Triggiani M, Iacovoni A, Fiocchi R, Sebastiani R, Deyneka K, Ferrazzi P, Gamba A
Cardiac Surgery Unit, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1996-8. doi: 10.1016/j.transproceed.2008.05.008.
Patients with end-stage ischemic cardiomyopathy (IHD) and left ventricular (LV) dilatation are increasingly treated by means of surgical ventricular restoration (SVR). In some patients, SVR can delay heart transplantation (HTX). We retrospectively analyzed our experience, trying to ascertain whether HTX after a failed SVR (fSVR) carried a greater mortality risk. Since 1985, we performed 742 HTX. Since June 1999, 133 IHD patients were listed for HTX. We assigned them to 3 groups: (A) not a redo (n=54); (B) redo after coronary artery bypass grafting (n=54); and (C) redo after fSVR (n=25). Respectively, 37, 33, and 12 patients underwent HTX with in-hospital mortality after HTX of 4/37 (10.8%), 12/33 (36.4%), and 2/12 (16.7%). Mortality on the list was 9/54 (16.7%), 11/54 (20.4%), and 7/25 (28.0%) respectively. Removal from the list occurred in 4, 5, and 2 patients, and 4, 5, and 4 patients are still awaiting HTX, respectively. In group C, the mean time from SVR to HTX list was 45.6+/-43.3 months, and list mortality occurred after 5.83+/-5.81 months. In-hospital mortality in both patients of group C was due to the occurrence of multisystem organ failure; 10/12 were extubated after 19.3+/-9.6 hours and discharged from the intensive care unit after 3.9+/-1.6 days. The recorded complications were: 3 acute renal failure, 1 pericardial effusion, and 2 episodes of acute rejection. Since only 5/25 patients with fSVR had undergone SVR at our institution, we cannot establish which patients were really eligible for HTX at the time of SVR. Our experience showed that patients listed for HTX displayed a high list mortality, but that HTX after a failed SVR did not seem to have a poorer outcome than HTX after previous conventional CABG.
终末期缺血性心肌病（IHD）合并左心室（LV）扩张的患者越来越多地接受外科心室修复术（SVR）治疗。在一些患者中，SVR可以延迟心脏移植（HTX）。我们回顾性分析了我们的经验，试图确定SVR失败（fSVR）后进行HTX是否具有更高的死亡风险。自1985年以来，我们共进行了742例HTX。自1999年6月起，133例IHD患者被列入HTX名单。我们将他们分为3组：（A）非再次手术组（n = 54）；（B）冠状动脉旁路移植术后再次手术组（n = 54）；（C）fSVR后再次手术组（n = 25）。分别有37、33和12例患者接受了HTX，HTX后的院内死亡率分别为4/37（1０.8%）、12/33（36.4%）和2/12（16.7%）。名单上的死亡率分别为9/54（16.7%）、11/54（20.4%）和7/25（28.0%）。名单上被移除的患者分别为4例、5例和2例，目前仍分别有4例、5例和4例患者在等待HTX。在C组中，从SVR到列入HTX名单的平均时间为45.6±43.3个月，名单上的死亡发生在5.83±5.81个月后。C组两名患者的院内死亡均归因于多系统器官衰竭；10/12例患者在19.3±9.6小时后拔管，在3.9±1.6天后从重症监护病房出院。记录的并发症有：3例急性肾衰竭、1例心包积液和2次急性排斥反应。由于在我们机构接受fSVR的25例患者中只有5例进行了SVR，我们无法确定哪些患者在进行SVR时真正符合HTX的条件。我们的经验表明，列入HTX名单的患者名单死亡率较高，但fSVR后进行HTX的结果似乎并不比先前传统冠状动脉旁路移植术后进行HTX的结果更差。
