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Master Thesis

Caractéristiques et devenir de patients en choc cardiogénique ayant nécessité une évacuation sanitaire de 10000 km pour greffe cardiaque : expérience de La Réunion de 2005 à 2015

Abstract : Introduction: There is no heart transplantation (HT) center on Reunion Island, which is a French overseas territory. Patients needed emergent HT had to be transferred from Reunion Island to Paris (10,000 km). The aim of this study was to describe the characteristics and the prognosis of adults with cardiogenic shock transferred from Reunion Island to Metropolitan France. Material and methods: This retrospective study was conducted on Reunion Island between 2005 and 2015. Results: during the study period 33 adults with cardiogenic shock were transferred from Reunion Island to Paris for HT. Among them 19 (57.6%) needed a mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (ECMOa-v) before transfer. Median age was 51 [33-57] years old, 46% had ischemic heart disease and 27% had idiopathic dilated cardiomyopathy. Before transfer, patients with ECMOa-v were sicker than patients without ECMOa-v with higher Sequential Organ Failure Assessment score, Interagency Registry for Mechanically Assisted Circulatory Support score and Index for Mortality Prediction After Cardiac Transplantation score (P ≤ 0,03). Before transfer, incidence of thromboembolic events, severe infectious complications and major haemorrhaging events where higher in the group of patients with ECMOa-v than in the group of patients without ECMOa-v (58% vs. 7%, P =0.003, 84% vs. 36%, P =0,01 and 42% vs. 0%, P = 0.005, respectively). Sixteen of the 33 patients (48.5%) could be recorded on HT waiting list. Seven patients from the ECMOa-v group (36.8%) and 6 from the group without ECMOa-v (42.9%, P = 0.7) underwent HT after a median delay of 10 [4-29] days on emergent HT waiting list. From HT, 1-year survival rates were 84.6% overall, 85.7% for ECMOa-v patients, and 83.3% in patients without ECMOa-v. Conclusions: This study suggests that HT for patients with cardiogenic shock needed very long air transfer evacuation is feasible with good results: 49% could be registered on HT list; 39% of transfered patients underwent HT and 84.6% of the patients with HT were still alive at one year.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01442674
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Friday, January 20, 2017 - 6:37:01 PM
Last modification on : Friday, August 25, 2017 - 1:08:15 AM
Long-term archiving on: : Friday, April 21, 2017 - 4:31:36 PM

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  • HAL Id : dumas-01442674, version 1

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Clément Charon. Caractéristiques et devenir de patients en choc cardiogénique ayant nécessité une évacuation sanitaire de 10000 km pour greffe cardiaque : expérience de La Réunion de 2005 à 2015. Médecine humaine et pathologie. 2016. ⟨dumas-01442674⟩

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