Marks J D, Karwande S V, Richenbacher W E, Jones K W, Doty D B, Millar R C, O'Connell J B, Renlund D G, Bristow M R, Pantalos G M
Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Salt Lake City.
J Heart Lung Transplant. 1992 Jan-Feb;11(1 Pt 1):117-28.
Mechanical circulatory assistance has become a necessary supplement to more conventional means of hemodynamic support as a shortage of donor organs and associated increase in waiting time have contributed to an increased incidence of hemodynamic deterioration in potential transplant recipients. This review summarizes the experience with circulatory support before and after transplantation of the Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program and draws conclusions on the efficacy of one program's use of mechanical circulatory support. Between March 1985 and October 1990, 401 patients were accepted for first-time heart transplantation by the UTAH program. One hundred and eighty patients (46%) were supported before transplantation with conventional hemodynamic therapies, 72 patients (18%) with oral enoximone, 96 patients (25%) with intravenous inotropes, and 34 patients (9%) with an intraaortic balloon; nine patients (2%) required centrifugal blood pump circulatory support. Not included in these statistics are 10 patients awaiting transplantation as of October 10, 1990. Thirty-eight candidates (10%) died awaiting transplantation, 329 (84%) received transplantation, and 24 (6%) were removed from the transplantation list for other reasons. Ten patients (3%) required mechanical circulatory support after transplantation with 38% of this group surviving 1 year after after transplantation. No single factor, including either hemodynamic support before transplantation or donor heart ischemic time, was found to be predictive of the need for mechanical circulatory support after transplantation. One-year survival rates after transplantation of patients requiring mechanical circulatory support before transplantation (86%) were not significantly different than for all transplant patients (88%). The experience of the UTAH Cardiac Transplant Program shows that with the judicious use of mechanical circulatory support transplant patients with advanced forms of hemodynamic support can have as equal a probability of survival as patients who undergo elective transplantation.
由于供体器官短缺以及等待时间相应增加，导致潜在移植受者血流动力学恶化的发生率上升，机械循环辅助已成为更传统血流动力学支持手段的必要补充。本综述总结了犹他移植附属医院（UTAH）心脏移植项目在移植前后使用循环支持的经验，并就该项目使用机械循环支持的疗效得出结论。1985年3月至1990年10月期间，UTAH项目共接受了401例首次心脏移植患者。180例患者（46%）在移植前接受了传统血流动力学治疗，72例患者（18%）接受口服依诺昔酮治疗，96例患者（25%）接受静脉注射强心剂治疗，34例患者（9%）接受主动脉内球囊反搏治疗；9例患者（2%）需要离心血泵循环支持。截至1990年10月10日等待移植的10例患者未纳入这些统计数据。38例候选者（10%）在等待移植期间死亡，329例（84%）接受了移植，24例（6%）因其他原因被从移植名单中剔除。10例患者（3%）在移植后需要机械循环支持，其中38%的患者在移植后存活了1年。未发现任何单一因素，包括移植前的血流动力学支持或供心缺血时间，可预测移植后是否需要机械循环支持。移植前需要机械循环支持的患者移植后1年生存率（86%）与所有移植患者（88%）相比无显著差异。UTAH心脏移植项目的经验表明，合理使用机械循环支持，患有晚期血流动力学支持形式的移植患者与接受择期移植的患者有同等的生存概率。
