机械辅助循环桥接心脏移植在难治性心力衰竭中的应用

Mechanical circulation support device as a bridging tool for heart transplantation recipients with refractory heart failure

目的探讨机械辅助循环(mechanical circulatory support,MCS)桥接心脏移植在难治性心力衰竭患者中应用的临床疗效。方法回顾性分析2017年3月至2021年12月间接受心脏移植前采用MCS桥接治疗的7例受者的临床资料。观察所有受者基本资料、治疗过程及最终结局。结果7例受者中男性2例,女性5例;年龄(39.0±16.3)岁,范围在7~56岁;体重(57.6±19.9)kg,范围在30~85 kg。受者原发疾病为扩张型心肌病4例,重症病毒性心肌炎2例,缺血性心肌病1例。所有受者均为难治性心力衰竭,药物或主动脉内球囊反搏(intra-aortic balloon counterpulsation,IABP)辅助治疗无效,遂行MCS桥接治疗,其中实施体外膜氧合(extracorporeal membrane oxygenerator,ECMO)支持6例,HeartCon左心室辅助1例。接受MCS辅助治疗时间(20.0±11.5)d,范围在7~34 d。所有受者均经机械辅助循环桥接实施心脏移植手术。心脏移植术后1例受者死于多器官功能衰竭,1例死于严重感染;另5例受者存活出院,随访0.5~2年,规范免疫抑制治疗,均健康存活,期间无排斥反应发生,定期行心脏超声检查指标均良好。结论对于难治性心力衰竭的心脏移植前受者,在出现多器官功能衰竭前积极实施MCS桥接治疗,是提高整体救治疗效的重要手段;此类受者围手术期风险相对较高,但远期预后良好。

Objective To explore the clinical outcomes of recipients with refractory heart failure requiring an insertion of mechanical circulation support(MCS)device prior to heart transplantation(HT).Methods From March 2017 to December 2021,retrospective review is performed for clinical data of 7 recipients with refractory heart failure requiring a bridging placement of MCS.There are 2 males and 5 females with an average age of(39.0±16.3)years(7~56 years)and an average weight of(57.6±19.9)kg(7~56 kg).The primary diseases of recipients are dilated cardiomyopathy(4 cases)severe viral myocarditis(2 cases)and ischemic cardiomyopathy(1 case).All of them develope acute decompensation of congestive heart failure.Before implanting MCS,two or more inotropic drugs are offered at maximal doses ages or IABP device,6 cases required cardio-pulmonary resuscitation treatment and another patient for Heartcon assistance.All the patients bridge to heart transplatation.Results Adjuvant therapy of MCS was offered for(20.0±11.5)d(7~34 d).Emergency HT is performed.Two post-HT deaths occurr due to multiple organ failure(1 case)and severe infection(1 case).The remainders recover smoothly during a follow-up period of(6~24 months).Conclusions MCS device is recommended as a bridging too for HT recipients with refractory heart failure.It is imperative to improve clinical outcomes with MCS support before an onset of multiple organ dysfunction.Despite a perioperative mortality,long-term prognosis is generally satisfactory.