Release date: 2009-03-31
On March 30th, a group of Chinese researchers conducted a study focusing on the protection of the heart during prolonged ischemia and its impact on heart transplantation outcomes. The team selected 26 patients who experienced more than six hours of cardiac ischemia due to various objective factors, with an average ischemic time of (401 ± 43) minutes. During the surgical procedure, the heart was quickly exposed, and both the left and right chambers were decompressed effectively. A 4°C St. Thomas solution was infused through the aortic root, with a total volume of 500 ml, while the heart surface was washed with ice-cold physiological saline to lower its temperature. After removal, 2000 ml of 4°C UW solution was administered antegrade via the aortic root, and the heart was then stored in UW solution for transport.
For patients with elevated pulmonary arterial pressure, intraoperative administration of thioprostone and continuous inhalation of nitric oxide were used to manage the condition. All 26 patients underwent orthotopic heart transplantation using a double-chamber vein anastomosis technique. The results showed that all patients survived the surgery, with 21 cases experiencing spontaneous re-start of the heart and 5 requiring electrical defibrillation. One week post-surgery, echocardiography confirmed normal chamber sizes, normal pulmonary artery pressures, and normal left ventricular ejection fractions across all patients.
One patient required re-surgery because they could not be weaned off cardiopulmonary bypass due to an abnormal coronary artery opening. Another patient faced challenges in discontinuing ventilator support due to cardiac insufficiency and renal dysfunction, necessitating a tracheotomy and bedside hemodialysis. Two patients developed first-degree atrioventricular block, which was monitored but did not require intervention. One patient had a moderate pericardial effusion, but no specific treatment was needed.
The study concluded that, with effective myocardial protection during the transplant process, donors whose hearts exceeded the standard storage time could still achieve favorable short-term outcomes. However, the researchers emphasized that it is still crucial to keep the heart's preservation time within safe limits whenever possible. This research highlights the importance of refining techniques in heart preservation and transplantation to improve patient outcomes and expand the pool of viable donor organs.
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