原位心脏移植16例报告

Orthotopic heart transplantation:a report of 16 cases

目的总结16例心脏移植经验,探讨心脏移植的近期与远期疗效。方法对1998年10月至2009年9月施行的16例次(15例患者)原位心脏移植的临床资料进行总结分析。结果16例次心脏移植中,经典式原位心脏移植术4例次、双腔静脉吻合法心脏移植术12例次,全部病例采用术后早期免疫诱导+三联免疫抑制剂的抗排斥反应方案。6例死亡,存活时间5 d～103个月,中位数3.5个月。1例存活5 d,死于低心排血量及主动脉内球囊反搏(IABP)的并发症;1例存活13 d,死于金黄色葡萄球菌感染及多器官功能衰竭;1例存活3个月,死于肺部细菌、真菌感染;1例存活4个月,死于肺结核;1例存活18个月,死于中、重度急、慢性排斥反应;1例存活103个月,死于肺部真菌感染合并肝功能衰竭,尸体解剖检查未发现排斥反应。余9例(10例次)至今存活,存活时间3～119个月,中位数49个月。结论心脏移植是治疗终末期心脏病的有效手段,近、远期疗效良好。术后近期须密切监测和处理感染、急性排斥反应等术后并发症,长期生存病例须特别注意慢性排斥反应的发生。

Objective To summarize the experience of orthotopic heart transplantation （OHT） in 16 cases and to evaluate the short and long-term therapeutic efficacy of OHT as a treatment modality for endstage heart disease. Methods Fifteen patients underwent OHT and one of them underwent cardiac retransplantation from October 1998 to September 2009. All clinical data of these cases were collected and analyzed. Results Among the 16 cases, traditional orthotopic transplant technique was performed in 4 cases, and bicaval technique was performed in another 12 cases. In all the cases, early post-operative immune-induction plus triple immunosuppressive regimen was used. Six cases died, survival time was 5 days - 103 months, median was 3.5 months. One patient died of persistent low cardiac output and complication of intra-aortic balloon pulsation on day 5 after the operation. One patient survived 13 days but finally succumbed to staphylococcus aureus infection with multiple organ failure. One patient died of pulmonary bacterial and fugal infection 3 months later and another patient died of pulmonary tuberculosis. One patient survived 18 months but succumbed to severe co-existent acute and chronic rejection. One patient lived 103 months before dying of pulmonary fungal infection and hepatic failure and the autopsy showed no evidence of rejection. The remaining 9 recipients （ 10 eases） had survived for 3 - 119 months, median was 49 months. Conclusion Heart transplantation remains the most effective therapeutic modality for end-stage heart failure with good Intimate monitoring and prompt treatment for infection and acute period as well as close attention to chronic rejection in long-term long-term outcomes. short, intermediate and long-term prognosis. rejection during the immediate post-operative survivors are pivotal to improve the short and