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优化心脏移植结果：多学科心脏团队与针对原发性移植物功能障碍的机械循环支持

Optimizing outcomes in heart transplantation: multidisciplinary Heart Teams and mechanical circulatory support for primary graft dysfunction.

作者信息

Haneya Assad, Lanmüller Pia, Panholzer Bernd, Sommer Wiebke, Kuliczkowski Wiktor, Sokolski Mateusz, Przybylski Roman, Schmack Bastian, Ali-Hasan-Al-Saegh Sadeq, Takemoto Sho, Zayat Rachad, Werner Nikos

机构信息

Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital, Nordallee 1, Trier 54292, Germany.

Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany.

出版信息

Eur Heart J Suppl. 2025 Apr 28;27(Suppl 4):iv55-iv61. doi: 10.1093/eurheartjsupp/suaf003. eCollection 2025 Apr.

DOI:10.1093/eurheartjsupp/suaf003
PMID:40302843
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12036520/
Abstract

Heart transplantation (HTx) is a definitive treatment for selected patients with advanced heart failure. However, primary graft dysfunction (PGD), a severe early complication, is a major cause of post-HTx morbidity and mortality. This paper explores the pathophysiology, diagnostic approaches, and management strategies for PGD, with a particular focus on temporary mechanical circulatory support (MCS) devices such as venoarterial extracorporeal membrane oxygenation and Impella. It also highlights the essential role of the multidisciplinary Heart Team in optimizing outcomes through patient-tailored MCS selection and timely intervention.

摘要

心脏移植（HTx）是针对特定晚期心力衰竭患者的一种确定性治疗方法。然而，原发性移植功能障碍（PGD）作为一种严重的早期并发症，是心脏移植术后发病和死亡的主要原因。本文探讨了PGD的病理生理学、诊断方法和管理策略，特别关注临时性机械循环支持（MCS）设备，如静脉-动脉体外膜肺氧合和Impella。本文还强调了多学科心脏团队在通过为患者量身定制MCS选择和及时干预来优化治疗结果方面的重要作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845e/12036520/a44b957e637b/suaf003f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845e/12036520/a44b957e637b/suaf003f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845e/12036520/a44b957e637b/suaf003f1.jpg

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本文引用的文献

1
Practical Guidance for Hemodynamic Assessment by Right Heart Catheterization in Management of Heart Failure.右心导管术在心力衰竭管理中心血管动力学评估的实用指南。
JACC Heart Fail. 2024 Jul;12(7):1141-1156. doi: 10.1016/j.jchf.2024.03.020.
2
Physical preconditioning on biventricular temporary mechanical circulatory support while awaiting heart transplantation.在等待心脏移植期间对双心室临时机械循环支持进行身体预处理。
Interdiscip Cardiovasc Thorac Surg. 2024 Jun 5;38(6). doi: 10.1093/icvts/ivae106.
3
Impella RP Flex: Rescue for the Failing Right Ventricle After Heart Transplantation-Case Report.
Impella RP Flex：心脏移植后右心室衰竭的挽救——病例报告
ASAIO J. 2025 Feb 1;71(2):e33-e37. doi: 10.1097/MAT.0000000000002253. Epub 2024 Jun 21.
4
Primary graft dysfunction in heart transplantation: the challenge to survival.心脏移植中的原发性移植物功能障碍：对生存的挑战。
J Cardiothorac Surg. 2024 Jun 1;19(1):313. doi: 10.1186/s13019-024-02816-6.
5
Differential utilization of Impella devices, extracorporeal membrane oxygenation, and combined therapies as escalation and de-escalation strategies.作为升级和降级策略，Impella设备、体外膜肺氧合及联合治疗的差异化应用
Eur Heart J Suppl. 2023 Dec 13;25(Suppl I):I32-I38. doi: 10.1093/eurheartjsupp/suad131. eCollection 2023 Dec.
6
The Use of Impella 5.5 for Donor-Heart Hemodynamic Support in Heart Transplantation.经皮左心室辅助装置 5.5 在心脏移植供心保护中的应用。
ASAIO J. 2023 Dec 1;69(12):e520-e522. doi: 10.1097/MAT.0000000000002022. Epub 2023 Jul 27.
7
The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients.国际心肺移植学会（ISHLT）心脏移植受者护理指南。
J Heart Lung Transplant. 2023 May;42(5):e1-e141. doi: 10.1016/j.healun.2022.10.015. Epub 2022 Dec 20.
8
Prolonged waitlisting is associated with mortality in extracorporeal membrane oxygenation-supported heart transplantation candidates.在接受体外膜肺氧合支持的心脏移植候选患者中，长时间等待名单与死亡率相关。
JTCVS Open. 2022 Oct 5;12:234-254. doi: 10.1016/j.xjon.2022.09.010. eCollection 2022 Dec.
9
Temporal trends in the use and outcomes of temporary mechanical circulatory support as a bridge to cardiac transplantation in Spain. Final report of the ASIS-TC study.西班牙作为心脏移植桥梁的临时机械循环支持的使用情况及结局的时间趋势。ASIS-TC研究的最终报告。
J Heart Lung Transplant. 2023 Apr;42(4):488-502. doi: 10.1016/j.healun.2022.10.020. Epub 2022 Nov 9.
10
Lack of volume-outcome association in ECMO bridge to heart transplantation.体外膜肺氧合（ECMO）过渡到心脏移植过程中容量与预后缺乏相关性。
J Card Surg. 2022 Dec;37(12):4883-4890. doi: 10.1111/jocs.17157. Epub 2022 Nov 9.