Modified Orthotopic Heart Transplantation

An orthotopic heart transplantation is the implantation of a donor heart in situ after resection of the recipient's diseased heart. According to different right heart connection methods, it is divided into standard orthotopic heart transplantation and modified orthotopic heart transplantation. Treating diseases: heart disease, surgical procedures 1. Total Atrial Heart Transplantation Recent studies have found that there are some anatomical and physiological deficiencies in the "standard" procedure of orthotopic heart transplantation introduced by Shumway et al. Mainly due to the fact that the receptor and donor each have their own sinus node, which makes the receptor and donor atrium contraction, and there may be arrhythmia and the possibility of secondary and tricuspid regurgitation in the long term. And convex to the atrial line of the suture, so that vortex in the atrium, easy to form a thrombus in the atrium. To this end, Reitz et al. proposed an orthotopic heart transplant after total cardiac resection. Surgical steps: (1) Cut the heart: the main and pulmonary artery cutting planes are the same as the traditional ones. The superior vena cava should be cut at the entrance of the azygous vein, and the inferior vena cava should be cut off at the distal side of the iliac crest. When the left atrium is removed, the upper left and lower veins are left in one cuff in the posterior wall of the left atrium, and the upper and lower veins in the right lung are in the other sleeve-like incision. Wait until the recipient's left atrium left and right cuffs respectively. (2) Resection of the heart of the lesion receptor: The aortic intubation method is the same as the traditional method. The superior and inferior vena cava cannula are as far as possible from the heart, and are inserted into the superior and inferior vena cava respectively by right angle cannula. The main and pulmonary arteries are cut horizontally from the semilunar valve. The right atrium was cut from the entrance of the superior and inferior vena cava atrium, and the left superior and inferior veins were retained in a sleeve-shaped incision, and the upper left and lower veins were in another sleeve-shaped incision. (3) implantation of the donor heart: the graft anastomosis starts from the left pulmonary vein, and then the right pulmonary vein is anastomosed. The anastomosis is generally sutured by a 5-0 polypropylene thread. End-to-end anastomosis of the superior and inferior vena cava, first anastomosis of the inferior vena cava, Finally, the main and pulmonary artery were anastomosed, and the latter was the same as the standard orthotopic heart transplantation. 2. Double Vena Cava Anastomosis for Orthotopic Heart Transplantation Sarsam reported in 1993 the method of double-chamber vein orthotopic heart transplantation. This method has the advantage of full heart orthotopic transplantation, that is, there is only one sinus node, and the atrial contraction does not cause the disorder of blood flow in the atrium like the standard orthotopic heart transplantation, resulting in mitral and tricuspid valve leaflets. The closure is incomplete, and it can also overcome the shortcomings of the operation of the atrial orthotopic transplantation of the anastomosis of the pulmonary vein. Surgical points: The treatment of the superior and inferior vena cava and right atrium of the donor and recipient is similar to a total atrial orthotopic heart transplantation. The operation of the left atrium is similar to standard orthotopic heart transplantation. The order of anastomosis was left atrium inferior vena cava superior vena cava aorta pulmonary artery.

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