Laske A, Bauer E, von Segesser L, Gallino A, Turina M
Klinik für Herzgefässchirurgie, Universitätsspital Zürich.
Ther Umsch. 1990 Feb;47(2):111-21.
Orthotopic heart transplantation is an established treatment for terminal cardiac diseases. Close cooperation and coordination with other clinics and laboratories is mandatory to transplant a good organ with minimal ischemic time. Accurate donor evaluation and treatment is essential for fast recovery after operation. Our series is 79 orthotopic heart transplantations form 9/85 to 10/89 in 78 patients. Average ischemic time is 38 minutes in organ procurement from table to table and rises distinctly in distal heart procurement (n = 33), but is usually under 120 minutes at organ procurement from any place in Switzerland. The transplantation is performed in the technique from Lower and Shumway. Immunosuppression with triple therapy (Cyclosporin A, Azathioprim, Prednisone) and initial cytolytic therapy is well tolerated. Consequent diagnosis and treatment for rejection and infections lead to good short and medium term survival. Prophylactic treatment is indicated in high risk constellation for cytomegalovirus and toxoplasmosis infection. Early mortality (less than 30 days) was two out of seven and caused by bacterial infections. Actuarial survival is 91% at one and two years and 85% at three years with good quality of life and NYHA class I.
原位心脏移植是终末期心脏疾病的既定治疗方法。要移植一个缺血时间最短的优质器官，与其他诊所和实验室密切合作与协调是必不可少的。准确的供体评估和治疗对于术后快速恢复至关重要。我们的系列包括78例患者在1985年9月至1989年10月期间进行的79例原位心脏移植。从一台手术到另一台手术，器官获取的平均缺血时间为38分钟，在远端心脏获取（n = 33）时明显延长，但在瑞士任何地方进行器官获取时通常在120分钟以内。移植采用Lower和Shumway的技术进行。三联疗法（环孢素A、硫唑嘌呤、泼尼松）免疫抑制和初始溶细胞疗法耐受性良好。对排斥反应和感染进行连续的诊断和治疗可带来良好的短期和中期生存率。对于巨细胞病毒和弓形虫感染的高风险情况，应进行预防性治疗。早期死亡率（小于30天）为7例中的2例，由细菌感染引起。1年和2年的精算生存率为91%，3年为85%，生活质量良好，纽约心脏协会心功能分级为I级。
