合（VA-ECMO）与心脏移植围术期采用左心室循环辅助（LVAD）等机械循环辅助（Mechanical Circulatory Support，MCS）支持患者的临床资料，总结阜外医院在心脏移植领域应用机械循环辅助治疗的临床经验。

方法 回顾分析中国医学科学院阜外医院2015年1月至2022年12月731例心脏移植受者的临床资料。根据患者机械循环辅助的支持情况，对比患者的围手术期情况及远期预后。

结果 在731例心脏移植受者中，有57例（7.8%）在围术期接受了体外膜肺氧合（ECMO）支持，另外7例接受了左心室辅助装置（LVAD）。接受ECMO支持的患者中，术前使用ECMO作为桥接治疗的17例患者围术期生存率为52.9%，其中9例患者顺利出院；术中或术后启用ECMO的48例患者中，85.4%成功撤机，围术期生存率为64.6%。术中即应用ECMO的患者远期生存率显著优于术后ICU应用ECMO的患者（P<0.05）。术中与术后应用ECMO的患者在总体外循环时间、总升主动脉阻断时间、机械通气总时间等方面无显著差异，但术后在ICU应用ECMO的患者撤机成功率与出院存活率均低于术中应用ECMO的患者。ICU内应用ECMO的患者发生二次气管插管、气管切开、二次开胸、心跳骤停等不良事件的概率显著更高，术后出血的概率也较术中应用ECMO的患者更高。围术期内ECMO支持患者的主要死亡原因包括多器官衰竭、感染和移植心脏衰竭。在接受LVAD辅助的7例患者中，围术期生存率达到85.7%，术后主要并发症包括肾功能不全和血栓形成。总体来看，围术期使用机械循环辅助的患者早期生存率低于未使用者，但在术后90天内存活的患者中，两组的远期生存率差异无显著统计学意义。

结论 对于有指征的患者应用机械循环辅助可使其远期预后与其他心脏移植患者无显著差异；尽早应用ECMO可显著减少患者术后并发症的发生，改善其近期及远期预后；LVAD在心脏移植围术期应用中展现了巨大的应用潜力和更多的潜在益处。

Objective To retrospectively analyze the clinical data of patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and other mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVAD), during the perioperative period of heart transplantation, and to summarize the clinical experience of Fuwai Hospital in the application of MCS in heart transplantation.

Methods Clinical data of 731 consecutive heart transplant recipients between January 2015 and December 2022 at Fuwai Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The perioperative outcomes and long-term prognosis were compared between patients with and without MCS support.

Results Of the 731 heart transplant recipients, 57 (7.8%) received ECMO support and 7 received LVAD support during the perioperative period. Among the ECMO-supported patients, the 17 patients who received preoperative ECMO as a bridge to transplantation had a 30-day survival rate of 52.9%, with 9 patients discharged alive. Among the 48 patients who underwent ECMO initiation during or after surgery, 85.4% successfully underwent weaning from ECMO, with a perioperative survival rate of 64.6%. Patients who received intraoperative ECMO had significantly better long-term survival than those who received postoperative ECMO in the ICU (P<0.05). There were no significant differences in total cardiopulmonary bypass time, total aortic cross-clamp time, and total mechanical ventilation time between intraoperative and postoperative ECMO groups. However, the successful weaning rate and survival rate at discharge were lower in the postoperative ECMO group. Patients who received ECMO in the ICU had a significantly higher incidence of adverse events, such as reintubation, tracheotomy, re-thoracotomy, and cardiac arrest, as well as a higher incidence of postoperative bleeding. The main causes of death in patients with perioperative ECMO support were multiple organ failure, infection, and graft failure. Among the 7 patients who received LVAD support, the 30-day survival rate was 85.7%, and the major postoperative complications included renal dysfunction and thrombosis. Overall, patients who received perioperative MCS had lower early survival rates than those who did not. However, among patients who survived 90 days after surgery, there was no statistically significant difference in long-term survival between the two groups.

Conclusion For patients with appropriate indications, the use of mechanical circulatory support results in long-term outcomes comparable to those of other heart transplant recipients. Early initiation of ECMO significantly reduces postoperative complications and improves both short-term and long-term prognoses. LVAD demonstrates substantial potential and numerous benefits in the perioperative management of heart transplantation.