Kawaguchi A T, Cabrol C, Pavie A, Leger P, Bors V, Takahashi N, Gandjbackhch I
Chirurgie Cardiovasculaire, Hôpital de la Pitié, Paris, France.
Circulation. 1992 Nov;86(5 Suppl):II311-5.
Because mechanical circulatory assist as a bridge to heart transplantation places a further strain on current donor shortage as well as on medical cost containment, safe and effective use of the device is essential.
To predict survival before undertaking staged heart transplantation with the Jarvik-7 artificial heart, our 58 attempts were reviewed retrospectively. Scores of 1-4 were given for six preoperative factors based on results obtained by univariate and multivariate analyses between survivors and nonsurvivors of staged heart transplantation: transplant rejection (scored 4: S4) or postoperative heart failure (S3) as the indication, recipient height < 175 cm (S3), body surface area < 1.8 m2 (S3), hyperbilirubinemia > 24 microM/l (S2), weight < 60 kg (S2), and age > 40 years (S1). Of 14 survivors, 13 had a total score < 4 (sensitivity, 93%), with an average score of 1.6 in contrast to 5.5 for 44 nonsurvivors (p < 0.001). Among 26 patients scored < 4, 21 had heart transplantation, of whom 13 left the hospital. Of 32 patients scored > or = 4, only four could be discharged after transplantation (specificity, 70%).
Multiple preoperative factors successfully predicted transplantability and survival in staged heart transplantation. The results underscore the importance of preoperative condition and patient selection to achieve successful and effective use of Jarvik-7 as a bridge to heart transplantation.
由于作为心脏移植桥梁的机械循环辅助装置给当前供体短缺以及医疗费用控制带来了进一步压力，因此安全有效地使用该装置至关重要。
为预测使用Jarvik-7人工心脏进行分期心脏移植前的生存情况，我们回顾性分析了58例尝试。根据分期心脏移植存活者与非存活者之间单因素和多因素分析的结果，对六个术前因素给予1至4分：以移植排斥反应（评分为4：S4）或术后心力衰竭（S3）为指征，受者身高<175 cm（S3），体表面积<1.8 m²（S3），高胆红素血症>24 μmol/L（S2），体重<60 kg（S2），以及年龄>40岁（S1）。14例存活者中，13例总分<4（敏感性为93%），平均分为1.6，而44例非存活者平均分为5.5（p<0.001）。在26例评分<4的患者中，21例接受了心脏移植，其中13例出院。在32例评分≥4的患者中，移植后只有4例可以出院（特异性为70%）。
多个术前因素成功预测了分期心脏移植的可移植性和生存情况。结果强调了术前状况和患者选择对于成功有效使用Jarvik-7作为心脏移植桥梁的重要性。
