Zhang Jing,Dong Nianguo,Sun Yongfeng,et al.Infantile heart transplantation: a report of four cases from a single center[J].Journal of Clinical Pediatric Surgery,,20():532-537.[doi:10.12260/lcxewkzz.2021.06.006]
Infantile heart transplantation: a report of four cases from a single center
- CLC:
- R541.1;R726.542.8
- Abstract:
- Objective To summarize institutional experience of surgical strategies,perioperative managements,immunosuppressive regimens and complications of four cases of infantile heart transplantation at a single Chinese center. Methods Four infants of end-stage heart failure underwent orthotopic heart transplantation from January 2014 to December 2020.There were 2 boys and 2 girls with an age of (4.75±2.75) years and a body weight of (5.18±1.98) kg.Under general anesthesia,orthotopic heart transplantation was performed under middle/low-temperature cardio-pulmonary bypass (CPB).For one case of aortic coarctation,aortic arch reconstruction was performed simultaneously.Delayed sternal closure and intensive care of organ function,immunosuppression,infection prevention and nutrition support were offered.Results All 4 cases survived during perioperative period.The mean duration of intraoperative CPB was (122.50±32.60) min and the mean CPB-assisting time was (47.00±25.86) min.The duration of postoperative mechanical ventilation ranged from 92 to 2054 hours and intensive care unit (ICU) stay ranged from 15 to 117 days.Delayed chest closure was performed without surgical site infection.ECMO was employed postoperatively due to a low cardiac output in 2 infants for 115-253 hours and weaned off successfully.Three cases of acute renal insufficiency became cured with peritoneal dialysis.All patients of pulmonary infection recovered with NYHA Class Ⅰ-Ⅱ cardiac function and were discharged.During a follow-up period of 1-6.5 years,there was one case of epilepsy.All of them grew up well without any onset of malignance,allograft dysfunction,new-onset diabetes,dyslipidemia,skin lesion,lymphoproliferative disease or rejection.Conclusion Heart transplantation is effective for end-stage heart disease in infants.The key points of successful transplantation are proper surgical strategies and strict perioperative managements.
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Memo
收稿日期:2021-04-10;。
基金项目:国家自然科学基金（编号：81373170）
通讯作者:周诚,Email:zhoucheng_xhxw@163.com