Radovancevic B, Nakatani T, Frazier O H, Moncrief C, Vega J, Haupt H, Duncan J M
Cullen Cardiovascular Surgical Research Laboratories, Texas Heart Institute, Houston 77225.
ASAIO Trans. 1989 Jul-Sep;35(3):539-41. doi: 10.1097/00002480-198907000-00118.
Perioperative acute donor heart failure can be caused by various factors, such as recipient pulmonary hypertension, marginal donor heart function, or immunologic mismatch. Of 265 patients who underwent orthotopic transplantation, four received mechanical support for acute perioperative donor heart failure. In two patients with reactive pulmonary hypertension, right heart bypass (RHB) with a centrifugal pump was used for 53 and 36 hr, respectively. One patient who experienced biventricular donor heart failure was supported for three days with an intraarterial, transvalvular, axial-flow left ventricular assist device (LVAD). Circulation was supported effectively with the LVAD, despite an initial absence of right ventricular function. The fourth patient, who had signs of heart failure, received intraaortic balloon pump support for 24 hr after transplantation. All four patients were weaned from circulatory support, and heart function was restored in each; the mean left ventricular ejection fraction was 63% (range from 57 to 71%). One patient died of fungal infection 14 days after being weaned from pump support, another died of lymphoma two months after support was discontinued, and the remaining two patients are well 9 and 18 months after transplantation. In cases of acute donor heart dysfunction, temporary mechanical assistance is a reliable option for supporting the circulation during heart recovery.
围手术期急性供体心脏衰竭可由多种因素引起，如受体肺动脉高压、边缘供体心脏功能或免疫配型不符。在265例行原位心脏移植的患者中，有4例因围手术期急性供体心脏衰竭接受了机械支持。在2例反应性肺动脉高压患者中，分别使用离心泵进行右心旁路（RHB）支持53小时和36小时。1例出现双心室供体心脏衰竭的患者使用动脉内、经瓣膜、轴流左心室辅助装置（LVAD）支持了三天。尽管最初右心室功能缺失，但LVAD有效地维持了循环。第4例有心力衰竭体征的患者在移植后接受了24小时的主动脉内球囊泵支持。所有4例患者均成功撤掉循环支持，心脏功能均得以恢复；左心室平均射血分数为63%（范围为57%至71%）。1例患者在撤掉泵支持14天后死于真菌感染，另1例在停止支持两个月后死于淋巴瘤，其余2例患者在移植后9个月和18个月情况良好。对于急性供体心脏功能障碍的病例，临时机械辅助是心脏恢复过程中维持循环的可靠选择。
