Cohn William E, Fikfak Vid, Gregoric Igor D, Frazier O H
Department of Cardiopulmonary Transplantation and Mechanical Circulatory Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA.
J Heart Lung Transplant. 2008 Aug;27(8):865-8. doi: 10.1016/j.healun.2008.05.017. Epub 2008 Jul 7.
New sternum-preserving techniques are increasingly being utilized for implantation of left ventricular assist devices (LVADs) in bridge-to-transplant patients. During device explantation for transplantation through median sternotomy, the outflow graft is divided where convenient, which generally results in retention of a significant blind limb of outflow graft attached to the descending thoracic or supraceliac aorta. Although the retained graft could be completely excised through a repeat thoracotomy, we decided to investigate the short- and long-term complications related to retained grafts and whether they outweigh the risk of additional surgery.
We reviewed the charts and computed tomography (CT) scans of 18 patients who underwent successful bridge to cardiac transplantation between January 2003 and August 2006, and in whom the initial LVAD implant was performed via a sternum-sparing procedure. In each case, a blind graft limb was retained at the time of device explantation.
An LVAD was implanted either through a left sub-costal incision (6 patients) or through a left thoracotomy (12 patients). Patients were supported for an average of 113 days while awaiting transplantation (13 to 299 days). Four patients died of causes not directly related to the retained graft. Mean observation time of the remaining 14 patients was 53.6 months (21.6 to 76.9 months). There was no evidence of distal emboli, pseudoaneurysm or graft infection in any patient.
The presence of a retained graft limb after LVAD removal for transplantation is associated with few complications. For patients in whom removal of the graft would require additional surgery, oversewing the graft and leaving it in place is a reasonable strategy.
在桥接移植患者中，新型保留胸骨技术越来越多地用于植入左心室辅助装置（LVAD）。在通过正中胸骨切开术进行移植的装置取出过程中，流出道移植物在方便的位置被切断，这通常会导致一段与胸降主动脉或腹腔干上方主动脉相连的流出道移植物盲端显著留存。尽管留存的移植物可通过再次开胸手术完全切除，但我们决定研究与留存移植物相关的短期和长期并发症，以及这些并发症是否超过再次手术的风险。
我们回顾了2003年1月至2006年8月期间18例成功进行心脏移植桥接手术患者的病历和计算机断层扫描（CT）图像，这些患者最初通过保留胸骨的手术植入了LVAD。在每例患者中，装置取出时均留存了一段移植物盲端。
LVAD通过左肋下切口植入6例患者，通过左胸开胸植入12例患者。患者在等待移植期间平均获得113天的支持（13至299天）。4例患者死于与留存移植物无直接关系的原因。其余14例患者的平均观察时间为53.6个月（21.6至76.9个月）。所有患者均未出现远端栓塞、假性动脉瘤或移植物感染的证据。
LVAD取出用于移植后留存移植物肢体与较少的并发症相关。对于移除移植物需要再次手术的患者，缝合移植物并将其留在原位是一种合理的策略。
