13例原位心脏移植术中长时间心肌缺血的心肌保护和术后近期效果

Donor Heart Preservation Techniques and Early Results in Orthotopic Heart Transplantation in 13 Patients with Long Donor Ischemia Time

目的 :总结分析 13例原位心脏移植手术中心肌缺血时间大于 2 4 0min的心肌保护技术和术后近期疗效。方法 2 0 0 0年 5月～ 2 0 0 4年 9月连续为 79例患者进行原位心脏移植术 ,其中 13例心肌缺血时间大于 2 4 0min。本组术前心功能均为Ⅳ级。手术按标准法行原位心脏移植手术 2例 ,行双腔静脉吻合法移植手术 11例。心肌缺血时间在 2 4 0～ 383min ,平均 (312± 4 2 )min。供心的保护方法包括在主动脉阻断时经主动脉根部灌注晶体停搏液 ,在取下心脏后 ,再次灌注UW液 ,并置于UW液中保存。结果 :本组无手术死亡。术后均获完整随访 ,随访时间 1个月～ 3年 ,平均 8.2个月 ,术后无死亡 ,所有病人心功能均恢复至I～II级。结论 :我们所采取的心脏获取和心肌保护方法 ,加之合适的供体、受体选择 ,双腔静脉吻合技术 ,以及加强术中、术后监测和处理 ,长时间心肌缺血的病人可获得满意的早期疗效。

Objective: To introduce the donor heart pr es ervation techniques and clinical experience in 13 patients of orthotopic heart t ransplantations with long donor ischemia time (DIT) in our center.Methods:Between May 2000 and Sep. 2004, 79 patients underwent or thotopic heart transplantation at our center, among them 13 patients DIT were mo re then 240 min. Crystalloid cardioplegia was infused through aortic root, after aorta was cross clamped. UW solution was used when donor heart was removed. Bic aval anastomotic cardiac transplantation (11) was performed. DIT was 240-383 (me an 312±42)min. Results: There was no death in this group. All survivors were ob tained for follow-up from 1 months to 3 years, with mean time of 8.2 months. The re is no late death, with cardiac function class of I～II (NYHA) in all patients .Conclusion: With proper donor heart procurement and preservation , recipient selection, anastomotic technique and efficient postoperative surveil lance and treatment, transplanted patients with long DIT would reach satisfying early results.