原位心脏移植的手术体会

Operative experience of orthotopic heart transplantation

目的 探讨原位心脏移植的手术方法及围术期处理要点。方法 2 0 0 0年 5月至 2 0 0 1年10月连续为 15例病人施行了原位心脏移植术 ,其中扩张型心肌病 14例 ,复杂性先天性心脏病 1例。采用标准原位心脏移植手术 10例 ,双腔静脉吻合法 5例。 5例术前存在中度肺动脉高压 ,予NO吸入等措施降肺动脉压力。抗排异治疗采用环孢素A(或FK5 0 6 ) +皮质激素 (Pred) +骁悉 (MMF)三联方案。结果 15例病人全部生存 ,围术期无感染、严重排异反应或右心衰等并发症发生 ,术后心功能恢复至I～II级(NYHA)。随访期间发生巨细胞病毒感染和轻度排斥反应各 1例。结论 心脏移植的成功是多环节的 ,手术操作是影响成功的重要因素。无论采用标准法或双腔静脉法 ,只要设计合理 ,均能取得良好效果。

Objective: The review the experiences of perioperative management of orthotopic heart transplantation. Methods: Between May 2000 and October 2001, 15 patients, 9 men and 6 women, fourteen with diagnosis of dilated cardiomyopathy and one with complicated congenital heart disease, underwent orthotopic heart transplantation at our institute. The operative procedures included ten conventional Stanford orthotopic cardiac transplantations and five bicaval anastomotic cardiac transplantations. Postoperatively, five patients with moderate pulmonary hypertension were treated with inhalation of NO. Eight cases were prescribed with Cyclosporine A+Corticosteroids+MMF, others with FK506+Corticosteroids+MMF. Results: All patients survived without infection or rejection. During follow up, all patients resumes daily work are in heart function class of I～II (NYHA). One patient developed cytomegalovirus infection and one patient with acute refection, postoperatively. Conclusion: The operative skill is a key factor among factors that influence result of heart transplantation. Both conventional orthotopic cardiac transplantation and bicaval anastomotic cardiac transplantation could achieve satisfying outcome as long as all anastomoses were well designed.