125例脑死亡捐献心脏供体的单中心回顾性分析及边缘供心使用探讨

Single-center retrospective analysis of 125 donor hearts from brain death donation and to explore the use of marginal donor hearts

目的总结分析125例脑死亡捐献供心,探讨评估维护和边缘供心的使用。方法回顾性分析2016年4月至2019年8月125例供心的评估、维护和手术及边缘供心使用后的随访结果。其中男98例、女27例,年龄6~50(36.0±2.4)岁。结果12例供心获取后评估不合格而丢弃。113例心脏移植均采用双腔静脉法。平均冷缺血时间(220.1±6.7)min。4例术后30 d内死亡,4例术后右心辅助循环,12例术后主动脉内球囊反搏(IABP)辅助,12例术后体外膜肺氧合(ECMO)辅助。边缘供心包括15例乙肝抗原阳性供心,2例三尖瓣反流,1例二尖瓣反流,5例冠状动脉钙化,4例心肌顿抑和2例体重严重不匹配。随访时间2年。边缘供心术后随访效果满意。结论提升心脏供体的评估与维护提高了心脏的利用率,边缘供心缺乏长期随访。

Objective To analyze the assessment and m aintenance of 125 donor hearts from brain death donation and explore the use of marginal donor hearts.Methods A retrospective analysis was conducted on the evaluation,maintenance,operation and follow-up results of 125 donor hearts from April 2016 to August 2019.There were 98 males and 27 females at age of 6-50(36.0±2.4)years.Results Twelve donor hearts were discarded due to unqualified evaluation after heart harvest.113 patients of heart transplantation were perform ed with a double lum en venous anastomosis m anner.The mean time of cold ischemia was 220.1±6.7 min.Four patients died w ithin 30 days after operation.Postoperative right ventricular assist circulation was performed in 4 patients,intra-aortic balloon counterattack(IABP)in 12 patients and extracorporeal membrane oxygenation(ECMO)in 12 patients.Marginal donors included 15 hepatitis Bantigen positive donor hearts,2 tricuspid regurgitation,1 mitral regurgitation,5 coronary calcification,4 myocardial stunning and 2 severe weight mismatch.The results of follow-up(2 years)after marginal donor heart transplantation were satisfactory.Conclusion Improving the assessment and maintenance of donor hearts can improve the utilization rate of the heart,and the marginal donor heart transplantation needs long-term follow-up.