Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
Thorac Cardiovasc Surg. 2024 Jun;72(4):253-260. doi: 10.1055/a-2015-1507. Epub 2023 Jan 18.
Predicted cardiac mass (PCM) has been well validated for size matching donor hearts to heart transplantation recipients. We hypothesized that cardiothoracic ratio (CTR) could be reflective of recipient-specific limits of oversizing, and sought to determine the utility of donor to recipient PCM ratio (PCMR) and CTR in predicting delayed chest closure after heart transplantation.
A retrospective review of prospectively collected data on 38 consecutive heart transplantations performed at our institution from 2017 to 2020 was performed. Donor and recipient PCM were estimated using Multi-Ethnic Study of Atherosclerosis predictive models. Receiver operating characteristic analysis was performed to determine the discriminatory power of the ratio of PCMR to CTR in predicting delayed sternal closure.
Of the 38 patients, 71.1% (27/38) were male and the median age at transplantation was 58 (interquartile range [IQR]: 47-62) years. Ischemic cardiomyopathy was present in 31.6% of recipients (12/38). Median recipient CTR was 0.63 [IQR: 0.59-0.66]. Median donor to recipient PCMR was 1.07 [IQR: 0.96-1.19], which indicated 7% oversizing. Thirteen out of 38 (34.2%) underwent delayed sternal closure. Primary graft dysfunction occurred in 15.8% (6/38). PCMR/CTR showed good discriminatory power in predicting delayed sternal closure [area under the curve: 80.4% (65.3-95.6%)]. PCMR/CTR cut-off of 1.7 offered the best trade-off between the sensitivity (69.6%) and specificity (91.7%).
CTR could be helpful in guiding the recipient-specific extent of oversizing donor hearts. Maintaining the ratio of PCMR to CTR below 1.7 could avoid excessive oversizing of the donor heart.
预测的心脏质量（PCM）已被充分验证，可用于将供体心脏与心脏移植受者进行大小匹配。我们假设心胸比（CTR）可以反映受体特异性的过度增大限制，并试图确定供体与受体 PCM 比（PCMR）和 CTR 在预测心脏移植后延迟关胸中的作用。
对 2017 年至 2020 年在我院进行的 38 例连续心脏移植患者的前瞻性数据进行回顾性分析。使用多民族动脉粥样硬化研究预测模型估算供体和受体的 PCM。通过接受者操作特征分析确定 PCMR 与 CTR 比值预测延迟胸骨闭合的区分能力。
38 例患者中，71.1%（27/38）为男性，移植时中位年龄为 58 岁（四分位距[IQR]：47-62）。31.6%（12/38）的受者存在缺血性心肌病。中位受体 CTR 为 0.63[IQR：0.59-0.66]。供体与受体的 PCMR 中位数为 1.07[IQR：0.96-1.19]，表明存在 7%的过度增大。38 例中有 13 例（34.2%）行延迟胸骨闭合。原发性移植物功能障碍发生率为 15.8%（6/38）。PCMR/CTR 在预测延迟胸骨闭合方面具有良好的区分能力[曲线下面积：80.4%（65.3-95.6%）]。PCMR/CTR 截断值为 1.7 时，敏感性（69.6%）和特异性（91.7%）之间具有最佳的权衡。
CTR 有助于指导受体特异性的供体心脏过度增大程度。维持 PCMR/CTR 比值低于 1.7 可避免供体心脏过度增大。
