Blanche C, Valenza M, Aleksic I, Czer L S, Trento A
Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048.
J Cardiovasc Surg (Torino). 1994 Aug;35(4):283-7.
An alternative technique for orthotopic heart transplantation is described. It consists of total excision of the recipient's atria with donor heart transplantation performed using bicaval end-to-end anastomosis, as well as pulmonary venous anastomoses. Thus, total atrial as well as ventricular transplantation is performed. This new surgical approach is technically simple and preserves the anatomic size, geometric configuration and physiologic function of the atria. This technique has the potential to improve the long-term hemodynamic results in heart transplant patients as it reduces the incidence of postoperative atrioventricular valve regurgitation. In addition, the incidence of early posttransplant bradyarrhythmias (within 4 to 6 weeks after transplantation) that require the insertion of a permanent pacemaker is also significantly reduced. This report describes some technical guidelines for harvesting the donor heart, as well as for the implantation of the cardiac allograft, in order to avoid the development of serious intraoperative and postoperative complications directly associated with this technique.
本文描述了一种原位心脏移植的替代技术。该技术包括完全切除受体心房，采用双腔静脉端端吻合及肺静脉吻合进行供体心脏移植，从而实现全心房和心室移植。这种新的手术方法技术上简单，能保留心房的解剖大小、几何构型和生理功能。该技术有可能改善心脏移植患者的长期血流动力学结果，因为它降低了术后房室瓣反流的发生率。此外，移植后早期（移植后4至6周内）需要植入永久起搏器的缓慢性心律失常的发生率也显著降低。本报告描述了获取供体心脏以及植入心脏移植物的一些技术指南，以避免出现与该技术直接相关的严重术中及术后并发症。
