Kawaguchi A T, Gandjbakhch I, Pavie A, Muneretto C, Solis E, Bors V, Leger P, Vaissier E, Levasseur J P, Szefner J
Department of Cardiovascular Surgery, Hopital de la Pitié, Paris, France.
Circulation. 1990 Nov;82(5 Suppl):IV322-7.
To identify factors affecting the successful bridge to transplantation, experience with 32 recipients of the Jarvik-7 artificial heart was reviewed. Between patients with and without a successful bridge, there were no significant differences in preoperative hepatorenal function or postoperative hemodynamics, but there were significant differences in body size. When recipients were divided according to body surface areas of less than or greater than 1.8 m2, the smaller patients more frequently developed respirator dependence (73% vs. 18%, p less than 0.01), renal failure (53% vs. 18%, p less than 0.05), and hepatic failure and sepsis, resulting in less frequent qualification for transplantation (20% vs. 65%, p less than 0.05). There were no successful bridge operations in seven patients with body surface areas of less than 1.7 m2, and only one success in nine patients who were less than 170 cm in height, despite use of a smaller stroke volume model. The smaller patients had poorer ventricular filling, which was largely compensated for by the drive controls set for significantly longer diastole and higher vacuum, resulting in similar hemodynamics between the groups. The results suggest that device fitting as manifested by body size is an important factor affecting major organ recovery and subsequent transplantation in recipients of the Jarvik-7 artificial heart. A paracorporeal device may be advisable for patients with body surface areas of less than 1.8 m2 or who were less than 175 cm in height until an even smaller model with a better fit in the thorax becomes available.
为了确定影响成功过渡到移植的因素，回顾了32例接受Jarvik-7人工心脏患者的经验。在成功过渡和未成功过渡的患者之间，术前肝肾功能或术后血流动力学无显著差异，但体型存在显著差异。当根据体表面积小于或大于1.8平方米对接受者进行划分时，体型较小的患者更频繁地出现呼吸依赖（73%对18%，p<0.01）、肾衰竭（53%对18%，p<0.05）以及肝衰竭和败血症，导致符合移植条件的频率较低（20%对65%，p<0.05）。7例体表面积小于1.7平方米的患者未成功进行过渡手术，9例身高低于170厘米的患者中仅有1例成功，尽管使用了较小冲程容积的型号。体型较小的患者心室充盈较差，这在很大程度上通过设置显著更长的舒张期和更高的真空度的驱动控制得到了补偿，从而使两组之间的血流动力学相似。结果表明，体型所体现的设备适配性是影响Jarvik-7人工心脏接受者主要器官恢复及后续移植的重要因素。对于体表面积小于1.8平方米或身高低于175厘米的患者，在有更适合胸腔的更小型号可用之前，采用体外设备可能是可取的。
