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1.

郑珊珊刘盛唐汉韡宋云虎王巍黄洁廖中凯郑哲《器官移植》2021,12(4):450-457

目的分析危重状态病人心脏移植的早期结果及其在供者分配决策中的意义。方法回顾性分析449例心脏移植受者的临床资料,根据术前状态分为危重状态组（64例）和一般状态组（385例）。总结危重状态的发生情况;比较两组受者的临床资料;分析两组受者术后生存情况及死亡原因;比较危重状态受者术前不同机械循环辅助桥接移植的围手术期结果。结果危重状态病人占总移植人数14.3%,近5年危重状态病人比例逐年增高。与一般状态组受者比较,危重状态组受者术前吸烟史比例较低,既往心脏手术史比例较高,血清肌酐水平较高,原发病为既往移植心脏衰竭比例较高;术后使用机械循环辅助比例较高,术后并发症发生率较高,重症监护室（ICU）入住时间较长,院内病死率较高（均为P≤0.01）。危重状态组受者术后1年生存率低于一般状态组受者（83%比95%,P < 0.01）。危重状态组受者因感染、多器官衰竭死亡的比例高于一般状态组受者。64例危重状态受者中,术前1例单独使用呼吸机,63例加用机械循环辅助桥接移植。其中49例（77%）单用主动脉内球囊反搏泵（IABP）,8例（13%）联合应用体外膜肺氧合（ECMO）和IABP,4例（6%）单用ECMO,2例（3%）单用左心室辅助装置（LVAD）。术前应用ECMO、联合应用ECMO和IABP桥接移植的危重状态病人术后并发症发生的比例较高、ICU入住时间较长、机械通气时间较长,院内病死比例较高。结论危重状态病人心脏移植总体预后不佳,有效的术前管理可在一定程度逆转危重病人的高风险状态。供心分配应把有限的供心分配给最紧急且能从移植中受益最多的病人。相似文献

2.

Detection of early changes in the coronary artery microstructure after heart transplantation: A prospective optical coherence tomography study

Tor Skibsted Clemmensen Niels Ramsing Holm Hans Eiskjær Lars Jakobsen Katrine Berg Omeed Neghabat Brian Bridal Løgstrup Evald Høj Christiansen Jouke Dijkstra Christian Juhl Terkelsen Michael Maeng Steen Hvitfeldt Poulsen 《The Journal of heart and lung transplantation》2018,37(4):486-495

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3.

Comparative effectiveness of coronary screening in heart valve surgery: Computed tomography versus conventional coronary angiography

Wonjae Lee Joon Bum Kim Dong Hyun Yang Cherry Kim Jihoon Kim Min Ho Ju Ho Jin Kim Joon-Won Kang Sung-Ho Jung Young-Hak Kim Suk Jung Choo Cheol Whan Lee Cheol Hyun Chung Jae Won Lee Tae-Hwan Lim 《The Journal of thoracic and cardiovascular surgery》2018,155(4):1423-1431.e3

Background

Although conventional coronary angiography (CAG) is considered the gold standard for coronary artery disease (CAD) screening in the setting of heart valve surgery, coronary artery computed tomography angiography (CCTA) has emerged as an alternative modality. This study was conducted to evaluate the clinical outcomes of CCTA compared with conventional CAG for CAD screening in patients undergoing heart valve surgery.

Methods

A total of 3150 consecutive patients aged >40 years or with coronary risk factors undergoing elective valve operations between 2001 and 2015 were evaluated. Of these, 1402 patients underwent CCTA (CT group) and 1748 patients underwent conventional CAG (CAG group) for CAD screening.

Results

The 30-day mortality rates were similar in the 2 groups (2.1% in the CT group vs 1.7% in the CAG group; P = .463); however, the incidence of low cardiac output syndrome was higher in the CT group (2.3% vs 1.0%; P = .008). The final rate of detection of significant CAD (≥50% stenosis) (4.9% vs 9.7%; P < .001) and proportion of receiving coronary bypass grafting (CABG) (2.9% vs 4.3%; P = .041) were lower in the CT group. After adjustment by propensity score matching (563 pairs), the main findings of our crude analyses did not change, with lower rates of CAD detection (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.36-0.85) and CABG (OR, 0.47; 95% CI, 0.26-0.81), a similar risk of early mortality (OR, 1.51; 95% CI, 0.54-4.52), but a higher risk of low cardiac output syndrome (OR, 3.30; 95% CI, 1.16-11.78) in the CT group compared with the CAG group.

Conclusions

The detection of significant CAD and identification of candidates for CABG were inferior with CCTA compared with conventional CAG in patients scheduled for elective heart valve operations. 相似文献