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,2021,20(06):532-537.[doi:10.12260/lcxewkzz.2021.06.006]
4例婴儿心脏移植的单中心经验总结
- Title:
- Infantile heart transplantation: a report of four cases from a single center
- 分类号:
- R541.1;R726.542.8
- 摘要:
- 目的 总结婴儿心脏移植的临床经验。方法 2008年1月到2020年12月华中科技大学同济医学院附属协和医院共完成婴儿心脏移植4例，受者年龄（4.75±2.75）个月，体重（5.18±1.98）kg，于全身麻醉、中低温体外循环下行原位心脏移植术，1例在摘除受体心脏后，深低温停循环下同期行主动脉缩窄矫治术。术后延迟关胸，加强脏器功能支持，并防治排斥反应和感染。结果 4例患者围术期全部存活。体外循环时间（122.50±32.60）min，主动脉阻断时间（47.00±25.86）min。4例全部延迟关胸，无伤口感染发生。2例因术后移植物功能衰竭行ECMO辅助，辅助时间分别为115 h和253 h，均顺利脱机。3例发生急性肾功能不全行腹膜透析治疗5~27 d。4例患者呼吸机辅助时间92~2 054 h，均发生了肺部感染。ICU停留时间15~117 d，术后住院时间70~129 d。随访1~6.5年，4例患者心功能良好，无临床排斥反应发生。1例发生癫痫，其余未发生肝肾功能异常、新发糖尿病、血脂异常、皮肤病变、肿瘤、淋巴系统增生性疾病等免疫抑制剂相关并发症。结论 心脏移植是婴儿终末期心力衰竭的有效治疗方法，对手术及围术期处理有较高的要求。
- 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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备注/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