vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2016-3-116-127vtio-678Research ArticleОбзор литературыLiterature ReviewsТРАНСПЛАНТАЦИЯ СЕРДЦА У РЕЦИПИЕНТОВ ПОСЛЕ РАНЕЕ ВЫПОЛНЕННЫХ КАРДИОХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВHEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERYСаитгареевР. Ш.SaitgareevR. Sh.ПопцовВ. Н.PoptsovV. N.ЗахаревичВ. М.ZakharevichV. M.

Кафедра трансплантологии и искусственных органов

ЗакирьяновА. Р.ZakiryanovA. R.

123182, г. Москва, ул. Щукинская, д. 1 Тел. (968) 622-9275

1, Shchukinskaya St., Moscow, 123182

zakiryanov@gmail.comФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, МоскваРоссияV.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation, MoscowRussian FederationФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва; ФГБОУ ВО «Первый МГМУ им. И.М. Сеченова», МоскваРоссияV.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation, Moscow; I.M. Sechenov First Moscow State Medical University, Department of transplantology and artifi cial organs, MoscowRussian Federation201618112016183116127Copyright © Саитгареев Р.Ш., Попцов В.Н., Захаревич В.М., Закирьянов А.Р., 20162016Саитгареев Р.Ш., Попцов В.Н., Захаревич В.М., Закирьянов А.Р.Saitgareev R.S., Poptsov V.N., Zakharevich V.M., Zakiryanov A.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/678

Трансплантация сердца (ТС) на сегодняшний день остается наиболее эффективным и радикальным методом лечения больных с терминальной стадией сердечной недостаточности. Дефицит донорских сердец вынуждает все чаще прибегать к использованию различных систем длительной механической поддержки кровообращения, в том числе в качестве «моста» к последующей ТС. По данным регистра ISHLT, число оперированных в условиях искусственного кровообращения реципиентов увеличилось с 40% за период с 2004-го по 2008 г. до 49,6% за период с 2009-го по 2015 г. Выполнение ТС у «повторных пациентов», с одной стороны, связано со значительными техническими трудностями и повышенными рисками, с другой стороны, ТС зачастую является для них безальтернативным вмешательством, и не продиктованный абсолютными противопоказаниями отказ от ее выполнения равносилен 100% их смертности. В настоящем обзоре приведены результаты ряда опубликованных исследований, направленных на изучение непосредственных и отдаленных результатов ТС у пациентов, ранее оперированных на «открытом сердце». Рассмотрено влияние повторной стернотомии при ТС и связанных с ее выполнением особенностей у реципиентов, ранее оперированных на «открытом сердце», и ее влияние на показатели непосредственной и отдаленной выживаемости. Также представлены результаты исследований, анализирующих факторы риска развития периоперационных осложнений у «повторных» реципиентов. Отдельно рассмотрены риски ТС после имплантации систем длительной механической циркуляторной поддержки. Данные литературы не позволяют однозначно определить влияние фактора ранее выполненных кардиохирургических вмешательств на «открытом сердце» на течение периоперационного периода и прогноз выживаемости у реципиентов, перенесших ТС. С другой стороны, при условии штатного течения операции и периоперационного периода риски в данной клинической ситуации являются обоснованными, так как долгосрочный прогноз в группе реципиентов, ранее оперированных на «открытом сердце», сравним с таковым у пациентов, перенесших первичную ТС. 

Heart Transplantation (HTx) to date remains the most effective and radical method of treatment of patients with end-stage heart failure. The defi cit of donor hearts is forcing to resort increasingly to the use of different longterm mechanical circulatory support systems, including as a «bridge» to the follow-up HTx. According to the ISHLT Registry the number of recipients underwent cardiopulmonary bypass surgery increased from 40% in the period from 2004 to 2008 to 49.6% for the period from 2009 to 2015. HTx performed in repeated patients, on the one hand, involves considerable technical diffi culties and high risks; on the other hand, there is often no alternative medical intervention to HTx, and if not dictated by absolute contradictions the denial of the surgery is equivalent to 100% mortality. This review summarizes the results of a number of published studies aimed at understanding the immediate and late results of HTx in patients, previously underwent open heart surgery. The effect of resternotomy during HTx and that of the specifi c features associated with its implementation in recipients previously operated on open heart, and its effects on the immediate and long-term survival were considered in this review. Results of studies analyzing the risk factors for perioperative complications in repeated recipients were also demonstrated. Separately, HTx risks after implantation of prolonged mechanical circulatory support systems were examined. The literature does not allow to clearly defi ning the impact factor of earlier performed open heart surgery on the course of perioperative period and on the prognosis of survival in recipients who underwent HTx. On the other hand, subject to the regular fl ow of HTx and the perioperative period the risks in this clinical situation are justifi ed as a long-term prognosis of recipients previously conducted open heart surgery and are comparable to those of patients who underwent primary HTx. Studies cited in the review may have important clinical applications, because they outline the range of problems and possible solutions in the performance of the HTx in recipients previously operated on open heart. This knowledge can facilitate the decision making process with regard to the opportunities and risks of the implementation of HTx. Given the uniqueness of each of the recipient and the donor, it is required to make a personalized approach to the question of the possible risks and to the preventive measures to reduce those risks in any given clinical situation. 

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The authors declare that there are no conflicts of interest present.