Vallabhaneni Srilakshmi, Singh Amitoj, Meera Srinidhi J, Shirani Jamshid
Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA.
Int J Crit Illn Inj Sci. 2020 Jul-Sep;10(3):129-133. doi: 10.4103/IJCIIS.IJCIIS_82_19. Epub 2020 Sep 22.
Cardiac transplant (CT) is the sole option in a minority of hypertrophic cardiomyopathy (HC) adults with refractory symptoms or end-stage disease.
AIMS/METHODS: We aimed to examine the trends and hospital outcomes of CT in HC using 2003-2011 Nationwide Inpatient Sample database.
HC comprised 1.1% of CT (151 of 14,277) performed during this time period (age 45±12 years, 67% male, 79% Caucasians). Number of HC CT increased from 2003 to 2011 (odds ratio=1.174; 95% confidence interval=1.102-1.252; P< 0.001). Comorbidities included congestive heart failure (76%), hypertension (23%), chronic kidney disease (23%), hyperlipidemia (19%), diabetes (13%), and coronary artery disease (10%). Acute in-hospital major adverse events occurred in 1 in 4 (23%) patient and 1 in 25 (3.8%) patients died perioperatively. Other major adverse events included allograft rejection or vasculopathy (23%), postoperative stroke or transient ischemic attack (3.5%), acute renal failure (43%), respiratory failure requiring mechanical ventilation (13%), sepsis (10%) or need for blood transfusion (10%). Compared to 1990-2004 United Network of Organ Sharing registry data (n=303), patients in current cohort had more comorbid conditions [diabetes (13%-vs-0%); chronic obstructive lung disease (9%-vs-1%); < 0.001 for both), were more likely to be male (66%-vs-48% P< 0.001), were less likely to be Caucasian (79%-vs-86%; < 0.001) or smokers (3%-vs-17%; < 0.001) and less often required perioperative circulatory support or hemodialysis (17%-vs-49%, < 0.001 and 3.2%-vs-8.3%, = 0.04, respectively).
HC comprises a small proportion of patients undergoing CT. The annual number of CT in HC has increased in recent years at least in part due to inclusion of patients with more comorbid conditions. Transplant recipients in the current cohort, however, required less postoperative circulatory support or renal replacement therapy.
心脏移植（CT）是少数有难治性症状或终末期疾病的肥厚型心肌病（HC）成年患者的唯一选择。
目的/方法：我们旨在利用2003 - 2011年全国住院患者样本数据库研究HC患者CT的趋势及住院结局。
在此期间进行的CT中，HC占1.1%（14277例中的151例）（年龄45±12岁，67%为男性，79%为白种人）。2003年至2011年，HC患者的CT数量增加（优势比 = 1.174；95%置信区间 = 1.102 - 1.252；P < 0.001）。合并症包括充血性心力衰竭（76%）、高血压（23%）、慢性肾病（23%）、高脂血症（19%）、糖尿病（13%）和冠状动脉疾病（10%）。四分之一（23%）的患者发生急性院内主要不良事件，25分之一（3.8%）的患者围手术期死亡。其他主要不良事件包括移植物排斥或血管病变（23%）、术后中风或短暂性脑缺血发作（3.5%）、急性肾衰竭（43%）、需要机械通气的呼吸衰竭（13%）、败血症（10%）或输血需求（10%）。与1990 - 2004年器官共享联合网络登记数据（n = 303）相比，当前队列中的患者有更多合并症[糖尿病（13%对0%）；慢性阻塞性肺疾病（9%对1%）；两者P均< 0.001]，更可能为男性（66%对48%，P < 0.001），不太可能是白种人（79%对86%；P < 0.001）或吸烟者（3%对17%；P < 0.001），围手术期较少需要循环支持或血液透析（分别为17%对49%，P < 0.001和3.2%对8.3%，P = 0.04）。
HC患者在接受CT的患者中占比小。近年来，HC患者的CT年度数量有所增加，至少部分原因是纳入了合并症更多的患者。然而，当前队列中的移植受者术后需要的循环支持或肾脏替代治疗较少。
