Gonzalez-Stawinski Gonzalo V, Chang Albert S Y, Navia Jose L, Banbury Michael K, Buda Tiffany, Hoercher Kathy, Starling Randall C, Taylor David O, Smedira Nicholas G
Department of Thoracic, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
ASAIO J. 2006 Jul-Aug;52(4):445-9. doi: 10.1097/01.mat.0000225265.11371.ed.
Regional referral networks ("hub and spoke") have been created to facilitate the transfer of patients on mechanical circulatory support. Although individual centers report good success, overall outcomes have remained poor. We investigated whether preoperative variables influenced survival and could be used to help select patients best served by referral. A retrospective chart review was conducted on all patients transferred to our institution supported on cardiac assist devices. Between January 1995 and September 2003, 39 patients were received in transfer for continued care after the implantation of a cardiac assist device. Eighty-five percent of patients had the ABIOMED BVS 5000 implanted. The most common indication was postcardiotomy shock. Sixty-four percent of patients were not candidates for heart transplantation due to medical or social contraindications. The 30-day mortality of this group was 62%. Survivors had less comorbidity and were less likely to have complex surgeries, neurologic impairment, and multisystem organ failure when presenting to our center. Devices were weaned in 30% of cases. Only six patients (15%) were successfully transplanted, and five of these patients have done well at follow-up. Based on our experience, we believe that cardiogenic shock patients benefit from a regional referral system if they have not had complex cardiac surgical procedures or developed multisystem organ failure. Furthermore, there is a survival advantage when using long-term devices because this allows possible recovery or transplantation.
为促进接受机械循环支持患者的转运，已建立了区域转诊网络（“中心辐射”模式）。尽管个别中心报告取得了良好成效，但总体结果仍然不佳。我们调查了术前变量是否会影响生存率，以及能否用于帮助选择最适合转诊服务的患者。对所有转至我院并接受心脏辅助装置支持的患者进行了回顾性病历审查。1995年1月至2003年9月期间，39例患者在植入心脏辅助装置后被转来继续接受治疗。85%的患者植入了ABIOMED BVS 5000。最常见的适应证是心脏术后休克。64%的患者因医学或社会禁忌证而不适合心脏移植。该组患者的30天死亡率为62%。幸存者的合并症较少，在转诊至我院时进行复杂手术、出现神经功能障碍和多系统器官衰竭的可能性较小。30%的病例成功撤机。只有6例患者（15%）成功接受了移植，其中5例患者在随访中情况良好。根据我们的经验，我们认为，如果心源性休克患者未接受复杂的心脏手术或未发生多系统器官衰竭，那么他们将从区域转诊系统中获益。此外，使用长期装置具有生存优势，因为这有可能实现恢复或移植。
