长时间供心保护的原位心脏移植

The Orthotopic Heart Transplantion with Long Donor Heart presesvation in 3 Patients

目的总结3例供心离体保护时间较长的原位心脏移植过程和近期生存观察情况.方法2005年3～8月,先后对3例患有终末期扩张性心肌病患者(心功能均为Ⅳ级)行心脏移植手术;3例供体心脏离体保存时间分别为542、367、485 min.移植手术方式采用双腔静脉吻合法.供心的保护过程:主动脉根部灌注心脏停搏液,快速取下心脏后再灌注冷UW液,并放置于UW液中低温保存.结果3例移植手术均获成功,目前患者心功能在I～Ⅱ级,生活质量好.结论合适的供体、快捷的心脏获取方法和心肌保存方法,在离体心脏保存时间较长时,合适的受体,并选用双腔静脉吻合技术,可收到良好手术效果.

Objective To introduce the clinical experience in 3 patients of orthotopic heart transplantation with longer donor heart preservation. Methods Between Marth 2005 to October 2005, 3 patients of terminal myocardiosis with heart function of NYHA class Ⅳ recieved heart transplantation with 3 isolated hearts preserved for 542 min, 367 min and 485 rain. The operation was performed with inferior and superior vena anastomotic technique. Crystalloid cardioplegia was infused through aortic root after aorta was crossly clamped. UW solution was infused through aortia root after the donor heart was removed quickly, and the isolated heart was soaked in UW solution. Results The 3 patients survived and discharged uneventfully, with heart function improved from NYHA class Ⅳ preoperatively to NYHA class Ⅰ- Ⅱ ; Conclusion With suitable recipient, proper donor heart procurement and pres ervation, inferior and superior vena anastomotic technique can reach satisfying early results for heart transplantation.