L\u00e9ka\u0159\u016fm v \u010cesku se da\u0159\u00ed zvy\u0161ovat po\u010dty transplantac\u00ed srdce, pom\u00e1h\u00e1 jim k tomu i pokro\u010dil\u00e1 technologie, kter\u00e1 org\u00e1n udr\u017euje mimo t\u011blo. Vydr\u017e\u00ed dvakr\u00e1t d\u00e9le ne\u017e p\u0159i standardn\u00edm postupu. <\/p>\n\n\n\n
L\u00e9ka\u0159i v pra\u017esk\u00e9m IKEMu p\u0159edstavili unik\u00e1tn\u00ed p\u0159\u00edstroj, kter\u00fd umo\u017e\u0148uje p\u0159ev\u00e1\u017eet k transplantaci bij\u00edc\u00ed srdce. Dok\u00e1\u017ee a\u017e trojn\u00e1sobn\u011b prodlou\u017eit dobu, po kterou m\u016f\u017ee z\u016fstat mimo t\u011blo, a dokonce i zlep\u0161it kvalitu srdce. <\/p>\n\n\n\n
Vypad\u00e1 jako nen\u00e1padn\u00e1 krabice, dok\u00e1\u017ee ale z\u00e1zraky. Srdce p\u0159ipraven\u00e9 k transplantaci uchov\u00e1 ve stavu, jako by z\u016fstalo v lidsk\u00e9m t\u011ble. P\u0159\u00edstroj zachr\u00e1nil \u017eivot u\u017e 51 pacient\u016fm. Mezi nimi i panu Josefovi. Po 2,5 letech na srde\u010dn\u00ed podpo\u0159e se na\u0161el vhodn\u00fd d\u00e1rce a pak u\u017e to \u0161lo r\u00e1z nar\u00e1z. <\/p>\n\n\n\n
Org\u00e1n po odebr\u00e1n\u00ed cestuje sanitkou nebo letadlem ve steriln\u00edch obalech a speci\u00e1ln\u00edm termoboxu p\u0159i teplot\u011b 34 stup\u0148\u016f. Unik\u00e1tn\u00ed p\u0159\u00edstroj dok\u00e1\u017ee srdce uchovat klidn\u011b a\u017e 10 hodin. To umo\u017e\u0148uje org\u00e1n p\u0159ipraven\u00fd k transplantaci p\u0159ev\u00e1\u017eet t\u0159eba i do zahrani\u010d\u00ed. L\u00e9ky, kter\u00e9 d\u00edky technologii do srdce proud\u00ed, dok\u00e1\u017e\u00ed zlep\u0161it stav d\u00e1rcovsk\u00e9ho org\u00e1nu a l\u00e9ka\u0159i tak m\u016f\u017eou transplantovat i srdce, kter\u00e1 se d\u0159\u00edve nedala pou\u017e\u00edt.<\/p>\n\n\n\n
Za\u010dalo to p\u0159ed 2,5 lety du\u0161nost\u00ed. Ve skute\u010dnosti u\u017e tou dobou panu Josefovi selh\u00e1valo srdce, p\u0159e\u017e\u00edval pak d\u00edky mechanick\u00e9 podpo\u0159e.<\/p>\n\n\n\n
Josef S., pacient po transplantaci srdce<\/strong> P\u0159i\u0161el telefon, jestli bych byl ochoten p\u0159ijet, \u017ee n\u011bco zase je na obzoru. <\/p>\n\n\n\n Byl to d\u00e1rce. P\u0159ed transplantac\u00ed panu Josefovi l\u00e9ka\u0159i nechali bij\u00edc\u00ed org\u00e1n v speci\u00e1ln\u00ed schr\u00e1nce. Ta supluje krevn\u00ed ob\u011bh.<\/p>\n\n\n\n Miroslav Ko\u0148a\u0159\u00edk, vedouc\u00ed programu ex-vivo perfuze srdce<\/strong> M\u011bli jsme informace, \u017ee ten \u0161t\u011bp je vystaven negativn\u00edmu p\u016fsoben\u00ed vy\u0161\u0161\u00edch d\u00e1vek farmak, tak\u00e9 toxick\u00fdch l\u00e1tek v r\u00e1mci mozkov\u00e9 smrti, co\u017e je b\u011b\u017en\u00fd fyziologick\u00fd jev.<\/p>\n\n\n\n Po \u010dty\u0159ech hodin\u00e1ch bylo jasn\u00e9, \u017ee srdce je v po\u0159\u00e1dku a i \u0161ance, \u017ee se ujme v t\u011ble pana Josefa, je vysok\u00e1.<\/p>\n\n\n\n Mroslav Ko\u0148a\u0159\u00edk, vedouc\u00ed programu ex-vivo perfuze srdce<\/strong> Loni l\u00e9ka\u0159i v \u010cesku provedli 101 transplantac\u00ed srdce. V\u011bt\u0161inu z nich pr\u00e1v\u011b tady v IKEMu, zhruba p\u011btinu p\u0159\u00edpad\u016f by neuskute\u010dnili bez syst\u00e9mu Transmedics<\/strong>. D\u00edky n\u011bmu udr\u017e\u00ed srdce funk\u010dn\u00ed a\u017e deset hodin, tedy v\u00edc ne\u017e dvakr\u00e1t d\u00e9le oproti tomu, kdy se org\u00e1n pouze vyjme a chlad\u00ed, vydr\u017e\u00ed tak i p\u0159eshrani\u010dn\u00ed transporty.<\/p>\n\n\n\n Zdravotn\u00edci v IKEM maj\u00ed tento speci\u00e1ln\u00ed p\u0159\u00edstroj k dispozici u\u017e t\u00e9m\u011b\u0159 6 let.<\/strong><\/p>\n\n\n\n Unik\u00e1tn\u00ed p\u0159\u00edstroj udr\u017euje d\u00e1rcovsk\u00e9 srdce v t\u00e9m\u011b\u0159 p\u0159irozen\u00e9m stavu, proto\u017ee je fyziologicky prokrvov\u00e1no okysli\u010denou krv\u00ed, tepe a z\u016fst\u00e1v\u00e1 tak pln\u011b vit\u00e1ln\u00ed i p\u0159i p\u0159eprav\u011b na dlouh\u00e9 vzd\u00e1lenosti. \u201eSrdce je po celou dobu transportu v p\u0159\u00edstroji, kdy pracuje proti minim\u00e1ln\u00edmu odporu. Z\u00e1rove\u0148 je optim\u00e1ln\u011b vy\u017eivov\u00e1no. D\u00e1v\u00e1me mu tak v\u00fdrazn\u011b lep\u0161\u00ed podm\u00ednky pro to, aby se mohlo zotavit, p\u0159\u00edpadn\u011b pro to, abychom transport mohli prodlou\u017eit a\u017e na dvojn\u00e1sobek obecn\u011b tolerovan\u00e9 bezpe\u010dn\u00e9 doby p\u0159evozu – m\u016f\u017ee to b\u00fdt a\u017e 8-9 hodin,<\/em>\u201c<\/em>\u0159\u00edk\u00e1 MUDr. Miroslav Ko\u0148a\u0159\u00edk, vedouc\u00ed programu ex-vivo perfuze srdce Kliniky kardiovaskul\u00e1rn\u00ed chirurgie IKEM. Na transportech se p\u0159itom krom\u011b zdravotn\u00edk\u016f a dal\u0161\u00edch zam\u011bstnanc\u016f nemocnice pod\u00edlej\u00ed tak\u00e9 Arm\u00e1da \u010cR a Policie \u010cR. \u201e<\/em>Bez jejich pomoci bychom nemohli tyto logisticky n\u00e1ro\u010dn\u00e9 transporty v\u016fbec uskute\u010dnit. V\u0161em z\u00fa\u010dastn\u011bn\u00fdm pat\u0159\u00ed velk\u00fd d\u00edk za vst\u0159\u00edcnost, flexibilitu a ochotu pom\u00e1hat,<\/em>\u201c<\/em> dopl\u0148uje. <\/p>\n\n\n\n Jedn\u00e1 se o jedinou technologii sv\u00e9ho typu schv\u00e1lenou i americkou FDA (\u00da\u0159ad pro kontrolu potravin a l\u00e9\u010div). Krom\u011b prost\u00e9 d\u00e1lkov\u00e9 p\u0159epravy ale um\u00ed org\u00e1n i zotavit. A za 6 let pomohl l\u00e9ka\u0159\u016fm d\u00edky mo\u017enosti p\u0159\u00edstrojov\u00e9 rekondice jinak neakceptovateln\u00fdch d\u00e1rcovsk\u00fdch org\u00e1n\u016f zachr\u00e1nit des\u00edtky \u017eivot\u016f nav\u00edc. \u201eTechnologie n\u00e1m umo\u017e\u0148uje vyu\u017e\u00edt i srdce od takzvan\u00fdch margin\u00e1ln\u00edch d\u00e1rc\u016f, tedy t\u011bch, jejich\u017e org\u00e1n bychom b\u011b\u017en\u011b museli odm\u00edtnout. D\u00edky tomu m\u016f\u017eeme transplantaci nab\u00eddnout v\u00edce p\u0159\u00edjemc\u016fm. Zd\u016fraz\u0148uji ale, \u017ee se nejedn\u00e1 o \u017e\u00e1dn\u00e9 nekvalitn\u00ed org\u00e1ny. Jde o srdce, kter\u00e1 maj\u00ed p\u0159echodn\u011b v\u00fdrazn\u011b zhor\u0161enou funkci v d\u016fsledku negativn\u00edch dopad\u016f mozkov\u00e9 smrti d\u00e1rce. Po n\u011bkolika hodin\u00e1ch na p\u0159\u00edstroji se ale m\u016f\u017ee jejich metabolick\u00e1 kondice zlep\u0161it natolik, \u017ee se stanou vhodn\u00fdmi pro transplantaci. \u00dasp\u011b\u0161nost je velmi vysok\u00e1, v r\u00e1mci programu nedo\u0161lo p\u0159i pe\u010dliv\u00e9m v\u00fdb\u011bru potenci\u00e1ln\u011b vhodn\u00fdch srdc\u00ed k jejich zotaven\u00ed pouze ve dvou p\u0159\u00edpadech,\u201c<\/em> vysv\u011btluje prof. MUDr. Ivan Netuka, p\u0159ednosta Kliniky kardiovaskul\u00e1rn\u00ed chirurgie IKEM. Pr\u00e1v\u011b to umo\u017e\u0148uje l\u00e9ka\u0159\u016fm navy\u0161ovat po\u010det transplantac\u00ed srdce oproti minulosti. <\/p>\n\n\n\n Krom\u011b pacient\u016f p\u0159\u00edmo v Institutu klinick\u00e9 a experiment\u00e1ln\u00ed medic\u00edny slou\u017e\u00ed syst\u00e9m TransMedics OCSTM<\/sup> Heart i CKTCH Brno a d\u011btsk\u00fdm pacient\u016fm ve FN Motol. Moravsk\u00e1 metropole vyu\u017eila spolupr\u00e1ce ji\u017e ve t\u0159ech p\u0159\u00edpadech. U d\u011bt\u00ed je \u0161ance na nalezen\u00ed vhodn\u00e9ho d\u00e1rce ni\u017e\u0161\u00ed ne\u017e u dosp\u011bl\u00fdch kv\u016fli po\u017eadavk\u016fm na velikost org\u00e1nu a v\u011bk, proto m\u00e1 velk\u00fd v\u00fdznam prodlou\u017een\u00ed vzd\u00e1lenosti, ze kter\u00e9 je mo\u017en\u00e9 srdce dopravit. \u201eProgram transplantac\u00ed srdce u d\u011bt\u00ed v D\u011btsk\u00e9m kardiocentru 2. LF UK a FN Motol vznikl p\u0159ed 12 lety za velk\u00e9 podpory IKEM. Od t\u00e9 doby bylo u d\u011bt\u00ed transplantov\u00e1no 43 srdc\u00ed. Z toho ve \u010dty\u0159ech p\u0159\u00edpadech pomohl pr\u00e1v\u011b syst\u00e9m TransMedics. U dvou srdc\u00ed umo\u017enil transport ze zahrani\u010d\u00ed a u dvou pomohl p\u0159i sledov\u00e1n\u00ed funk\u010dn\u00edch parametr\u016f d\u00e1rcovsk\u00e9ho srdce,\u201c <\/em>uv\u00e1d\u00ed MUDr. Karel Koubsk\u00fd, Ph.D., vedouc\u00ed transplanta\u010dn\u00edho programu D\u011btsk\u00e9ho kardiocentra 2. LF UK a FN Motol. \u201eZa mo\u017enost vyu\u017e\u00edt tento syst\u00e9m a za dlouhodobou perfektn\u00ed a v\u017edy vst\u0159\u00edcnou spolupr\u00e1ci s IKEM v oblasti transplanta\u010dn\u00ed medic\u00edny a dlouhodob\u00fdch mechanick\u00fdch srde\u010dn\u00edch podpor jsme velmi vd\u011b\u010dn\u00ed,\u201c <\/em>dopl\u0148uje doc. MUDr. Ond\u0159ej Materna, Ph.D., p\u0159ednosta D\u011btsk\u00e9ho kardiocentra 2. LF UK a FN Motol.<\/p>\n\n\n\n P\u0159\u00edstroj IKEM dostal v roce 2019 darem od Nada\u010dn\u00edho fondu Kapka nad\u011bje a spole\u010dnosti Shell Czech Republic. \u201e<\/em>Znovu d\u011bkuji za jeho po\u0159\u00edzen\u00ed, i v\u0161em zdravotn\u00edk\u016fm a nel\u00e9ka\u0159sk\u00fdm profesion\u00e1l\u016fm, jejich\u017e z\u00e1sluhou se ho da\u0159\u00ed vyu\u017e\u00edvat na pravideln\u00e9 b\u00e1zi. Jedn\u00e1 se o z\u00e1sadn\u00ed posun Pohled perfuzionisty<\/strong> <\/strong>T\u00fdm k odb\u011bru srdce s TransMedics OCSTM <\/sup>Heart tvo\u0159\u00ed 2 kardiochirurgov\u00e9, perfuzionista, anesteziologick\u00e1 sestra a transplanta\u010dn\u00ed koordin\u00e1tor. Je k dispozici 24\/7. Role perfuzionisty spo\u010d\u00edv\u00e1 v technick\u00e9m zaji\u0161t\u011bn\u00ed syst\u00e9mu, jeho p\u0159\u00edprav\u011b \u2013 tzv. settingu (\u00fakony sm\u011b\u0159uj\u00edc\u00ed k p\u0159\u00edprav\u011b syst\u00e9mu pro n\u00e1slednou implantaci org\u00e1nu chirurgem, tj. spr\u00e1vn\u00e9 slo\u017een\u00ed provozn\u00edho roztoku, jeho optimalizace, se\u0159\u00edzen\u00ed line\u00e1rn\u00edch d\u00e1vkova\u010d\u016f atp.) a n\u00e1sledn\u00e9 obsluze (kooperace s chirurgy). <\/p>\n\n\n\n Samotn\u00fd p\u0159\u00edstroj se d\u00e1 velmi zjednodu\u0161en\u011b popsat jako varianta mimot\u011bln\u00edho ob\u011bhu, kter\u00fd pou\u017e\u00edv\u00e1me u kardiochirurgick\u00fdch operac\u00ed. Skl\u00e1d\u00e1 se z vlastn\u00edho p\u0159\u00edstroje (jeho\u017e sou\u010d\u00e1st\u00ed je monitorace sledovan\u00fdch pr\u016ftokov\u00fdch parametr\u016f org\u00e1nu, resp. EKG), kter\u00fd je pro jednotliv\u00fd p\u0159\u00edpad osazena jednor\u00e1zov\u00fdm steriln\u00edm setem; tento sest\u00e1v\u00e1 mj. z perfuzn\u00edho rezervo\u00e1ru, \u010derpadla, oxygen\u00e1toru (zde doch\u00e1z\u00ed k okysli\u010den\u00ed a odstran\u011bn\u00ed CO2 z krve), tepeln\u00e9ho v\u00fdm\u011bn\u00edku, soustavy line\u00e1rn\u00edch d\u00e1vkova\u010d\u016f apod. <\/p>\n\n\n\n B\u011bhem uchov\u00e1v\u00e1n\u00ed org\u00e1nu v syst\u00e9mu sledujeme pr\u016ftokov\u00e9 a metabolick\u00e9 parametry org\u00e1nu a ty jsme schopni na\u0161imi z\u00e1sahy optimalizovat, a tak poskytnout srdci ty nejlep\u0161\u00ed podm\u00ednky.<\/p>\n\n\n\n Po p\u0159ivol\u00e1n\u00ed do slu\u017eby za\u010d\u00edn\u00e1me rutinn\u00ed p\u0159\u00edpravou v IKEM, kter\u00e1 trv\u00e1 cca t\u0159i \u010dtvrt\u011b hodiny; b\u011bhem t\u00e9to prob\u00edh\u00e1 kontrola pot\u0159ebn\u00e9ho materi\u00e1lu (l\u00e9ky, roztoky, krevn\u00ed analyz\u00e1tory, defibril\u00e1tor Po p\u0159\u00edjezdu do d\u00e1rcovsk\u00e9 nemocnice a po kontrole aktu\u00e1ln\u00edch parametr\u016f d\u00e1rce a makroskopii srdce za\u010d\u00ednaj\u00ed kardiochirurgov\u00e9 odb\u011br srdce a my perfuzionist\u00e9 p\u0159\u00edpravu syst\u00e9mu na vlo\u017een\u00ed srdce. Pot\u0159ebujeme odebrat 1200-1500 ml krve od d\u00e1rce, kterou spolu se speci\u00e1ln\u00edm roztokem pln\u00edme syst\u00e9m, odvzdu\u0161\u0148ujeme, instalujeme m\u011b\u0159\u00edc\u00ed prvky, pomocn\u00e9 roztoky, testujeme biochemick\u00e9 parametry n\u00e1pln\u011b a upravujeme je p\u0159id\u00e1v\u00e1n\u00edm aditiv. Do p\u0159ipraven\u00e9ho syst\u00e9mu l\u00e9ka\u0159i vlo\u017e\u00ed zakanylovan\u00e9 srdce a za\u010d\u00edn\u00e1 vlastn\u00ed kontrolovan\u00e1 perfuze. Po stabilizaci hodnot zahajujeme cestu k p\u0159\u00edjemci. B\u011bhem cesty pokra\u010duje nep\u0159etr\u017eit\u00e1 kontrola v\u0161ech pot\u0159ebn\u00fdch hodnot tlak\u016f, pr\u016ftok\u016f a laboratorn\u00edch v\u00fdsledk\u016f. Po p\u0159\u00edjezdu k p\u0159\u00edjemci v sou\u010dinnosti s transplantuj\u00edc\u00edm t\u00fdmem je perfuze ukon\u010dena a \u0161t\u011bp je transplantov\u00e1n. N\u00e1sledn\u011b v\u0161e p\u0159ipravujeme na nov\u00fd v\u00fdjezd.<\/p>\n","protected":false},"excerpt":{"rendered":" L\u00e9ka\u0159\u016fm v \u010cesku se da\u0159\u00ed zvy\u0161ovat po\u010dty transplantac\u00ed srdce, pom\u00e1h\u00e1 jim k tomu i pokro\u010dil\u00e1 technologie, kter\u00e1 org\u00e1n udr\u017euje mimo t\u011blo. Vydr\u017e\u00ed dvakr\u00e1t d\u00e9le ne\u017e […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":58529,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-58497","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/58497","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=58497"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/58497\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/58529"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=58497"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=58497"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=58497"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
To srdce bylo ze Slovenska. Sanitka, letadlo, sanitka, \u010dili ten transport samotn\u00fd trval jen 4,5 hodiny.<\/p>\n\n\n\n
v kvalit\u011b transplantac\u00ed srdce v \u010cesk\u00e9 republice. P\u0159in\u00e1\u0161\u00ed nemocn\u00fdm v\u011bt\u0161\u00ed \u0161anci, \u017ee se do\u010dkaj\u00ed nov\u00e9ho org\u00e1nu,<\/em>\u201c<\/em> uzav\u00edr\u00e1 \u0159editelka IKEM Ing. Helena R\u00f6gnerov\u00e1.<\/p>\n\n\n\n
Mgr. Romana Ku\u0161i\u010dkov\u00e1, ECCP, sestra pro klinickou perfuziologii, Klinika kardiovaskul\u00e1rn\u00ed chirurgie, Kardiocentrum IKEM<\/strong><\/p>\n\n\n\n
a v neposledn\u00ed \u0159ad\u011b p\u0159\u00edstroj pro ex-vivo perfuzi) a jeho p\u0159esun do dopravn\u00edch prost\u0159edk\u016f, nej\u010dast\u011bji sanitn\u00edch voz\u016f. <\/p>\n\n\n\n