桥接恢复与桥接移植患者的长期结局。
Long-term outcomes of patients bridged to recovery versus patients bridged to transplantation.
机构信息
Heart Science Centre, Imperial College, Harefield, United Kingdom.
出版信息
J Thorac Cardiovasc Surg. 2012 Jul;144(1):190-6. doi: 10.1016/j.jtcvs.2012.03.021. Epub 2012 Apr 11.
OBJECTIVE
The proportion of patients who can be bridged with left ventricular assist devices to myocardial recovery and the long-term outcome of these patients is unknown.
METHODS
We investigated the outcomes of patients bridged to recovery compared with those bridged to transplantation. All left ventricular assist devices were implanted as a bridge to transplantation with a very proactive program of promoting myocardial recovery. A total of 40 patients were bridged to recovery and 52 to transplantation. Of the bridged to recovery (explanted) group, 33 were men (age, 32.8 ± 11.8 years), 37 had dilated cardiomyopathy (familial in 3, peripartum cardiomyopathy in 3) and 3 had myocarditis. Of the bridged to transplantation (transplanted) group, 42 were men (age, 42.3 ± 12.5 years; P < .0005 vs bridged to recovery). The diagnosis was ischemic heart disease in 24, dilated cardiomyopathy in 21 (only 13 received drug therapy), hypertrophic obstructive cardiomyopathy in 2, arrythmogenic right ventricular dysplasia in 2, myocarditis in 1, and congestive heart disease in 2.
RESULTS
The survival rate was 89.9%, 73.9%, and 73.9% and 80.4%, 78.3, and 78.3% in the explanted and transplanted groups at 1, 5, and 7 years, respectively. In total, 12 (23%) patients bridged transplantation either died from, or required ventricular assist device support, for primary graft failure. Of the explanted patients, 4 (10%) subsequently required transplantation at 34, 512, 1019, and 1213 days (2 died 25 and 1867 days after transplantation and 2 were well after 1523 and 3199 days). The rate of transplant or ventricular assist device-free survival less noncardiac death for the bridged to recovery and bridged to transplantation groups, respectively, was 89.9%, 73.9%, and 73.9% and 80.4%, 78.3%, and 78.3% at 1, 3, and 7 years. At latest follow-up (1394 ± 1195 days for the bridged to recovery and 1913 ± 941 days for the bridged to transplantation group), 5 of the bridged to transplantation patients (9.6%) had malignancy, 34 (65.4%) had hypercholesterolemia, 25 (48.1%) had hypertension, and 7 (13.5%) had coronary disease. The creatinine was 125.5 ± 43.5 vs 95.2 ± 16.5 μmol/L for the bridged to transplantation and bridged to recovery groups (P < .001).
CONCLUSIONS
The outcome after explantation for myocardial recovery is comparable, if not better than, after bridge to transplantation.
目的
尚不清楚能够通过左心室辅助设备恢复的患者比例以及这些患者的长期预后。
方法
我们研究了与移植桥接相比，通过恢复桥接的患者的结局。所有左心室辅助设备均作为移植桥接植入，同时积极推进心肌恢复计划。共有 40 例患者通过恢复桥接（已移除），52 例通过移植桥接。在已移除（已移除）组中，33 例为男性（年龄 32.8±11.8 岁），37 例为扩张型心肌病（3 例家族性，3 例围产期心肌病），3 例为心肌炎。在移植桥接（已移植）组中，42 例为男性（年龄 42.3±12.5 岁；与已移除组相比，P<0.0005）。诊断为缺血性心脏病 24 例，扩张型心肌病 21 例（仅 13 例接受药物治疗），肥厚型梗阻性心肌病 2 例，致心律失常性右室发育不良 2 例，心肌炎 1 例，充血性心力衰竭 2 例。
结果
在已移除和已移植组中，1 年、5 年和 7 年的存活率分别为 89.9%、73.9%和 73.9%以及 80.4%、78.3%和 78.3%。共有 12 例（23%）患者因原发性移植物衰竭而需要心脏移植或接受心室辅助设备支持。在已移除的患者中，4 例（10%）随后分别在 34、512、1019 和 1213 天后需要移植（2 例分别在移植后 25 天和 1867 天后死亡，2 例在移植后 1523 天和 3199 天后情况良好）。在已移除和已移植组中，分别有 89.9%、73.9%和 73.9%以及 80.4%、78.3%和 78.3%的患者在 1 年、3 年和 7 年时未发生移植或心室辅助设备相关的死亡。在最近的随访中（已移除组为 1394±1195 天，已移植组为 1913±941 天），5 例已移植患者（9.6%）患有恶性肿瘤，34 例（65.4%）患有高胆固醇血症，25 例（48.1%）患有高血压，7 例（13.5%）患有冠心病。已移除组的肌酐为 125.5±43.5μmol/L，已移植组为 95.2±16.5μmol/L（P<0.001）。
结论
通过恢复桥接移除设备后的结局与移植桥接后相当，甚至更好。
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