成人先天性心脏病心脏移植：单中心病例系列。
Cardiac transplantation in adults with congenital heart disease: A single center case series.
机构信息
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
出版信息
Clin Transplant. 2021 Oct;35(10):e14430. doi: 10.1111/ctr.14430. Epub 2021 Jul 27.
BACKGROUND
Adult congenital heart disease (CHD) transplant recipients historically experienced worse survival early after transplantation. We aim to review updated trends in adult CHD transplantation.
METHODS
We performed a single center case series of adult cardiac transplants from January 2013 through July 2020. Outcomes of patients with CHD were compared to non-CHD. The primary outcome was overall survival. Secondary outcomes included a variety of post-operative complications.
RESULTS
18/262 (7%) transplants were CHD recipients. CHD patients were younger with median age 41 (32-47) versus 58 (48-65) (P < .001). Fontan circulation for single ventricle physiology was present in 4/18 (22%) of CHD recipients, while 16/18 (89%) had systemic right ventricles. CHD recipients had higher rates of previous cardiovascular operations (94% vs. 51%, P < .001). 9/18 (50%) of CHD patients required reconstructive procedures at the time of transplant. Operative and cardiopulmonary bypass times were longer for the CHD cohort (7.5 h [6.6-8.5] vs. 5.6 h [4.6-7] P < .001) and (197 min [158-240] vs. 130 [105-167] P < .001), respectively. There were no differences in operative complications or survival between CHD and non-CHD recipients.
CONCLUSIONS
These data highlight the added technical challenges of performing adult CHD transplants. However, similar outcomes can be achieved as for non-CHD recipients.
SUMMARY
Modern advances in palliation of congenital heart defects (CHD) has led to increased survival into adulthood. Many of these patients require heart transplantation as adults. There are limited data on adult CHD transplantation. Historically, these patients have had worse perioperative outcomes with improved long-term survival. We retrospectively analyzed 262 heart transplants at a single center, 18 of which were for adult CHD. Here, we report our series of 18 CHD recipients. We detail the palliative history of all CHD patients and highlight the added technical challenges for each of the 18 patients at transplant. In our analysis, CHD patients had more prior cardiovascular surgeries as well as longer transplant operative and bypass times. Despite this, there were no differences in perioperative and long-term outcomes. We have added patient and institution specific data for transplanting patients with adult CHD. We hope that our experience will add to the growing body of literature on adult CHD transplantation.
背景
成人先天性心脏病（CHD）移植受者在移植后早期的存活率较差。我们旨在回顾成人 CHD 移植的最新趋势。
方法
我们对 2013 年 1 月至 2020 年 7 月期间进行的成人心脏移植的单中心病例系列进行了研究。将 CHD 患者的结果与非 CHD 患者进行比较。主要结果是总生存率。次要结果包括各种术后并发症。
结果
262 例移植中有 18 例（7%）为 CHD 受者。CHD 患者年龄较小，中位年龄为 41（32-47）岁，而 58 岁（48-65）岁（P<0.001）。18 例 CHD 患者中有 4 例（22%）为单心室生理学的 Fontan 循环，而 16 例（89%）为右心室系统。CHD 患者有更高的心血管手术史（94%对 51%，P<0.001）。18 例 CHD 患者中有 9 例（50%）在移植时需要进行重建手术。CHD 组的手术和体外循环时间更长（7.5 小时[6.6-8.5]对 5.6 小时[4.6-7]，P<0.001）和（197 分钟[158-240]对 130 分钟[105-167]，P<0.001）。CHD 和非 CHD 受者在手术并发症或存活率方面无差异。
结论
这些数据突出了成人 CHD 移植所面临的技术挑战。然而，与非 CHD 受者一样，可以达到类似的结果。
总结
先天性心脏病（CHD）姑息治疗的现代进展导致成年后生存率提高。这些患者中的许多人需要在成年后进行心脏移植。关于成人 CHD 移植的资料有限。历史上，这些患者围手术期结局较差，但长期生存率提高。我们回顾性分析了单中心的 262 例心脏移植，其中 18 例为成人 CHD。在这里，我们报告了我们的 18 例 CHD 受者系列。我们详细描述了所有 CHD 患者的姑息治疗史，并突出了 18 例患者在移植时各自面临的额外技术挑战。在我们的分析中，CHD 患者有更多的既往心血管手术史，以及更长的移植手术和体外循环时间。尽管如此，围手术期和长期结局没有差异。我们增加了患者和机构特定的成人 CHD 移植数据。我们希望我们的经验将为成人 CHD 移植的不断增长的文献做出贡献。
Zotero 插件