Chen Liang-wan, Chen Dao-zhong, Huang Xue-shan, Wu Xi-jie, Lin Feng, Wang Qi-min, Huang Zhong-yao, Qiu Han-fan, Cao Hua, Dai Xiao-fu
Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China.
Zhonghua Wai Ke Za Zhi. 2006 Mar 15;44(6):398-401.
To report the preliminary experience of 21 orthotopic heart transplantations without early death.
Between April 2002 and June 2005, 21 patients underwent orthotopic heart transplantation. Recipients' pulmonary vascular resistance ranged from 3.0 to 5.9 wood units [mean (4.3 +/- 1.4) wood units]; Stanford myocardial protective solution or HTK solution was perfused for donor heart myocardial preservation, donor heart cold ischemic period ranged from 52 to 310 min [mean (81 +/- 23) min]; Three patients had previous cardiac operations under cardiopulmonary bypass, conventional Stanford orthotopic cardiac transplantation in 20 cases and total heart technique in 1 case; Recipients received simulect preoperatively and cyclosporine A, cellcept and prednisone postoperatively for prevention of acute allograft rejection; Patients received appropriate medical control of hypertension, hyperglycemia, hypercholesterolemia and uricacidemia.
Acute right heart failure in 3 cases and pericardial effusion in 4 cases were observed at the early postoperative stage, but no any infection and acute rejection were found. All patients survived with good life quality.
Heart transplantation may produce satisfying early results. Suitable selection of recipients with low pulmonary vascular resistance, excellent donor heart conservation, practised anastomotic technique, proper immunosuppression treatment and efficient postoperative management are key measures of orthotopic heart transplantation with excellent early outcome.
报告21例原位心脏移植无早期死亡的初步经验。
2002年4月至2005年6月，21例患者接受原位心脏移植。受者肺血管阻力为3.0至5.9伍德单位[平均（4.3±1.4）伍德单位]；采用斯坦福心肌保护液或HTK液灌注供心进行心肌保护，供心冷缺血时间为52至310分钟[平均（81±23）分钟]；3例患者既往有体外循环下心脏手术史，20例行传统斯坦福原位心脏移植，1例行全心脏技术；受者术前接受舒莱，术后接受环孢素A、骁悉和泼尼松预防急性移植物排斥反应；患者接受高血压、高血糖、高胆固醇血症和高尿酸血症的适当药物控制。
术后早期观察到3例急性右心衰竭和4例心包积液，但未发现任何感染和急性排斥反应。所有患者均存活，生活质量良好。
心脏移植可取得满意的早期效果。选择肺血管阻力低的合适受者、良好的供心保护、熟练的吻合技术、适当的免疫抑制治疗和有效的术后管理是原位心脏移植取得优异早期结果的关键措施。
