Coskun Oguz, Coskun Tolga, El-Arousy Mahmud, Parsa Muhmammed Amin, Reiss Nils, Blanz Ute, Von Knyphausen Edzard, Sandica Eugen, Schulz Uwe, Knobl Hermann, Tenderich Gero, Bairaktaris Andreas, Kececioglu Deniz, Körfer Reiner
Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany.
ASAIO J. 2007 Jan-Feb;53(1):103-6. doi: 10.1097/01.mat.0000250956.08459.8e.
End-stage congenital heart disease (CHD) is an important indication for pediatric heart transplantation (HTx) as well as transplantation in adult populations. The purpose of this retrospective analysis was to compare the survival rate of adults who underwent HTx for end-stage CHD with those who underwent HTx for other causes. To find out whether HTx is a viable therapeutic option for adult patients with preoperated CHD, data from 15 adult patients with different forms of CHD, who had previously undergone different corrective and palliative procedures, were retrospectively analyzed and compared with the HTx data of 1400 adult patients (>15 years old) whose indications for HTx were other than end-stage CHD. From 1989 to 2005, 15 adult patients (eight men/seven women) were given transplantation for end-stage CHD. Ten patients had been preoperated once, five patients twice. Their mean age was 34.06 +/- 3.9 years. In five cases, patients had development of acute renal failure. One female patient died 40 days after surgery, after having a cerebral infarction; one male patient died 4 years after HTx for OKT 3 monoclonal antibody-resistant rejection; and two patients died as the result of multiple organ failure at 4 days and 30 days after HTx, respectively; 11 patients are still alive. The cumulative survival rate at 1 year is 80% versus 80% in patients given transplantation for noncongenital indications. Heart transplantation in adults with end-stage CHD can be performed with a good long-term prognosis. Previous palliative operations do not affect outcome after HTx.
终末期先天性心脏病（CHD）是儿童心脏移植（HTx）以及成人心脏移植的重要指征。本回顾性分析的目的是比较因终末期CHD接受HTx的成人与因其他原因接受HTx的成人的生存率。为了确定HTx对于术前患有CHD的成年患者是否是一种可行的治疗选择，我们回顾性分析了15例患有不同形式CHD且先前接受过不同矫正和姑息手术的成年患者的数据，并将其与1400例HTx指征不是终末期CHD的成年患者（>15岁）的HTx数据进行比较。从1989年到2005年，15例成年患者（8例男性/7例女性）因终末期CHD接受了移植。10例患者曾接受过一次手术，5例患者接受过两次手术。他们的平均年龄为34.06±3.9岁。其中5例患者出现了急性肾衰竭。1例女性患者在术后40天因脑梗死死亡；1例男性患者在接受HTx后4年因对OKT 3单克隆抗体耐药的排斥反应死亡；2例患者分别在HTx后4天和30天因多器官衰竭死亡；11例患者仍存活。1年时的累积生存率为80%，与因非先天性指征接受移植的患者相同。患有终末期CHD的成人进行心脏移植可以获得良好的长期预后。先前的姑息手术不影响HTx后的结果。
