Park Sang-Uk, Song Kyungsub, Kim Yun Seok, Kim In Cheol, Kim Jae-Bum, Park Namhee, Jang Woo Sung
Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.
Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.
J Chest Surg. 2023 Sep 5;56(5):322-327. doi: 10.5090/jcs.23.033. Epub 2023 Aug 14.
Superior vena cava (SVC) stenosis during follow-up is a major concern after heart transplantation, and many technical modifications have been introduced. We analyzed the surgical results of the SVC intima layer-only suture technique in heart transplantation.
We performed SVC anastomosis with sutures placed only in the intima during heart transplantation. We measured the area of the SVC at 3 different points (above the anastomosis, at the anastomosis, and below the anastomosis) in an axial view by freely drawing regions of interest, and then evaluated the degree of stenosis. Patients who underwent cardiac computed tomography (CT) at 2 years postoperatively between June 2017 and May 2020 were included in this study.
We performed heart transplantation in 41 patients. Among them, 24 patients (16 males and 8 females) underwent follow-up cardiac CT at 2 years postoperatively. The mean age at operation was 49.4±4.9 years. The diagnoses at time of operation were dilated cardiomyopathy (n=12), ischemic heart disease (n=8), valvular heart disease (n=2), hypertrophic cardiomyopathy (n=1), and congenital heart disease (n=1). No cases of postoperative bleeding requiring intervention occurred. The mean CT follow-up duration was 1.9±0.7 years. At follow-up, the mean areas at the 3 key points were 2.7±0.8 cm, 2.7±0.8 cm, and 2.7±1.0 cm (p=0.996). There were no SVC stenosis-related symptoms during follow-up.
The suture technique using only the SVC intimal layer is a safe and effective method for use in heart transplantation.
心脏移植术后随访期间的上腔静脉（SVC）狭窄是一个主要问题，并且已经引入了许多技术改进。我们分析了心脏移植中SVC仅内膜层缝合技术的手术结果。
在心脏移植过程中，我们仅在内膜放置缝线进行SVC吻合。通过自由绘制感兴趣区域，在轴向视图中测量SVC在3个不同点（吻合上方、吻合处和吻合下方）的面积，然后评估狭窄程度。本研究纳入了2017年6月至2020年5月期间术后2年接受心脏计算机断层扫描（CT）的患者。
我们对41例患者进行了心脏移植。其中，24例患者（16例男性和8例女性）在术后2年接受了随访心脏CT检查。手术时的平均年龄为49.4±4.9岁。手术时的诊断为扩张型心肌病（n = 12）、缺血性心脏病（n = 8）、瓣膜性心脏病（n = 2）、肥厚型心肌病（n = 1）和先天性心脏病（n = 1）。未发生需要干预的术后出血病例。CT随访的平均持续时间为1.9±0.7年。随访时，3个关键点的平均面积分别为2.7±0.8 cm、2.7±0.8 cm和2.7±1.0 cm（p = 0.996）。随访期间没有与SVC狭窄相关的症状。
仅使用SVC内膜层的缝合技术是一种用于心脏移植的安全有效的方法。
