Kawaguchi A T, Cabrol C, Gandjbackhch I, Pavie A, Bors V, Muneretto C
Department of Cardiovascular Surgery, Hôpital de la Pitié, Paris, France.
Eur J Cardiothorac Surg. 1991;5(10):509-14. doi: 10.1016/1010-7940(91)90102-p.
To distinguish high-risk patients prior to implantation of a Jarvik-7 artificial heart as a bridge to transplantation, our 37 attempts were reviewed retrospectively. Arbitrary scores of 1 to 4 were given for nine preoperative factors on the basis of results obtained by uni- and multivariate analyses between successful cases and failed attempts; transplant rejection (scored 4: S4) or postoperative heart failure (S3) as the indication, recipient height less than 175 cm (S3), body surface area less than 1.8 m2 (S3), hyperbilirubinemia greater than 24 microM/l (S2), preoperative renal failure requiring dialysis (S2), weight less than 60 kg (S2), and age greater than 40 years (S1). All except one of the 16 patients with successful bridge had a total score of less than 4, with an average score of 1.3 in contrast to 6.6 in the 21 failed cases (p less than 0.001). Among the 17 patients who scored less than 4, 15 received transplants (specificity 90%), while only one qualified for transplantation among 20 patients who scored 4 or more (sensitivity 94%). The two unpredicted failures resulted from mediastinitis and pulmonary infarction, both attributable to postoperative management. Multiple preoperative factors in combination could have successfully predicted the outcome of mechanical support in our experience. These results underscore the importance of patient selection to achieve successful and effective use of the Jarvik-7 as a bridge to heart transplantation.
为了在植入Jarvik - 7人工心脏作为移植桥梁之前区分高风险患者，我们回顾性地分析了37次尝试。根据成功案例与失败尝试之间单因素和多因素分析的结果，对九个术前因素给出1至4分的任意评分：移植排斥反应（评分为4：S4）或术后心力衰竭（S3）作为指征，受体身高小于175厘米（S3），体表面积小于1.8平方米（S3），高胆红素血症大于24微摩尔/升（S2），术前肾衰竭需要透析（S2），体重小于60千克（S2），以及年龄大于40岁（S1）。16例成功过渡患者中除1例之外，所有患者的总分均小于4分，平均分为1.3分，而21例失败病例的平均分为6.6分（p小于0.001）。在17例得分小于4分的患者中，15例接受了移植（特异性为90%），而在20例得分4分及以上的患者中只有1例符合移植条件（敏感性为94%）。两例未预测到的失败是由纵隔炎和肺梗死导致的，二者均归因于术后管理。根据我们的经验，多个术前因素相结合可以成功预测机械支持的结果。这些结果强调了患者选择对于成功且有效地将Jarvik - 7作为心脏移植桥梁的重要性。
