Arnaoutakis George J, Blitzer David, Fuller Stephanie, Eckhauser Aaron W, Montenegro Lisa M, Rossano Joseph W, Gaynor J William
Department of Cardiac Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah.
Ann Thorac Surg. 2017 Jan;103(1):193-197. doi: 10.1016/j.athoracsur.2016.05.015. Epub 2016 Jul 15.
Circulatory failure necessitating cardiac transplantation will ultimately develop in many patients with functional single-ventricle physiology. Interest in the use of mechanical circulatory support (MCS) in this population is growing.
This was a retrospective case series of patients with functional single-ventricle physiology who underwent MCS with a ventricular assist device or a total artificial heart as a bridge to cardiac transplantation between January 2006 and December 2014. Baseline demographics, intraoperative data, postoperative complications, and outcome data were collected from the medical record.
MCS was used in 5 patients: HeartWare ventricular assist device (HeartWare International, Framingham, MA) in 1 patient, SynCardia total artificial heart (SynCardia Systems, Tucson, AZ) in 1, Thoratec Paracorporeal ventricular assist device (Thoratec Corp, Pleasanton, CA) in 1, and the Berlin Heart EXCOR (Berlin Heart Inc, The Woodlands, TX) in 2. The mean age at MCS was 12 ± 8 years. There were 2 early deaths at 12 and 28 days after MCS: 1 patient died of multiorgan system failure and 1 of neurologic injury. Overall, neurologic complications occurred in 3 patients (60%), and 1 patient (20%) required renal replacement therapy. Three patients (60%) underwent successful cardiac transplantation. The median time on the waiting list was 59 days (interquartile range, 18 to 126 days), and the median duration of MCS was 60 days (interquartile range, 28 to 93 days). At the time of transplant, all 3 patients were ambulatory, without the need for mechanical ventilation, and end-organ dysfunction had resolved. The 3 patients who received transplants were discharged from the hospital and were alive at an average follow-up of 9 ± 14 months.
MCS can be successfully used as a bridge to transplantation in patients with a failing single-ventricle circulation. Use of MCS can allow for resolution of end-organ dysfunction and rehabilitation, leading to improved outcomes in this difficult population.
许多功能性单心室生理患者最终会发展为需要心脏移植的循环衰竭。在这一人群中使用机械循环支持（MCS）的兴趣日益增加。
这是一项回顾性病例系列研究，研究对象为2006年1月至2014年12月期间接受MCS治疗的功能性单心室生理患者，使用心室辅助装置或全人工心脏作为心脏移植的桥梁。从病历中收集基线人口统计学数据、术中数据、术后并发症和结局数据。
5例患者接受了MCS治疗：1例使用HeartWare心室辅助装置（HeartWare International，弗雷明汉，马萨诸塞州），1例使用SynCardia全人工心脏（SynCardia Systems，图森，亚利桑那州），1例使用Thoratec体外心室辅助装置（Thoratec Corp，普莱森顿，加利福尼亚州），2例使用柏林心脏EXCOR（柏林心脏公司，伍德兰兹，得克萨斯州）。接受MCS治疗时的平均年龄为12±8岁。MCS治疗后12天和28天有2例早期死亡：1例死于多器官系统衰竭，1例死于神经损伤。总体而言，3例患者（60%）发生神经并发症，1例患者（20%）需要肾脏替代治疗。3例患者（60%）成功接受心脏移植。等待名单上的中位时间为59天（四分位间距，18至126天），MCS的中位持续时间为60天（四分位间距，28至93天）。在移植时，所有3例患者均能行走，无需机械通气，且终末器官功能障碍已得到缓解。接受移植的3例患者出院，平均随访9±14个月时仍存活。
MCS可成功用作单心室循环衰竭患者移植的桥梁。使用MCS可使终末器官功能障碍得到缓解并实现康复，从而改善这一困难人群的结局。
Zotero 插件