How does heart transplant surgery work
Your heart beats more than 100,000 times a day. In just a minute, it pumps over five liters of blood throughout your body. But unlike skin and bones, the heart has a limited ability to repair itself. So if this organ is severely damaged, there’s often only one medical solution: replacing it. Today, nearly 3,500 heart transplants are performed each year in a complex and intricate procedure with no room for error.
你的心脏每天跳动 超过 100,000 次。 在短短一分钟内，它就促使五升以上 的血液泵入你的全身。但与皮肤和骨骼不同的是，心脏 的自我修复能力有限。 所以如果这个器官严重受损， 它通常只有一种医疗解决方案： 更换它。如今，每年执行 近 3,500 例心脏移植, 在错综复杂的过程中, 没有犯错的余地。
The process begins by testing potential recipients to ensure they’re healthy enough for this demanding operation. Doctors are especially concerned with identifying immunocompromising illnesses or any other conditions that could compromise a patient's chance of survival.
首先要测试潜在的接受者 以确保他们足够健康来接受这种艰难的手术。 医生特别关心 识别免疫功能低下的疾病或任何其他可能 危及患者的生存机会的状况。
The next step is to match an eligible recipient with a heart donor. Donors are often comatose patients with no chance of being resuscitated or victims of a fatal event whose hearts are still healthy. In both cases, these patients need to be registered as an organ donor or have their families give consent. And even when a heart is available, surgeons can’t just pair any donor with any recipient. The recipient’s immune system will view a transplanted heart as a foreign organism that must be attacked. So doctors need to match recipients with donors that share their blood type and have similar antigens.
下一步是匹配符合条件的心脏捐赠者的接受者。 捐赠者通常是没有 复活的机会的昏迷患者 或心脏仍然健康的 致命事件受害者。 在这两种情况下，这些患者都需要 登记为器官捐献者， 或让他们的家人同意。 即使有一颗心脏， 外科医生不能直接配对 任何捐赠者和任何接受者。 接受者的免疫系统将会把 移植的心脏看作为 必须受到攻击的外来生物。 所以医生需要匹配接受者 给跟他们有一样血型 并具有相似抗原的捐赠者。
If a match can be made, the surgery can begin. Once the donor's heart is confirmed to be healthy, the organ is immersed in an ice slush and injected with a solution to induce cardiac arrest. These treatments stop the heart from pumping to ensure it can be removed cleanly. Surgeons then place the organ in a mix of cold saline and preservation solution.
如果可以匹配， 手术就可以开始。 一旦捐赠者的心脏 被确认是健康的， 该器官会被浸入冰泥中 并被注入可以促使 心脏骤停的溶液。 这些治疗使心脏停止跳动 以确保它可以被 干净利落地移除。 然后外科医生将放置器官 在冷盐水和保存 溶液的混合物中。
This is when the clock starts. Disconnected from its blood supply, the heart’s cells start taking on damage from lack of oxygen. The organ will only remain viable outside the body for a few hours, so it needs to reach its recipient as fast as possible.
这是时间开始的时候。 与它的血液供应断开， 心脏细胞开始由于缺氧，受到损伤。 器官只会在体外保持有效几个小时， 所以它需要尽可能快的 到达它的接收者。
Once the heart arrives, the recipient is put under general anesthesia. The surgeon makes an incision down the length of the chest, cutting through the breastbone to separate the rib cage and expose the heart. To keep blood flowing while they remove the damaged organ, surgeons use a cardiopulmonary bypass machine. This takes over the heart's job, generating enough force to push blood through the patient's circulatory system.
一旦心脏到达， 接受者会被全身麻醉。 外科医生会沿着胸部的 长度做一个切口， 穿过胸骨来分离肋骨 并暴露心脏。 当他们移除受损器官时， 为了保持血液流动， 外科医生会 使用心肺旁路机。 这接管了心脏的工作， 产生足够的力量来推动血液 并把它泵入患者的循环系统。
After the old heart is removed, the surgeon begins sewing the donor heart into place. This is an incredibly precise process, where each blood vessel and artery must be carefully attached to avoid leaks. The procedure can last several hours, potentially longer if there’s scar tissue from previous surgeries. Once it’s finished, the bypass machine is turned off and blood is allowed to flow into the aorta. Doctors carefully monitor the new heart to ensure it’s beating on its own before sewing the recipient back up.
旧的心脏取出来后， 外科医生开始缝纫 捐赠的心脏到位。 这是一个非常精确的过程， 每个血管和动脉 都必须小心的连接 以避免泄漏。 这个过程可以持续几个小时， 如果有从之前的手术得到的 疤痕组织的话可能会更长。 一旦完成， 旁路机会被关上 和然后血液就可以 流入大动脉。 在缝合接受者之前， 医生会仔细的监测新心脏 以确保它是自己在跳动。
Even after the procedure is complete, there's still work to be done. Surgeons are unable to directly connect the heart to the recipient’s nervous system, and it can take years for the body to fully innervate the new organ. During this period, the transplanted organ has a higher resting heart rate and risk of stroke, making exercise difficult and dangerous. And since it’s incredibly rare to find a perfect match between donor and recipient, the immune system will also have some response to the new heart. Immunosuppressive drugs can help manage the risk of rejection, but they also leave patients open to contracting dangerous infections. It requires constant monitoring and testing to balance these two concerns.
即使在手术完成后，还有工作要做。外科医生无法直接连接心脏 到接受者的神经系统， 身体可能需要数年时间来充分支配新器官。 在此期间，移植的器官会有一个较高的静息心率 和中风的风险，让做运动 变得困难和危险。 而且因为能找到捐赠者 和接受者的 完美匹配非常罕见，免疫系统也会 对新心脏有一些反应。 免疫抑制药物可以帮助 控制拒绝的风险， 但他们也可以让病人 感染危险的病毒。需要持续的监督和测试来平衡这两个问题。
Despite these challenges, about 70% of heart transplant recipients survive for at least five years after the operation, and just over 20% live another 20 years. So when this procedure is successful, it's truly lifesaving. Unfortunately, people in developing countries are often unable to access this surgery, and many viable hearts can’t be donated due to legal and regulatory issues. Thousands of people remain on waiting lists, and many are never able to find a suitable donor.
尽管存在这些挑战，约 70%的心脏移植受者在手术后， 存活了至少五年，超过 20% 的人 还能再活 20 年。 所以当这个手术成功时， 它真的是可以救命的。不幸的是，在不发达的 国家的人们往往无法 接触这个手术， 由于法律和监管问题，很多有可行的心脏无法被捐赠。 仍有数千人在等候名单上，而许多人永远无法 寻找合适的捐赠者。
