摘要
目的:回顾性分析我院心脏再次移植术患者的临床资料,探讨再次移植的原因及再次移植治疗的效果。方法:总结2007年8月至2016年6月,在北京阜外医院完成的心脏再次原位移植术患者6例,其中男性5例,女性1例;年龄26~56岁;体质量54~70kg。1例患者为心脏移植术后10年出现巨细胞性心肌炎接受心脏再次移植术。其余5例患者首次心脏移植术后早期出现移植物功能衰竭(PGF)而应用体外膜肺氧合(ECMO)辅助循环,判定为等待移植超紧急状态,并在3个月内进行心脏再次移植术,首次移植和再次移植均采用双腔静脉吻合原位心脏移植术。结果:6例患者接受心脏再次移植术后2例应用ECMO辅助循环,3例应用主动脉内球囊泵反搏(IABP)辅助循环,4例使用连续肾替代治疗(CRRT)。心脏再次移植术后4例存活,2例死亡,2例死亡患者均死于无法逆转的严重并发症。本组心脏再次移植术后病例,呼吸机使用时间,重症监护室(ICU)停留时间及住院时间均比首次移植后明显延长。结论:PGF是心脏移植术后早期再次移植的主要原因,再次移植术后患者往往病情危重,常合并其他并发症,康复时间较长及死亡率高。
Objective： To summarize and analyze the clinical outcomes and reasons of heart re-transplantation in patients suffering from recurrent end-stage heart failure after heart transplantation. Methods ： From 2007 to 2016, 6 patients had been underwent orthotopic cardiac re-transplantation in our center. One patient received heart re-transplantation because of giant cell myocarditis 10 years after first transplantation,5 patients underwent urgent heart re-transplantation due to primary graft failure （PGF） less than 3 months after first heart transplantation. Results： Two cases of patients received extracorporeal membrane oxygenation （ ECMO ） treatment, three cases of patients received intra-aortic balloon pump （IABP） treatment, and four cases of patients received continuous renal replacement therapy （CRRT） treatment after the re-transplantation. In the early stage of postoperative periods, two cases of patients died of severe low cardiac output and complications, the other four cases of patients were cured thoroughly. Conclusion： Retranslated recipients have occurred compromised outcomes compared with first transplant recipients. Patients with primary graft failure suffering from compromised hemodynamic events, especially those eases of patients underwent the post-transplant operation procedure in the period of shorter than 3 months, are not appropriate candidates for re-transplantation operation procedure.
出处
《心肺血管病杂志》
2017年第9期758-761,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
心脏再次移植
原因分析
心脏外科
Heart re-transplantation
Outcomes and reasons analysis
Cardiac surgery
