Objective To analyze and summarize the clinical effects and experiences of orthotopic cardiac transplantation for end-stage heart disease.Methods Twenty-five patients underwent orthotopic cardiac transplantation from March 2003 to October 2012 in Qianfoshan Hospital affiliated to Shandong University.The primary diseases included dialated cardiomyopathy in 18 patients,hypertrophic cardiomyopathy in 4,and ischemic heart disease in 3(one also accompanied by abdominal aorta aneurysm).Conventional Standford orthotopic cardiac transplantation was performed in 1 patient and double cavity vein anastomosis method was performed in 24 patients.Seven patients with moderate or severe pulmonary hypertension received nitric oxide inhalation and iloprost intravenous pumping to treat pulmonary arterial hypertension.Immunosuppressive therapy included cyclosporine A,corticosteroid,and mycophenolate mofetile.Six patients received the Tac monoclonal antibody induction therapy during operation,while 14 received the basiliximab monoclonal antibody during anesthesia induction and on postoperative day 4.According to the plasma peak and vale concentration,the dose of cyclosporine A was regulated in time.Results The succesful rate of the operation was 96%(24/25),with 1 patient died of intestinal bleeding in 25 h after operation.The rest 24 patients were followed up(58±37) months(1-116 months).The 1-,3-,5-year survival rate was 87%,82.3%,72.7%,respectively.Acute rejection occurred in 2 cases at early stage and in 4 at late stage after operation,all recovered after cortieasteriod impulse therapy.Renal failure occurred in 2 cases at early stage(renal function recovery after hemodialysis) and in 4 at late stage after operation.Three patients had lung aspergillus infection(2 of them were cured).Two patients died from transplant dysfunction in 14 months and 41 months after operation.One patient was diagnosed as having endometrial neoplasm after 17 months and was cured by hysterectomy.Conclusion Orthotopic cardiac transplantation is a reliable choice for end-stage heart disease.Strict indication,careful management,and regulatory immunosuppressive therapy of perioperative period are required.Moreover,we should pay attention to observation and treatment of acute injection and infection.

尽管提高手术和体外循环技术,改进麻醉和围术期管理,已使体外循环术后肾功能损害明显减少,但肾功能衰竭仍然是心脏直视手术后常见的并发症之一.肾功能损害的诱因往往是多因素的,本文旨在通过对比分析,评价体外循环术后导致肾功能损害的相关性因素.

OBJECTIVE To explore and analyse the risk factors which lead to renal failure after cardiopulmonary bypass surgery.METHODS 60 patients were divided into two groups based on whether they have renal failure after the open-heart surgerys. Correlated analysis was conducted to demonstrate the correlations between various factors and renal failure. RESULTS There are significant difference between two groups in preoperative heart function, cardiopulmonary bypass time, occurrence frequency of lower peri-operative blood pressure, high dosage of catecholamine and bank blood.CONCLUSION Poor preoperative heart function, longer cardiopulmonary bypass time, lower peri-operative blood pressure, huge dosage of catecholamine and bank blood were believed to be important factors for the postoperative renal dysfunction. Preoperative hypertension and diabetes were also considered as risk factors for renal failure.