儿童心脏移植单中心临床分析

目的总结单中心儿童心脏移植关键技术和方法，为中国儿童心脏移植发展提供参考。 方法回顾性分析华中科技大学同济医学院附属协和医院心脏大血管外科2008年9月1日至2018年12月31日完成的47例儿童心脏移植临床资料，观察受者临床特征、手术相关指标、术后并发症和生存率。正态分布计量资料以均数±标准差( ±s)表示，非正态分布计量资料以中位数表示，计数资料以百分比表示。以全因死亡或再次移植为主要终点事件，运用Kaplan-Meier法计算生存率。 结果47例患儿心脏移植时年龄为(10.3±4.8)岁，男性24例，女性23例，体质量(32±15)kg，术前肺动脉压(33±12)mmHg。原发病包括：心肌病36例、复杂先天性心脏病9例和心脏肉瘤2例，4例患儿既往有心脏手术史。受者群体反应性抗体均<10%，供受者ABO血型相同39例，相容8例，供受者体质量比1.6±0.6。供心冷缺血时间为(330±115)min，其中24例冷缺血时间>6 h。采用双腔静脉法37例，双房法10例。术中体外循环时间(119±53)min，体外循环并行辅助时间(80±48) min。术后机械通气时间中位数32 h(13～1 250 h)，ICU停留时间中位数7 d(5～11 d)。术后20例受者发生一种或以上并发症，包括心功能不全7例、心律失常5例、肾功能不全7例、排斥反应3例和血液系统并发症1例。受者术后3周时左心室射血分数为(67±5)%(57%～79%)，46例受者顺利康复出院，1例术后59 d死于肺炎。截至2019年6月30日，46例受者平均随访时间(42±31)个月(6～129个月)，术后1、3和5年生存率分别为95.74%、93.01%和93.01%。 结论心脏移植是治疗儿童终末期心脏病的有效方法。本中心儿童心脏移植术后近、中期生存率良好，建立了较为完整的儿童心脏移植技术流程，行之有效，值得借鉴。

A single-center experience of pediatric heart transplantation

ObjectiveTo summarize key technologies and methods of pediatric heart transplantation and to provide a reference for the development of pediatric heart transplantation in China. MethodsThe clinical data of 47 pediatric heart transplantation recipients who got transplantation between January 1, 2008 and December 31, 2018 in the Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed. Clinical features, surgical related indicators, postoperative complications and survival rate of recipients were collected. ResultsTwenty-four recipients were male and 23 recipients were female among 47 recipients. The mean age, weight and preoperative pulmonary arterial pressure of 47 recipients was (10.3±4.8) years, (32±15) kg and (33±12) mmHg. The protopathy included 36 cases of cardiomyopathy, 9 cases of congenital heart disease and 2 cases of cardiac tumor. Four recipients had a history of heart surgery. The panel reactive antibody of recipients was less than 10%. The ABO blood type between recipient and donor: 39 cases were same and 8 cases were compatible. The mean donor/recipient body weight ratio was 1.6±0.6. The mean cold ischemic time of donor heart was (330±115) minutes, with 24 cases greater than 6 hours. Thirty-seven recipients received bicaval heart transplantation and 10 recipients received biatrial heart transplantation. The mean duration of intraoperative cardiopulmonary bypass was (119±53) minutes, in which the mean CPB-assist time was (80±48) minutes. The average duration of postoperative mechanical ventilation was 32 h (13-1 250 h), and the average intensive care unit stay was 7 d (5-11 d). Postoperative complications occurred in 20 cases including 7 cases of cardiac insufficiency, 5 cases of arrhythmia, 7 cases of renal insufficiency, 3 cases of rejection and 1 case of hematological disease. The left ventricular ejection fraction of recipients was (67±5)% (57%-79%). Forty-six recipients were safely discharged and 1 recipient died of pneumonia 59 days after transplantation. The mean follow up time were (42±31) months (6-129 months), and the 1-year, 3-year, and 5-year survival rate after transplantation was 95.74%, 93.01% and 93.01% respectively. ConclusionsHeart transplantation is an effective means for end-stage heart disease in children. The clinical outcome of pediatric heart transplantation in our center is satisfactory with good intermediate and long-term survival rate, and a set of complete heart transplantation technique processes has been established.