Ibrahim M, Masters R G, Hendry P J, Davies R A, Smith S, Struthers C, Walley V M, Keon W J
University of Ottawa Heart Institute, Division of Cardiac Surgery, Ottawa Civic Hospital, Canada.
Ann Thorac Surg. 1995 Mar;59(3):604-8. doi: 10.1016/0003-4975(94)00955-4.
To identify the preoperative factors that influence hospital survival after transplantation we analyzed our consecutive experience of 183 transplantations in 179 patients over a 10-year period. There were 151 male and 29 female transplant recipients ranging in age from 10 days to 70 years (mean, 48 +/- 1 years). Diagnoses included coronary disease in 110 patients, cardiomyopathy in 55 patients, valvular disease in 6 patients, and congenital heart disease in 9 patients. Seventy-seven had undergone a previous cardiac operation, and 30 patients required preoperative mechanical support. Forty patients received hearts from donors who were 40 years old or older (range, 40 to 62 years). Ischemic time was greater than 240 minutes in 32 cases, and pulmonary vascular resistance was greater than 3 Wood units in 40 patients (range, 3.1 to 10.0 Wood units). Cyclosporine induction was used in 52 patients, whereas 128 recipients received polyclonal antibody prophylaxis. There were 25 hospital deaths. Recipient diagnosis, use of mechanical support, donor age, and the immune suppression protocol were related to hospital survival according to univariate analysis. Using multiple logistic regression, only the method of immune suppression induction and the use of mechanical assists were significant independent determinants of survival. In conclusion, we believe that extended ischemic times and donor age do not adversely affect the early success of transplantation, whereas induction with immune globulin may reduce early mortality. Patients requiring mechanical support before transplantation continue to be a challenge.
为了确定影响移植术后患者院内生存率的术前因素，我们分析了10年间179例患者连续接受183次移植手术的经验。151例男性和29例女性接受了心脏移植，年龄从10天至70岁（平均48±1岁）。诊断包括冠心病110例、心肌病55例、瓣膜病6例、先天性心脏病9例。77例患者曾接受过心脏手术，30例患者术前需要机械支持。40例患者接受了年龄40岁及以上供者的心脏（范围40至62岁）。32例患者的缺血时间超过240分钟，40例患者的肺血管阻力超过3伍德单位（范围3.1至10.0伍德单位）。52例患者使用环孢素诱导治疗，128例接受多克隆抗体预防。共有25例患者在院内死亡。单因素分析显示，受者诊断、机械支持的使用、供者年龄和免疫抑制方案与院内生存率相关。多因素逻辑回归分析显示，只有免疫抑制诱导方法和机械辅助的使用是影响生存率的显著独立决定因素。总之，我们认为延长缺血时间和供者年龄不会对移植早期成功率产生不利影响，而免疫球蛋白诱导治疗可能降低早期死亡率。术前需要机械支持的患者仍然是一个挑战。
