Objectives: To report outcomes in a pilot study of autologous mitochondrial transplantation (MT) in pediatric patients requiring postcardiotomy extracorporeal membrane oxygenation (ECMO) for severe refractory cardiogenic shock after ischemia-reperfusion injury (IRI). Methods: A single-center retrospective study of patients requiring ECMO for postcardiotomy cardiogenic shock following IRI between May 2002 and December 2018 was performed. Postcardiotomy IRI was defined as coronary artery compromise followed by successful revascularization. Patients undergoing revascularization and subsequent MT were compared with those undergoing revascularization alone (Control). Results: Twenty-four patients were included (MT, n = 10; Control, n = 14). Markers of systemic inflammatory response and organ function measured 1 day before and 7 days following revascularization did not differ between groups. Successful separation from ECMO—defined as freedom from ECMO reinstitution within 1 week after initial separation—was possible for 8 patients in the MT group (80%) and 4 in the Control group (29%) (P =.02). Median circumferential strain immediately following IRI but before therapy was not significantly different between groups. Immediately following separation from ECMO, ventricular strain was significantly better in the MT group (−23.0%; range, −20.0% to −28.8%) compared with the Control group (−16.8%; range, −13.0% to −18.4%) (P =.03). Median time to functional recovery after revascularization was significantly shorter in the MT group (2 days vs 9 days; P =.02). Cardiovascular events were lower in the MT group (20% vs 79%; P <.01). Cox regression analysis showed higher composite estimated risk of cardiovascular events in the Control group (hazard ratio, 4.6; 95% confidence interval, 1.0 to 20.9; P =.04) Conclusions: In this pilot study, MT was associated with successful separation from ECMO and enhanced ventricular strain in patients requiring postcardiotomy ECMO for severe refractory cardiogenic shock after IRI.

Autologous mitochondrial transplantation for cardiogenic shock in pediatric patients following ischemia-reperfusion injury / Guariento, A.; Piekarski, B. L.; Doulamis, I. P.; Blitzer, D.; Ferraro, A. M.; Harrild, D. M.; Zurakowski, D.; del Nido, P. J.; Mccully, J. D.; Emani, S. M.. - In: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 0022-5223. - (2020). [10.1016/j.jtcvs.2020.10.151]

Autologous mitochondrial transplantation for cardiogenic shock in pediatric patients following ischemia-reperfusion injury

Ferraro A. M.
Membro del Collaboration Group
;
2020

Abstract

Objectives: To report outcomes in a pilot study of autologous mitochondrial transplantation (MT) in pediatric patients requiring postcardiotomy extracorporeal membrane oxygenation (ECMO) for severe refractory cardiogenic shock after ischemia-reperfusion injury (IRI). Methods: A single-center retrospective study of patients requiring ECMO for postcardiotomy cardiogenic shock following IRI between May 2002 and December 2018 was performed. Postcardiotomy IRI was defined as coronary artery compromise followed by successful revascularization. Patients undergoing revascularization and subsequent MT were compared with those undergoing revascularization alone (Control). Results: Twenty-four patients were included (MT, n = 10; Control, n = 14). Markers of systemic inflammatory response and organ function measured 1 day before and 7 days following revascularization did not differ between groups. Successful separation from ECMO—defined as freedom from ECMO reinstitution within 1 week after initial separation—was possible for 8 patients in the MT group (80%) and 4 in the Control group (29%) (P =.02). Median circumferential strain immediately following IRI but before therapy was not significantly different between groups. Immediately following separation from ECMO, ventricular strain was significantly better in the MT group (−23.0%; range, −20.0% to −28.8%) compared with the Control group (−16.8%; range, −13.0% to −18.4%) (P =.03). Median time to functional recovery after revascularization was significantly shorter in the MT group (2 days vs 9 days; P =.02). Cardiovascular events were lower in the MT group (20% vs 79%; P <.01). Cox regression analysis showed higher composite estimated risk of cardiovascular events in the Control group (hazard ratio, 4.6; 95% confidence interval, 1.0 to 20.9; P =.04) Conclusions: In this pilot study, MT was associated with successful separation from ECMO and enhanced ventricular strain in patients requiring postcardiotomy ECMO for severe refractory cardiogenic shock after IRI.
2020
ECMO; ischemia reperfusion injury; mitochondrial transplantation; pediatric cardiac surgery
01 Pubblicazione su rivista::01a Articolo in rivista
Autologous mitochondrial transplantation for cardiogenic shock in pediatric patients following ischemia-reperfusion injury / Guariento, A.; Piekarski, B. L.; Doulamis, I. P.; Blitzer, D.; Ferraro, A. M.; Harrild, D. M.; Zurakowski, D.; del Nido, P. J.; Mccully, J. D.; Emani, S. M.. - In: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 0022-5223. - (2020). [10.1016/j.jtcvs.2020.10.151]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1491448
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