先天性心脏病患儿的心脏移植

Heart transplantation in children with congenital heart disease.

作者信息

Hsu D T, Quaegebeur J M, Michler R E, Smith C R, Rose E A, Kichuk M R, Gersony W M, Douglas J F, Addonizio L J

机构信息

Department of Pediatrics, College of Physicians and Surgeons, Columbia University, Babies Hospital, New York, New York 10032, USA.

出版信息

J Am Coll Cardiol. 1995 Sep;26(3):743-9. doi: 10.1016/0735-1097(95)00253-Z.

DOI:10.1016/0735-1097(95)00253-Z

PMID:7642869

Abstract

OBJECTIVES

The aim of this study was to describe heart transplantation in children with congenital heart disease and to compare the results with those in children undergoing transplantation for other cardiac diseases.

BACKGROUND

Reports describe decreased survival after heart transplantation in children with congenital heart disease compared with those with cardiomyopathy. However, transplantation is increasingly being considered in the surgical management of children with complex congenital heart disease. Present-day results from this group require reassessment.

METHODS

The diagnoses, previous operations and indications for transplantation were characterized in children with congenital heart disease. Pretransplant course, graft ischemia time, post-transplant survival and outcome (rejection frequency, infection rate, length of hospital stay) were compared with those in children undergoing transplantation for other reasons (n = 47).

RESULTS

Thirty-seven children (mean [+/- SD] age 9 +/- 6 years) with congenital heart disease underwent transplantation; 86% had undergone one or more previous operations. Repair of extracardiac defects at transplantation was necessary in 23 patients. Causes of death after transplantation were donor failure in two patients, surgical bleeding in two, pulmonary hemorrhage in one, infection in four, rejection in three and graft atherosclerosis in one. No difference in 1- and 5-year survival rates (70% vs. 77% and 64% vs. 65%, respectively), rejection frequency or length of hospital stay was seen between children with and without congenital heart disease. Cardiopulmonary bypass and donor ischemia time were significantly longer in patients with congenital heart disease. Serious infections were more common in children with than without congenital heart disease (13 of 37 vs. 6 of 47, respectively, p = 0.01).

CONCLUSIONS

Despite the more complex cardiac surgery required at implantation and longer donor ischemic time, heart transplantation can be performed in children with complex congenital heart disease with success similar to that in patients with other cardiac diseases.

摘要

目的

本研究旨在描述先天性心脏病患儿的心脏移植情况，并将结果与因其他心脏疾病接受移植的患儿进行比较。

背景

报告显示，与患有心肌病的患儿相比，先天性心脏病患儿心脏移植后的生存率较低。然而，在复杂先天性心脏病患儿的外科治疗中，移植越来越受到关注。这组患儿目前的治疗结果需要重新评估。

方法

对先天性心脏病患儿的诊断、既往手术情况和移植指征进行了分析。将先天性心脏病患儿的移植前病程、移植物缺血时间、移植后生存率和结局（排斥反应频率、感染率、住院时间）与因其他原因接受移植的患儿（n = 47）进行比较。

结果

37例（平均[±标准差]年龄9±6岁）先天性心脏病患儿接受了心脏移植；86%的患儿曾接受过一次或多次手术。23例患者在移植时需要修复心外缺损。移植后死亡原因包括供体衰竭2例、手术出血2例、肺出血1例、感染4例、排斥反应3例和移植物动脉粥样硬化1例。先天性心脏病患儿与非先天性心脏病患儿的1年和5年生存率（分别为70%对77%和64%对65%）、排斥反应频率或住院时间无差异。先天性心脏病患者的体外循环和供体缺血时间明显更长。与非先天性心脏病患儿相比，先天性心脏病患儿严重感染更为常见（分别为37例中的13例对47例中的6例，p = 0.01）。