Muneretto C, Rabago G, Pavie A, Leger P, Gandjbakhch I, Sasako Y, Tedy G, Bors V, Desruennes M, Szefner J
Department of Thoracic and Cardiovascular Surgery, La Pitie Hospital, Paris, France.
J Cardiovasc Surg (Torino). 1990 Jul-Aug;31(4):486-91.
Since April 1986, 40 total artificial hearts (TAH) were implanted as a bridge to transplantation in our institution. In an attempt to identify factors affecting survival of TAH recipients we reviewed our experience over 1000 days of mechanical support. There was no postoperative bleeding requiring surgery nor were there any clinical episodes of thromboembolic complications. Over a total functioning period greater than 3 years there were no mechanical failures in the driving system but one artificial ventricle had to be replaced because of mechanical dysfunction. Infections and multiple organ failure were the primary causes of morbidity and mortality during mechanical support. When the patients who underwent staged transplantation (no. 17) were compared with those who died during mechanical support (no. 23) there were no differences in TAH driving mode or hemodynamic variables between the groups. Although preoperative pulmonary, hepatic and renal functions were found to be similar between the groups, there were significant differences in the early evolution (3 days) of hepatic and renal functions following TAH implant (p less than 0.01). Urinary output was found to be the earliest variable discriminating recovery and survival (p less than 0.01). Finally, univariate analysis indicated age (less than 40 vs greater than 40 years) and modality of cardiac decompensation (acute vs chronic) as the most important factors affecting survival after TAH implantation. Since young patients (less than 40 years of age) with acute decompensation were successfully transplanted in 82% of cases while 100% of older patients with chronic decompensation died before or after transplantation, TAH should be advised in young patients with acute or chronic heart failure and in selected older candidates with recent, acute cardiac failure.
自1986年4月以来，我院共植入40颗全人工心脏（TAH）作为移植桥梁。为了确定影响TAH接受者生存的因素，我们回顾了超过1000天的机械支持经验。术后无需要手术处理的出血情况，也没有血栓栓塞并发症的临床发作。在超过3年的总运行期内，驱动系统没有机械故障，但有一个人工心室因机械功能障碍而不得不更换。感染和多器官功能衰竭是机械支持期间发病和死亡的主要原因。将接受分期移植的患者（17例）与在机械支持期间死亡的患者（23例）进行比较，两组之间TAH驱动模式或血流动力学变量没有差异。尽管发现两组术前肺、肝和肾功能相似，但TAH植入后肝肾功能的早期演变（3天）存在显著差异（p<0.01）。尿量是区分恢复和生存的最早变量（p<0.01）。最后，单因素分析表明年龄（小于40岁与大于40岁）和心脏失代偿方式（急性与慢性）是影响TAH植入后生存的最重要因素。由于急性失代偿的年轻患者（小于40岁）82%成功移植，而100%慢性失代偿的老年患者在移植前后死亡，对于急性或慢性心力衰竭的年轻患者以及部分近期发生急性心力衰竭的老年候选患者，建议使用TAH。
