Pavie A, Leger P, Regan M, Nataf P, Bors V, Szefner J, Cabrol C, Gandjbakhch I
Department of Thoracic and Cardiovascular Surgery, La Pitie Hospital, Paris, France.
J Card Surg. 1995 Sep;10(5):552-8. doi: 10.1111/j.1540-8191.1995.tb00631.x.
Since April 1986, 82 patients have received a pneumatic total artificial heart, 62 a JARVIK-7, and 20 a Cardiowest. The duration of support ranged from less than 1 day to 603 days (mean duration: 27 +/- 82). The indications were for acute shock (38 cases) or for chronic deterioration on the transplant waiting list (44 cases). The etiology was mainly due to idiopathic and ischemic cardiomyopathy. With the help of our scoring system, we divided our patients in three groups: Chronic Implantation, represented by two females staying on device for 6 and 19 months, respectively; a High-Risk group of 29 patients characterized by high-risk indications; graft failure, rejection, postcardiotomy patient, postpartum cardiomyopathy, and valvular and congenital reoperation. In addition, the dilated and ischemic cardiomyopathy patients with a score over 6 were included in this group; and an Elective Indication group (51 patients) represented all of the dilated and ischemic cardiomyopathy patients with a score under 6. Due to the shortage of donors, our criteria for transplantation are very strict. Transplants should be made only in cases of hemodynamic stability, on an extubated patient with normal renal and liver functions, without coagulation problems or infection. With such criteria, in the high-risk group, only four patients could be transplanted and of these two are still alive. In contrast, in the elective group, 31 were transplanted (61%), and 71% of these patients were discharged. The rate is improved in the most recent cases, with 90% of the Cardiowest patients being survivors.
自1986年4月以来，82例患者接受了气动全人工心脏，其中62例植入JARVIK-7型人工心脏，20例植入Cardiowest型人工心脏。支持时间从不到1天至603天不等（平均时间：27±82天）。适应证为急性休克（38例）或移植等待名单上的慢性病情恶化（44例）。病因主要是特发性和缺血性心肌病。借助我们的评分系统，我们将患者分为三组：慢性植入组，由两名分别使用人工心脏6个月和19个月的女性代表；高危组，共29例患者，其特点是具有高危适应证，包括移植失败、排斥反应、心脏术后患者、产后心肌病以及瓣膜和先天性心脏病再次手术患者。此外，扩张型和缺血性心肌病评分超过6分的患者也纳入该组；择期适应证组（51例患者）包括所有扩张型和缺血性心肌病评分低于6分的患者。由于供体短缺，我们的移植标准非常严格。仅在血流动力学稳定、肾功能和肝功能正常、无凝血问题或感染且已拔除气管插管的患者中进行移植。按照这些标准，在高危组中，只有4例患者能够进行移植，其中2例仍然存活。相比之下，在择期组中，31例患者进行了移植（61%），这些患者中有71%出院。在最近的病例中该比率有所提高，Cardiowest型人工心脏患者的存活率为90%。
