Abstract
Aim:to show the analysis of 10-year heart transplantation experience, the main complications and problems of the heart transplantation evaluation. Materials and methods.66 orthotopic heart transplantations were performed in patients with terminal chronic heart failure in our clinic since 2008. The heart failure causes were dilated cardiomyopathy in 46 cases (70%), postinfarction cardiosclerosis in 20 cases (30%). The recipients were 59 men (89%) and 7 women (11%), the average age was 46 ± 10 years. All patients had a severe left heart dilatation and critical left ventricular systolic dysfunction (left ventricular EDV 283 ± 58 ml, left ventricular ejection fraction 17 ± 5%, cardiac index 1.5 ± 0.3 l/min/m2). In some recipients, heart transplantation is performed in the second stage after preliminary implantation of mechanical circulatory support systems (LVAD, BVAD). The fi rst heart transplantations were performed using the biatrial technique (8 cases (12%)), the others were performed using the bicaval technique (58 cases (88%)). After the operation, patients received a three-component immunosuppressive therapy: the inhibitors of calcineurin, mycophenolate and corticosteroids.Results.54 patients (82%) were discharged from the clinic after heart transplantation. The hospital mortality was 12 recipients (18%). The mortality in the long-term period was 10 recipients (15%). The hospital mortality cases were acute graft dysfunction in 5 cases (42%), infectious-septic complications in 4 cases (33%), massive intraoperative bleeding in 2 cases (17%), and total thrombosis of pulmonary artery in 1 case (8%). The death causes in the long-term period were acute transplant rejection in 4 cases (40%), coronary artery disease of the transplanted heart in 3 cases (30%), Kaposi’s sarcoma in 1 case (10%), lung cancer in 1 case (10%), and viral pneumonia in 1 case (10%).Conclusion.Over a 10-year period, we have gained a lot of experience in heart transplantation; the procedures complications have been studied; the stages of preservation, harvesting and transportation of the donor heart, operative technique and postoperative treatment of patients have been improved to avoid complications in the early and long-term postoperative period.
Highlights
Цель: провести анализ 10-летнего опыта трансплантации сердца, оценить результаты проведенных операций, определить основные осложнения и проблемы процедуры трансплантации сердца
Materials and methods. 66 orthotopic heart transplantations were performed in patients with terminal chronic heart failure in our clinic since 2008
Heart transplantation is performed in the second stage after preliminary implantation of mechanical circulatory support systems (LVAD, BVAD)
Summary
За 10-летний период в нашей клинике накоплен большой опыт по проведению трансплантации сердца, изучены многие осложнения данной процедуры, усовершенствованы этапы подготовки, забора и транспортировки донорского сердца, проведения операции и послеоперационного лечения пациентов для избежания ряда осложнений в раннем и отдаленном послеоперационном периоде. Over a 10-year period, we have gained a lot of experience in heart transplantation; the procedures complications have been studied; the stages of preservation, harvesting and transportation of the donor heart, operative technique and postoperative treatment of patients have been improved to avoid complications in the early and long-term postoperative period. Годовая выживаемость после пересадки сердца достигает 85%, средняя продолжительность жизни составляет 10,7 года, а среди пациентов, переживших первый год после трансплантации, – 13,5 года [5]. В клинике выполнена серия операций по двухэтапной трансплантации сердца, после предварительной имплантации различных устройств механической поддержки сердца. Целью нашего сообщения явились анализ 10-летнего опыта ТС, оценка результатов трансплантаций сердца, пути совершенствования этого уникального метода лечения терминальной стадии ХСН
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