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首页> 外文期刊>Artificial Organs >Bridge to Transplantation With Long-Term Mechanical Assist Devices in Adults With Transposition of the Great Arteries
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Bridge to Transplantation With Long-Term Mechanical Assist Devices in Adults With Transposition of the Great Arteries

机译：大桥与成年人的长期机械辅助装置移植，具有伟大动脉的转置

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摘要

Prior to the widespread adoption of the arterial switch operation, patients with transposition of the great arteries (TGA) commonly underwent atrial switch operation (Mustard or Senning). It is not uncommon for these patients to progress to end stage heart failure and increasingly ventricular assist devices (VADs) are used to support these patients as a bridge to transplantation, though there is limited experience with this worldwide. A retrospective review of our institution's VAD database was undertaken and revealed seven adult patients with a history of TGA and subsequent systemic ventricular failure were implanted with a VAD: four of whom received the VAD as a bridge to transplantation (BTT) at the time of implantation, two who were initially designated as destination therapy secondary to severe pulmonary hypertension, and one who was designated as destination therapy secondary to a high risk of life-threatening non-compliance. Seven patient cases who received a VAD for severe systemic ventricular failure were included in this study. The mean age of the patients was 40 years and the majority of patients were male (6/7, 85%). Five of the patients (71.4%) had previously undergone an atrial switch operation and all of these were Mustard procedures. Two of the seven patients (28.5%) had congenitally corrected transposition of the great arteries (CC-TGA). Two of the seven patients (28.5%) had supra-systemic pulmonary pressures before VAD implantation and were designated as destination therapy (DT). One of these patients was later designated as BTT as an improvement in his pulmonary vascular resistance was observed, and subsequently underwent heart transplantation. Because of anatomic considerations, four of the patients (57%) underwent redo-sternotomy with outflow cannula anastomosis to the ascending aorta, one patient underwent VAD implantation via a left subcostal incision with anastomosis of the outflow graft to the descending thoracic aorta, and two patients (28.5%) underwent VAD implantation via a left thoracotomy and anastomosis of the outflow cannula to the descending thoracic aorta. Six of the seven patients had a HeartWare HVAD VAD implanted; one received a Thoratec Heartmate II VAD. Two patients underwent VAD explant and orthotopic heart transplant, 222 days and 444 days after VAD implant, respectively. One patient died on postoperative day 17 after complications from recurrent VAD thrombosis despite multiple pump exchanges. Four patients remain on VAD support, three of these patients are awaiting transplantation at last follow-up (mean days on support, 513 days). Bridge to transplantation with a durable VAD is technically feasible and relatively safe in patients with TGA. Multiple redo-sternotomies can be avoided with a left posterior thoracotomy approach and outflow graft anastomosis to the descending thoracic aorta after careful anatomic considerations.
机译：在广泛采用动脉切换操作之前，患者患者的巨大动脉（TGA）通常接受心房开关操作（芥末或参议员）。这些患者进展到末端阶段心力衰竭和越来越多的心室辅助装置（VADS）并不罕见，用于支持这些患者作为移植的桥梁，尽管在全世界的经验有限。对我们所机构的VAD数据库进行回顾述评，并揭示了七名成年患者TGA历史，随后的全身性心室失效植入了VAD：其中四个在植入时将VAD作为移植（BTT）的桥梁接受，初始被指定为初步肺动脉高血压的目的地疗法的两名，以及被指定为次要危及生命威胁性的高风险的目的地疗法的人。本研究包括七个接受重症全身性心室失效的VAD的病例。患者的平均年龄为40岁，大多数患者是男性（6/7,85％）。五名患者（71.4％）以前经历过心房开关操作，所有这些都是芥末手术。 7名患者中的两名（28.5％）先天矫正了伟大动脉（CC-TGA）的转置。七名患者中的两名（28.5％）在VAD植入前具有Supra-全身性肺压力，并指定为目的地疗法（DT）。其中一个患者后来被指定为BTT，因为观察到他的肺血管阻力以及随后进行心脏移植的改善。由于解剖学考虑因素，四个患者（57％）对升管吻合术进行了重做胸骨术，通过左骨腐切口进行了一名患者，通过左骨腐切口进行了左侧骨移植到下流移植到下降胸主动脉，两个患者（28.5％）通过左胸廓切开术和流出套管的吻合术来进行VAD植入到下降胸主动脉。七名患者中有六个植入了一个心脏HVAD VAD;一个人收到了一个Thoratec CeartMate II Vad。两名患者分别接受了VAD植入蛋白和原位心脏移植，分别在VAD植入后222天和444天。尽管多个泵交换，一名患者在术后第17天术后第17天死亡。尽管多个泵交换。四名患者仍然存在于VAD支持，其中三名患者在最后一次随访时等待移植（平均支持，513天）。用耐用VAD进行移植桥在技术上可行，在TGA患者中是相对安全的。在仔细解剖考虑后，可以用左后胸廓术方法和流出移植移植物吻合术来避免多个重做术。

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