Dawkins K D, Jamieson S W, Hunt S A, Baldwin J C, Burke C M, Morris A, Billingham M E, Theodore J, Oyer P E, Stinson E B
Circulation. 1985 May;71(5):919-26. doi: 10.1161/01.cir.71.5.919.
During the first 31/2 years of the Stanford heart-lung transplant program, 23 transplants have been carried out in 22 patients with severe pulmonary vascular disease. Actuarial survival curves predict 1 and 2 year survival rates of 71% and 57%, respectively, for all patients. As a result of increasing experience, the early mortality of 26% has been reduced, with only one early death occurring in the last eight patients; prior cardiac surgery was a contributing factor in three of the six patients suffering early deaths. Two late deaths occurred in the series 14 and 15 months after operation. One patient died suddenly as a result of an acute myocardial infarct and the other patient died because of respiratory failure. At autopsy, both patients had severe proliferative coronary atherosclerosis with obliterative bronchiolitis affecting the lungs. An additional patient required a retransplant for obliterative bronchiolitis 37 months after the initial procedure, and he too was found to have severe coronary artery disease. Hemodynamics and left ventricular function were normal in patients studied 1 and 2 years after undergoing the transplantation procedure. Thus, the early mortality and morbidity of combined heart and lung transplantation has been significantly reduced, but the long-term complications, particularly graft atherosclerosis and obliterative bronchiolitis, are yet to be fully controlled.
在斯坦福心肺移植项目开展的头3年半时间里，已对22例患有严重肺血管疾病的患者实施了23例移植手术。精算生存曲线预测，所有患者的1年和2年生存率分别为71%和57%。由于经验的增加，早期死亡率已从26%降低，在最后8例患者中仅发生1例早期死亡；在6例早期死亡的患者中，有3例的促成因素是既往心脏手术。该系列中有2例患者在术后14个月和15个月出现晚期死亡。1例患者因急性心肌梗死突然死亡，另1例患者因呼吸衰竭死亡。尸检发现，这2例患者均有严重的增殖性冠状动脉粥样硬化，伴有影响肺部的闭塞性细支气管炎。另有1例患者在初次手术后37个月因闭塞性细支气管炎需要再次移植，他也被发现患有严重的冠状动脉疾病。接受移植手术1年和2年的患者的血流动力学和左心室功能正常。因此，心肺联合移植的早期死亡率和发病率已显著降低，但长期并发症，特别是移植物动脉粥样硬化和闭塞性细支气管炎，仍有待充分控制。
