el-Gamel A, Deiraniya A K, Rahman A N, Campbell C S, Yonan N A
Wythenshawe Hospital Transplant Unit, Manchester, United Kingdom.
J Heart Lung Transplant. 1996 Jun;15(6):564-71.
We have described an alternative technique for orthotopic heart transplantation (bicaval Wythenshawe technique) which maintains the right and left atrial anatomy and contractility.
Fifty patients were randomized into two groups: group A (n = 25) who had orthotopic heart transplantation using the bicaval Wythenshawe technique and group B (n = 25) who had conventional (Lower and Shumway) technique of orthotopic heart transplantation. We compared the cardiac output (measured by thermodilution technique) with atrial activation (AAI pacing) to cardiac output without atrial activity (VVI pacing) in both groups to identify any beneficial hemodynamic effects. All patients were studied the first and second weeks after transplantation. The inaccuracies of comparing cardiac output measurements caused by different loading conditions, inotropic state, and systemic vascular resistance were eliminated by using the patient as his or her own control.
The difference between the measured cardiac output with atrial pacing and ventricular pacing was 1.42 +/- 0.44 L/min in group A in comparison with 0.32 +/- 0.4 L/min in group B (p = 0.001 Wilcoxon signed rank). The percentage of atrial contribution to the cardiac output in group A was 30% +/- 12% (standard deviation), 95% confidence interval in comparison with 7% +/- 9%, 95% confidence interval in group B. The mean stroke volume in group A was higher in sinus rhythm (65 +/- 19.2 ml) and atrial pacing (62 +/- 17.7 ml) compared with ventricular pacing (49.17 +/- 16.43 ml) p = 0.001. In group B no statistical difference was found between stroke volume measured with atrial (47.71 +/- 6.23 ml) or ventricular pacing (46.9 +/- 6.35 ml).
We conclude that the bicaval technique of orthotopic heart transplantation preserve the atrial kick and its contribution to cardiac output early after transplantation.
我们描述了一种原位心脏移植的替代技术（双腔威辛肖技术），该技术可维持左右心房的解剖结构和收缩功能。
50例患者被随机分为两组：A组（n = 25）采用双腔威辛肖技术进行原位心脏移植，B组（n = 25）采用传统的（洛厄尔和舒姆韦）原位心脏移植技术。我们比较了两组患者在心房起搏（AAI起搏）时的心输出量（通过热稀释技术测量）与无心房活动（VVI起搏）时的心输出量，以确定任何有益的血流动力学效应。所有患者在移植后的第一周和第二周进行研究。通过将患者自身作为对照，消除了不同负荷条件、心肌收缩状态和体循环血管阻力对心输出量测量比较造成的误差。
A组心房起搏和心室起搏时测量的心输出量差异为1.42±0.44升/分钟，而B组为0.32±0.4升/分钟（p = 0.001，威尔科克森符号秩检验）。A组心房对心输出量的贡献百分比为30%±12%（标准差），95%置信区间，而B组为7%±9%，95%置信区间。A组窦性心律时的平均每搏输出量（65±19.2毫升）和心房起搏时（62±17.7毫升）高于心室起搏时（49.17±16.43毫升），p = 0.001。B组心房起搏（47.71±6.23毫升）或心室起搏（46.9±6.35毫升）时测量的每搏输出量之间未发现统计学差异。
我们得出结论，原位心脏移植的双腔技术在移植后早期保留了心房收缩及其对心输出量的贡献。
