Yagdi T, Oguz E, Engin C, Engin Y, Nalbantgil S, Zoghi M, Ozbaran M
Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
Transplant Proc. 2012 Jul-Aug;44(6):1729-31. doi: 10.1016/j.transproceed.2012.05.049.
Heart failure is a serious disease ending with death if untreated. Although heart transplantation is the best therapy for end-stage heart failure, most candidates die in the waiting period due to the lack of donor organs. This condition represent a new era of heart failure surgery.
We retrospectively investigated 159 patients from 1998 to 2011 with a mean age of 40.0 years (range = 5-65), who were mostly diagnosed as dilated cardiomyopathy (n = 113). After April 2007, 67 patients underwent vascular assist device (VAD) implantation surgery for acute or chronic end-stage heart failure. We performed 69 heart transplantation with 27 on VAD systems before transplantation.
Early mortality was 13.3% with 21 patients after the heart transplantation. The 67 patients supported with VAD did not experience an intraoperative death. The mean support time was 214 days (range = 3-1035). Twenty-four patients (35.8%) are still on pump support. The overall survival until transplantation or weaning was 77.6% at mean of 250.7 days survival reached 90% with Heartware (Hartware Inc, Miramar, Fla, USA) continuous flow pumps.
After the introduction of VAD in 2007, the overall picture has been restructured radically for heart failure surgery, reducing patient loss on the waiting list. Especially, since 2009 nearly 80% of donor hearts were used for patients on mechanical circulatory support.
心力衰竭是一种严重疾病，若不治疗最终会导致死亡。尽管心脏移植是终末期心力衰竭的最佳治疗方法，但由于供体器官短缺，大多数候选患者在等待期死亡。这种情况代表了心力衰竭手术的新时代。
我们回顾性研究了1998年至2011年的159例患者，平均年龄40.0岁（范围为5至65岁），大多数被诊断为扩张型心肌病（n = 113）。2007年4月之后，67例患者因急性或慢性终末期心力衰竭接受了血管辅助装置（VAD）植入手术。我们进行了69例心脏移植，其中27例在移植前使用了VAD系统。
心脏移植后早期死亡率为13.3%，有21例患者死亡。接受VAD支持的67例患者术中无死亡。平均支持时间为214天（范围为3至1035天）。24例患者（35.8%）仍在接受泵支持。移植或撤机前的总体生存率为77.6%，平均生存250.7天，使用Heartware（美国佛罗里达州米拉马尔市哈特韦尔公司）连续流泵时生存率达到90%。
2007年引入VAD后，心力衰竭手术的整体情况发生了根本性改变，减少了等待名单上的患者损失。特别是自2009年以来，近80%的供体心脏用于接受机械循环支持的患者。
