Orthotopic heart transplantation in 14 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 简劲峰 ¹ , 封加涛 ¹ , 彭峰 ¹ , 苏艳玲 ¹ , 叶华安 ¹ , 林家旺 ¹ , 陈良万 ² , 黄雪珊 ² , 吴锡阶 ²

1. ;
2. ;

Corresponding author：

简劲峰, Email: jjfeng@fsyyy.com

Keywords：

心脏移植; 免疫抑制; 治疗效果

DOI：

10.7507/1007-4848.201607006

Video：

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目的总结 14 例原位心脏移植的治疗经验。方法回顾性分析 2006 年 1 月至 2015 年 9 月我院行原位心脏移植术终末期心脏病患者的临床资料，其中男 11 例、女 3 例，年龄 22～62（46.7±10.1）岁。4 例使用抗 Tac 单克隆抗体诱导治疗，10 例使用巴利昔单克隆抗体诱导治疗。采用 4℃ 组氨酸-色氨酸-酮戊二酸（HTK）液保护供心。2 例采用经典式原位心脏移植，12 例采用双腔静脉法行心脏移植。术后采用环孢素或他克莫司+吗替麦考酚酯+激素三联抗排斥方案。结果术后早期 1 例因多器官功能衰竭合并严重感染死亡。早期并发症有：败血症 1 例，硬膜外血肿 1 例，急性肾功能不全 1 例，移植物右心功能不全 2 例，低心排血量并需要体外膜肺氧合支持 1 例。术后长期随访：截至 2016 年 6 月，2 例失访，1 例于术后 30 个月因自行停服抗排斥药物死于急性排斥，1 例于术后 36 个月死于肺癌。余 9 例存活 9～121 个月，生活质量良好。结论心脏移植是治疗终末期心脏病的有效方法，熟练的手术技巧、合理的免疫抑制治疗，围术期管理经验、密切监测和治疗感染和排斥及患者依从性均影响着心脏移植的效果。

Citation： 简劲峰, 封加涛, 彭峰, 苏艳玲, 叶华安, 林家旺, 陈良万, 黄雪珊, 吴锡阶. Orthotopic heart transplantation in 14 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 569-572. doi: 10.7507/1007-4848.201607006 Copy

1.	杨守国, 王春生, 陈昊, 等. 298 例原位心脏移植受者远期疗效分析.中华移植杂志(电子版), 2011, 5(2): 101-105.
2.	胡盛寿, 董念国, 魏翔, 等. 我国心脏移植现状分析—2013 年中国心脏移植年度报告. 中华器官移植杂志, 2014, 35(6): 324-328.
3.	陈良万, 陈道中, 杨国锋, 等. 61 例心脏移植术的供心获取. 中国胸心血管外科临床杂志, 2009, 16(4): 296-299.
4.	Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult heart transplant report-2010. J Heart Lung Transplant, 2010, 29(10):1089-1103.
5.	杨国锋, 陈道中, 陈良万, 等. 改善的心脏移植术前准备方法对已停跳供心心肌的保护作用. 福建医科大学学报, 2009, 43(3): 263-265.
6.	Stobierska-dzierzek B, Awad H, Michler RE. The evolving management of acute might sided heart failure in cardiac transplant recipients. J Am Coll Cardiol, 2001, 38: 923-931.
7.	Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report-2012. J Heart Lung Transplant, 2012,31(10) : 1052-1064.
8.	Carlsen J, Hasseriis Andersen K, Boesgaard S. Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease. J Heart Lung Transplant, 2013, 32(3): 347-354.
9.	Gude E, Simonsen S, Geiran OR, et al. Pulmonary hypertension in heart transplantation: discrepant prognostic impact of pre-operative compared with 1-year post-operative right heart hemodynamics. J Heart Lung Transplant, 2010, 29(2): 216-223.
10.	Bedanova H, Orban M,Vrsansky D, et al. Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2013, 157(1): 35-40.
11.	Perez-Villa F, Farrero M, Cardona M, et al. Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation.Clin Transplant, 2013, 27(1): 25-31.
12.	Vakil K, Duval S, Sharma A, et al. Impact of pre-transplant pulmonary hypertension on survival after heart transplantation: A UNOS registry analysis. Int J Cardiol, 2014, 176(3): 595-599.
13.	Listijono DR, Watson A, Pye R, et al. Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction. J Heart Lung Transplant, 2011, 30 (7): 783-789.
14.	邱志兵, 陈鑫, 蒋英硕, 等. 心脏移植术后急性排异反应的无创性监测. 中国医师杂志,2014, 16(8): 1035-1038.
15.	黄雪珊, 陈道中, 陈良万, 等. 心脏移植中远期急性排斥反应的临床观察. 南方医科大学学报,2009, 29(7): 1465-1467.
16.	Stehlik J, Edwards LB, Rowe A, et al. ISHLT international registry for heart and lung transplantation-three decades of scientific contributions. Transplant Rev, 2013, 27(2): 38-42.

1. 杨守国, 王春生, 陈昊, 等. 298 例原位心脏移植受者远期疗效分析.中华移植杂志(电子版), 2011, 5(2): 101-105.
2. 胡盛寿, 董念国, 魏翔, 等. 我国心脏移植现状分析—2013 年中国心脏移植年度报告. 中华器官移植杂志, 2014, 35(6): 324-328.
3. 陈良万, 陈道中, 杨国锋, 等. 61 例心脏移植术的供心获取. 中国胸心血管外科临床杂志, 2009, 16(4): 296-299.
4. Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult heart transplant report-2010. J Heart Lung Transplant, 2010, 29(10):1089-1103.
5. 杨国锋, 陈道中, 陈良万, 等. 改善的心脏移植术前准备方法对已停跳供心心肌的保护作用. 福建医科大学学报, 2009, 43(3): 263-265.
6. Stobierska-dzierzek B, Awad H, Michler RE. The evolving management of acute might sided heart failure in cardiac transplant recipients. J Am Coll Cardiol, 2001, 38: 923-931.
7. Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report-2012. J Heart Lung Transplant, 2012,31(10) : 1052-1064.
8. Carlsen J, Hasseriis Andersen K, Boesgaard S. Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease. J Heart Lung Transplant, 2013, 32(3): 347-354.
9. Gude E, Simonsen S, Geiran OR, et al. Pulmonary hypertension in heart transplantation: discrepant prognostic impact of pre-operative compared with 1-year post-operative right heart hemodynamics. J Heart Lung Transplant, 2010, 29(2): 216-223.
10. Bedanova H, Orban M,Vrsansky D, et al. Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2013, 157(1): 35-40.
11. Perez-Villa F, Farrero M, Cardona M, et al. Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation.Clin Transplant, 2013, 27(1): 25-31.
12. Vakil K, Duval S, Sharma A, et al. Impact of pre-transplant pulmonary hypertension on survival after heart transplantation: A UNOS registry analysis. Int J Cardiol, 2014, 176(3): 595-599.
13. Listijono DR, Watson A, Pye R, et al. Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction. J Heart Lung Transplant, 2011, 30 (7): 783-789.
14. 邱志兵, 陈鑫, 蒋英硕, 等. 心脏移植术后急性排异反应的无创性监测. 中国医师杂志,2014, 16(8): 1035-1038.
15. 黄雪珊, 陈道中, 陈良万, 等. 心脏移植中远期急性排斥反应的临床观察. 南方医科大学学报,2009, 29(7): 1465-1467.
16. Stehlik J, Edwards LB, Rowe A, et al. ISHLT international registry for heart and lung transplantation-three decades of scientific contributions. Transplant Rev, 2013, 27(2): 38-42.

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