Griffith B P, Hardesty R L, Trento A, Paradis I L, Duquesnoy R J, Zeevi A, Dauber J H, Dummer J S, Thompson M E, Gryzan S
Ann Thorac Surg. 1987 Jan;43(1):6-16. doi: 10.1016/s0003-4975(10)60157-9.
Since March, 1982, 33 patients have undergone cardiopulmonary transplantation. Nineteen were discharged from the hospital following the operation, and 16 continue to do well. Eight patients have survived 1 year, 5 patients 2 years, and 1 patient 3 years. Often survival has been influenced most by the selection of candidates, as no patient who had undergone a previous sternotomy survived (3 of 3). All 7 early (between 30 and 72 days) and 3 late (145 to 466 days) deaths were related to infection. Methods for ex vivo preservation of the heart-lung bloc have included storage at 4 degrees C, cardiopulmonary bypass and profound hypothermia, and autoperfusion of the heart-lung bloc. The last technique is original and currently is preferred for distant procurement. Because dehiscence of the tracheal anastomosis has occurred in 3 patients, a sutured line is now encircled with a wrap of omentum. Isolated rejection of the lung is frequent in the first three weeks following operation and has been controlled with methylprednisolone. Late survivors have shown a mild restrictive lung disorder that has not progressed between 6 and 24 months. Bronchoalveolar lavage has been useful for diagnosing infection and providing insight into the immunobiology of the transplanted lung. Although mortality and morbidity have been high, the experiences gained through this series will likely result in an improved outlook for future recipients.
自1982年3月以来，33例患者接受了心肺移植手术。19例术后出院，16例情况良好。8例患者存活了1年，5例存活了2年，1例存活了3年。通常，候选者的选择对存活率影响最大，因为此前接受过胸骨切开术的患者无一存活（3例均未存活）。所有7例早期死亡（术后30至72天）和3例晚期死亡（145至466天）均与感染有关。心肺联合块的体外保存方法包括4℃保存、体外循环和深度低温以及心肺联合块的自身灌注。最后一种技术是原创的，目前在远距离获取时更受青睐。由于3例患者发生了气管吻合口裂开，现在用网膜包裹缝合线。术后前三周肺部孤立性排斥反应很常见，已用甲基泼尼松龙控制。晚期存活者表现出轻度限制性肺部疾病，在6至24个月间未进展。支气管肺泡灌洗有助于诊断感染并深入了解移植肺的免疫生物学。尽管死亡率和发病率一直很高，但通过该系列病例获得的经验可能会改善未来接受者的前景。
