Ott G Y, Norman D J, Hosenpud J D, Hershberger R E, Ratkovec R M, Cobanoglu A
Oregon Cardiac Transplant Program, Oregon Health Sciences University, Portland.
J Thorac Cardiovasc Surg. 1994 Jan;107(1):203-9.
A significant proportion of potential transplant recipients have undergone previous cardiac procedures and may be subject to an increased risk because of technical and other factors inherent in a reoperation. Between December 1985 and June 1991, 155 orthotopic heart transplantations were carried out in 146 patients. Eighty-five transplantations (54.8%) were carried out as the initial cardiac operation (group I); 61 operations (45.2%) were performed in patients who had previous nontransplant cardiac operations (group II). Preoperative variables including hemodynamic indexes, renal function, and status on the waiting list were similar between these groups; however, group II patients tended to be older than group I patients (51.9 +/- 10.7 versus 47.7 +/- 11.6 years, respectively; p < 0.05) and were more likely to have ischemic heart disease (80.3% versus 34.1%) than were those in group I. Significantly longer cardiopulmonary bypass time (127.6 +/- 44.7 minutes versus 108.2 +/- 18.8 minutes, p < 0.01) and duration of operation (448.1 +/- 120.9 minutes versus 353.2 +/- 85.1 minutes, p < 0.01) was found in group II. Operative mortality in group I was 4.7% and in group II was 6.6% (p > 0.9). Group I actuarial survival at 1 year and 5 years was 87.1% +/- 3.6% and 72.9% +/- 6.2%, respectively. Group II actuarial survival was 85.3% +/- 4.5% and 76.0% +/- 6.6%, respectively, for the same time periods. In spite of the greater technical challenge implied by previous cardiac operations, no significant survival differences occurred between these groups (p > 0.9). However, patients undergoing a second cardiac transplantation (n = 9) were identified as a high-risk subset with operative mortality of 22.8% and 1-year survival of only 33.3% +/- 15.7% (p < 0.0003). Cardiac transplantation in patients who have undergone previous nontransplant cardiac operations can be carried out without compromising immediate or long-term outcome.
相当一部分潜在的心脏移植受者之前接受过心脏手术，由于再次手术中固有的技术和其他因素，他们可能面临更高的风险。1985年12月至1991年6月，对146例患者实施了155例原位心脏移植手术。85例移植手术（54.8%）是作为初次心脏手术进行的（第一组）；61例手术（45.2%）是在之前接受过非移植心脏手术的患者中进行的（第二组）。这些组之间的术前变量，包括血流动力学指标、肾功能和等待名单上的状态相似；然而，第二组患者往往比第一组患者年龄更大（分别为51.9±10.7岁和47.7±11.6岁；p<0.05），并且比第一组患者更有可能患有缺血性心脏病（80.3%对34.1%）。第二组的体外循环时间（127.6±44.7分钟对108.2±18.8分钟，p<0.01）和手术持续时间（448.1±120.9分钟对353.2±85.1分钟，p<0.01）明显更长。第一组的手术死亡率为4.7%，第二组为6.6%（p>0.9）。第一组1年和5年的精算生存率分别为87.1%±3.6%和72.9%±6.2%。第二组在相同时间段的精算生存率分别为85.3%±4.5%和76.0%±6.6%。尽管之前的心脏手术带来了更大的技术挑战，但这些组之间没有出现显著的生存差异（p>0.9）。然而，接受第二次心脏移植的患者（n=9）被确定为高风险亚组，手术死亡率为22.8%，1年生存率仅为33.3%±15.7%（p<0.0003）。之前接受过非移植心脏手术的患者进行心脏移植可以在不影响近期或长期结果的情况下进行。
