Chapelier A, Vouhé P, Macchiarini P, Lenot B, Cerrina J, Le Roy Ladurie F, Parquin F, Hervé P, Brenot F, Lafont D
Department of Thoracic and Vascular Surgery, Hôpital Marie-Lannelongue, Plessis Robinson, France.
J Thorac Cardiovasc Surg. 1993 Aug;106(2):299-307.
Despite the development of several lung transplantation procedures, the most advantageous for pulmonary hypertension remains controversial. Between 1986 and February 1992, 30 patients with end-stage primary pulmonary hypertension (n = 24), chronic pulmonary embolism (n = 4), and hystiocytosis X (n = 2) underwent heart-lung (n = 21), double lung (n = 8), or single lung (n = 1) transplantation. Indications for double lung transplantation were similar to those for heart-lung transplantation, and the preoperative clinical and hemodynamic parameters were not significantly different between the two groups. There were no intraoperative deaths, but two reoperations were needed for pleural hematoma. Five early deaths were related to graft failure (two heart-lung transplantations), mediastinitis (one heart-lung transplantation), multiorgan failure (one double lung transplantation), and aspergillosis (one double lung transplantation). There was a similar improvement in early (days 0 and 2) and late (6 months postoperatively) right-sided hemodynamic function in patients undergoing heart-lung and double lung transplantation. Three double lung transplant recipients had early and reversible left ventricular-failure. The early postoperative course of the one patient who had single lung transplantation was characterized by severe pulmonary edema, left ventricular failure, and persistent desaturation and later on by moderate pulmonary hypertension and an important ventilation/perfusion mismatch. The pulmonary function results were also similar in the heart-lung and double lung transplantation groups. The overall projected 2- and 4-year survivals were 49% and 41%, respectively, and were not significantly different between the heart-lung and double lung recipients. Results demonstrate that heart-lung and double lung transplantation are equally effective in obtaining early and durable right-sided hemodynamic and respiratory improvement and similar respiratory function. In patients with pulmonary hypertension, double lung transplantation should be preferred to single lung transplantation because of the critical postoperative course and the uncertain long-term results of single lung transplantation.
尽管已经开发了多种肺移植手术，但对肺动脉高压最有利的手术仍存在争议。1986年至1992年2月期间，30例终末期原发性肺动脉高压患者（n = 24）、慢性肺栓塞患者（n = 4）和组织细胞增多症X患者（n = 2）接受了心肺移植（n = 21）、双肺移植（n = 8）或单肺移植（n = 1）。双肺移植的适应症与心肺移植相似，两组术前的临床和血流动力学参数无显著差异。术中无死亡病例，但有2例因胸腔血肿需要再次手术。5例早期死亡与移植失败（2例心肺移植）、纵隔炎（1例心肺移植）、多器官功能衰竭（1例双肺移植）和曲霉菌病（1例双肺移植）有关。接受心肺移植和双肺移植的患者在早期（第0天和第2天）和晚期（术后6个月）右侧血流动力学功能有相似的改善。3例双肺移植受者出现早期且可逆的左心室衰竭。接受单肺移植的1例患者术后早期病程的特点是严重肺水肿、左心室衰竭和持续低氧血症，后期表现为中度肺动脉高压和严重的通气/灌注不匹配。心肺移植组和双肺移植组的肺功能结果也相似。总体预计2年和4年生存率分别为49%和41%，心肺移植受者和双肺移植受者之间无显著差异。结果表明，心肺移植和双肺移植在获得早期和持久的右侧血流动力学及呼吸改善以及相似的呼吸功能方面同样有效。对于肺动脉高压患者，由于单肺移植术后病程凶险且长期结果不确定，应首选双肺移植而非单肺移植。
