de Begona J A, Gundry S R, Razzouk A J, Boucek M M, Kawauchi M, Bailey L L
Department of Surgery, School of Medicine, Loma Linda University Medical Center, Calif. 92354.
J Thorac Cardiovasc Surg. 1993 Dec;106(6):1196-201; discussion 1200-1.
Transplant surgeons are reluctant to use hearts that have undergone cardiopulmonary resuscitation for cardiac arrest because of the fear of poor early and late cardiac function. A policy of minimizing contraindications to use of donor hearts has led to the unique opportunity of assessing the effects of donor arrest and successful cardiopulmonary resuscitation on early and late cardiac function in pediatric heart transplantation. A number of 140 infants and children undergoing transplantation from birth to 17 years of age were studied retrospectively and divided into two groups on the basis of cardiopulmonary resuscitation status. Group 1 (72 patients) received donor hearts that were not subjected to cardiopulmonary resuscitation; group 2 (68 patients) received donor hearts that had cardiopulmonary resuscitation for a mean of 18.8 +/- 14.6 minutes, the longest period of time being 60 minutes. Mean ischemic times were almost identical in the two groups: 4.43 +/- 2.0 hours (cardiopulmonary resuscitation) versus 4.5 +/- 2.1 hours (no cardiopulmonary resuscitation). Early cardiac function was assessed on the basis of the number of days the recipient was supported by the ventilator, days receiving dopamine, days receiving isoproterenol, and the amount of inotropic agents required after the operation. The groups did not differ. Parameters of systolic function included fractional shortening, posterior wall thickening, and maximum velocity of change in left ventricular posterior wall dimension during systole. Diastolic function was measured on the basis of left ventricular end-diastolic volume, left ventricular mass, and maximum velocity of change in left ventricular posterior wall dimension during diastole. Both systolic and diastolic function were measured and analyzed from M-mode echocardiography at 1 week, 1 month, 6 months, 1 year, and 2 years after the operation. There were no statistically significant differences in graft function between the two groups in any of the echocardiographic parameters studied, even at 2 years. No group differed from ranges of normal. Our results suggest that hearts undergoing cardiopulmonary resuscitation for periods of up to 60 minutes can be used safely without evidence of deterioration of early or late cardiac function.
由于担心早期和晚期心脏功能不佳，心脏移植外科医生不愿使用因心脏骤停而接受过心肺复苏的心脏。一项尽量减少供体心脏使用禁忌证的政策带来了一个独特的机会，可用于评估供体心脏骤停及成功的心肺复苏对小儿心脏移植早期和晚期心脏功能的影响。对140例年龄从出生到17岁接受移植的婴幼儿和儿童进行了回顾性研究，并根据心肺复苏状况将其分为两组。第1组（72例患者）接受未经过心肺复苏的供体心脏；第2组（68例患者）接受平均进行了18.8±14.6分钟心肺复苏的供体心脏，最长时间为60分钟。两组的平均缺血时间几乎相同：4.43±2.0小时（心肺复苏组）对4.5±2.1小时（未进行心肺复苏组）。根据受体接受呼吸机支持的天数、接受多巴胺的天数、接受异丙肾上腺素的天数以及术后所需的强心剂用量来评估早期心脏功能。两组之间没有差异。收缩功能参数包括缩短分数、后壁增厚以及收缩期左心室后壁尺寸变化的最大速度。舒张功能根据左心室舒张末期容积、左心室质量以及舒张期左心室后壁尺寸变化的最大速度来测量。在术后1周、1个月、6个月、1年和2年通过M型超声心动图测量并分析收缩和舒张功能。在所研究的任何超声心动图参数中，两组之间的移植物功能均无统计学显著差异，即使在2年时也是如此。两组均未超出正常范围。我们的结果表明，进行长达60分钟心肺复苏的心脏可以安全使用，且没有早期或晚期心脏功能恶化的证据。
