Taghavi Shahrokh, Zuckermann Andreas, Ankersmit Jan, Wieselthaler Georg, Rajek Angela, Laufer Günther, Wolner Ernst, Grimm Michael
Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria.
Ann Thorac Surg. 2004 Nov;78(5):1644-9. doi: 10.1016/j.athoracsur.2004.04.059.
Acute right ventricular failure after heart transplantation is a life-threatening condition, and sometimes the use of mechanical circulatory support is inevitable. The aim of this retrospective study was to investigate the effectiveness of two different mechanical circulatory support systems for this indication.
From 1984 to 2003, 28 heart transplant recipients exhibited right ventricular failure resistant to drug therapy. Right ventricular assist device (n = 15) or extracorporeal membrane oxygenation (n = 13) was implanted to support the failing heart.
Overall in-hospital survival was 43%. In the right ventricular assist device group, only 2 patients (13%) could be weaned from mechanical circulatory support compared with 10 patients (77%) in the extracorporeal membrane oxygenation group (p = 0.001). Retransplantation was necessary in 6 patients in the right ventricular assist device group and in 1 patient in the extracorporeal membrane oxygenation group (p = 0.049). There was no difference in patient survival between groups, but graft survival was significantly better in the extracorporeal membrane oxygenation group (p = 0.005).
In view of these results, extracorporeal membrane oxygenation seems to be the better option as mechanical circulatory support for right ventricular failure in heart transplantation.
心脏移植术后急性右心室衰竭是一种危及生命的状况，有时不可避免地要使用机械循环支持。这项回顾性研究的目的是调查两种不同的机械循环支持系统针对这一适应症的有效性。
1984年至2003年期间，28例心脏移植受者出现对药物治疗耐药的右心室衰竭。植入右心室辅助装置（n = 15）或体外膜肺氧合（n = 13）以支持衰竭的心脏。
总体住院生存率为43%。在右心室辅助装置组中，只有2例患者（13%）能够脱离机械循环支持，而体外膜肺氧合组有10例患者（77%）能够脱离（p = 0.001）。右心室辅助装置组有6例患者需要再次移植，体外膜肺氧合组有1例患者需要再次移植（p = 0.049）。两组患者生存率无差异，但体外膜肺氧合组的移植物生存率明显更高（p = 0.005）。
鉴于这些结果，体外膜肺氧合似乎是心脏移植中右心室衰竭机械循环支持的更好选择。
