Dagenais F, Voisine P, Normandin L, Martin M, Poirier N L
Service de Chirurgie Cardiaque, Centre Hospitalier de l'Université de Montréal, Québec, Canada.
Ann Chir. 1998;52(8):834-9.
Results of cardiac surgery in renal transplant patients are not well documented. Immunosuppression as well as associated conditions in these patients, and the increased susceptibility of the renal allograft to the extracorporeal circulation (ECC) may alter the prognosis of renal transplant patients submitted to cardiac surgery. To evaluate this hypothesis, we reviewed the files of 24 patients (18 Male, 6 Female; age: 49 +/- 12 years) operated under ECC between 1978 and 1997. Twenty patients underwent coronary artery bypass surgery, 5 patients a valve replacement procedure (aortic and/or mitral), and one patient necessitated a Cabrol procedure for an ascending aorta aneurysm. Preoperatively, the majority of patients were in functional class (NYHA) IV (16 patients), and ejection fraction was > 50% in 18 patients. Two operative deaths secondary to cardiogenic shock were encountered. Five patients (23%) were reoperated for bleeding; 5 patients (23%) sustained a major infection (2 pneumonias, 2 mediastinitis and one wound infection) resulting in death in one patient; 5 patients (23%) were treated for arythmia; and 2 patients (9%) suffered a perioperative myocardial infarction. Serum creatinine levels did not increase significantly during hospitalization (p = 0.41 between extreme values). Mean follow-up (41 +/- 28 months) of the 20 survivors revealed recurrent angina in 5 patients and late death in 4 patients, cardiac-related in 3 cases.
Cardiac surgery in renal transplant patients is subjected to a high morbidity and mortality. Mid-term prognosis is reserved especially in presence of associated conditions.
肾移植患者心脏手术的结果记录并不完善。这些患者的免疫抑制以及相关病症，加上肾移植对体外循环（ECC）的易感性增加，可能会改变接受心脏手术的肾移植患者的预后。为了评估这一假设，我们回顾了1978年至1997年间在体外循环下接受手术的24例患者（18例男性，6例女性；年龄：49±12岁）的病历。20例患者接受了冠状动脉搭桥手术，5例患者进行了瓣膜置换手术（主动脉和/或二尖瓣），1例患者因升主动脉瘤需要进行卡布罗尔手术。术前，大多数患者心功能分级（纽约心脏协会[NYHA]）为IV级（16例患者），18例患者的射血分数>50%。发生了2例心源性休克导致的手术死亡。5例患者（23%）因出血接受了再次手术；5例患者（23%）发生了严重感染（2例肺炎、2例纵隔炎和1例伤口感染），其中1例患者死亡；5例患者（23%）接受了心律失常治疗；2例患者（9%）发生了围手术期心肌梗死。住院期间血清肌酐水平没有显著升高（极值之间p = 0.41）。对20名幸存者的平均随访（41±28个月）显示，5例患者出现复发性心绞痛，4例患者晚期死亡，其中3例与心脏相关。
肾移植患者心脏手术的发病率和死亡率很高。中期预后不佳，尤其是存在相关病症时。
