Study On Heart Transplantation With Marginal Cardiac Grafts

Objective To explore the probability of heart transplantation with prolonged cold ischemic time cardiac grafts and its outcomes in two centers.Methods According to the kind of grafts, two experimental groups were established:marginal donor group (patients received the donor heart with cold ischemic time more than 6-hours) and control group (patients received the donor heart with cold ischemic time less than 6-hours), then:(1)Quality of grafts were detected by pathological section, energy metabolism and the cardiac muscle zymogram between marginal donor group and control group. (2) ECMO were used to support circulation for cases in marginal donor group. (3) In-muscle-electrocardiogram (IMEG) tests were performed in recipients. (4)The terms of outcomes of heart transplantation, ECMO and IMEG were analyzed.Results (1) Outcomes between marginal donor group and control group:there was no significant difference (P>0.05) of achievement ratio in heart transplantation (13/15 vs 28/30) in 30 days after transplantation. (2) Data for quality of grafts were successfully got in marginal donor group and control group. (3) In marginal donor group,11 cases were support by intraoperative ECMO (i-ECMO) and 2 cases after standart cardiopulmonary bypass (s-CPB). As consequence, only 2 cases in this group died. (4) IMEG were performed in recipients with 22 cases positive prediction (14 rejections were confirmed) and 699 cases negative prediction (701 rejections were confirmed). Conclusion (1) There was no significant difference of outcomes between patients who receive the donor hearts with cold ischemic time more than 6-hours and patients who receive the donor hearts with cold ischemic time less than 6-hours. (2) Quality of grafts could predict outcomes of transplantation. (3) intraoperative ECMO (i-ECMO group) or ECMO support after Standard cardiopulmonary bypass (s-CPB group) could support the circulation well for marginal donor recipients. (4) To some extent, IMEG could predicted cardiac rejections.Objective To report the short term results and summarize the experience of heart transplantation with cardiac grafts from donors with high dose dopermin maintenancedMethods From September 2009 to April 2010,3 cases of heart transplantation with Cardiac grafts from donors with high dose Dopermin maintenanced were performed in two centers. Before donor hearts were harvested, donors were maintained to be a good homodynamic stability and, satisfying acid base status, electrolysis and stable haemodynamics without pulmonary edema by high dose dopamine.Results The processes of heart transplantation were successful in 3 cases and the recipients were survived with good life quality.Conclusion Heart transplantation with cardiac grafts from donors after high dose dopamine maintenanced could have good outcomes. Objective To discuss the effectiveness of CBP (continuous blood purification) in heart transplantation. Summarize the experience in perioperative usage.Methods A recipient who was waiting for heart transplantation, with restrictive cardiomyopathy, heart function NYHAâ…£, appeared obstinate heart failure and perennial inadequacy, improved heart function by CBP with the mode of CVVH (Continuous Veno-Venous Hemofiltration). The recipient was treated for 3 days,12 hours per day, the dose of ultrafiltrated is 2000-2200ml/d,25 days later, the recipien undertook heart transplant.22 cases of Orthotopic Heart transplantation and 1 case of heart-kidney transplantation in 2004.6-2009.12 in Zhongshan People's Hospital.2 recipients in 10 before the year of 2005 with ARF in 2-3 days after operation and were treated by CBP for 3,6 days. One recipience in 13 after the year of 2005 with ARF in 0 day after operation and was trented by CBP for 19 days.Results After the treatment of CBP, the recipient was relieved from nausea, vomit and abdominal distention. Urinary production was recovered. The sign of bubble and ascites was disappeared. The biochemistry analysis was normal. The vital sign was stable. The dose of vasoactive agent was decreased obviously. After the heart transplantation, the urinary production maintain 2800ml/d in the first 5 days. The recipient returned to isolation ward on 6th day, without serious right heart failure and infection. One recipience died. The other 2 recipiences who were cured, were provide well renal functions and came back to work.Conclusion The renal insufficiency before heart transplantation is prerenal insufficiency usually. It is reversible, so we should adopt active measure just as CBP. CBP is used for the preparation of heart transplantation, by no means serious renal insufficiency. The reasons of ARF after Heart transplantation are about heart function before operation, the mean blood pressure during operation, heart function and make use of renal-toxic drug. Have effect process can improve the survival rate after Heart transplantation.