Hardesty R L, Griffith B P, Trento A, Thompson M E, Ferson P F, Bahnson H T
Ann Thorac Surg. 1986 Feb;41(2):126-9. doi: 10.1016/s0003-4975(10)62651-3.
Cardiac transplantation was resumed in 1980 at the University Health Center of Pittsburgh. Generally accepted criteria for selection of patients were used, one being the expectation that survival would not reach 6 months. All of the initial recipients were in New York Heart Association Functional Class IV, but many were ambulant. We soon saw patients who were more clearly terminally ill. They were characterized by a systolic arterial pressure of less than 80 mm Hg, a cardiac index of less than 2 L/min/m2, evidence of reduced blood flow as indicated by urine output of less than 20 ml per hour, impaired mental function, and signs of decreased peripheral perfusion. The initial success of cardiac transplantation in these patients prompted us to reconsider selection criteria to include them among less strikingly ill candidates and to develop a therapeutic protocol designed to maintain peripheral perfusion and adequate renal and hepatic function until transplantation could be accomplished. Actuarial survival at 30 months for the group of terminally ill patients was 75% compared with 67% for the less critically ill group. Actuarial survival at 30 months for the combined group of 77 patients was 67%. Twenty-nine of the 33 mortally ill patients were alive and active at the time of writing, January, 1985.
1980年，匹兹堡大学健康中心恢复了心脏移植手术。采用了普遍认可的患者选择标准，其中一条是预期生存期不超过6个月。所有最初的接受者均处于纽约心脏协会心功能IV级，但许多人仍可走动。很快，我们就见到了病情更明显处于终末期的患者。他们的特征包括收缩压低于80毫米汞柱、心脏指数低于2升/分钟/平方米、每小时尿量少于20毫升表明血流减少、精神功能受损以及外周灌注减少的迹象。这些患者心脏移植的初步成功促使我们重新考虑选择标准，将他们纳入病情不太严重的候选者中，并制定一种治疗方案，旨在维持外周灌注以及充足的肾和肝功能，直到能够完成移植手术。病情终末期患者组30个月的精算生存率为75%，相比之下，病情不太严重组为67%。77例患者的合并组30个月的精算生存率为67%。在撰写本文时，即1985年1月，33例病情严重的患者中有29例存活且情况良好。
