Zimpfer Daniel, Zrunek Philipp, Sandner Sigrid, Schima Heinz, Grimm Michael, Zuckermann Andreas, Wolner Ernst, Wieselthaler Georg
Department of Cardiothoracic Surgery, Medical University of Vienna, Wahringer Guertel 18-20, A-1090 Vienna, Austria.
Eur J Cardiothorac Surg. 2007 Apr;31(4):698-702. doi: 10.1016/j.ejcts.2006.12.036. Epub 2007 Feb 7.
We have previously shown that fixed pulmonary hypertension in cardiac transplant candidates can be lowered using left ventricular assist devices (LVADs). The post-transplant survival of these patients is uncertain as pulmonary hypertension may reappear, possibly affecting post-transplant survival.
Between 01/2000 and 01/2005 a total of 26 cardiac transplant candidates (92% male; mean age 56.2 years) in whom fixed pulmonary hypertension was lowered by LVAD implantation (pulmonary vascular resistance (PVR) before implantation: 5.1+/-2.8wood units (WU); PVR before cardiac transplantation: 2.0+/-.9WU) underwent cardiac transplantation at our institution. These patients were age and sex matched with 52 cardiac transplant candidates without pulmonary hypertension undergoing cardiac transplantation during the same time period. Study endpoints were peri-transplant complications and long-term survival. Mean follow-up was 36+/-14 months.
Peri-transplant mortality was 5% in patients after LVAD therapy and 7% in patients without prior LVAD therapy (p=.089). We observed 2 cases (4%) of acute right heart failure requiring mechanical support in patients without prior LVAD therapy. None of the patients with LVAD therapy developed peri-transplant right heart failure requiring mechanical support. Incidence of other peri-transplant complications was comparable between the two groups. Log-rank (p=.124) revealed comparable long-term survival between patients with (1 year: 85%, 2 year: 85%, 3 year: 85%) and without (1 year: 90%, 2 year 82%, 3 year prior 79%) prior LVAD therapy.
LVAD therapy lowers fixed pulmonary hypertension in cardiac transplant candidates with fixed pulmonary hypertension. Thereafter, long-term post-transplant survival is comparable to cardiac transplant recipients without pulmonary hypertension.
我们之前已经表明，心脏移植候选者中固定性肺动脉高压可通过左心室辅助装置（LVAD）降低。这些患者移植后的生存情况尚不确定，因为肺动脉高压可能会再次出现，这可能会影响移植后的生存。
在2000年1月至2005年1月期间，共有26例心脏移植候选者（92%为男性；平均年龄56.2岁）在我院接受心脏移植，这些患者通过植入LVAD降低了固定性肺动脉高压（植入前肺血管阻力（PVR）：5.1±2.8伍德单位（WU）；心脏移植前PVR：2.0±0.9WU）。这些患者在年龄和性别上与同期52例无肺动脉高压的心脏移植候选者相匹配。研究终点为移植围手术期并发症和长期生存。平均随访时间为36±14个月。
接受LVAD治疗的患者围手术期死亡率为5%，未接受LVAD治疗的患者为7%（p = 0.089）。我们观察到2例（4%）未接受LVAD治疗的患者出现急性右心衰竭需要机械支持。接受LVAD治疗的患者中没有发生需要机械支持的移植围手术期右心衰竭。两组间其他移植围手术期并发症的发生率相当。对数秩检验（p = 0.124）显示，接受LVAD治疗的患者（1年：85%，2年：85%，3年：85%）和未接受LVAD治疗的患者（1年：90%，2年：82%，3年：79%）长期生存率相当。
LVAD治疗可降低患有固定性肺动脉高压的心脏移植候选者的固定性肺动脉高压。此后，移植后的长期生存率与无肺动脉高压的心脏移植受者相当。
