首页> 外文期刊>European journal of cardio-thoracic surgery: Official journal of the European Association for Cardio-thoracic Surgery >Short- and long-term results of open heart surgery in patients with abdominal solid organ transplant.
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Short- and long-term results of open heart surgery in patients with abdominal solid organ transplant.

机译:腹部实体器官移植患者接受心脏直视手术的短期和长期结果。

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OBJECTIVES: Cardiac disease is a common cause of mortality and morbidity in patients with abdominal solid organ transplant. Improvement of the results of abdominal organ transplantation has contributed to an increasing pool of patients who require open heart surgery. We investigated short- and long-term results of open heart surgery in patients with functioning abdominal solid organ transplants. METHODS: We retrospectively examined 60 patients (52.5 years in average) undergoing coronary artery bypass grafting and/or valve surgery since July 1988 after abdominal organ transplantation. There were 22 females (37%). They consisted of 46 kidney, nine kidney-pancreas and five liver recipients. Cardiac surgery was performed 68.9 months after transplantation. Preoperative serum creatinine level was 2.1 mg/dl, and 11 patients (18%) had creatinine level more than 3.0 mg/dl. Eleven patients (18%) were operated upon on non-elective basis. Twelve patients (20%) were not given stress-dose steroids postoperatively. RESULTS: Three patients died early after surgery (5.0%). Twenty-six major complications were seen in 17 patients (28%), including deterioration of renal function in seven (three patients required temporary hemodialysis), three major infections, two bleeding complications, and two strokes. No graft loss was encountered. No differences were seen in mortality and morbidity between patients with or without stress-dose steroids. Multivariate analysis identified cardiopulmonary bypass time (P<0.05) as a risk factor for operative death, preoperative creatinine level (P<0.05), cardiopulmonary bypass time (P<0.05) and the amount of fresh frozen plasma used (P<0.05) for major complication, non-elective surgery (P<0.01) for deterioration of renal function. Thirteen patients died and five kidney allografts failed late after surgery. Three- and 5-year patient and graft survivals were 70.8 and 66.8, 84.5 and 84.5%, respectively. Multivariate regression analysis identified female gender (P<0.05), body mass index (P<0.001) and non-elective surgery (P<0.001) as risk factors for late death, and preoperative creatinine level (P<0.05) for late graft loss. CONCLUSIONS: Open heart surgery can be performed with acceptable short- and long-term results in patients with functioning abdominal transplants. Stress-dose steroid may be unnecessary in selected patients. Aggressive use of open heart surgery in this patient population to avoid non-elective surgery may further improve early and late surgical outcomes.
机译:目的:心脏疾病是腹部实体器官移植患者死亡和发病的常见原因。腹部器官移植结果的改善已导致需要进行心脏直视手术的患者人数增加。我们调查了功能正常的腹部实体器官移植患者的心脏直视手术的短期和长期结果。方法:我们回顾性分析了自1988年7月以来在腹部器官移植后接受冠状动脉搭桥术和/或瓣膜手术的60例患者(平均52.5年)。有22位女性(37%)。他们包括46个肾脏,9个肾脏-胰腺和5个肝脏接受者。移植后68.9个月进行了心脏手术。术前血清肌酐水平为2.1 mg / dl,其中11例(18%)肌酐水平高于3.0 mg / dl。 11例患者(占18%)在非选修基础上手术。十二名患者(20%)术后未接受应激剂量的类固醇治疗。结果:三例患者在手术后早期死亡(5.0%)。在17例患者中发现了26例主要并发症(占28%),其中包括7例肾功能恶化(3例需要临时血液透析),3例主要感染,2例出血并发症和2例中风。没有遇到移植物丢失。有或没有应激剂量类固醇的患者在死亡率和发病率上均未见差异。多变量分析确定了体外循环时间(P <0.05)是手术死亡的危险因素,术前肌酐水平(P <0.05),体外循环时间(P <0.05)和新鲜冷冻血浆的使用量(P <0.05)严重并发症,非选择性手术(P <0.01)可导致肾功能恶化。术后13例死亡,同种异体的5例肾移植失败。三年和五年患者和移植物的存活率分别为70.8和66.8、84.5和84.5%。多元回归分析确定女性(P <0.05),体重指数(P <0.001)和非择期手术(P <0.001)是晚期死亡的危险因素,术前肌酐水平(P <0.05)是晚期移植物丢失的危险因素。 。结论:功能正常的腹部移植患者可以进行开胸手术,短期和长期结果均可接受。在某些患者中可能不需要使用压力剂量的类固醇。在该患者人群中积极使用心脏直视手术以避免非择期手术可能会进一步改善早期和晚期手术结局。

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