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

Authors：

 簡勁峰 ¹ , 封加濤 ¹ , 彭峰 ¹ , 蘇艷玲 ¹ , 葉華安 ¹ , 林家旺 ¹ , 陳良萬 ² , 黃雪珊 ² , 吳錫階 ²

1. ;
2. ;

Corresponding?author：

簡勁峰, Email: jjfeng@fsyyy.com

Keywords：

心臟移植; 免疫抑制; 治療效果

DOI：

10.7507/1007-4848.201607006

Video：

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目的總結 14 例原位心臟移植的治療經驗。方法回顧性分析 2006 年 1 月至 2015 年 9 月我院行原位心臟移植術終末期心臟病患者的臨床資料，其中男 11 例、女 3 例，年齡 22～62（46.7±10.1）歲。4 例使用抗 Tac 單克隆抗體誘導治療，10 例使用巴利昔單克隆抗體誘導治療。采用 4℃ 組氨酸-色氨酸-酮戊二酸（HTK）液保護供心。2 例采用經典式原位心臟移植，12 例采用雙腔靜脈法行心臟移植。術后采用環孢素或他克莫司+嗎替麥考酚酯+激素三聯抗排斥方案。結果術后早期 1 例因多器官功能衰竭合并嚴重感染死亡。早期并發癥有：敗血癥 1 例，硬膜外血腫 1 例，急性腎功能不全 1 例，移植物右心功能不全 2 例，低心排血量并需要體外膜肺氧合支持 1 例。術后長期隨訪：截至 2016 年 6 月，2 例失訪，1 例于術后 30 個月因自行停服抗排斥藥物死于急性排斥，1 例于術后 36 個月死于肺癌。余 9 例存活 9～121 個月，生活質量良好。結論心臟移植是治療終末期心臟病的有效方法，熟練的手術技巧、合理的免疫抑制治療，圍術期管理經驗、密切監測和治療感染和排斥及患者依從性均影響著心臟移植的效果。

Citation： 簡勁峰, 封加濤, 彭峰, 蘇艷玲, 葉華安, 林家旺, 陳良萬, 黃雪珊, 吳錫階. 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.	楊守國, 王春生, 陳昊, 等. 298 例原位心臟移植受者遠期療效分析.中華移植雜志(電子版), 2011, 5(2): 101-105.
2.	胡盛壽, 董念國, 魏翔, 等. 我國心臟移植現狀分析—2013 年中國心臟移植年度報告. 中華器官移植雜志, 2014, 35(6): 324-328.
3.	陳良萬, 陳道中, 楊國鋒, 等. 61 例心臟移植術的供心獲取. 中國胸心血管外科臨床雜志, 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.	楊國鋒, 陳道中, 陳良萬, 等. 改善的心臟移植術前準備方法對已停跳供心心肌的保護作用. 福建醫科大學學報, 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, 陳鑫, 蔣英碩, 等. 心臟移植術后急性排異反應的無創性監測. 中國醫師雜志,2014, 16(8): 1035-1038.
15.	黃雪珊, 陳道中, 陳良萬, 等. 心臟移植中遠期急性排斥反應的臨床觀察. 南方醫科大學學報,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. 楊守國, 王春生, 陳昊, 等. 298 例原位心臟移植受者遠期療效分析.中華移植雜志(電子版), 2011, 5(2): 101-105.
2. 胡盛壽, 董念國, 魏翔, 等. 我國心臟移植現狀分析—2013 年中國心臟移植年度報告. 中華器官移植雜志, 2014, 35(6): 324-328.
3. 陳良萬, 陳道中, 楊國鋒, 等. 61 例心臟移植術的供心獲取. 中國胸心血管外科臨床雜志, 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. 楊國鋒, 陳道中, 陳良萬, 等. 改善的心臟移植術前準備方法對已停跳供心心肌的保護作用. 福建醫科大學學報, 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, 陳鑫, 蔣英碩, 等. 心臟移植術后急性排異反應的無創性監測. 中國醫師雜志,2014, 16(8): 1035-1038.
15. 黃雪珊, 陳道中, 陳良萬, 等. 心臟移植中遠期急性排斥反應的臨床觀察. 南方醫科大學學報,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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Orthotopic heart transplantation in 14 patients

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