心肺移植：成人适应症及预后
Heart-lung transplantation: adult indications and outcomes.
作者信息
Toyoda Yoshiya, Toyoda Yasuhiro
机构信息
1 Temple University, USA ; 2 University of Pittsburgh, USA.
出版信息
J Thorac Dis. 2014 Aug;6(8):1138-42. doi: 10.3978/j.issn.2072-1439.2014.06.01.
Combined heart-lung transplantation remains the only definitive therapy for patients who have both end-stage heart failure and end-stage lung failure. The most common indication is congenital heart disease (CHD) and the proportion is increasing for acquired heart disease concomitant with pulmonary hypertension and/or intrinsic lung diseases. Previously, idiopathic pulmonary hypertension was the most common indication. However, it has been shown that right ventricular failure can be reversed after double lung transplantation. Therefore, patients with idiopathic pulmonary arterial hypertension (IPAH) should not undergo combined heart-lung transplantation unless left ventricular dysfunction co-exists. The ISHLT registry data shows survival after heart-lung transplantation is improving, but still its survival rates are 71% at 3 months, 63% at 1 year, 44% at 5 years and 31% at 10 years. With appropriate patient selection and surgical expertise, these outcomes should improve further.
心肺联合移植仍然是终末期心力衰竭和终末期肺衰竭患者的唯一确定性治疗方法。最常见的适应症是先天性心脏病（CHD），并且后天性心脏病合并肺动脉高压和/或原发性肺部疾病的比例正在增加。以前，特发性肺动脉高压是最常见的适应症。然而，已经表明双肺移植后右心室衰竭可以逆转。因此，除非同时存在左心室功能障碍，特发性肺动脉高压（IPAH）患者不应接受心肺联合移植。国际心脏和肺移植学会（ISHLT）登记数据显示，心肺移植后的生存率正在提高，但3个月时的生存率仍为71%，1年时为63%，5年时为44%，10年时为31%。通过适当的患者选择和手术专业知识，这些结果应该会进一步改善。
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