Ono Minoru, Wolf Randall K, Angouras Dimitrios C, Brown David A, Goldstein Andrew H, Michler Robert E
Division of Cardiothoracic Surgery, The Ohio State University, Columbus, USA.
Eur J Cardiothorac Surg. 2002 Jun;21(6):1061-72. doi: 10.1016/s1010-7940(02)00060-x.
Cardiac disease is a common cause of mortality and morbidity in patients with abdominal solid organ transplant. Improvement of the results of abdominal organ transplantation has contributed to an increasing pool of patients who require open heart surgery. We investigated short- and long-term results of open heart surgery in patients with functioning abdominal solid organ transplants.
We retrospectively examined 60 patients (52.5 years in average) undergoing coronary artery bypass grafting and/or valve surgery since July 1988 after abdominal organ transplantation. There were 22 females (37%). They consisted of 46 kidney, nine kidney-pancreas and five liver recipients. Cardiac surgery was performed 68.9 months after transplantation. Preoperative serum creatinine level was 2.1 mg/dl, and 11 patients (18%) had creatinine level more than 3.0 mg/dl. Eleven patients (18%) were operated upon on non-elective basis. Twelve patients (20%) were not given stress-dose steroids postoperatively.
Three patients died early after surgery (5.0%). Twenty-six major complications were seen in 17 patients (28%), including deterioration of renal function in seven (three patients required temporary hemodialysis), three major infections, two bleeding complications, and two strokes. No graft loss was encountered. No differences were seen in mortality and morbidity between patients with or without stress-dose steroids. Multivariate analysis identified cardiopulmonary bypass time (P<0.05) as a risk factor for operative death, preoperative creatinine level (P<0.05), cardiopulmonary bypass time (P<0.05) and the amount of fresh frozen plasma used (P<0.05) for major complication, non-elective surgery (P<0.01) for deterioration of renal function. Thirteen patients died and five kidney allografts failed late after surgery. Three- and 5-year patient and graft survivals were 70.8 and 66.8, 84.5 and 84.5%, respectively. Multivariate regression analysis identified female gender (P<0.05), body mass index (P<0.001) and non-elective surgery (P<0.001) as risk factors for late death, and preoperative creatinine level (P<0.05) for late graft loss.
Open heart surgery can be performed with acceptable short- and long-term results in patients with functioning abdominal transplants. Stress-dose steroid may be unnecessary in selected patients. Aggressive use of open heart surgery in this patient population to avoid non-elective surgery may further improve early and late surgical outcomes.
心脏疾病是腹部实体器官移植患者死亡和发病的常见原因。腹部器官移植效果的改善导致需要进行心脏直视手术的患者群体不断增加。我们调查了腹部实体器官移植功能正常的患者进行心脏直视手术的短期和长期结果。
我们回顾性研究了自1988年7月以来接受腹部器官移植后进行冠状动脉搭桥术和/或瓣膜手术的60例患者（平均年龄52.5岁）。其中女性22例（37%）。包括46例肾移植患者、9例肾胰联合移植患者和5例肝移植患者。心脏手术在移植后68.9个月进行。术前血清肌酐水平为2.1mg/dl，11例患者（18%）肌酐水平超过3.0mg/dl。11例患者（18%）接受了非择期手术。12例患者（20%）术后未给予应激剂量的类固醇。
3例患者术后早期死亡（5.0%）。17例患者（28%）出现26种主要并发症，包括7例肾功能恶化（3例患者需要临时血液透析）、3例严重感染、2例出血并发症和2例中风。未出现移植物丢失。接受或未接受应激剂量类固醇的患者在死亡率和发病率方面无差异。多因素分析确定体外循环时间（P<0.05）是手术死亡的危险因素，术前肌酐水平（P<0.05）、体外循环时间（P<0.05）和用于主要并发症的新鲜冰冻血浆量（P<0.05）是主要并发症的危险因素，非择期手术（P<0.01）是肾功能恶化的危险因素。13例患者术后晚期死亡，5例肾移植失败。3年和5年的患者生存率和移植物生存率分别为70.8%和66.8%，84.5%和84.5%。多因素回归分析确定女性性别（P<0.05）、体重指数（P<0.001）和非择期手术（P<0.001）是晚期死亡的危险因素，术前肌酐水平（P<0.05）是晚期移植物丢失的危险因素。
腹部移植功能正常的患者进行心脏直视手术可获得可接受的短期和长期结果。部分患者可能不需要应激剂量的类固醇。在该患者群体中积极采用心脏直视手术以避免非择期手术可能会进一步改善早期和晚期手术结果。
