原位心脏移植8例报告

Result of orthotopic heart transplantation in 8 cases

目的探讨影响心脏移植手术效果的主要因素。方法2003年3月至2004年12月8例患者施行了原位心脏移植术,其中扩张型心肌病7例,肥厚型心肌病1例。采用标准原位心脏移植手术1例,双腔静脉吻合法原位心脏移植手术7例。4例术前存在中度肺动脉高压,NO吸入等措施降肺动脉压力。抗排异治疗采用环孢素A(CsA)+皮质激素(Pred)+骁悉(MMF)三联方案。结果手术均获成功,1例术后第9天出现急性排异反应,给予大剂量泼尼松龙冲击治疗3d缓解;1例术后第3天出现肾功能衰竭,给予血液透析治疗;1例于术后35天死于肾功能衰竭及抗排异药物神经毒性反应,其余病例心功能恢复至Ⅰ￣Ⅱ级。术后5例已恢复正常工作和生活。结论严格掌握受体适应证、供体的心脏保护、合适的手术方法及围术期患者管理,是心脏移植手术成功的关键。

Objective To explore factors that affect the results of orthotopic heart transplantation. Methods From March 2003 to December 2004, 8 patients with end-stage cardiomyopathy, seven with dilated and one with hypertrophic, underwent orthotopic heart transplantation at our hospital. Conventional Stanford cardiac transplantation was applied in one patient and bicaval anastomotic cardiac transplantation in the other seven. Four patients had moderate pulmonary hypertension befroe operation and were treated with inhalation of NO post-operation. All cases were prescribed with Cyclosporine A ＋ Corticosteroids ＋ MMF. Results All patients were operated successfully and there were no operation death. Acute rejection happened in one patient at the ninth days and got controlled after therapy of high dose medrol for 3 days. Acute renal failure occurred in another patient at the third days post- operation. Hemodialysis was necessary in this case. During follow-up, one patient died due to acute renal failure and neuropathy at 35th day, Cardiac function was recovered in the other cases with NYHA class Ⅰ - Ⅱ, 5 of them resume daily work. Conclusion The results of heart transplantation was improved by accurate selection of recipient, suitable surgical procedure, excellent myocardial preservation and accurate management of peri-operation.