Brügemann J, van der Horst I C C, van Veldhuisen D J, van den Broek S A J, de Jonge-Weber A T G, Ebels T, Boonstra P W, Zijlstra F
Neth Heart J. 2006 Dec;14(12):405-408.
Ten years ago, there was a difference of opinion about the suitability of ventilated patients with end-stage cardiac failure for heart transplantation (HTX). Although guidelines at that time qualified mechanical ventilation as a contraindication, we thought those patients could be candidates for HTX. In the same period a number of other patients received a donor heart in our centre. In this article we describe the clinical course and survival after these procedures.
We performed a retrospective study using our post HTX database. All patients undergoing transplants in our hospital were selected. Patients underwent echocardiography, scintigraphy (MUGA), ergo-spirometry (VO peak), blood tests and completed a quality of life questionnaire (SF-36). All tests were completed in the 1st quarter of 2006.
Eight patients were identified; three were mechanically ventilated at the time of HTX. All eight patients were treated according to the standard protocol. Repeated surveillance cardiac biopsies were taken. One patient died 3.5 years after HTX due to an acute myocardial infarction. Seven patients, including the three patients on a ventilator at the time of the HTX, are alive, resulting in a survival rate of 88%. The current median survival time is 126 months (range 55 to 184 months). All patients are in good cardiac condition. The SF-36 domains of social functioning and mental health show high scores, the average score of general health and vitality is moderate.
Survival of our eight transplanted patients after a median period of ten years was 88%, which is at least comparable with data from larger series. This finding suggests that HTX can be performed effectively and safely in a low volume centre. The finding that all three patients on a ventilator prior to HTX are alive is remarkable. It appears that mechanical ventilation is not always an absolute contraindication for HTX.
十年前，对于终末期心力衰竭且接受机械通气的患者是否适合进行心脏移植（HTX）存在不同意见。尽管当时的指南将机械通气列为禁忌证，但我们认为这些患者可以成为心脏移植的候选者。同一时期，我们中心还有其他一些患者接受了供体心脏。在本文中，我们描述了这些手术之后的临床病程及生存情况。
我们利用心脏移植术后数据库进行了一项回顾性研究。选取了我院所有接受移植的患者。患者接受了超声心动图、闪烁扫描（多门电路心血池显像）、运动肺功能测定（最大氧摄取量）、血液检查，并完成了一份生活质量问卷（SF-36）。所有检查均在2006年第一季度完成。
共确定了8例患者；其中3例在心脏移植时接受机械通气。所有8例患者均按照标准方案进行治疗。进行了多次监测性心脏活检。1例患者在心脏移植后3.5年因急性心肌梗死死亡。7例患者存活，包括心脏移植时接受机械通气的3例患者，生存率为88%。目前的中位生存时间为126个月（范围55至184个月）。所有患者心脏状况良好。SF-36社会功能和心理健康领域得分较高，总体健康和活力平均得分中等。
我们的8例移植患者在中位期十年后的生存率为88%，这至少与更大样本系列的数据相当。这一发现表明，在小规模中心也能有效且安全地进行心脏移植。心脏移植前接受机械通气的3例患者均存活这一发现值得注意。似乎机械通气并不总是心脏移植的绝对禁忌证。
