Hetzer R, Albert W, Hummel M, Pasic M, Loebe M, Warnecke H, Haverich A, Borst H G
Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefässchirurgie, Germany.
Ann Thorac Surg. 1997 Dec;64(6):1661-8. doi: 10.1016/s0003-4975(97)01091-6.
Heart transplantation has a dramatic impact on both life expectancy and quality of life in patients with terminal heart failure. The aim of the study was to evaluate psychologic, social, occupational, and somatic status of patients living long-term, 9 to 13 years after orthotopic heart transplantation.
Seventy-seven of 182 patients who received transplants between July 1983 and January 1988 in Hannover (1983-1985; n = 69 patients) and Berlin (1986-1988; n = 113 patients) have survived up to now, 9 to 13 years after transplantation (mean, 10 years 4 months). The patients and their medical records (eg, cardiac catheter studies, echocardiography) were examined to assess their somatic status. Psychologic, social, and occupational status and quality of life data were assessed by combination of self-rating questionnaires (the Short Form Health Survey Questionnaire, Giessener Beschwerdebogen [the Giessen Subjective Complaints List], the Sickness Impact Profile, and the Hospital Anxiety and Depression Scale) and semistructured interviews.
Ninety-one percent of the patients were in New York Heart Association functional class I (70%) or II (21%). The results of the psychologic investigation revealed a definite impact of the side effects of chronic immunosuppression; however, overall, the quality of life rating was within the normal range. Sixty-seven (86%) patients were married, 51 (66%) patients were retired, 17 (22%) worked full-time or part-time, and 9 (12%) were housewife or houseman. Four male patients have fathered five healthy children 1 to 10 years after the transplantation. More than 75% of the patients had normal systolic ventricular function (mean left ventricular ejection fraction, 0.63). Coronary angiograms were normal or with minor wall irregularities in 86% (n = 66 patients), and revealed severe obstructions in 14% (n = 11). Normal function of all valves was found in one-third of the patients, tricuspid valve incompetence was not found or was insignificant in 87% (n = 67 patients) and severe in 8% (n = 10). Six patients had undergone tricuspid valve replacement, invariably for structural valve defects attributable to biopsy injuries. Fifty-eight patients (75%) exhibited various degrees of compensated renal insufficiency, 7 of them were on chronic hemodialysis, and 2 patients have undergone kidney transplantation. Hepatic function was normal in 68% (n = 52) of the patients, and 1 patient has developed liver cirrhosis. Osteoporosis was diagnosed of the discrete form in 7 (9%) and of a significant degree in 24 patients (31%); 38.5% (n = 30) complained of symptoms of polyneuropathy.
The patients surviving 9 to 13 years after orthotopic heart transplantation are mostly in good physical status, the quality of life is comparable to the general population, and only a few of them have significantly limited in their life style. They do show the substantial chronic side effects of long-term immunosuppression, remaining treatment-dependent for a lifetime.
心脏移植对终末期心力衰竭患者的预期寿命和生活质量具有重大影响。本研究的目的是评估原位心脏移植术后9至13年长期存活患者的心理、社会、职业和躯体状况。
1983年7月至1988年1月期间在汉诺威（1983 - 1985年；69例患者）和柏林（1986 - 1988年；113例患者）接受移植的182例患者中，77例至今存活，移植后9至13年（平均10年4个月）。对患者及其病历（如心脏导管检查、超声心动图）进行检查以评估其躯体状况。心理、社会、职业状况和生活质量数据通过自评问卷（简短健康调查问卷、吉森主观症状清单、疾病影响量表和医院焦虑抑郁量表）和半结构化访谈相结合的方式进行评估。
91%的患者处于纽约心脏协会心功能I级（70%）或II级（21%）。心理调查结果显示慢性免疫抑制副作用有明确影响；然而，总体而言，生活质量评分在正常范围内。67例（86%）患者已婚，51例（66%）患者退休，17例（22%）全职或兼职工作，9例（12%）为家庭主妇或主夫。4例男性患者在移植后1至10年育有5名健康子女。超过75%的患者收缩期心室功能正常（平均左心室射血分数为0.63）。86%（66例患者）的冠状动脉造影正常或有轻微管壁不规则，14%（11例患者）显示严重阻塞。三分之一的患者所有瓣膜功能正常，87%（67例患者）未发现或仅有轻微三尖瓣关闭不全，8%（10例患者）严重。6例患者因活检损伤导致的结构性瓣膜缺陷接受了三尖瓣置换术。58例（75%）患者表现出不同程度的代偿性肾功能不全，其中7例接受慢性血液透析，2例接受了肾移植。68%（52例患者）的肝功能正常，1例患者发展为肝硬化。7例（9%）患者被诊断为离散型骨质疏松，24例（31%）患者为重度骨质疏松；38.5%（30例患者）主诉有多发性神经病变症状。
原位心脏移植术后9至13年存活的患者大多身体状况良好，生活质量与普通人群相当，只有少数患者的生活方式受到显著限制。他们确实表现出长期免疫抑制的严重慢性副作用，并终生依赖治疗。
