Vijayanagar R R, Chan G L, Weinstein S S
Heart Transplant Service, Tampa General Hospital, FL 33606, USA.
Cardiovasc Surg. 1995 Jun;3(3):331-5. doi: 10.1016/0967-2109(95)93886-t.
Critically ill patient status and prior sternotomy have separately been associated with increased risk of mortality and morbidity after heart transplantation. Consequently, the justification of assigning urgent priority for transplantation to critically ill patients with prior sternotomy may be arguable. The authors therefore undertook a retrospective analysis to evaluate the outcome of urgent and elective heart transplantation in 64 patients who had undergone one to four previous sternotomies. Patients in group 1 (n = 23) were critically ill and underwent urgent heart transplantation. Group 2 (n = 41) consisted of more stable patients who received heart transplantation as an elective procedure. Intravenous inotropes or mechanical circulatory support were required by all patients in group 1 but by none in group 2. The mortality rate within 30 days post-transplant was higher in group 1 than in group 2 (22% versus 10%), though the difference was not statistically significant. The 1-year actuarial allograft survival was similar between the two groups (72% versus 74%). In addition, there was no significant difference between groups 1 and 2 in the incidence of postoperative coagulopathy (57% versus 42%), re-exploration (13% versus 15%), early infections (57% versus 49%), renal failure (17% versus 10%) or rejection episodes in the first 3 months (65% versus 78%). The authors' findings suggest that despite higher operative mortality in critically ill patients with previous sternotomies, the intermediate-term outcome of heart transplantation in these patients is similar to that in more stable patients. Critically ill patients with prior sternotomies should therefore continue to be considered for urgent heart transplantation.
危重症患者状态和既往胸骨切开术分别与心脏移植后死亡率和发病率增加相关。因此，将紧急移植优先级分配给有既往胸骨切开术的危重症患者的合理性可能存在争议。因此，作者进行了一项回顾性分析，以评估64例曾接受过一至四次胸骨切开术的患者进行紧急和择期心脏移植的结果。第1组（n = 23）为危重症患者，接受紧急心脏移植。第2组（n = 41）由病情较稳定的患者组成，他们接受择期心脏移植手术。第1组所有患者均需要静脉使用正性肌力药物或机械循环支持，而第2组患者均不需要。移植后30天内第1组的死亡率高于第2组（22%对10%），尽管差异无统计学意义。两组的1年移植心脏 actuarial 生存率相似（72%对74%）。此外，第1组和第2组在术后凝血病发生率（57%对42%）、再次手术探查率（13%对15%）、早期感染率（57%对49%）、肾衰竭发生率（17%对10%）或前3个月内排斥反应发生率（65%对78%）方面无显著差异。作者的研究结果表明，尽管有既往胸骨切开术的危重症患者手术死亡率较高，但这些患者心脏移植的中期结果与病情较稳定患者相似。因此，有既往胸骨切开术的危重症患者应继续被考虑进行紧急心脏移植。
