Department of Paediatric Cardiac Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
Eur J Cardiothorac Surg. 2013 Nov;44(5):836-40. doi: 10.1093/ejcts/ezt225. Epub 2013 May 2.
Internationally, the number of donors for cardiac transplantation has remained static, while the number of patients requiring transplantation for congenital heart disease (CHD) has increased. Although the availability of mechanical circulatory support (MCS) may increase the number of transplants performed by reducing deaths while waiting, it may also lead to increased morbidity post-transplantation. We sought to assess the impact of mechanical support on post-transplant outcomes in a single centre.
We assessed the outcomes of paediatric (age ≤16 years) heart transplantation in a single unit in the era of mechanical support (1998-2012) by retrospective cohort study. Outcomes before (1998-2005) and after (2005-2012) the routine use of the Berlin Heart EXCOR device were contrasted.
A total of 167 patients underwent heart transplantation during this period. The diagnosis was dilated cardiomyopathy in 61.7%, two-ventricle CHD in 11.4%, single ventricle CHD in 16.8% and miscellaneous in 10.1%. Sixty-nine (41%) were bridged to transplant by mechanical support; with extracorporeal membrane oxygenation in 19 (28%), ventricular assist device in 40 (58%) and a combination in 10 (14.0%). Post-transplant mortality at 30 days was significantly greater in those supported by MCS than without (7 vs 1%, P < 0.05), and a greater proportion of patients had neurological (23 vs 8%, P < 0.01) and major respiratory sequelae (20 vs 4%, P < 0.001). There was no significant increase in the need for post-transplant mechanical support (10 vs 6%, P = 0.3) in those supported prior to transplant. The number of transplants performed increased from 67 in 1998-2005 to 100 in the most recent era (2005-2012), and an increased proportion of these patients have been supported mechanically prior to transplantation (51 vs 27%, P < 0.01).
Along with strategies to increase donor utilization, MCS has allowed an increase in cardiac transplant activity at the expense of a higher early mortality and morbidity.
在国际范围内，用于心脏移植的捐赠者数量保持不变，而需要接受先天性心脏病 (CHD) 移植的患者数量却在增加。尽管机械循环支持 (MCS) 的应用可能会通过减少等待期间的死亡人数来增加移植数量，但它也可能导致移植后发病率增加。我们试图评估在一个中心使用机械支持对移植后结果的影响。
我们通过回顾性队列研究评估了单一单位在机械支持时代（1998-2012 年）儿科（年龄≤16 岁）心脏移植的结果。对比了常规使用柏林心脏 EXCOR 设备前后（1998-2005 年和 2005-2012 年）的结果。
在此期间，共有 167 名患者接受了心脏移植。诊断为扩张型心肌病 61.7%，双心室 CHD 11.4%，单心室 CHD 16.8%和其他 10.1%。69 例（41%）通过机械支持桥接至移植；其中体外膜氧合 19 例（28%），心室辅助装置 40 例（58%），组合 10 例（14.0%）。30 天的移植后死亡率在接受机械支持的患者中明显高于未接受机械支持的患者（7%对 1%，P <0.05），且有更多的患者出现神经系统（23%对 8%，P <0.01）和主要呼吸系统后遗症（20%对 4%，P <0.001）。在移植前接受支持的患者中，需要进行移植后的机械支持的患者比例没有明显增加（10%对 6%，P = 0.3）。在最近的时代（2005-2012 年），进行的移植数量从 1998-2005 年的 67 例增加到 100 例，且这些患者中更多的人在移植前已接受机械支持（51%对 27%，P <0.01）。
除了增加供体利用的策略外，机械循环支持还增加了心脏移植的活动量，但代价是早期死亡率和发病率增加。
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