Lee K C, Chang C Y, Chuang Y C, Sue S H, Yang H S, Weng C F, Lee Y T, Huang W S, Chen I C, Wei J
Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
Transplant Proc. 2012 May;44(4):886-9. doi: 10.1016/j.transproceed.2011.11.010.
To establish quicker cardiac arrest and less myocardial distension injury during heart procurement, we combined St. Thomas and histidine-tryptophan-ketoglutarate (HTK) solutions for donor heart preservation since June 2008.
From June 2008 to March 2010, we enrolled 31 heart transplantation (HT) patients in this study. During heart procurement we initially infused 1,000 mL cold St Thomas cardioplegic solution to achieve cardiac arrest. After procurement, a further 2,000 mL of cold HTK solution was infused at low perfusion pressure. Another 1,000 mL cold HTK solution was perfused before donor heart implantation. We examined donor age, recipient preoperative characteristics, ischemia time, hospital stay, postoperative graft function, major cardiac events, and transplant vasculopathy (TCAD).
Twenty-two patients (71.0%) presented with dilated cardiomyopathy and 7 (23.3%) with ischemia cardiomyopathy. There were 23 (76.7%) male donors, and the mean donor age was 38.4 ± 13.8 years. Six patients underwent a redo sternotomy, 1 patient needed a third-do sternotomy, and 1 a seventh sternotomy (third HT) for repeated endocarditis and graft failure. The average ischemia time was 224.9 ± 71.0 minutes and the postoperative hospital stay was 57.7 ± 47.7 days. The surgical mortality (3.2%) was not accompanied by hospital or follow-up mortality. Patient left ventricular ejection fraction postoperative was 59.6 ± 2.3% with good functional status. Major cardiac events occurred in 8 patients (26.7%) without major complications. There were two subjects with TCAD but normal graft function. The correlation between ischemia time and hospital stay was insignificant (r = 0.21; P = .26).
Donor heart preservation combining St Thomas cardioplegic arest and low-pressure perfusion with HTK solution seemed to be safe with. short-term survival similar to other approaches.
自2008年6月起，为在心脏获取过程中更快地实现心脏骤停并减少心肌膨胀性损伤，我们将圣托马斯液与组氨酸-色氨酸-酮戊二酸（HTK）溶液联合用于供心保存。
2008年6月至2010年3月，我们纳入了31例心脏移植（HT）患者进行本研究。在心脏获取过程中，我们首先输注1000 mL冷圣托马斯心脏停搏液以实现心脏骤停。获取后，在低灌注压力下再输注2000 mL冷HTK溶液。在供心植入前再灌注1000 mL冷HTK溶液。我们检查了供体年龄、受体术前特征、缺血时间、住院时间、术后移植物功能、主要心脏事件和移植血管病变（TCAD）。
22例患者（71.0%）表现为扩张型心肌病，7例（23.3%）表现为缺血性心肌病。有23例（76.7%）男性供体，供体平均年龄为38.4±13.8岁。6例患者接受了再次胸骨切开术，1例患者因反复心内膜炎和移植物衰竭需要进行第三次胸骨切开术，1例患者进行了第七次胸骨切开术（第三次心脏移植）。平均缺血时间为224.9±71.0分钟，术后住院时间为57.7±47.7天。手术死亡率为3.2%，未伴有住院或随访期间死亡。患者术后左心室射血分数为59.6±2.3%，功能状态良好。8例患者（26.7%）发生主要心脏事件，无重大并发症。有2例患者患有TCAD但移植物功能正常。缺血时间与住院时间之间的相关性不显著（r = .21；P = .26）。
将圣托马斯心脏停搏液与HTK溶液低压灌注相结合的供心保存方法似乎是安全的，短期生存率与其他方法相似。
