心脏移植和机械型循环辅助（英文）.ppt

Cardiac Transplantation and Mechanical Circulatory Support Andrew Boyle, MD Associate Professor of Medicine Medical Director of Heart Failure, Cardiac Transplantation, and Mechanical Circulatory Support Division of Cardiology University of Minnesota Metabolic Stress Testing AGE DISTRIBUTION OF HEART RECIPIENTS (1/1982-6/2003) DIAGNOSIS IN ADULT HEART TRANSPLANTS HEART TRANSPLANTS: Donor Age by Year of Transplant Description of UNOS Status Levels Status IA RHC in place and: two or more inotropes regardless of dose IV milrinone at least 0.5 mcg/kg/min IV dobutamine at least 7.5 mcg/kg/min 30 days following medical stabilization after VAD implantation Status IB inotrope-dependent LVAD not meeting criteria for IA status No advantage for being hospitalized Status II Not inotrope-dependent and no VAD Priority on UNOS list based on status level and duration of time in that status level No credit given for time at a lower status level Inotropic Therapy for End-Stage Heart Failure Pulsatile vs Continuous Flow LVADs HeartMate II BTT Clinical TrialAdverse Event Rates HM II as BTT in Women VentrAssist as Bridge to Transplant Newest VAD: Heartware VADs vs CRT for NYHA Class IV Heart Failure 2 Year Mortality with CRT/CRT-D in NYHA Class IV Patients COMPANION NYHA Class IV Patients Improvement in Median Distance Walked in Six Minutes: HeartMate II vs CRT/CRT-D Conclusions Test to determine candidacy for transplant is metabolic stress test Median survival post-transplant is 10 years Frequency of transplantation is declining Long term inotropic therapy not very successful Continuous flow VADs show good long term survival with reduced adverse events VADs now approved for BSA as low as 1.2 CRT for NYHA Class IV heart failure not terribly effective * Mancini D et al. Circulation 1991; 83: 778-786. Group 1: peak VO2 14 Group 2: peak VO2 14 Group 3: rejected for OHTx % of Transplants J Heart Lung Transpl. 2004; 23: 796-803. HEART TRANSPLANTATION Kaplan-Meier