原位心脏移植56例的临床经验

目的　总结分析复旦大学器官移植中心 5 6例原位心脏移植的临床经验。方法　 2 0 0 0年 5月至 2 0 0 3年 12月连续为 5 6例患者行原位心脏移植术 ,包括扩张型心肌病 4 7例 ,终末期瓣膜性心肌病 2例 ,终末期缺血性心肌病 2例 ,原发性心脏恶性肿瘤 2例 ,复杂先天性心脏病 1例 ,肌营养不良性心肌病 1例 ,恶性心律失常 1例。手术按标准法行原位心脏移植手术 19例 ,双腔静脉吻合法移植手术 37例。术后抗排斥反应治疗采用环孢素 泼尼松 霉酚酸酯三联方案。结果　手术死亡1例 ,死因为第 5次手术术后渗血不止。所有存活病例获完整随访 ,在平均 12 .4个月的随访中 ,术后1年内死亡 5例 ,1年存活率 91% ,其中死于肾功能衰竭 1例 ,慢性右心衰 1例 ,急性排斥反应 2例 ,车祸 1例。 1例术后 3年 2个月死于移植物冠状动脉硬化。存活病例心功能恢复至ⅠⅡ级。结论通过选择适当的受体病例 ,保护良好的心肌 ,采用双腔静脉吻合技术 ,加强术后监测与预防多种并发症 ,心脏移植可获得满意的早中期疗效。

Orthotopic heart transplantation: clinical experience on 56 patients

OBJECTIVE: To summarize the clinical experience on 56 patients undergoing orthotopic heart transplantation. METHODS: Between May 2000 and December 2003 56 patients, 47 with cardiomyopathy, 2 with end-stage valvular heart disease, 2 with end-stage ischemic heart disease, 2 with primary malignant cardiac tumor, 1 with complicated congenital heart disease, 1 with muscular dystrophy cardiomyopathy, and 1 with refractory malignant ventricular arrhythmias, underwent orthotopic heart transplantation in the Transplantation Center of Fudan University. The operative procedures included 19 conventional Stanford orthotopic cardiac transplantation in 19 cases and bicaval anastomotic cardiac transplantation in 37 cases. Postoperatively, the patients were prescribed with cyclosporine A + corticosteroids + MMF or FK506 + corticosteroids + MMF as anti-rejection therapy. RESULTS: One patient undergoing his fifth operation died of bleeding 3 days after operation. All survivors were followed-up for 12.4 months on average. Five patients died within 1 year postoperatively with a one-year survival rate of 91%. One patient died of allograft vasculopathy 38 months after operation. Other patients enjoyed heart function recovering to class I-II (NYHA). CONCLUSION: With proper recipient selection, excellent donor heart conservation, bicaval anastomotic technique, and efficient postoperative surveillance and treatment, heart transplantion may produce satisfying mid-term results.