Baldwin J C
Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven 06510.
J Card Surg. 1992 Dec;7(4):313-23. doi: 10.1111/j.1540-8191.1992.tb01021.x.
Heart-lung transplantation was, for many years, conceptualized as a possible treatment for patients with combined end-stage cardiac and pulmonary disease. As experience grew with heart transplantation, particularly in the 1970s, the difficulties of performing the orthotopic operation in patients with fixed pulmonary hypertension became apparent. This further impetus for combined heart-lung transplantation led to successful animal experiments in the late 1970s, and the first successful heart-lung transplant operation was performed in 1981. There has been significant evolution in the operative technique for the recipient operation, with emphasis on preservation of the phrenic, vagal, and recurrent laryngeal nerves and on meticulous hemostasis, with particular attention to the bronchial vessels of the posterior mediastinum. Donor procurement is of critical importance to the success of the operation, and criteria for donor selection have been well established. Lung preservation remained, for many years, a significant limitation, but current techniques involving the use of prostaglandin E1 have led to safe distant procurement with ischemic times up to 6 hours. The heart-lung transplant operation remains an effective modality for the treatment of patients with congenital heart disease, primary pulmonary hypertension, chronic obstructive pulmonary disease, and cystic fibrosis.
多年来，心肺移植一直被视为治疗终末期心脏和肺部合并疾病患者的一种可能疗法。随着心脏移植经验的积累，尤其是在20世纪70年代，在患有固定性肺动脉高压的患者中进行原位手术的困难变得明显起来。这种对联合心肺移植的进一步推动促使在20世纪70年代后期进行了成功的动物实验，并且在1981年进行了首例成功的心肺移植手术。受体手术的操作技术有了显著发展，重点在于保留膈神经、迷走神经和喉返神经以及细致止血，尤其要注意后纵隔的支气管血管。供体获取对于手术的成功至关重要，并且供体选择标准已经确立。多年来，肺保存一直是一个重大限制，但目前使用前列腺素E1的技术已实现安全的远距离获取，缺血时间长达6小时。心肺移植手术仍然是治疗先天性心脏病、原发性肺动脉高压、慢性阻塞性肺疾病和囊性纤维化患者的有效方式。
