ABSTRACT
Objective To analyze the early outcomes of heart transplantation in critical patients and its significance in donor allocation decision. Methods Clinical data of 449 recipients undergoing heart transplantation were retrospectively analyzed. According to preoperative status, all patients were divided into the critical status group (n=64) and general status group (n=385). The incidence of critical status was summarized. Clinical data of recipients were statistically compared between two groups. Postoperative survival and causes of death in recipients between two groups were analyzed. Perioperative results of critical recipients undergoing different mechanical circulation support as a bridge to heart transplantation were compared. Results Critical patients accounted for 14.3% of the total number of transplant recipients. The proportion of critical patients gradually increased in recent 5 years. Compared with the general status group, the recipients in critical status group had a lower proportion of smoking history, a higher proportion of cardiac surgery history, a higher serum level of creatinine, and a higher proportion of primary diseases of heart failure before heart transplantation(all P≤0.01). The proportion of undergoing mechanical circulation support was higher, the incidence of complications was higher, the stay time in intensive care unit (ICU) was longer and the in-hospital fatality was higher after heart transplantation in the critical status group (all P≤0.01). The 1-year survival rate of recipients in critical status group was significantly lower than that in general status group (83% vs. 95%, P < 0.01). The fatality of recipients due to infection and multiple organ failure in critical status group was higher than that in general status group. Among 64 critical recipients, 1 recipient received ventilator alone, and 63 recipients underwent mechanical circulation support devices as a bridge to heart transplantation. Among them, intra-aortic balloon pump (IABP) alone was applied in 49 cases (77%), 8 cases (13%) of extracorporeal membrane oxygenation (ECMO) combined with IABP, 4 cases (6%) of ECMO alone, and 2 cases (3%) of left ventricular assist device (LVAD) alone. Critical patients who received preoperative ECMO and ECMO combined with IABP bridging to heart transplantation have a higher proportion of postoperative complications, a longer ICU stay time, a longer mechanical ventilation time, and a higher proportion of hospital deaths. Conclusions The overall prognosis of critical patients undergoing heart transplantation is relatively poor. Effective preoperative management may reverse the high-risk status of critical patients in a certain extent. The limited quantity of donor heart should be allocated to the most urgent patients who can obtain the greatest benefit from heart transplantation.
ABSTRACT
The Clinical Mass Spectrometry Research Committee (CMSRC), in affiliation with the Korean Society of Clinical Chemistry (KSCC), conducted a questionnaire survey on opinions about the general status of clinical mass spectrometric analysis in Korea. As a result, we understand that this field has passed through the introductory stage and is settled as a field of clinical laboratory testing in Korea, with the number of new laboratories performing mass spectrometric analysis being low. In spite of the many difficulties in introducing and operating clinical mass spectrometric analysis, there is a strong interest in this field, and even though further expansion is expected, there are still many issues to be resolved. In the future, it will be necessary to make concrete and thorough efforts to further develop the laboratory tests using clinical mass spectrometric analysis in Korea, centering on the CMSRC affiliated with the KSCC.
Subject(s)
Chemistry, Clinical , Korea , Mass SpectrometryABSTRACT
Objective To understand the relationship between MTHFR 677C/T polymorphism and general status of pregnant women and offspring congenital heart disease (CHD).Methods A case-control study was conducted among the biological mothers of 100 infants with CHD and 100 healthy controls to collect the information about their demographic characteristics,general status during pregnancy and awareness of eugenics.Their MTHFR 677C/T polymorphism and serum homocysteine (HCY),folic acid,vitamin B12 levels were detected.Results The differences in MTHFR genotype and allele frequency between the two groups were not statistical significant (x2=1.08,P=0.582;x2=0.53,P=0.468),but the difference in serum HCY between two groups were statistical significant (t=-8.14,P=0.000).Univariate analysis showed that 14 factors had statistical significances (P＜0.05).Multivariate logistic regression analysis indicated that mother's educational level(OR=3.386,95％ CI:1.279-8.961),annual household income (OR =8.699,95％ CI:2.177-34.765),chronic disease prevalence (OR=0.343,95％ CI:0.134-0.881),awareness of eugenics (OR=0.906,95％ CI:0.836-0.981),serum HCY level(OR=1.734,95％CI:1.458-1.986) and abnormal reproductive history(OR=3.710,95％ CI:1.217-11.308) were correlated with offspring CHD.Conclusion There was no correlation between MTHFR 677C/T polymorphism of pregnant women and offspring CHD,but low educational level,low annual household income,abnormal reproductive history,low awareness of eugenics and high serum HCY levels of pregnant women might increase the risk of offspring CHD.