【摘要】 目的:探讨超长距离跨省转运脑死亡器官捐献供心进行心脏移植的可行性，观察临床效果。方法:回顾性分析2018年4月—2024年7月在阜外华中心血管病医院长距离跨省转运供心施行心脏移植手术的55例患者的临床资料。通过优化获取的流程，细节把握，流程精准地把控转运途中的各个时间节点，并采用供心到达医院后再次灌注HTK液加强心肌保护，结合超节省手术操作步骤快速开放等综合策略进行围移植手术期管理。结果:围术期结果供心均顺利完成获取，无热缺血时间。开放升主动脉阻断钳后，自动复跳52例，电击复律3例。供心获取(供者心脏阻断灌注至供心打包完成)时间25～34 min,平均(30±2.2) min;供心转运(供心打包完成至供心进入移植手术室)时间209～348 min,平均(295.6±8.5) min;供心冷缺血(供者心脏阻断灌注至供心再次复跳)时间289～488 min,平均(375.23±20.57) min;受体体外循环时间161～596 min,平均(253.27±64.27) min;主动脉阻断时间47～188 min,平均(109.63±23.12) min;术后4 h超敏肌钙蛋白T(cTnT)604.12～2012.56 pg/mL,平均(1242.34±165.23) pg/mL。术后及近期随访结果：体外膜肺氧合辅助8例，其中4例因多器官功能衰竭而死亡，4例治疗好转后撤机。重症感染2例，经积极处理后均好转；急性排斥反应0例。截至2024年6月，随访时间2个月～6年，4例受者死亡，死因分别为重症感染3例、急性排异1例。其余受者心功能良好，生存良好，健康回归社会。结论:超长距离跨省转运器官捐献供心经高铁或民用航空转运，需要加强各时间节点把控，做好中间环节的衔接，采取再次灌注等综合策略进行供心保护，长距离转运是可行的。更多还原

【Abstract】 Objective: Explore the feasibility of long-distance cross provincial transportation of brain dead organ donation(DBD) donor hearts for heart transplantation and observe clinical outcomes. Methods: A retrospective analysis was conducted on the clinical data of 55 patients who underwent heart transplantation with long-distance inter-provincial transported donor hearts at Fuwai Central China Cardiovascular Hospital from April 2018 to July 2024. By optimizing the obtained process, grasping details, and accurately controlling various time nodes during transportation, and using comprehensive strategies such as re infusion of HTK solution after the donor heart arrives at the hospital to enhance myocardial protection, combined with super saving surgical operation steps and rapid opening, perioperative management of transplantation is carried out. Results: Perioperative results: The donor heart was successfully obtained without any hot ischemia time. After opening the AAO blocking forceps, there were 52 cases of automatic rebound and 3 cases of electric shock recovery. The time for obtaining the donor heart(from occlusion of the donor’s aorta to completion of the donor heart bagging) was 25-34 minutes, with an average of 30±2.2 minutes; The time for heart transfer(from the completion of heart bagging to the entry of the heart into the recipient’s operating room) was 209-348 minutes, with an average of 295.6±8.5 minutes; The duration of cold ischemia of the donor heart(from aortic occlusion to beating again) was 289-488 minutes, with an average of 375.23±20.57 minutes; The receptor CPB time was 161-596 min, with an average of 253.27±64.27 min, and the aortic occlusion time was 47-188 min, with an average of 109.63±23.12 min; The levels of high-sensitivity cardiac troponin T(cTnT) ranged after surgery for four hours from 604.12 to 2012.56 pg/mL, with an average of 1242.34±165.23 pg/mL. Postoperative and recent follow-up results: ECMO assisted 8 cases, of which 4 cases died(due to multiple organ failure), and 4 cases improved and were withdrawn from the machine. Two cases of severe infection improved after active treatment. There were no cases of acute rejection reactions. As of June 2024, with a follow-up period of 2 months to 6 years, 4 recipients died during this period, with 3 cases of severe infection and 1 case of acute rejection as the causes of death. The rest of the recipients have good heart function, survive well, and return to society in good health. Conclusion: The long-distance cross provincial transportation of organ donation hearts via high-speed rail or civil aviation requires strengthened control of each time node, good connection between intermediate links, and comprehensive strategies such as reperfusion for extracorporeal circulation heart protection. Long distance transportation is feasible.更多还原