Elmistekawy Elsayed, Mesana Thierry G, Ruel Marc
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):716-9. doi: 10.1093/icvts/ivs157. Epub 2012 Jun 29.
This best evidence topic in Cardiac Surgery was written according to a structured protocol. The question addressed was: for [Jehovah's Witness patients with end-stage heart failure] can these patients undergo a [heart transplantation] without an increased rate of mortality. Altogether, 133 papers were found using the reported search strategy. Of those, 29 papers represented the best evidence to answer the clinical question. Five papers focusing on patients of the Jehovah's Witness (JW) faith who had end-stage heart failure were published. Successful heart transplantation was performed in a total of seven patients without mortality, re-exploration or blood transfusion. One patient had left ventricular reduction surgery twice and another patient had bypass surgery several years after transplantation. Other successful organ transplantations were also reported, including lung, liver, kidney and pancreas in both adult and paediatric patients of the JW faith, with comparable mortality and morbidity to non-JW patients. A publication bias is likely; nevertheless, we conclude that although there are no large studies directly focused on heart transplantation in JW patients, a multidisciplinary team approach to such surgery can make it technically feasible and without an increased mortality risk in suitable candidates. Therefore, such patients may be considered for heart transplantation under selected and favourable circumstances.
这篇心脏外科领域的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是：对于[患有终末期心力衰竭的耶和华见证会患者]，这些患者能否接受[心脏移植]而不增加死亡率。使用报告的检索策略共找到133篇论文。其中，29篇论文代表了回答该临床问题的最佳证据。发表了5篇关注患有终末期心力衰竭的耶和华见证会（JW）信徒患者的论文。共有7例患者成功进行了心脏移植，无一例死亡、再次手术或输血。1例患者接受了两次左心室减容手术，另1例患者在移植后数年接受了搭桥手术。还报道了其他成功的器官移植，包括JW信徒的成年和儿科患者的肺、肝、肾和胰腺移植，其死亡率和发病率与非JW患者相当。可能存在发表偏倚；然而，我们得出结论，尽管没有直接针对JW患者心脏移植的大型研究，但多学科团队 approach 进行此类手术在技术上是可行的，且在合适的候选人中不会增加死亡风险。因此，在选定的有利情况下，可以考虑为这类患者进行心脏移植。 （注：“approach”此处结合语境推测可能是“方法、方式”之意，但原英文表述不太准确，按字面翻译为“途径”不太通顺，故意译为“方法”使译文更合理）
