Bhatia D S, Bowen J C, Money S R, Van Meter C H, McFadden P M, Kot J B, Pridjian A K, Ventura H O, Mehra M R, Smart F W, Ochsner J L
Department of Surgery, Ochsner Clinic, New Orieans, Louisiana, USA.
Ann Surg. 1997 Jun;225(6):686-93; discussion 693-4. doi: 10.1097/00000658-199706000-00006.
The authors present their experience with patients having undergone orthotopic heart transplantation (OHT) in whom surgical conditions subsequently developed that required operative intervention. The incidence, morbidity, and mortality of these procedures are reported.
Several studies have evaluated the management options of biliary tract disease after OHT. Multiple reports of patients having undergone OHT who subsequently underwent peripheral vascular reconstructions, plastic reconstructive, and thoracic procedures also have been published.
A chart review of 349 patients who underwent OHT between 1985 and 1996 was conducted to identify surgical procedures that were required in the post-transplant period. Their outcomes are reported.
Of 349 patients who underwent OHT, conditions requiring 94 surgical procedures developed in 54 patients (15%). Biliary tract disease developed in 17 patients (5%) who required cholecystectomy, 2 of the 5 patients with acute cholecystitis died. Eight patients (2%) underwent orthopedic procedures with no operative mortality. Flap advancements for sternal wound infections were performed in five patients and four deaths occurred. Seventeen thoracic procedures were performed in 11 patients with an overall mortality of 45%. Twenty-one vascular procedures were performed on 17 patients with 1 delayed death due to a malignancy. Seven patients underwent procedures of the colon and rectum with no mortality. Seven patients underwent repair of inguinal or incisional hernias with no mortality. Various infections occurred with one resultant death after operative intervention. Six procedures were performed for diseases of the small intestine with no resultant mortalities.
Patients having undergone OHT and chronic immunosuppression are at increased risk of having complications develop from infection. Acute cholecystitis and sternal wound infection caused an inordinate risk of complications and death. Malignancies developed in four patients who required surgical intervention. A heightened awareness of coexisting peripheral vascular disease in patients transplanted for ischemic cardiomyopathy should exist. Close screening before surgery and surveillance after surgery to identify risk factors for infection and vascular disease and to screen for malignancies are essential.
作者介绍了原位心脏移植（OHT）患者术后出现需要手术干预的外科情况的经验。报告了这些手术的发生率、发病率和死亡率。
多项研究评估了OHT术后胆道疾病的处理方法。也发表了多篇关于OHT患者随后接受外周血管重建、整形重建和胸科手术的报道。
对1985年至1996年间接受OHT的349例患者进行病历回顾，以确定移植后阶段所需的外科手术。报告了他们的手术结果。
在349例接受OHT的患者中，54例（15%）出现了需要94次外科手术的情况。17例（5%）患者发生胆道疾病，需要行胆囊切除术，5例急性胆囊炎患者中有2例死亡。8例（2%）患者接受骨科手术，无手术死亡。5例患者因胸骨伤口感染行皮瓣推进术，4例死亡。11例患者进行了17次胸科手术，总死亡率为45%。17例患者进行了21次血管手术，1例因恶性肿瘤延迟死亡。7例患者进行结肠和直肠手术，无死亡。7例患者进行腹股沟或切口疝修补术，无死亡。术后干预后发生各种感染，1例死亡。6例患者因小肠疾病接受手术，无死亡。
接受OHT和长期免疫抑制的患者发生感染并发症的风险增加。急性胆囊炎和胸骨伤口感染导致并发症和死亡的风险过高。4例需要手术干预的患者发生了恶性肿瘤。对于因缺血性心肌病接受移植的患者，应提高对并存外周血管疾病的认识。术前密切筛查和术后监测，以识别感染和血管疾病的危险因素并筛查恶性肿瘤至关重要。
