Favorable Short-Term Outcome of Transplanted Hearts Selected from Marginal Donors by Pharmacological Stress Echocardiography
Favorable Short-Term Outcome of Transplanted Hearts Selected from Marginal Donors by Pharmacological Stress Echocardiography
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DOI：
10.1016/j.echo.2010.11.014
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发表时间：
2011-04-01
影响因子：
6.5
通讯作者：
Picano, Eugenio
中科院分区：
文献类型：
--
作者：
Bombardini, Tonino;Gherardi, Sonia;Picano, Eugenio
背景：由于捐赠心脏的短缺，接受的标准已大大扩大。经心脏尸检证实，药物负荷超声心动图的异常结果与显着的冠状动脉疾病和/或隐匿性心肌病相关。本研究的目的是确定一种基于药物负荷超声心动图的方法作为扩展心脏捐献者标准的看门人的可行性。方法：从 2005 年 4 月到 2010 年 4 月，最初招募了 39 名“边缘”候选捐献者（平均年龄 56 +/- 6 岁；21 名男性）。合法宣告脑死亡后，边缘供体接受静息超声心动图检查，如果结果正常，则进行双嘧达莫（0.84 mg/kg，6分钟内，n = 25）或多巴酚丁胺（高达40 μg/kg/min，n = 3）负荷超声心动图检查。 结果：总共找到19颗符合条件的心脏，结果正常。其中，三例由于缺乏匹配的受体而没有进行移植，心脏尸检证实不存在明显的冠状动脉疾病或心肌病异常。其余 16 颗符合条件的心脏顺利移植到边缘紧急接受者身上。 1 个月时，所有患者的血管造影、血管内超声、血流动力学和心室造影结果均显示正常（n = 14）或接近正常（其中两人有轻微单血管疾病）。随访时（中位时间为 14 个月；四分位距为 4-31 个月），14 名患者存活，两名患者死亡，一名患者在 2 个月时死于一般脓毒症，一名患者在 32 个月时死于复发性多发性骨髓瘤的同种异体移植血管病变。结论：药物负荷超声心动图可以安全地对患有脑死亡的候选心脏捐献者进行，并显示出扩大心脏移植捐献者标准的潜力。 (J Am Soc Echocardiogr 2011；24:353-62。)
Background: Because of the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Abnormal results on pharmacologic stress echocardiography are associated with significant coronary artery disease and/or occult cardiomyopathy on verification by cardiac autopsy. The aim of this study was to establish the feasibility of an approach based on pharmacologic stress echocardiography as a gatekeeper for extended heart donor criteria.Methods: From April 2005 to April 2010, 39 "marginal" candidate donors (mean age, 56 +/- 6 years; 21 men) were initially enrolled. After legal declaration of brain death, marginal donors underwent rest echocardiography, and if the results were normal, dipyridamole (0.84 mg/kg over 6 min, n = 25) or dobutamine (up to 40 mu g/kg/min, n = 3) stress echocardiography.Results: A total of 19 eligible hearts were found with normal findings. Of these, three were not transplanted because of the lack of a matching recipient, and verification by cardiac autopsy showed absence of significant coronary artery disease or cardiomyopathy abnormalities. The remaining 16 eligible hearts were uneventfully transplanted in marginal emergency recipients. All showed normal (n = 14) or nearly normal (minor single-vessel disease in two) angiographic, intravascular ultrasound, hemodynamic and ventriculographic findings at 1 month. At follow-up (median, 14 months; interquartile range, 4-31 months), 14 patients survived and two had died, one at 2 months from general sepsis and one at 32 months from allograft vasculopathy in recurrent multiple myeloma.Conclusions: Pharmacologic stress echocardiography can safely be performed in candidate heart donors with brain death and shows potential for extending donor criteria in heart transplantation. (J Am Soc Echocardiogr 2011; 24:353-62.)