原位心脏移植18例

Orthotopic cardiac transplantation (Report of 18 cases)

目的 总结 1995年 8月至 2 0 0 0年 6月 18例同种原位心脏移植的临床治疗经验和教训。方法 18例终末期扩张性心肌病病人接受标准式或全心脏式移植术 ,其中 1例为心肾联合移植。供心保护液为 4℃Stanford大学溶液、福协VI号溶液或冷血保护液。免疫抑制治疗采用三联方案。结果 全组无手术后早期死亡。 4例早中期死亡。其余 14例长期生存 ,生活质量良好。结论 心脏移植是治疗终末期扩张性心肌病的有效方法。提高心脏移植后生存率的基本经验是 :正确选择病例、合适的手术方法、良好的供心保护以及合理应用免疫抑制剂和慎密的随访。

Objective: To review the clinical experience of orthotopic cardiac transplantation for endstage dilated cardiomyopathy. Methods: From August 1995 to June 2000, 18 patients with dilated cardiomyopathy underwent orthotopic cardiac transplantation including 1 cardionephric transplantation. There were 15 males and 3 females with a mean age of 35 6 years(range 13 to 58 years).Surgical procedures performed included standard approach in 17, total heart transplantation approach in 1, Donor organs were preserved by Stanford solution?FuXie IV solution or cool blood cardioplegia. The triple immunosuppressive agents treatment of cyclosporine or tacrolimus (FK506),azathioprine or cellcept, and prednisone were applied following transplantation. Results: All patients survived operation. There were 3 early deaths within one week and 1 late death at the end of fourth month, postoperatively. The remainders were followed up for 1 month to 5 years. Clinical condition, cardiac function, quality of life after transplantation were improved significantly. Conclusion: Cardiac transplantation is a very effective treatment for severe dilated cardiomyopathy. Our results of this study suggest that better long term survival is closely related to the following factors:selection of proper surgical candidates and operative procedures, better preservation of donor organs, rational employment of immunosuppressants and careful follow up.