Attenhofer Jost Christine H, Schmidt Dörthe, Huebler Michael, Balmer Christian, Noll Georg, Caduff Rosmarie, Greutmann Matthias
Division of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
J Transplant. 2013;2013:376027. doi: 10.1155/2013/376027. Epub 2013 Feb 7.
Due to impressive improvements in surgical repair options, even patients with complex congenital heart disease (CHD) may survive into adulthood and have a high risk of end-stage heart failure. Thus, the number of patients with CHD needing heart transplantation (HTx) has been increasing in the last decades. This paper summarizes the changing etiology of causes of death in heart failure in CHD. The main reasons, contraindications, and risks of heart transplantation in CHD are discussed and underlined with three case vignettes. Compared to HTx in acquired heart disease, HTx in CHD has an increased risk of perioperative death and rejection. However, outcome of HTx for complex CHD has improved over the past 20 years. Additionally, mechanical support options might decrease the waiting list mortality in the future. The number of patients needing heart-lung transplantation (especially for Eisenmenger's syndrome) has decreased in the last years. Lung transplantation with intracardiac repair of a cardiac defect is another possibility especially for patients with interatrial shunts. Overall, HTx will remain an important treatment option for CHD in the near future.
由于手术修复方案取得了令人瞩目的进展，即使是患有复杂先天性心脏病（CHD）的患者也可能存活至成年，并面临终末期心力衰竭的高风险。因此，在过去几十年中，需要心脏移植（HTx）的CHD患者数量一直在增加。本文总结了CHD心力衰竭患者死亡原因的变化病因。通过三个病例 vignettes 讨论并强调了CHD心脏移植的主要原因、禁忌症和风险。与获得性心脏病的心脏移植相比，CHD的心脏移植围手术期死亡和排斥反应的风险增加。然而，在过去20年中，复杂CHD的心脏移植结果有所改善。此外，机械支持方案可能会在未来降低等待名单上的死亡率。在过去几年中，需要心肺移植（特别是针对艾森曼格综合征）的患者数量有所减少。对于有心脏缺损的患者，心脏内修复的肺移植是另一种可能性。总体而言，在不久的将来，心脏移植仍将是CHD的重要治疗选择。
