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Sekulovski M, Simonska B, Peruhova M, Krastev B, Peshevska-Sekulovska M, Spassov L, Velikova T. Factors affecting complications development and mortality after single lung transplant. World J Transplant 2021; 11:320-334. [PMID: 34447669 PMCID: PMC8371496 DOI: 10.5500/wjt.v11.i8.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/15/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease. Furthermore, as a therapeutic option for high-risk candidates, single LT (SLT) can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single (double) LT (SSLTx). Still, the long-term overall survival is, in general, better for SSLTx. Despite the great success over the years, the early post-SLT period remains a perilous time for these patients. Patients who undergo SLT are predisposed to evolving early or late postoperative complications. This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction, native lung complications, anastomosis complications, infections, cardiovascular, gastrointestinal, renal, and metabolite complications, and their association with morbidity and mortality in these patients. Furthermore, we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.
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Affiliation(s)
- Metodija Sekulovski
- Department of Anesthesiology and Intensive care, University Hospital Lozenetz, Sofia 1407, Bulgaria
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Bilyana Simonska
- Department of Anesthesiology and Intensive care, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Milena Peruhova
- Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Boris Krastev
- Department of Clinical Oncology, MHAT Hospital for Women Health Nadezhda, Sofia 1330, Bulgaria
| | | | - Lubomir Spassov
- Department of Cardiothoracic Surgery, University Hospital Lozenetz, Sofia 1431, Bulgaria
| | - Tsvetelina Velikova
- Department of Clinical Immunology, University Hospital Lozenetz, Sofia 1407, Bulgaria
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2
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Martínez-Chamorro E, Ibáñez L, Navallas M, Navas I, Cambra F, Gónzalez-Serrano M, Borruel S. Acute cholecystitis in recent lung transplant patients: a single-institution series of 10 cases. Abdom Radiol (NY) 2021; 46:3855-3865. [PMID: 33745020 DOI: 10.1007/s00261-021-03039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the clinical and imaging findings of acute cholecystitis in recent lung transplant patients. METHODS We retrospectively reviewed all abdominal ultrasounds and computed tomography (CT) scans of patients who developed acute cholecystitis in the early postoperative period following lung transplantation from November 2014 to December 2020 in a tertiary care university hospital. RESULTS Ten patients (4.4%) were included in this series (6 male, mean age 62.9 years ± 2.1 [standard deviation]) of a total 227 lung transplant patients performed from November 2014 to December 2020 (172 unilateral and 55 bilateral). Nine (90%) patients received a double-lung transplant and seven (70%) required extracorporeal circulation during surgery. Acute cholecystitis occurred during the initial admission for lung transplantation (average of 33 ± 25.9 days post-transplantation). Six patients (60%) died during admission with an average of 24.3 ± 21.8 days after cholecystectomy. The most frequent imaging findings were gallbladder wall discontinuity or decreased gallbladder mural enhancement (100%, 10 patients) and gallbladder distension (90%, 9 patients). All acute cholecystitis were found to be ischemic / gangrenous at surgery and/or pathology, 40% (4 patients) were hemorrhagic and 30% (3 patients) were perforated, one of them with a cholecystoduodenal fistula. Fungal cholecystitis was demonstrated at histological exam in one patient. CONCLUSION Acute cholecystitis in the early postoperative period after lung transplantation is an important cause of morbidity and mortality. Ischemic or gangrenous cholecystitis prevails. The key imaging findings are parietal perfusion defects and gallbladder distension, which can easily go unnoticed if not specifically looked for.
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Affiliation(s)
- Elena Martínez-Chamorro
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain.
| | - Laín Ibáñez
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - María Navallas
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - Irene Navas
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - Félix Cambra
- Department of General Surgery, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - Matilde Gónzalez-Serrano
- Department of Anesthesiology, Transplant Unit, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
| | - Susana Borruel
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n. 28041, Madrid, Spain
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Beetz O, Bajunaid A, Meißler L, Vondran FWR, Kleine M, Cammann S, Hanke JS, Schmitto JD, Haverich A, Klempnauer J, Ringe KI, Oldhafer F, Timrott K. Abdominal Surgery in Patients with Ventricular Assist Devices: a Single-Center Report. ASAIO J 2020; 66:890-898. [PMID: 32740349 DOI: 10.1097/mat.0000000000001085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study was performed to evaluate the incidence and outcome of patients with ventricular assist devices (VADs) undergoing abdominal surgery at our institution. A total of 604 adult patients who underwent VAD implantation between February 2004 and February 2018 were analyzed retrospectively with a median follow-up time of 66 (6-174) months. Thirty-nine patients (6.5%) underwent abdominal surgery. Elective surgical procedures were performed in 22 patients (56.4%), mainly for abdominal wall hernia repairs, partial colectomies, and cholecystectomies. Early after elective abdominal surgery no patient died, resulting in a median survival of 23 (1-78) months. Emergency surgery was performed in 17 patients (43.6%). The most common emergency indications were intestinal ischemia and/or perforation. Eight patients undergoing emergent surgery (44.4%) died within the first 30 days after primary abdominal operation, mainly due to sepsis and consecutive multiple organ failure, resulting in a dismal median survival of one month (0-52). Patients undergoing abdominal surgery had significantly lower rates of realized heart-transplantation (p = 0.031) and a significantly higher rate of VAD exchange, before or after abdominal surgery, due to thromboses or infections (p = 0.037). Nonetheless, overall survival after primary VAD implantation in these patients (median 38 months; 0-107) was not significantly impaired when compared to all other patients undergoing VAD implantation (median 30 months; 0-171). In summary, elective abdominal surgery can be performed safely when well planned by an experienced multidisciplinary team. Abdominal complications in VAD patients requiring emergent surgery, however, lead to a significant increase in short-term morbidity and a high 30-day mortality rate.
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Affiliation(s)
- Oliver Beetz
- From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Anwar Bajunaid
- From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Luise Meißler
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Florian W R Vondran
- From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Moritz Kleine
- From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Sebastian Cammann
- From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Felix Oldhafer
- From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Kai Timrott
- From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
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Ushijima T, Tanoue Y, Hirayama K, Shiose A. Pneumopericardium suggesting left ventricular assist device-related gastrointestinal complication. J Artif Organs 2020; 23:275-277. [PMID: 31982969 DOI: 10.1007/s10047-020-01154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Abstract
We report an uncommon case of ventricular assist device-related infection and resultant fistula formation into the gastrointestinal tract. A 69-year-old man, who had undergone implantation of a HeartMate II 1 year earlier secondary to ischemic cardiomyopathy, presented to our hospital with a high fever. Computed tomography showed unusual gas collection around the heart apex (i.e., pneumopericardium), which had not been detected before. The patient developed sudden melena with fresh blood without abdominal symptoms 1 month after beginning antibiotic therapy. Emergent colonoscopy showed that the HeartMate II strain relief of the inflow conduit had penetrated the transverse colon. We immediately performed laparoscopy-assisted left-sided hemicolectomy and found intraoperatively that a fistula had formed between the splenic flexure and the pericardial cavity. Subsequently, the HeartMate II system was totally explanted and replaced with an Impella 5.0 for alternative hemodynamic support. In our patient, pneumopericardium might have been an early sign of a hidden gastrointestinal complication. Our experience is a caution for clinicians who manage patients with ventricular assist device support via the apex.
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Affiliation(s)
- Tomoki Ushijima
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yoshihisa Tanoue
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuto Hirayama
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Sanaiha Y, Xing H, Morales RR, Morchi R, Ragalie W, Benharash P. Abdominal Operations After Left Ventricular Assist Device Implantation and Heart Transplantation. J Surg Res 2019; 243:481-487. [DOI: 10.1016/j.jss.2019.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/02/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
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Zevallos-Villegas A, Alonso-Moralejo R, Cambra F, Hermida-Anchuelo A, Pérez-González V, Gámez-García P, Sayas-Catalán J, De Pablo-Gafas A. Morbidity and mortality of serious gastrointestinal complications after lung transplantation. J Cardiothorac Surg 2019; 14:181. [PMID: 31661002 PMCID: PMC6819340 DOI: 10.1186/s13019-019-0983-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. METHODS We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05. RESULTS There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). CONCLUSIONS SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.
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Affiliation(s)
- Annette Zevallos-Villegas
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain.
| | - Rodrigo Alonso-Moralejo
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Félix Cambra
- Department of General and Digestive Surgery, "12 de Octubre" University Hospital, Madrid, Spain
| | - Ana Hermida-Anchuelo
- Department of Anesthesiology, Lung Transplant Unit, "12 de Octubre" University Hospital, Madrid, Spain
| | - Virginia Pérez-González
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Pablo Gámez-García
- Department of Thoracic Surgery, Lung Transplant Unit, "12 de Octubre" University Hospital, Madrid, Spain
| | - Javier Sayas-Catalán
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Alicia De Pablo-Gafas
- Department of Respiratory Medecine, Lung Transplant Unit, "12 de Octubre" University Hospital, "i + 12" Research Institute, Avda de Córdoba s/n, 28041, Madrid, Spain
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7
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Fístula enterocutánea tras el trasplante cardiaco: una secuela de la asistencia ventricular izquierda. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Velásquez-Rodríguez J, Zatarain-Nicolás E, Barrio JM, Ruiz-Fernández M, Valerio M, Fernández-Avilés F. Enterocutaneous Fistula After Heart Transplant: A Consequence of a Left Ventricular Assist Device. ACTA ACUST UNITED AC 2018; 72:595-596. [PMID: 30056997 DOI: 10.1016/j.rec.2018.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/29/2018] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - José María Barrio
- Servicio de Anestesiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Ruiz-Fernández
- Servicio de Cirugía Cardiovascular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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9
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The Spectrum of General Surgery Interventions in Pediatric Patients with Ventricular Assist Devices. ASAIO J 2018; 64:105-109. [DOI: 10.1097/mat.0000000000000609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Pieri M, Scandroglio AM, Müller M, Pergantis P, Kretzschmar A, Kaufmann F, Falk V, Krabatsch T, Arlt G, Potapov E, Kukucka M. Surgical management of driveline infections in patients with left ventricular assist devices. J Card Surg 2016; 31:765-771. [PMID: 27766677 DOI: 10.1111/jocs.12860] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Driveline infections in patients with implantable left ventricular assist devices (VAD) carry increasing risk for pump infection, thromboembolic events, decreased quality of life, and increased hospitalization. We report our experience with a surgical technique for refractory driveline infections without mediastinitis consisting of translocation and wrapping of the driveline with greater omentum tissue. METHODS We retrospectively reviewed data of VAD patients who underwent surgical treatment by translocation and wrapping with omentum for severe chronic driveline infection. RESULTS Thirteen patients were treated between January 2010 and October 2015; 12 (92%) were male, and the mean age was 56 ± 14 years. Ten patients (77%) were managed with driveline sheathing with omentum and repositioning with a new exit site, and three (23%), suffering from driveline fistula, with driveline covering with omentum maintaining the previous exit site. Three episodes of postoperative bleeding (23%) required surgical revision. Twelve patients (92%) were discharged from the hospital and one (8%) died. Nine patients (69%) were free from infection at the time of discharge, and three (23%) had recurrence of infection within the first postoperative year. Only four patients (31%) required admission to the intensive care unit; overall median hospital stay was 23 days (range 7-205 days). CONCLUSIONS Driveline relocation with use of omentum is a feasible and effective procedure in selected cases of chronic severe driveline infection. The risk for perioperative bleeding should be taken into consideration and carefully monitored.
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Affiliation(s)
- Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marcus Müller
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Panagiotis Pergantis
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alexandra Kretzschmar
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Friedrich Kaufmann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic Surgery, Charitè Medicine University, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Georg Arlt
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Marian Kukucka
- Department of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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11
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Badami A, Fehrenbach Prell EA, Murray MA, Johnson MR, Akhter SA, Lozonschi L, Osaki S, Lushaj E, Kohmoto T. A novel approach to prevent post-operative ileus after continuous-flow left ventricular assist device implantation: A retrospective cohort study. Int J Surg 2015; 20:135-9. [PMID: 26118604 DOI: 10.1016/j.ijsu.2015.06.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 05/31/2015] [Accepted: 06/11/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with postoperative ileus (POI), a common post-surgical event, experience intense discomfort. Various treatments targeting prevention of POI have shown to have an unpredictable effect. We introduced a novel postoperative bowel management protocol in patients implanted with a continuous-flow left ventricular assist device (CF-LVAD). The effect of this protocol on POI was evaluated. METHODS Patients receiving an old bowel management protocol (OBMP; 01/2007-03/2009) were compared with those receiving a new bowel management protocol (NBMP; 04/2009-12/2013). The OBMP consisted of advancing the diet as tolerated, bisacodyl suppositories and enemas with the goal of a bowel movement (BM) every 3 days. The NBMP consisted of clear liquids until first BM is achieved, then full liquids until the second BM, then advancing to goal diet. Docusate is given on postoperative day (POD) 1 and bisacodyl PR on POD2 with enemas if ileus develops. Enemas are added POD3 if no BM has occurred. Polyethylene glycol is considered daily for patients prone to constipation. The goal is a BM every 2 days. Patients were made nil per os (NPO) with any signs of ileus. RESULTS One hundred eighteen patients were implanted with CF-LVADs during the study period. The incidence of ileus significantly decreased from 19% in the OBMP group to 4% percent in the NBMP group (p < 0.05). In-hospital mortality was not different between the two groups (6% vs. 2% p = 0.35). CONCLUSIONS A novel postoperative bowel management protocol successfully decreased the incidence of POI following CF-LVAD implant surgery at our institution.
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Affiliation(s)
- Abbasali Badami
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Erika A Fehrenbach Prell
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Margaret A Murray
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Maryl R Johnson
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Shahab A Akhter
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Lucian Lozonschi
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Satoru Osaki
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Entela Lushaj
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
| | - Takushi Kohmoto
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
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Abstract
PURPOSE OF REVIEW Ventricular assist devices (VADs) have revolutionized heart failure management in adults. Recently, VADs have similarly taken a prominent role in the management of end-stage heart failure in children. The purpose of this review is to describe the indications for VADs in children, types of devices available, current outcomes, and future directions of VAD therapy. RECENT FINDINGS There has been a dramatic increase in VAD utilization in children over the last decade. For small children, paracorporeal pneumatic pulsatile pumps (e.g., Berlin Heart EXCOR VAD, Berlin Heart GmbH, Berlin, Germany) are most commonly utilized for long-term support. In older children, intracorporeal continuous flow devices (e.g., HeartMate II Left Ventricular Assist System, Thoratec Corporation, Pleasanton, California, USA and HeartWare Ventricular Assist System, HeartWare Incorporated, Framingham, Massachusetts, USA) have been used and allow the possibility of destination therapy. Other devices, such as the total artificial heart, can be utilized for selected patients. Although overall outcomes of pediatric VADs are favorable, complication rates remain high. The utilization of VADs in complex circulations, such as single ventricle patients, remains infrequent and is associated with a high rate of adverse outcomes. SUMMARY VADs are well-established treatment for end-stage heart failure in children. Further investigation is needed to refine patient selection criteria, minimize complications, and develop additional pediatric-specific devices.
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13
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Miller JR, Lawrance CP, Silvestry SC. Current Options and Practices in Long-Term Ventricular Assist Devices. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Eck DL, Belli EV, Smith CD, Stauffer JA. Laparoscopic cholecystectomy in patients with HeartMate II left ventricular assist devices. J Laparoendosc Adv Surg Tech A 2013; 24:100-3. [PMID: 24368008 DOI: 10.1089/lap.2013.0460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION With an expanding population of patients requiring ventricular assist devices, it is inevitable that these patients will require noncardiac surgery. Ventricular assist devices provide mechanical support for a failing heart either as a bridge to transplant or now as a long-term support if transplant is not available, so-called destination therapy. These devices can add significant technical challenges to abdominal surgery, in that the power supply and drivelines crossing the abdomen can potentially be damaged. The use of preoperative or intraoperative imaging may aid in locating these devices and increase patient safety. MATERIALS AND METHODS We describe a laparoscopic cholecystectomy in two patients supported with HeartMate(®) II (Thoratec Corp., Pleasanton, CA) left ventricular assist devices. Our use of fluoroscopic guidance in port placement is also described. A literature review was performed to assess the frequency of laparoscopic procedures performed on patients with similar ventricular assist devices and of complications associated with the device and other comorbidities. RESULTS Laparoscopic cholecystectomy was performed without significant intraoperative hemodynamic changes. The use of imaging, such as fluoroscopy, can identify the location of the ventricular assist device and its associated drive wires to assure they are not damaged intraoperatively. CONCLUSIONS Laparoscopic cholecystectomy can be performed safely on patients with ventricular assist devices. Complications due to damage to the device can be avoided with the assistance of fluoroscopy to identify the implanted abdominal portions of the ventricular assist device. Each laparoscopic procedure performed on these patients presents the surgeon with unique obstacles in which careful operative planning and intraoperative monitoring are essential.
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Affiliation(s)
- Dustin L Eck
- Department of Surgery, Mayo Clinic , Jacksonville, Florida
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15
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Bartoli CR, Demarest CT, Khalpey Z, Takayama H, Naka Y. Current Management of Left Ventricular Assist Device Erosion. J Card Surg 2013; 28:776-82. [DOI: 10.1111/jocs.12207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Carlo R. Bartoli
- Division of Cardiovascular Surgery; University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Caitlin T. Demarest
- Department of Surgery; Columbia University Medical Center; New York New York
| | - Zain Khalpey
- Department of Surgery; Columbia University Medical Center; New York New York
- Division of Cardiothoracic Surgery; University of Arizona; Tucson Arizona
| | - Hiroo Takayama
- Department of Surgery; Columbia University Medical Center; New York New York
| | - Yoshifumi Naka
- Department of Surgery; Columbia University Medical Center; New York New York
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Hehir DA, Niebler RA, Brabant CC, Tweddell JS, Ghanayem NS. Intensive care of the pediatric ventricular assist device patient. World J Pediatr Congenit Heart Surg 2013; 3:58-66. [PMID: 23804685 DOI: 10.1177/2150135111420888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Utilization of ventricular assist devices (VADs) in children is increasing, as is the complexity of patients supported. We review the intensive care management of pediatric patients with VAD in the perioperative and rehabilitation phases, highlighting the technical aspects and physiology of VADs which impact care. Indications for VAD placement and the preoperative assessment of risk are discussed. Specific aspects of postoperative and long-term care including device troubleshooting, hemostasis and anticoagulation, support of the right ventricle, incidence and prevention of neurologic injury, and other complications are reviewed.
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Affiliation(s)
- David A Hehir
- Division of Pediatric Critical Care, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
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Akay MH, Gregoric I, Cohn WE, Frazier OH. HeartMate-II left ventricular assist device infections resulting from gastrointestinal-tract fistulas. J Card Surg 2012; 27:643-5. [PMID: 22978845 DOI: 10.1111/j.1540-8191.2012.01517.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with a left ventricular assist device (LVAD), pump-related infection can cause adverse effects that may result in death. METHODS We describe three patients who had infections related to a fistula between the gastrointestinal (GI) tract and the LVAD pocket and who subsequently underwent successful heart transplantation without developing sepsis. In no case did the LVAD-related infection adversely affect the outcome of transplantation. CONCLUSIONS For detecting the fistulas, full upper-GI endoscopy and colonoscopy were superior to other types of diagnostic imaging studies.
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Affiliation(s)
- Mehmet H Akay
- Center for Cardiac Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA
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18
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Califano S, Pagani FD, Malani PN. Left Ventricular Assist Device–Associated Infections. Infect Dis Clin North Am 2012; 26:77-87. [DOI: 10.1016/j.idc.2011.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Popov AF, Hosseini MT, Zych B, Mohite P, Hards R, Krueger H, Bahrami T, Amrani M, Simon AR. Clinical experience with HeartWare left ventricular assist device in patients with end-stage heart failure. Ann Thorac Surg 2012; 93:810-5. [PMID: 22289902 DOI: 10.1016/j.athoracsur.2011.11.076] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/29/2011] [Accepted: 11/30/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The gold standard treatment for end-stage heart failure is cardiac transplantation. Because of the increasing number of heart failure patients and the limited supply of donor hearts, a ventricular assist device (VAD) is used as a bridge to transplantation, recovery, or decision. Newer generation VADs have lower risk of fatal adverse events and are also smaller in size. We present our experience with the intrapericardial HeartWare VAD (HeartWare, Framingham, MA) and its clinical outcome. METHODS The clinical outcome of HeartWare VAD implantations for end-stage heart failure patients performed at Harefield Hospital from March 2007 to June 2011 was studied. The study design was a retrospective review of the prospectively collected data. RESULTS Thirty-four patients with a mean age of 51±10 years were included in this study. Twenty-nine patients were male (85%). The mean duration of mechanical support was 261±64 days. Five patients (15%) were successfully bridged to heart transplantation. The overall mortality was 24% (8 patients). There were 1 case of mechanical device failure (2%) and 3 cases of device failure due to thrombus formation (8%). Postoperative complications included 5 reoperations for bleeding (15%), 12 acute renal failures (36%), 7 respiratory failures (21%), 2 hepatic dysfunctions (6%), 3 neurologic dysfunctions (9%), 7 right-side heart failures (21%), and 5 driveline infections (15%). CONCLUSIONS Although cardiac transplantation remains the gold standard for treatment of end-stage heart failure patients, the HeartWare VAD can be used as a safe alternative with a satisfactory clinical outcome.
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Affiliation(s)
- Aron Frederik Popov
- Department of Cardiothoracic Surgery and Transplantation, Harefield Hospital, Harefield, United Kingdom.
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Samoukovic G, Vassiliou M, Giannetti N, Al-Sabah S, Lash V, Cecere R. Laparoscopic splenectomy in a patient with a Heartmate(®) II left ventricular assist device. J Laparoendosc Adv Surg Tech A 2011; 21:535-8. [PMID: 21767119 DOI: 10.1089/lap.2011.0169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Since the publication of the REMATCH trial results, it is estimated that almost 5 million Americans have been found to have heart failure. Limited availability of organs for transplantation, coupled with wider selection criteria for destination therapy, has resulted in a substantial increase in the number of patients with permanently assisted circulation. Given the high rate of complications related to circulatory assist devices, it is expected that these patients will be undergoing noncardiac surgical procedures more commonly. MATERIALS AND METHODS We describe a laparoscopic splenectomy in a patient supported with a Heartmate II left ventricular assist device. Using this case as a model, we discuss hemodynamic changes associated with pneumoperitoneum and anesthesia induction. Additionally, an extensive literature search was performed to asses the frequency of laparoscopic procedures performed on patients with circulatory support. RESULTS Laparoscopic splenectomy was performed without significant hemodynamic changes. To our knowledge, this is the first laparoscopic splenectomy performed in a patient with this mode of circulatory support. CONCLUSION Laparoscopic procedures can safely be performed in patients with compensated heart failure, who are supported with ventricular assist devices.
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Affiliation(s)
- Gordan Samoukovic
- Division of Cardiothoracic Surgery, McGill University Health Center, Montreal, Quebec, Canada
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Lahon B, Mordant P, Thabut G, Georger JF, Dauriat G, Mal H, Lesèche G, Castier Y. Early severe digestive complications after lung transplantation. Eur J Cardiothorac Surg 2011; 40:1419-24. [PMID: 21497510 DOI: 10.1016/j.ejcts.2011.02.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 02/02/2011] [Accepted: 02/08/2011] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study aimed to describe and to analyze early severe digestive complications (ESDC) after lung transplantation (LT) in our center. METHODS A retrospective study included 351 patients, who underwent LT without cardiopulmonary bypass (CPB) at our center between March 1988 and December 2009. There were 86 double LTs and 265 single LTs. ESDCs were defined as complications (1) occurring during the first 30 days after transplantation or during initial hospitalization if longer; (2) involving the gastrointestinal tract; and (3) jeopardizing survival or requiring invasive therapeutic procedure. Patients' characteristics, associated risk factors, and influence of ESDC on early outcome have been analyzed. RESULTS During the first 30 days after LT or initial hospitalization if longer, 26 ESDCs occurred in 26 patients (rate 7.4%, sex ratio M/F 66%, mean age 56 ± 6 years). This included 10 acute cholecystitis (38%), four angiocholitis (15%), three perforated gastroduodenal ulcers (11%), three digestive perforations (11%), two intestinal occlusions (8%), two mesenteric ischemia (8%), and two acute pancreatitis (8%). ESDC occurred after a mean postoperative follow-up of 14 days (5-46), required emergency surgical treatment in 20 cases (77%), significantly prolonged the mean duration of hospitalization (96 days with ESDC vs 55 days without ESDC, p < 0.0001), and was responsible for death in five cases (19%). Surgical treatment included cholecystectomy (n = 11), bowel resection (n = 3), ulcer surgery (n = 2), subtotal colectomy (n = 2), Hartmann procedure (n = 1), and open coelioscopy (n = 1). Age and bilateral LT were found to be significant risk factors for ESDC in both uni- and multivariate analyses. CONCLUSION ESDC occurred in 7.4% of patients after LT without CPB, and was responsible for longer in-hospital stay. Relevant risk factors included older age and bilateral LT, interfering with current debate regarding recipients' selection and procedure's choice.
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Affiliation(s)
- Benoît Lahon
- Service de Chirurgie Thoracique, Vasculaire, et de Transplantation Pulmonaire, Hôpital Bichat, AP-HP, Université Denis Diderot - Paris 7, Paris, France
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Gregoric ID, Cohn WE, Frazier OH. Diaphragmatic implantation of the HeartWare ventricular assist device. J Heart Lung Transplant 2011; 30:467-70. [PMID: 21211994 DOI: 10.1016/j.healun.2010.11.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/23/2010] [Accepted: 11/29/2010] [Indexed: 11/28/2022] Open
Affiliation(s)
- Igor D Gregoric
- Center for Cardiac Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA
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23
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Bibliography. Current world literature. Thoracic anesthesia. Curr Opin Anaesthesiol 2011; 24:111-3. [PMID: 21321525 DOI: 10.1097/aco.0b013e3283433a20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Early adverse events as predictors of 1-year mortality during mechanical circulatory support. J Heart Lung Transplant 2010; 29:981-8. [PMID: 20580265 DOI: 10.1016/j.healun.2010.04.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 04/15/2010] [Accepted: 04/28/2010] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ventricular assist devices (VADs) provide effective treatment for end-stage heart failure; however, most patients experience > or =1 major adverse events (AEs) while on VAD support. Although early, non-fatal AEs may increase the risk of later death during VAD support, this relationship has not been established. Therefore, we sought to determine the impact on 1-year mortality of AEs occurring during the first 60 days of VAD support. METHODS A retrospective analysis was performed using prospectively collected data from a single-site database for patients aged > or =18 years receiving left ventricular or biventricular support during 1996 to 2008 and who survived >60 days on VAD support. Fourteen major classes of AEs occurring during this 60-day period were examined. One-year survival rates of patients with and without each major AE were compared. RESULTS The study included 163 patients (80% men; mean age, 49.5 years), of whom 87% were European American, 72% had left ventricular support, and 83% were bridge to transplant. The occurrence of renal failure, respiratory failure, bleeding events, and reoperations during the first 60 days after implantation significantly increased the risk of 1-year mortality. After controlling for gender, age, VAD type, and intention to treat, renal failure was the only major AE significantly associated with later mortality (hazard ratio, 2.96; p = .023). CONCLUSIONS Specific AEs, including renal failure, respiratory and bleeding events, and reoperations, significantly decrease longer-term survival. Renal failure conferred a 3-fold increased risk of 1-year mortality. Peri-operative management should focus on strategies to mitigate risk for renal failure in order to maximize later outcomes.
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