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）是一种特发性疾病，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原因的病症。该疾病的临床病程存在显著异质性，重症患者可能需要接受心脏移植手术。目的：探讨围产期心肌病患者接受心脏移植（heart transplantation, HT）后的长期预后情况。方法：本单中心队列共完成1938例心脏移植手术，其中14例手术的适应证为围产期心肌病。我们将该14例患者与28例性别匹配的对照患者进行对比，评估其临床特征、移植相关并发症及长期预后。本研究的主要终点为任何原因导致的死亡；次要终点为移植相关并发症（包括排斥反应、感染、心脏移植血管病变）。以p值<0.05作为具有统计学显著性的判定标准。结果：除围产期心肌病组患者在心脏移植时正性肌力药物的使用率更高（p=0.03）外，两组患者的多数基线变量均无显著统计学差异（所有p值>0.05）。在中位随访7.7年期间，共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%）。围产期心肌病组的总体死亡率显著低于对照组（p=0.03）。移植相关并发症方面，两组未观察到显著统计学差异（p>0.05）。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，心脏移植是一项极具临床价值的治疗选择。