Kawaguchi A, Gandjbakhch I, Pavie A, Muneretto C, Bors V, Leger P, Cabrol A, Desruennes M, Cabrol C
Service de Chirurgie Cardiovasculaire Hôpital de la Pitié, Paris, France.
J Thorac Cardiovasc Surg. 1989 Nov;98(5 Pt 2):928-34.
In an attempt to identify the factors that influence survival after heterotopic heart transplantation, 42 consecutive recipients of heterotopic heart transplant were reviewed. Preoperative pulmonary artery pressures, pulmonary vascular resistance, and donor age significantly differed between hospital survivors and nonsurvivors. Postoperative survival analysis between pairs of groups of patients divided by each of these variables disclosed a significant difference, which confirmed the effects of these variables on survival. Evolution of pulmonary hemodynamics was compared between patients with preoperative pulmonary artery diastolic pressure greater than 25 mm Hg (pulmonary hypertension; n = 22) or less than 25 mm Hg (nonpulmonary hypertension; n = 20). Despite marked differences in preoperative pulmonary hemodynamics, pulmonary artery pressures were dramatically reduced immediately after transplantation, and pulmonary vascular resistance diminished to upper normal limits at 10 days when there were no longer differences in pulmonary vascular resistance between the two groups. Immediate deaths were related to left ventricular failure, and the incidence was similar between the groups. Despite such normalization of pulmonary hemodynamics, patients with preoperative pulmonary hypertension experienced more frequent ventricular fibrillation, required longer respiratory support, and developed lethal pulmonary or systemic infection, which resulted in a 32% (7/22) hospital survival rate compared with 90% (18/20) in patients without pulmonary hypertension. Despite the dramatic improvement in pulmonary hemodynamics, heterotopic heart failed to demonstrate the expected advantages because of frequent pulmonary complications and infection, which resulted in failure to improve the prognosis of patients with preoperative pulmonary hypertension.
为了确定影响异位心脏移植术后存活的因素，我们回顾了42例连续接受异位心脏移植的患者。医院存活者和非存活者之间术前肺动脉压力、肺血管阻力和供体年龄存在显著差异。根据这些变量中的每一个对患者进行分组后的术后生存分析显示出显著差异，这证实了这些变量对生存的影响。比较了术前肺动脉舒张压大于25mmHg（肺动脉高压；n = 22）或小于25mmHg（非肺动脉高压；n = 20）的患者之间的肺血流动力学演变。尽管术前肺血流动力学存在显著差异，但移植后肺动脉压力立即显著降低，两组肺血管阻力在10天时均降至正常上限，此时两组肺血管阻力不再有差异。即刻死亡与左心室衰竭有关，两组发生率相似。尽管肺血流动力学实现了如此程度的正常化，但术前肺动脉高压患者发生室颤的频率更高，需要更长时间的呼吸支持，并发生致命的肺部或全身感染，导致医院生存率为32%（7/22），而无肺动脉高压患者为90%（18/20）。尽管肺血流动力学有显著改善，但由于频繁的肺部并发症和感染，异位心脏未能显示出预期的优势，导致术前肺动脉高压患者的预后未能得到改善。
