Clinical experience of 63 cases orthotopic heart transplantation

Abstract

Objective To summarize the clinical experience on 63 patients undergoing orthotopic heart transplantation. Methods Clinical data of 63 cases getting heart transplantation in our centre during the past 13 years was retrospectively reviewed. The protopathy included dilated cardiomyopathy, ischemic heart disease, cardiomyopathy, valvular heart disease and restrictive cardiomyopathy. Stanford standard orthotopic heart transplantation was used in 1 case and bicaval orthotopic heart transpalantation was used in 62 cases. Immunosuppressive therapy with calcineurin inhibitor, mycophenolate mofetile and corticosteroid was adopted. Immunity induction therapy with Tac monoclonal antibody or basiliximab monoclonal antibody was used in 92.1%(58/63) of recipients. Results Four recipients died during the perioperation, one recipients received the second heart transplantation 2 days after operation. The success rate of operation was 92.2% (59/64). The median follow-up time was 43 months up to June 2016.The survival rate was 92.1% after 1 year, 82.1% after 3 years, 71.4% after 5 years. Cardiac function of surviving recipients all recovered to NYHA Ⅰ-Ⅱ. Heart failure occured in 8 cases, two recipients suffering severe pulmonary arterial hypertension pre-operation were successfully discharged from hospital after being applied with intra-aortic balloon bump (IABP) and extracorporeal membrane oxygenation (ECMO). Multiple organ failure occured in 2 cases, kidney function harm occured in 11 cases, acute rejection accured in 9 cases. Conclusions Heart transplantation was an effective treatment method for end stage heart disease, and quality matching between donor and recipient should be based on multi factors. Scientific application of adjuvant therapy like IABP and ECMO could increase success rate of heart transplantation. Key words: Heart transplantation; Immunosuppressive therapy; Cyclosporine concentration; Extracorporeal membrane oxygenation