Loisance D, Dubois Rande J L, Deleuze P, Benvenuti C, Dervanian P, Brunet S, Hillion M L, Castaigne A, Cachera J P
Department of Surgical Research, C.H.U. Henri Mondor, Créteil, France.
ASAIO Trans. 1989 Jul-Sep;35(3):242-4. doi: 10.1097/00002480-198907000-00020.
Patient selection and optimal timing for implantation are unsettled issues in candidates for a bridge to cardiac transplantation. A prospective evaluation of a strategy based on enoximone (E) given IV, in addition to sympathomimetic drugs, permitting to buy time, and delay by hours or days the decisions, has been performed from 1985 to 1988. Thirty-four patients in cardiogenic shock with hemodynamical criteria for TAH implantation have been included: Cl was 1.8 +/- 0.2 L/min/m2 PCWP 29 +/- 7 mmHg, diuresis less than 20 ml/hr. The protocol permitted to postpone decisions of implantation in 30 cases. The 4 unresponsive patients were implanted immediately with TAH (3) or VAD (1). Three were transplanted, two successfully. For 30, time given permitted discovery of hidden contraindications to transplantation in 17 patients. In 13, indication for transplantation was confirmed and performed in 11 within 6 hrs to 8 days (survival 64%). In two, sudden deterioration led to an unsuccessful TAH implantation. Multifactorial analysis showed that a 50% rise in Cl together with a 50% drop in PCWP, a 50% drop in PVR 30 min after IV E has a high predictive value of survival. These data suggest that enoximone IV bolus given in addition to maximal sympathomimetics to patients in cardiogenic shock reduces by 88% the need for TAH or VAD. It also permits a better selection of the candidates.
对于心脏移植过渡患者，患者选择和最佳植入时机仍是尚未解决的问题。1985年至1988年期间，对一种基于静脉注射依诺昔酮（E）的策略进行了前瞻性评估，该策略除了使用拟交感神经药物外，还能争取时间，将决策推迟数小时或数天。纳入了34例符合TAH植入血流动力学标准的心源性休克患者：心排血量（Cl）为1.8±0.2L/min/m²，肺毛细血管楔压（PCWP）为29±7mmHg，尿量小于20ml/小时。该方案允许在30例患者中推迟植入决策。4例无反应的患者立即植入了TAH（3例）或心室辅助装置（VAD，1例）。3例接受了移植，2例成功。对于30例患者，争取到的时间使17例患者发现了隐藏的移植禁忌证。在13例患者中，移植指征得到确认，其中11例在6小时至8天内接受了移植（生存率64%）。2例患者突然病情恶化，导致TAH植入失败。多因素分析表明，静脉注射E后30分钟，Cl升高50%同时PCWP降低50%、肺血管阻力（PVR）降低50%，对生存具有较高的预测价值。这些数据表明，在给予最大剂量拟交感神经药物的基础上，对心源性休克患者静脉推注依诺昔酮可使TAH或VAD的需求减少88%。它还能更好地筛选候选患者。
