Maynes Elizabeth J, O'Malley Thomas J, Austin Melissa A, Deb Avijit K, Choi Jae Hwan, Weber Matthew P, Khaghani Asghar, Massey H Todd, Daly Richard C, Tchantchaleishvili Vakhtang
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
Ann Cardiothorac Surg. 2020 Jan;9(1):20-28. doi: 10.21037/acs.2019.12.02.
The domino-donor operation occurs when a "conditioned" heart from the heart-lung transplant (HLT) recipient is transplanted into a separate heart transplant (HT) recipient. The purpose of this systematic review was to investigate the indications and outcomes associated with the domino procedure.
An electronic search was performed to identify all prospective and retrospective studies on the domino procedure in the English literature. Eight studies reported 183 HLT recipients and 263 HT recipients who were included in the final analysis.
HLT indications included cystic fibrosis in 58% (95% CI: 27-84%) of recipients, primary pulmonary hypertension (PPH) in 17% (95% CI: 12-24%), bronchiectasis in 5% (95% CI: 3-10%), emphysema in 5% (95% CI: 0-45%), and Eisenmenger's syndrome in 4% (95% CI: 2-8%). HT indications included ischemic heart disease in 40% (95% CI: 33-47%), non-ischemic disease in 39% (95% CI: 25-56%), and re-transplantation in 10% (95% CI: 1-59%). The pooled mean pulmonary vascular resistance (PVR) in HT recipients was 3.05 Woods units (95% CI: 0.14-5.95). The overall mortality in the HLT group was 28% (95% CI: 18-41%) at an average follow-up of 15.68 months (95% CI: 0.82-30.54), and 35% (95% CI: 17-58%) in the HT group at an average follow-up of 37.26 months (95% CI: 6.68-67.84). Freedom from rejection in HT was 94% (95% CI: 75-99%) at 1 month, 77% (95% CI: 30-96%) at 6 months, and 41% (95% CI: 33-50%) at 1 year.
The domino procedure appears to be a viable option in properly selected patients that can be performed safely with acceptable outcomes.
当心肺移植（HLT）受者的“适配”心脏被移植到另一位心脏移植（HT）受者体内时，就会发生多米诺供体手术。本系统评价的目的是研究与多米诺手术相关的适应症和结局。
进行电子检索，以识别英文文献中所有关于多米诺手术的前瞻性和回顾性研究。八项研究报告了183例HLT受者和263例HT受者，这些患者被纳入最终分析。
HLT适应症包括58%（95%CI：27 - 84%）的受者患有囊性纤维化，17%（95%CI：12 - 24%）患有原发性肺动脉高压（PPH），5%（95%CI：3 - 10%）患有支气管扩张，5%（95%CI：0 - 45%）患有肺气肿，4%（95%CI：2 - 8%）患有艾森曼格综合征。HT适应症包括40%（95%CI：33 - 47%）的受者患有缺血性心脏病，39%（95%CI：25 - 56%）患有非缺血性疾病，10%（95%CI：1 - 59%）需要再次移植。HT受者的合并平均肺血管阻力（PVR）为3.05伍兹单位（95%CI：0.14 - 5.95）。HLT组的总体死亡率在平均随访15.68个月（95%CI：0.82 - 30.54）时为28%（95%CI：18 - 41%），HT组在平均随访37.26个月（95%CI：6.68 - 67.84）时为35%（95%CI：17 - 58%）。HT受者在1个月时无排斥反应的比例为94%（95%CI：75 - 99%），6个月时为77%（95%CI：30 - 96%），1年时为41%（95%CI：33 - 50%）。
多米诺手术对于经过适当选择的患者似乎是一种可行的选择，可以安全地进行并获得可接受的结局。
