Heart Transplantation for Peripartum Cardiomyopathy: A Single-Center Experience

Abstract Background: Peripartum cardiomyopathy is an idiopathic disorder defined by the occurrence of acute heart failure during late pregnancy or post-partum period in the absence of any other definable cause. Its clinical course is variable and severe cases might require heart transplantation. Objective: To investigate long-term outcomes after heart transplantation (HT) for peripartum cardiomyopathy (PPCM). Methods: Out of a single-center series of 1938 HT, 14 HT were performed for PPCM. We evaluated clinical characteristics, transplant-related complications, and long-term outcomes, in comparison with 28 sex-matched controls. Primary endpoint was death from any cause; secondary endpoints were transplant-related complications (rejection, infection, cardiac allograft vasculopathy). A value of p < 0.05 was considered of statistical significance. Results: PPCM patients and matched controls were comparable for most variables (all p values > 0.05), except for a higher use of inotropes at the time of HT in PPCM group (p = 0.03). During a median follow-up of 7.7 years, 16 patients died, 3 (21.5%) in PPCM group and 13 (46.5%) in control group. Mortality was significantly lower in PPCM group (p = 0.03). No significant difference was found in terms of transplant-related complications (p > 0.05). Conclusions: Long-term outcomes following HT for PPCM are favorable. Heart transplantation is a valuable option for PPCM patients who did not recover significantly under medical treatment.

摘要 背景：围产期心肌病（peripartum cardiomyopathy, PPCM）是一类特发性疾病，指在妊娠晚期或产后阶段发生急性心力衰竭且无其他明确致病因素的情况。该疾病的临床病程存在较大异质性，重症患者可能需接受心脏移植（heart transplantation, HT）。
研究目的：探讨围产期心肌病患者接受心脏移植后的长期预后情况。
研究方法：本单中心队列共纳入1938例接受心脏移植的患者，其中14例因围产期心肌病接受心脏移植。我们匹配了28例性别一致的对照患者，对两组受试者的临床特征、移植相关并发症及长期预后进行评估。主要终点为任意原因导致的死亡；次要终点为移植相关并发症，包括排斥反应、感染及心脏移植血管病（cardiac allograft vasculopathy）。以p<0.05作为具有统计学显著性的判定标准。
研究结果：除围产期心肌病组患者在心脏移植时正性肌力药（inotropes）的使用比例更高（p=0.03）外，两组患者的多数基线变量均无显著差异（所有p值均>0.05）。中位随访时长为7.7年，期间共有16例患者死亡，其中围产期心肌病组3例（占比21.5%），对照组13例（占比46.5%）。围产期心肌病组的死亡率显著低于对照组（p=0.03）。两组间移植相关并发症发生率无显著差异（p>0.05）。
研究结论：围产期心肌病患者接受心脏移植后的长期预后良好。对于经药物治疗后未获得显著恢复的围产期心肌病患者，心脏移植是一项具有重要价值的治疗选择。