Elhenawy Abdelsalam M, Algarni Khaled D, Rodger Marnie, Maciver Jane, Maganti Manjula, Cusimano Robert J, Yau Terrence M, Delgado Diego H, Ross Heather J, Rao Vivek
Heart Transplant Program, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada.
J Card Surg. 2011 Sep;26(5):542-7. doi: 10.1111/j.1540-8191.2011.01310.x. Epub 2011 Aug 28.
The use of mechanical circulatory support (MCS) in nontransplant eligible candidates remains controversial. Our decision to offer MCS for nontransplant candidates has led to their reevaluation after a period of left ventricular assist device (LVAD) support.
From 2001 to September 2009, we had 37 patients who received an implantable LVAD, 22 (59%) were not deemed to be transplant eligible at the time of LVAD insertion (bridge to candidacy, BTC group).
Fifteen (41%) patients were considered transplant eligible (bridge to transplant, BTT group) at the time of device insertion and received a HeartMate XVE (n = 7), HeartMate 2 (n = 7), or a Novacor LVAS (n = 1). In the BTC group, patients received the HeartMate XVE device (n = 11), HeartMate 2 (n = 5), or the Novacor LVAS (n = 6). The primary criterion for transplant ineligibility was refractory pulmonary hypertension (PH) in 18 patients, 3 patients did not meet our body mass index criteria (>35 kg/m(2)), and 2 patients were dialysis-dependent. Six (27%) BTC patients died on support. Overall, 16/22 patients (73%) were subsequently listed for transplantation, with one listed for combined heart-lung due to refractory PH. Twelve patients (75%) underwent successful heart transplantation. Three patients died during their transplant. Overall posttransplant survival at one year shows lower survival in the BTC group compared to the BTT group (67% vs. 100%, p = 0.05). At two years and three years the survival was lower, but not statistically different (BTC vs. BTT: 67% vs. 90% and 64% vs. 87%, respectively, p = NS).
MCS can successfully convert a large proportion of transplant-ineligible patients into acceptable candidates.
在不符合移植条件的患者中使用机械循环支持（MCS）仍存在争议。我们为不符合移植条件的患者提供MCS的决定，促使他们在接受一段时间的左心室辅助装置（LVAD）支持后接受重新评估。
2001年至2009年9月，我们有37例患者接受了植入式LVAD，其中22例（59%）在植入LVAD时被认为不符合移植条件（过渡到符合移植条件，BTC组）。
15例（41%）患者在装置植入时被认为符合移植条件（过渡到移植，BTT组），并接受了HeartMate XVE（n = 7）、HeartMate 2（n = 7）或Novacor LVAS（n = 1）。在BTC组中，患者接受了HeartMate XVE装置（n = 11）、HeartMate 2（n = 5）或Novacor LVAS（n = 6）。不符合移植条件的主要标准是18例患者存在难治性肺动脉高压（PH），3例患者不符合我们的体重指数标准（>35 kg/m²），2例患者依赖透析。6例（27%）BTC患者在支持过程中死亡。总体而言，16/22例患者（73%）随后被列入移植名单，其中1例因难治性PH被列入心肺联合移植名单。12例患者（75%）成功接受了心脏移植。3例患者在移植过程中死亡。总体而言，一年时的移植后生存率显示BTC组低于BTT组（67%对100%，p = 0.05）。在两年和三年时生存率较低，但无统计学差异（BTC对BTT：分别为67%对90%和64%对87%，p = 无显著性差异）。
MCS可以成功地将很大一部分不符合移植条件的患者转变为可接受的移植候选人。
