Vedrinne J M, Vedrinne C, Coronel B, Mercatello A, Estanove S, Moskovtchenko J F
Intensive Care Unit, Edouard Herriot Hospital, Lyon, France.
J Cardiothorac Vasc Anesth. 1996 Oct;10(6):708-12. doi: 10.1016/S1053-0770(96)80194-7.
The brain-dead donor supply has become one of the criteria limiting the performance of heart transplantation. Conventional screening criteria are too limiting and exclude suitable heart donors. Echocardiography is now widely available and is a reliable tool to assess left ventricular dysfunction in brain-dead donors. Yet few data are available on the degree of left ventricular dysfunction where a transplantation is possible.
Fifty-five potential brain-dead heart donors (age 38 +/- 11 years) were prospectively evaluated by transesophageal echocardiography (TEE) before harvesting. Fractional area change (FAC) was used to assess left ventricular function in potential brain-dead donors. Transplanted hearts were evaluated on the fifth postoperative day. The transplantation was considered a success if the recipient was alive, not retransplanted, without an assistance device or an epinephrine infusion of more than 1 mg/h and showed an ejection fraction above 40%.
Of the 55 potential heart donors, 20 exhibited an FAC of less than 50%. Forty hearts were harvested, 36 of which were successfully transplanted. Nine patients had an FAC below 50% (group H2) and 27 had an FAC over 50% (group H1). Four patients died: 2 from hemorrhage (FAC > 50% in donors); 1 from right and one from left ventricular dysfunction (FAC < 50% in donors). The FAC increased significantly from 51 +/- 15% to 57 +/- 11% in 18 hearts that underwent TEE in donors and afterwards in recipients. Overall actuarial survival was 86.2% versus 64.6% at 1 and 2 years in group H1 and group H2, respectively (p = NS).
TEE is useful to assess left ventricular function in potential brain-dead donors. An FAC less than 50% is present in 36% of potential heart donors. Because left ventricular dysfunction is often reversible shortly after transplantation, an FAC below 50% may not necessarily preclude the use of hearts for transplantation.
脑死亡供体的供应已成为限制心脏移植开展的标准之一。传统的筛查标准过于严格，排除了合适的心脏供体。超声心动图目前应用广泛，是评估脑死亡供体左心室功能障碍的可靠工具。然而，关于有可能进行移植的左心室功能障碍程度的数据却很少。
55名潜在的脑死亡心脏供体（年龄38±11岁）在心脏摘取前接受经食管超声心动图（TEE）前瞻性评估。采用面积变化分数（FAC）评估潜在脑死亡供体的左心室功能。在术后第5天对移植心脏进行评估。如果受者存活、未再次移植、未使用辅助装置或肾上腺素输注量不超过1mg/h且射血分数高于40%，则认为移植成功。
在55名潜在心脏供体中，20名的FAC低于50%。摘取了40颗心脏，其中36颗成功移植。9名患者的FAC低于50%（H2组），27名患者的FAC高于50%（H1组）。4名患者死亡：2名死于出血（供体的FAC>50%）；1名死于右心室功能障碍，1名死于左心室功能障碍（供体的FAC<50%）。18颗在供体时接受TEE检查且之后在受者中接受检查的心脏，其FAC从51±15%显著增加至57±11%。H1组和H2组在1年和2年时的总体精算生存率分别为86.2%和64.6%（p=无显著性差异）。
TEE有助于评估潜在脑死亡供体的左心室功能。36%的潜在心脏供体存在FAC低于50%的情况。由于左心室功能障碍在移植后不久通常是可逆的，FAC低于50%不一定排除心脏用于移植。
