China ; Heart Transplantation ; methods ; Humans

OBJECTIVETo summarize the experiences of cardiopulmonary bypass (CPB) techniques in 15 patients of orthotopic heart transplantation.

METHODSAll patients received mild hypothermia and high flow rate perfusion. Effective strategies were taken to protect myocardium, lung, kidney, and blood conservation. The donor hearts were arrested with aorto perfusion using 1 000 ml St. Thomas solution at 4 degrees C, perfused with 1 000 ml University of Wiscosin (UW) solution or Histidin-Tryptophan-Ketoglutarat (HTK) solution at 4 degrees C, and then preserved in ice saline. Ice mud was covered on the donor heart during anastomosis. Low potassium cardioplegia solution was perfused before the unclamping of aorta.

RESULTSThe CPB time was (165.2 +/- 22. 8) min, the warm ischemia time was ( 7. 7 +/- 1. 7) min, and the cold ischemia time was ( 142. 4 +/- 11. 5) min. Heart beats was automatically recovered in 10 patients, and was recovered upon defibrillation in 5 patients. Left ventricular ejection fractions were (64. 1 +/- 4. 6) % after one month. All patients survived.

CONCLUSIONProper CPB management and effective donor heart protection are essential to guarantee the success of heart transplantation.

Cardiopulmonary Bypass ; Heart Transplantation ; methods ; Humans

PURPOSE: The purpose of this study was to describe the lived experience of patients with heart transplantation in Korea. METHODS: Individual indepth interviews and a focus group interview were used to collect the data from nine patients who had heart transplantations in 2015. All interviews were audio-taped and verbatim transcripts were made for the analysis. Data were analyzed using Colaizzi's phenomenological method. RESULTS: Among the nine participants, eight were men. Mean age was 57.30 years. Six theme clusters emerged from the analysis. ‘Joy of rebirth obtained by good luck’ describes the pleasure and expectation of new life after narrow survival. ‘Suffering from adverse drug effects’ illustrates various psychosocial difficulties, such as low self-esteem, helplessness, alienation, and burnout, arising from the side effects of medications. ‘Body and mind of being bewildered’ illustrates disintegrated health and haunting fear of death. ‘Alienation disconnected with society’ describes isolated feeling of existence due to misunderstandings from society. ‘Suffering overcome with gratitude and responsibility’ includes overcoming experience through various social supports and suitable jobs. Finally, ‘acceptance of suffering accompanied with new heart’ illustrate changed perspective of life itself. CONCLUSION: The findings in this study provide deep understanding and insights of the lived experience of heart related illness for these patients and should help in the development of tailored-interventions for patients with heart transplantation.
Emigrants and Immigrants ; Focus Groups ; Heart Transplantation* ; Heart* ; Humans ; Korea ; Life Change Events ; Male ; Methods ; Organ Transplantation ; Pleasure ; Qualitative Research

BACKGROUND: The shortage of human hearts for allotransplantation makes xenotransplantation a possible option for controllable organ providers. To detect acute xenograft rejection, invasive biopsy seems inevitable; however, this occasionally results in poor incision wound healing or infection. To date, no method of noninvasive imaging for early detection of xenograft rejection has been established. We hypothesized that ultrasound speckle tracking would better detect xenograft failure than routine left ventricular ejection fractions (EF). METHODS: From August 2013 to July 2015, a total of six cardiac heterotopic xenotransplants (α 1, 3-galactosyltransferase gene-knockout porcine heart) into cynomolgus monkeys were monitored with echocardiography every 3 to 7 days. M-mode and two-dimensional (2D)-EF measurements and myocardial strain analyses were performed. Cardiac xenograft pathology was reviewed from the immediate postoperative biopsy, as well as the necropsy. RESULTS: Myocardial speckle tracking analysis was feasible in all six cases. The longest survival was 43 days. Only one pathology-proven immunologic rejection occurred. Cardiac xenograft failure appeared as two types: a dilated pattern with decreased EF or a myocardial-thickening pattern with preserved EF. Both antibody-mediated rejection (n=1) and sepsis-induced myocardial dysfunction (n=2) revealed decreased radial or circumferential strains, but normal-range EF. Xenograft functional decline was significant with respect to radial or circumferential strain (P=0.028), but not to conventional M-mode or 2D-EFs (P=0.600, P=0.340, respectively). CONCLUSIONS: Radial and circumferential strains were significantly decreased in both types of xenograft failure, regardless of EF. Further studies are warranted to correlate the strain analysis and immunopathological details.
Biopsy ; Echocardiography ; Heart ; Heart Transplantation ; Heterografts ; Humans ; Macaca fascicularis ; Methods ; Pathology ; Stroke Volume ; Transplantation, Heterologous* ; Transplants* ; Ultrasonography ; Wound Healing

BACKGROUNDMore patients receive organ transplantation surgeries due to the advancement in immunosuppressive agents and surgical techniques. Some of those patients may need to undergo plastic or reconstructive surgery. Long-term use of immunosuppressive agents raises some serious problems. Therefore, this study aimed to introduce our experience about the safety and effectiveness of plastic surgeries after solid organ allograft transplantation.

METHODSA retrospective review of 17 transplant recipients who underwent different reconstructive or cosmetic operations was carried out. The subjects included 1 heart transplant, 1 liver transplant and 15 kidney transplant recipients.

RESULTSAll patients tolerated the plastic surgery procedures well. Flaps and skin grafts were the main constructive methods. There were no postoperative infections and wound dehiscence. Transferred flaps survived completely. Skin grafts took well. Three of the cosmetic surgery patients were satisfied with the results.

CONCLUSIONSImmunosuppressed organ transplant recipients can successfully undergo major reconstructive and cosmetic surgery when given special attention.

Adolescent ; Adult ; Female ; Heart Transplantation ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Liver Transplantation ; Male ; Middle Aged ; Organ Transplantation ; Surgery, Plastic ; adverse effects ; methods ; Young Adult

This paper is aimed to establish a novel abdominal heart transplantation model in mice and to generalize the experience of the successful cases. The thoracic inferior vena cava instead of pulmonary artery was employed to reconstruct the outflow tract of the graft heart (in the new method group, 82 cases). Meanwhile, in other 47 cases as the control group, traditional anastomosis was used between pulmonary artery of the graft and vena cava of the recipient. The recipient surgery time, vena cava-vena cava anastomosis time, graft cold ischemia time and graft re-beating time were (41.5 +/- 1. 5) min, (8.4 +/- 0.6) min, (32.3 +/- 0.4) min and (1.5 +/- 0.2) min respectively. All the above data were statistically superior to those in the traditional method group (P < 0.001 or P < 0.05). The survival rate of 100 d post surgery in the new method group was 93. 9%. Meanwhile, the cardiac tissue remained almost normal examined by HE and Picro-sirus red staining. Therefore, the novel model can facilitate the anastomosis of the outflow tract in recipient operation in mouse heart transplantation model.
Anastomosis, Surgical ; methods ; Animals ; Heart Transplantation ; methods ; Male ; Mice ; Mice, Inbred C57BL ; Models, Animal ; Peritoneal Cavity ; Pulmonary Artery ; surgery ; Transplantation, Heterotopic ; methods ; Vena Cava, Inferior ; surgery

OBJECTIVETo investigate the protective effect of high-pressure carbon monoxide for preservation of ex vivo rabbit heart graft in comparison with the conventional HTK cardioplegic solution preservation.

METHODSHeart grafts isolated from 85 New Zealand rabbits were randomly divided into Naive group (n=5), HTK group (n=40) and CO group (n=40). The grafts underwent no preservation procedures in Naive group, preserved at 4 degrees celsius; in HTK cardioplegic solution in HTK group, and preserved at 4 degrees celsius; in a high-pressure tank (PO2: PCO=3200 hPa: 800 hPa) in CO group with Krebs-Henseleit solution perfusion but without cardioplegic solution. After preservation for 2, 4, 6, 8, 10, 14, 18, and 24 h, 5 grafts from the two preservation groups were perfused for 30 min with a modified Langendorff apparatus and examined for left ventricular systolic pressure (LVSP), left ventricular diastolic pressure (LVDP), arrhythmia score (AS), myocardial ultrestructure, and cardiac enzyme profiles.

RESULTSAfter preservation for 6 to 24 h, the cardiac enzyme profiles and systolic and diastolic functions were significantly better in CO group than in HTK group, but these differences were not obvious between the two groups after graft preservation for 2 to 4 h. Significant changes in the myocardial ultrastructures occurred in the isolated hearts after a 24-h preservation in both CO and HTK groups, but the myocardial damages were milder in CO group.

CONCLUSIONPreservation using high-pressure carbon monoxide can better protect isolated rabbit heart graft than the conventional HTK preservation approach especially for prolonged graft preservation.

Animals ; Carbon Monoxide ; Cardioplegic Solutions ; Glucose ; Heart ; physiology ; Heart Transplantation ; Myocardium ; ultrastructure ; Rabbits ; Tissue Preservation ; methods ; Tromethamine

OBJECTIVE: To determine the application of modified low-potassium dextran (LPD) solution in heart-lung transplantation. METHODS: We used the modified LPD as the lung flush solution of the donor in the first heart-lung transplantation procedure in Hunan. RESULTS: The patient survived 555 days after the surgery and severe infection, lung disfunction or severe graft rejection never occurred. CONCLUSION Modified LPD as lung flush solution of the donor during heart-lung transplantation demonstrates an excellent effect of lung protection.
Adult ; Dextrans ; administration & dosage ; Heart Defects, Congenital ; surgery ; Heart-Lung Transplantation ; methods ; Humans ; Male ; Organ Preservation Solutions ; Potassium ; administration & dosage

Stem cells transplantation is a promising strategy for treating myocardial infarction and/or chronic heart failure; however, with respect to nonischemic heart failure, there are some limitations inherent in the current methods of transplantation. In this study, we investigated the feasibility of a novel method, i. e. transplantation through the root of aorta when the ascending aorta occluded above the sinus aortae. Japanese white ears rabbits were used as chronic heart failure models by intravenous injection of adriamycin. Autologous bone marrow mononuclear cells (MNC) were infused into the root of aorta when the ascending aorta was occluded by a couple of balloons above the sinus aortae. After 4 weeks, ejection fraction was significantly improved in MNC group. In conclusion, we have developed a unique method for efficient and safe cell transplantation based on infusion in aorta. This method, potentially suitable for nonischemic heart failure and could be used to achieve even and global supply of cells in heart.
Animals ; Aorta ; surgery ; Doxorubicin ; Feasibility Studies ; Heart Failure ; chemically induced ; surgery ; Rabbits ; Stem Cell Transplantation ; methods

Animals ; Heart Diseases ; surgery ; Stem Cell Transplantation ; methods ; Stem Cells ; cytology