心臟移植後冠狀動脈疾病之疾病標的因子研究

Abstract

Objective: Donor shortage and improved medical treatment of heart failure increase the prevalence of patients with end-stage heart failure and cardiac ascites to heart transplantation. The clinical outcome of heart transplantation in these patients has not been reported. Here, we sought to evaluate the clinical outcome of heart transplantation in patients with end-stage heart failure and ascites. Methods: Data were collected by retrospective chart review. Results: Between 1989 and 2005, 45 patients with end-stage heart failure and moderate to severe ascites underwent orthotopic heart transplantation. There were 33 men and 12 women with median age of 44 years (range 10-63 years). The causes of heart failure were congenital heart disease in 4 patients (9%), dilated cardiomyopathy in 21 patients (47%), rheumatic heart disease in 7 patients (16%), coronary artery disease in 10 patients (22%), and restrictive cardiomyopathy and transplant coronary artery disease each in 1 patient. Twenty of 45 patients (44%) had previous cardiac operation. There were 10 in-hospital deaths (22%): bleeding in 4 patients, sepsis with multiple organ failure in 5 patients and non-diagnostic graft failure in 1 patient. Profuse postoperative bleeding requiring reoperation occurred in 14 patients (31%). The independent risk factors for hospital death were low serum albumin (odds ratio, 0.05; 95% confidence interval, 0.003-0.591; p=0.018) and reoperation for bleeding (odds ratio, 30.11; 95% confidence interval, 2.38-380.26; p=0.009). 3 Conclusions: Heart transplantation in patients with end-stage heart failure and ascites was associated with high hospital mortality and morbidity. The co-existence of cardiac ascites and hypoalbuminemia implied poor prognosis.