Objective To summarize the experiences of donor heart procurement of heart transplantation so as to improve the efficiency of donor heart protection. [WTHZ]Methods [WTBZ]From April 2002 to October 2006, sixtyone patients with endstage heart disease had undergone orthotopic heart transplantation. Donors were all male brain deaths, aged from 21 to 53, and 5 of them were older than 40. There were 6 cases in which the weight difference between donor and recipient＞20%, and the rest ≤±20%. Fortyfive cases had the same ABO blood type, and 16 had matching ABO blood type. Four donor hearts were procured under the condition of stable hemodynamics and enough oxygen after brain death(typeⅠ), fortyfour donor hearts were procured under the condition of brain death with acute hemorrhage and hypovolemia (typeⅡ), and 13 donor hearts were procured under the condition of brain death with cardiac arrest (typeⅢ). Twenty cases underwent standard transplantation procedure, one underwent total heart transplantation procedure and 40 underwent bicaval transplantation procedure. The donor heart cold ischemic period ranged from 52 to 347 min（92±31 min）, and 13 cases were more than 240 min. Results Two cases died of low cardiac output syndrome on 7th and 9th day after operation respectively, and their donor heart cold ischemic period were 327 and 293 min respectively. The rest of patients all recovered and discharged. One died of acute rejection on 18th month after operation because of rejecting immunosuppressive agents, and 1 died in traffic accident on 23rd month after transplantation. The rest 57 cases survived 6-59 months(mean 35 months), and had good life quality with NYHA cardiac function classification in 0-I grade. Conclusions Heart transplantation with donor aged over 40 may also have satisfactory results. Patients with endstage dilated cardiomyopathy can procure donor heartsfrom donors with heavy weight. Using different techniques to procure donor hearts may furthest reduce myocardial injury. Donor hearts which have been protected by myocardium protecting liquid for a long time should be used with caution.
Abstract: Objective To study the preventive effect of n-3 polyunsaturated fatty acids on allograft arteriosclerosis. Methods Arterial homeotransplant model were created with 480 rats which were divided into four groups. Control group, no n-3 lyunsaturated fatty acids were taken. Group A, n-3 polyunsaturated fatty acids were taken for two weeks before operation with the dose of EPA 600mg/kg. Group B, 300 mg/kg and group C 150 mg/kg were taken respectively. The recipient’s transplanted vessel was excised after 1,7,14,21and 28 days respectively. The tissue pathological variations, ultrastructure variations and expression variations of intercellular adhesion molecule-1(ICAM-1), vascular cell adhesion molecule-1（VCAM-1）, nuclear factorkappa B（NF-κB） had been observed. Results The pathological changes occurred 7 days after operation in control group and were most prominent on the 28th day, blood vessels were obstructed and the expressions of ICAM-1, VCAM1,NF-κB were markedly intensified than those of group A, B, C (Plt;0.05). The pathological variations of transplanted vessel in group A, B, C occurred later than those in control group. The nonobstruction rates in group A, B, C were better than that in control group. The expressions of ICAM-1， VCAM-1， NF-κB in control group were ber than those in group A， B， C (Plt;0.05). The expressions of ICAM-1， VCAM-1， NF-κB after 1 day or 7 days demonstrated no statistically significant change in group A， B， C （Pgt;0.05）. The preventive effect for allograft vessel atheromatosis in group A and group B was ber than that in group C after 14, 21 and 28d (Plt;0.05). There were no significant difference between group A and group B (Pgt; 0.05). Conclusion The n-3 polyunsaturated fatty acids can prevent the allograft vessel atheromatosis, the most effective dose of n-3 polyunsaturated fatty acids is 300 mg/kg.
Objective To investigate the methods and effectiveness of multi ple surgical treatment for complex aortic arch and descending aorta disease, including cardiopulmonary bypass operation, hybrid operation, and total endovascular aneurysm repair (EVAR). Methods Between October 2006 and September 2011, 48 patients with complex aortic arch anddescending aorta disease were treated. There were 31 males and 17 females, aged from 28 to 81 years (mean, 52.4 years). The disease duration ranged from 1 to 90 days (mean, 10.2 days). There were 30 cases of type B aortic dissection involving the aortic arch, 11 cases of thoracic aortic aneurysm, 3 cases of thoracic pseudoaneurysme, 3 cases of penetrating aortic ulcer, and 1 case of aortoesophageal fistula. Cardiopulmonary bypass operation, hybrid operation, and total EVAR were performed in 15, 12, and 21 cases, respectively. Results In the patients undergoing cardiopulmonary bypass operation, the following complications occurred: 1 case of bleeding, 1 case of coma, 3 cases of psychiatric disorders, 4 cases of pneumonia, 2 cases of acute renal insufficiency, and 2 cases of multi-organ dysfunction; finally 3 patients died. In the patients undergoing hybrid operation, cerebral infarction and renal function failure occurred in 1 case. In the patients undergoing total EVAR, no complication occurred. A total of 41 patients were followed up 2 to 60 months (mean, 28.6 months). Sl ight left subclavian steal syndrome occurred in 3 cases, but self rel ieved. Other patients recovered to normal l ife. Conclusion In the surgical treatments of complex aortic arch and descending aorta disease, cardiopulmonary bypass operation will be gradually replaced by EVAR because of the surgical trauma and risk, hybrid operation is an important technique, and total EVAR will be the future progress.
Objective To investigate the surgical technique of establ ishing a rel iable rat model of orthotopic l ivertransplantation. Methods A total of 200 adult male SD rats weighing 200-250 g and 60 adult male Wistar rats weighing230-280 g were adopted. The weight of donor was 30 g less than that of receptor. Syngeneic group of SD-SD rats (SD-SD group, n=70) and allogeneic group of SD-Wistar rats (SD-Wistar group, n=60) l iver transplantation were performed, respectively. Orthotopic l iver transplantations in rats were performed using modified Kamada’s two-cuff technique. Under the sufficient exposure of the porta hepatis, the l iver was perfused through the cold of perfusion of portal vein without touching the l iver. The anastomosis of the suprahepatic vena cave was sutured end- to-end with 8-0 prolene l ine. Guided by double l ine, the continuity of portal vein was establ ished by cuff method easily. The fluid was supplemented sufficiently after operation to maintain the stabil ization of hemodynamics. Results The time for donor operation and receptor operation was (38.2 ± 2.5) minutes and (45.6 ± 3.5) minutes, and anhepatic time was (15.1 ± 2.2) minutes.The successful rate was 93%. The survival rate after 1 week was 92%. There was a significant difference when compared with traditional method (P lt; 0.05). There were 64 survivals in SDSD group and 57 in SD-Wistar group after l iver transplantation, and the survival time was 2-9 months (mean 145 days) and 8-20 days (mean 10.5 days) respectively. The l iver function recovered well in SD-SD group, while in SD-Wistar group the l iver functional failure and acute rejection occurred in pathology 3-5 days after l iver transplantation, all of which ended with death without any therapy. Conclusion The modified method is proved to be ideal for its advantages of simple operation, short anhepatic phase and high operative successful rate.
Objective To summarize the cl inical experience of vascular bypass grafting combined with endovascularaortic repair (EVAR) for aortic dilatation disease. Methods Between January 2008 and August 2011, 12 patients with aorticdilatation disease were treated with vascular bypass grafting combined with EVAR. Of 12 patients, 11 were male and 1 wasfemale, aged 47-81 years (mean, 65.9 years). All cases were diagnosed through computed tomography angiography (CTA),including 1 case of Stanford type A dissection, 5 cases of Stanford type B dissection, 4 cases of aortic arch aneurysm, and 2 casesof abdominal aortic aneurysm. Eight patients received neck artery bypass grafting before EVAR, and 4 patients underwentfemoral artery bypass grafting after EVAR. Results After operation, pulmonary infection occurred in 3 patients, renalinsufficiency in 2 patients, cerebral infarction in 1 case, decreased hemoglobin and platelets in 7 cases, and poor healing of groinwound in 1 case. Eleven patients were followed up 3-42 months, with an average of 18.6 months. In 1 case undergoing EVARof the thoracic and abdominal aorta, EVAR was performed again because new aneurysms formed at 6 months after operation,and the patient achieved good recovery after 3 months. CTA showed reduced false lumen, thrombosis formation, no endoleak,no deformation or displacement of stent, and anastomotic patency of artificial blood vessels in the other patients at 3, 6, and12 months after operation. Conclusion Vascular bypass grafting combined with EVAR can expand the indications forendovascular repair. It not only provides sufficient anchoring area, but also ensures the blood supply to vital organs, simplifiesthe surgical procedure, and reduces the difficulty of endovascular treatment.