单中心儿童心脏移植的供心保护经验总结

Management of donor heart protection in pediatric orthotopic heart transplantation

目的总结本中心儿童心脏移植供心的保护经验。方法武汉协和医院心脏移植中心自2008年9月至2015年8月，共完成21例儿童心脏移植，其中男11例，女10例，年龄3个月－18岁（11．75±7．94）岁，体重5．2～69（34．49±18．33）kg，身高56～172（133．61±35．79）cm，平均肺动脉压（MPAP）为20—52（33．15＋12．73）mmHg，心脏射血分数（EF）为15％～70％（40．25±20．14）％。21例心脏移植成人供心占15例，儿童供心占6例。供心获取和保护采用联合灌注改良St．Thomas液20ml／kg和康斯特保护液（HTK液）40。50ml／kg的方法，移植前供心修剪时再次灌注HTK液20mlVkg。结果供心冷缺血时间为106—522（269．55±152．51）min，体外循环时间为71～217（121．80±42．92）min，升主动脉阻断时间20—105（45．10±22．10）min。其中19例患者顺利停机，2例术后因早期供心功能不全而使用体外膜肺氧合（ECMO）辅助后成功脱机。所有患者均康复并顺利出院，术后3周复查EF为（67．47~5．75）％，术后平均随访16月尚无死亡病例。结论儿童心脏移植是治疗儿童终末期心脏病和复杂先天性心脏病的有效治疗手段。本中心采用的联合两种心肌保护液的供心灌注保护方法简单易行，心肌保护效果良好，尤其是对边缘供心的保护效果确切，取得良好的临床效果。

Objective To summarize the management experience of donor heart protection in 21 pediatric orthotopic heart transplantation patients. Methods From September 2008 to August 2015, 21 patients, 11 male and 10 female, aged from 3 month to 18 years underwent heart transplantation. Among them, 15 cases received donor heart （group Ⅰ ） from adult and 6 cases received donor heart （group Ⅱ ） from children. In Group Ⅱ, modified St. Thomas solution （20 ml/kg） was infused through aortic root after aorta was cross clamped, to make donor hearts stop beating quickly first , when the donor heart was taken off from the chest, it was perfused with HTK solution （40-50 ml/kg）. The donor heart transported in cold HTK solution and was perfused with HTK solution （20 ml/kg） before transplantation. Results The donor heart cold ischemic period was between 106 and 522（ 269.55± 152.51 ）mins, the CPB time was from 71 to 217 （121.80±42.92） mins, the aorta cross clamp duation was from 20 to 105 （45.10±22.10）rains. Two cases couldnot wean from the CPB due to primary graft dysfunction and required ECMO support. The EF values three weeks after heart transplantation was （67.47±5.75）%. All 21 patients survivedat16-monthin the follow-up. Conclusion Pediatric orthotopic heart transplantation is a promising therapeutic option with satisfying survival for the pediatric population with endstage heart disease and complex congenital heart disease. In our institute, using modified St. Thomas solution combine with HTK solution in donor heart procurement and preservation during perioperative period are considerably important for successful heart transplantion. It expands the use of edging donor hearts and improve success rate of heart transplantation, which is very important in a serious donor shortage today.