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Jones A, Amirjamshidi H, Olverson G, Ling FS, Hisamoto K. Transcatheter aortic valve replacement 23 years after heart transplant for aortic insufficiency. J Cardiothorac Surg 2023; 18:274. [PMID: 37805477 PMCID: PMC10560406 DOI: 10.1186/s13019-023-02407-x] [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: 02/13/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Clinicians continue to expand the availability of transcatheter aortic valve replacement (TAVR) for patients who historically would have been ineligible for surgical aortic valve replacement. Historically, reoperative aortic valve surgery after transplant was immensely complicated and high risk due to the repeat sternotomy approach, and the immunosuppression in transplant patients. As heart transplant patients continue to live longer, patients are beginning to develop novo aortic pathology of the transplanted organ. In these patients, TAVR may be a valuable rescue therapy for those with de-novo aortic valve disease. CASE PRESENTATION Here, we present a single case of a 70-year-old man with a history of heart transplant 23 years prior complicated by severe sternal infection and subsequent removal of his sternum. Additionally, this patient had a recent history of kidney transplant due to renal cell carcinoma necessitating nephrectomy. He subsequently developed progressive symptomatic aortic insufficiency and underwent a successful TAVR to treat his new aortic disease. CONCLUSIONS To our knowledge, this represents only the second case report of TAVR for severe aortic insufficiency and one of the first reports of TAVR in a multiple organ recipient. TAVR may represent an important rescue therapy for post-transplant valve pathologies instead of high-risk reoperative surgical aortic valve replacement.
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Affiliation(s)
- Andrew Jones
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Hossein Amirjamshidi
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box: Surg, Rochester, NY, 14620, USA
| | - George Olverson
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Frederick S Ling
- Department of Medicine, Cardiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Kazuhiro Hisamoto
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box: Surg, Rochester, NY, 14620, USA.
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2
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Preda S, Câlmâc L, Nica C, Cacoveanu M, Țigănașu R, Badea A, Zăman A, Ciomag (Ianula) R, Nistor C, Gașpar BS, Iliuță L, Dorobanțu L, Iliescu VA, Moldovan H. TAVI in a Heart Transplant Recipient-Rare Case Report and Review of the Literature. Biomedicines 2023; 11:2634. [PMID: 37893008 PMCID: PMC10604045 DOI: 10.3390/biomedicines11102634] [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: 06/29/2023] [Revised: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
The global demand for cardiac transplants continues to rise, even with advancements in assistive devices. Currently, the estimated annual mortality rate stands at 3-5%, and patients often face a waiting time of approximately four years on transplant waiting lists. Consequently, many transplant centers have started to consider heart transplants from donors who may be deemed "less than ideal" or marginal. However, the decision to accept such donors must be highly individualized, taking into consideration the risks associated with remaining on the waiting list versus those posed by the transplantation procedure itself. A potential solution lies in the creation of two distinct recipient lists, matched with donor criteria, allowing marginal donors to provide the lifeline that selected patients require. This paper follows a two-step approach. Firstly, it offers an overview of the current state of affairs regarding the topic of transcatheter aortic valve implantation (TAVI) in orthotopic heart transplant (OHT) patients. Secondly, it presents firsthand experience from our clinical center with a comprehensive case presentation of a patient in this unique medical context. The clinical case refers to a 62-year-old male patient, a smoker with a history of hypertension, dyslipidemia, and a prior OHT a decade earlier, who presented with fatigue during minimal physical exertion. The Heart Team carefully reviewed the case, considering the patient's immunosuppressed status and the heightened risk associated with a repeat intervention. In this instance, transcatheter aortic valve implantation (TAVI) was deemed the appropriate treatment. The TAVI procedure yielded successful results, leading to improved clinical status and enhanced cardiac function. The inclusion of marginal donors has introduced novel challenges related to the utilization of previously diseased marginal organs. TAVI has already demonstrated its efficacy and versatility in treating high-risk patients, including heart transplant recipients. Consequently, it emerges as a vital tool in addressing the unique challenges posed by the inclusion of marginal donors.
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Affiliation(s)
- Silvia Preda
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.P.); (R.C.); (C.N.); (B.S.G.); (L.I.); (V.A.I.)
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (L.C.); (C.N.); (R.Ț.); (A.B.); (A.Z.)
| | - Lucian Câlmâc
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (L.C.); (C.N.); (R.Ț.); (A.B.); (A.Z.)
| | - Claudia Nica
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (L.C.); (C.N.); (R.Ț.); (A.B.); (A.Z.)
| | - Mihai Cacoveanu
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (L.C.); (C.N.); (R.Ț.); (A.B.); (A.Z.)
| | - Robert Țigănașu
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (L.C.); (C.N.); (R.Ț.); (A.B.); (A.Z.)
| | - Aida Badea
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (L.C.); (C.N.); (R.Ț.); (A.B.); (A.Z.)
| | - Alexandru Zăman
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (L.C.); (C.N.); (R.Ț.); (A.B.); (A.Z.)
| | - Raluca Ciomag (Ianula)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.P.); (R.C.); (C.N.); (B.S.G.); (L.I.); (V.A.I.)
- Department of Cardiology, “Bagdasar Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania
| | - Claudiu Nistor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.P.); (R.C.); (C.N.); (B.S.G.); (L.I.); (V.A.I.)
- Department of Thoracic Surgery, Central Military Emergency University Hospital, 013058 Bucharest, Romania
| | - Bogdan Severus Gașpar
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.P.); (R.C.); (C.N.); (B.S.G.); (L.I.); (V.A.I.)
- Department of Cardiology, “Bagdasar Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania
| | - Luminița Iliuță
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.P.); (R.C.); (C.N.); (B.S.G.); (L.I.); (V.A.I.)
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Lucian Dorobanțu
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania;
- Department of Cardiovascular Surgery, Monza Metropolitan Hospital, 040204 Bucharest, Romania
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.P.); (R.C.); (C.N.); (B.S.G.); (L.I.); (V.A.I.)
- Department of Cardiovascular Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.P.); (R.C.); (C.N.); (B.S.G.); (L.I.); (V.A.I.)
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (L.C.); (C.N.); (R.Ț.); (A.B.); (A.Z.)
- Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania
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Gökler J, Aliabadi-Zuckermann AZ, Kaider A, Ambardekar AV, Antretter H, Artemiou P, Bertolotti AM, Boeken U, Brossa V, Copeland H, Generosa Crespo-Leiro M, Eixeré-Esteve A, Epailly E, Farag M, Hulman M, Khush KK, Masetti M, Patel J, Ross HJ, Rudež I, Silvestry S, Suarez SM, Vest A, Zuckermann AO. Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study. Front Cardiovasc Med 2022; 10:879612. [PMID: 35756840 PMCID: PMC9218180 DOI: 10.3389/fcvm.2022.879612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports. Methods We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate. Results Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 11), with a total of 110 patients. A median of 3 (IQR 2–8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 2). The median age at CASH was 57.7 (47.8–63.1) years, with a median time from transplant to CASH of 4.4 (1–9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% (n = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8–14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively. Conclusion Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure.
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Affiliation(s)
- Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Johannes Gökler,
| | | | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Amrut V. Ambardekar
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Herwig Antretter
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Panagiotis Artemiou
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia
| | - Alejandro M. Bertolotti
- Heart and Lung Transplant Service, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Vicens Brossa
- Heart Transplant Division, Hospital Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Hannah Copeland
- Division Cardiac Surgery, Lutheran Hospital, Indiana University School of Medicine, Indiana, IA, United States
| | - Maria Generosa Crespo-Leiro
- Complejo Hospitalario Universitario a Coruña (CHUAC), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), La Coruña, Spain
| | | | - Eric Epailly
- Heart and Heart-Lung Transplant Unit Medical, Department of Cardiovascular Surgery, Les Hôpitaux Universitaires NHC, Strasbourg, France
| | - Mina Farag
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michal Hulman
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia
| | - Kiran K. Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Orsola, Bologna, Italy
| | - Jignesh Patel
- Heart Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Heather J. Ross
- Cardiac Transplant Program, Peter Munk Cardiac Centre, Toronto, ON, Canada
| | - Igor Rudež
- Department of Cardiac Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Scott Silvestry
- Thoracic Transplant Program, AdventHealth Transplant Institute, Florida, FL, United States
| | - Sofia Martin Suarez
- Cardiac Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Orsola, Bologna, Italy
| | - Amanda Vest
- Cardiac Transplantation Program, Tufts Medical Center, Boston, MA, United States
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Wallen TJ, Spratt J, Kates MM, Wayangankar S, Vilaro J, Aranda J, Arnaoutakis GJ. Transcatheter aortic valve replacement 24 years after cardiac transplantation. J Card Surg 2020; 35:710-712. [PMID: 31971286 DOI: 10.1111/jocs.14438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As patient survival after cardiac transplantation has improved over the course of the last several decades, clinicians are now faced with late complications. This includes aortic stenosis which, traditionally, has been treated with reoperative sternotomy and aortic valve replacement. Transcather aortic valve replacement (TAVR) offers a minimally invasive alternative in this high-risk population. A small but growing number of cases of TAVR after heart transplantation in high-risk patients have been reported in the last 10 years; we now present a case of aortic valve replacement via a transcatheter approach 24 years after cardiac transplantation.
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Affiliation(s)
- Tyler J Wallen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Florida
| | - John Spratt
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Florida
| | - Malcolm M Kates
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Florida
| | - Siddharth Wayangankar
- Division of Cardiology, Department of Medicine, The University of Florida, Gainesville, Florida
| | - Juan Vilaro
- Division of Cardiology, Department of Medicine, The University of Florida, Gainesville, Florida
| | - Juan Aranda
- Division of Cardiology, Department of Medicine, The University of Florida, Gainesville, Florida
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Florida
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5
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Ius F, Moscalenco D, Boethig D, Tudorache I, Haverich A, Warnecke G, Cebotari S. Cardiac valve operations after solid organ transplantation: A single-center experience. J Thorac Cardiovasc Surg 2019; 161:595-606.e4. [PMID: 31761345 DOI: 10.1016/j.jtcvs.2019.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cardiac valve operations in patients who have undergone solid organ transplantation (ie, kidney, liver, pancreas, heart, and lung) pose unique challenges due to patient comorbidities and to the need for immunosuppressive therapy. The aim of this retrospective study was to present our experience with patients with solid-organ transplant who had cardiac valve operation at the time or after transplantation. METHODS Records of patients who had undergone cardiac valve operations after solid organ transplantation between January 1998 and January 2019 were retrospectively reviewed. Follow-up amounted to a median of 51 months (interquartile range, 5-88 months). RESULTS Among the 14,465 patients who underwent treatment for a cardiac valvular pathology during the study period, 127 patients (0.9%) had undergone a solid organ transplantation (kidney: n = 9 [76%]; liver: n = 12 [9%]; pancreas: n = 4 [3%]; heart: n = 16 [13%]; lung: n = 9 [7%]). Postoperatively, 14 patients (11%) underwent rethoracotomy for bleeding and 24 patients (19%) required new dialysis treatment. Twenty-five patients (20%) died in-hospital. Postoperative course was worse in patients operated for endocarditis or undergoing concomitant transplantation and valve surgery. Overall survival was 59%, 47%, and 40%, but survival conditioned to hospital discharge was 73%, 58%, and 50% at 5-, 10-, and 15-year follow-up, respectively. Freedom from major valve-related events amounted to 77%, 56%, and 46%, respectively. CONCLUSIONS Although the high prevalence of postoperative complications, especially in patients with endocarditis or concomitant transplantation and valve surgery, survival conditioned to hospital discharge was satisfactory in patients undergoing valve surgery after solid organ transplantation.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Daniel Moscalenco
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- 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
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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6
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Avula S, Mungee S, Barzallo MA. Successful minimal approach transcatheter aortic valve replacement in an allograft heart recipient 19 years post transplantation for severe aortic stenosis: A case report. World J Cardiol 2019; 11:209-212. [PMID: 31523399 PMCID: PMC6715582 DOI: 10.4330/wjc.v11.i8.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortic stenosis is one of the rare valvular complications in a transplanted heart. Over the past 8 years, transcatheter approach for aortic valve replacement (TAVR) has been slowly evolving to be the preferred approach in these patient population when compared to the surgical approach. We report a second case in the United States with successful transfemoral minimal approach with minimal sedation for TAVR in a heart transplant recipient 19 years post transplantation for severe symptomatic calcified aortic stenosis.
CASE SUMMARY We present a case of 73-year-old male who has undergone successful minimal approach transcatheter aortic valve replacement in an allograft heart. Patient had received orthotopic heart transplantation 19 years ago for non-ischemic cardiomyopathy. Follow up transthoracic echocardiograms as per routine protocol did not show any aortic valve disease until 15 years post transplantation. Aortic valve was noted to be mildly sclerotic at that time and gradually progressed to severe symptomatic aortic stenosis over the next 4 years. Patient had complaints of worsening shortness of breath that limited his functional capacity. Overall his post heart transplantation period has been mostly uneventful except for allograft non occlusive vasculopathy and aortic stenosis. His Society of Thoracic Surgery risk score was 12.205% and he was considered to be a high-risk surgical candidate by surgeon. Decision was made to undergo transcatheter aortic valve replacement.
CONCLUSION With the improved survival of these patients, we think it is time to look into pathophysiology of valvular disease in transplant heart recipients. Some other unanswered questions include, underlying donor and recipient risk factors for valvular diseases in heart transplant recipients.
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Affiliation(s)
- Sravani Avula
- Department of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - Sudhir Mungee
- Department of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - Marco A Barzallo
- Key Clinal Faculty, Department of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
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Akleh SI, Bandali A, Edwards R. Transcatheter aortic valve implantation in an orthotopic heart transplant recipient with bicuspid aortic valve. Clin Case Rep 2018; 6:2262-2265. [PMID: 30455933 PMCID: PMC6230648 DOI: 10.1002/ccr3.1845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/01/2018] [Accepted: 09/13/2018] [Indexed: 11/06/2022] Open
Abstract
Increasing longevity of heart transplantation recipients and aging donor population accompanied by the older age at transplantation led to an increase in the prevalence of degenerative valvular disease in particular aortic stenosis. TAVI is considered a safe and feasible alternative compared to conventional SAVR in this high-risk population.
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8
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Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? Transplant Direct 2017; 3:e209. [PMID: 29138760 PMCID: PMC5627740 DOI: 10.1097/txd.0000000000000725] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/01/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background Because of improved long-term survival after heart transplantation (HTx), late graft pathologies such as valvular disease or cardiac allograft vasculopathy (CAV) might need surgical intervention to enhance longer survival and ensure quality of life. To this date, there exist no guidelines for indication of cardiac surgery other than retransplantation after HTx. Methods In this retrospective, single-center study, we evaluated patients who underwent cardiac surgery after HTx at our institution. Results Between March 1984 and October 2016, 17 (1.16%) of 1466 HTx patients underwent cardiac surgery other than retransplantation after HTx. Indication were valvular disease (n = 7), CAV (n = 6), and other (n = 4). Of these, 29.4% (n = 5) were emergency procedures and 70.6% were elective cases. Median age at time of surgery was 61 years (interquartile range, 52-66 years); 82.4% (n = 14) were male. Median time to surgery after HTx was 9.3 years (2.7-11.1 years). In-hospital, mortality was 11.8% (n = 2); later need of retransplantation was 11.8% (n = 2) due to progressing CAV 3 to 9 months after surgery. One-year survival was 82.35%; overall survival was 47.1% (n = 8) with a median follow-up of 1477 days (416-2135 days). Overall survival after emergency procedures was 209 days (36-1119.5 days) whereas, for elective procedures, it was 1583.5 days (901.5-4319 days). Conclusions Incidence of cardiac surgery after HTx in our cohort was low (1.16%) compared with that of other studies. In elective cases, long-term survival was good.
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Margale S, Natani S. Anesthetic Management of Transfemoral Transcatheter Aortic Valve Replacement (TAVR) in a Heart Transplant Recipient With Severely Depressed Left Ventricular Function and Renal Failure. J Cardiothorac Vasc Anesth 2016; 31:1032-1036. [PMID: 27693207 DOI: 10.1053/j.jvca.2016.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Swaroop Margale
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | - Sarvesh Natani
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
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10
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Zanuttini D, Armellini I, Bisceglia T, Spedicato L, Bernardi G, Muzzi R, Proclemer A, Livi U. Transcatheter aortic valve implantation for degenerative aortic valve regurgitation long after heart transplantation. Ann Thorac Surg 2013; 96:1864-6. [PMID: 24182478 DOI: 10.1016/j.athoracsur.2013.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 02/14/2013] [Accepted: 03/18/2013] [Indexed: 12/15/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become a feasible therapeutic option for the management of high-risk patients with severe degenerative aortic stenosis. Recently it has been extended to high-risk patients with severe aortic regurgitation. Degenerative aortic valve disease is generally uncommon in heart transplant recipients. We report the case of a 75-year-old man in whom severe degenerative aortic regurgitation developed 14 years after heart transplantation (HTx). Because of multiple comorbidities and high surgical risk, TAVI was preferred. A 29-mm CoreValve prosthesis (Medtronic Inc, Minneapolis, MN) was successfully implanted using a transfemoral approach.
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Affiliation(s)
- Davide Zanuttini
- Department of Cardiology, Santa Maria della Misericordia Hospital, Udine, Italy
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11
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De Praetere H, Ciarka A, Dubois C, Herijgers P. Transapical transcatheter aortic valve implantation in a heart transplant recipient with severely depressed left ventricular function. Interact Cardiovasc Thorac Surg 2013; 16:906-8. [PMID: 23460597 DOI: 10.1093/icvts/ivt048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is becoming a valuable alternative to surgical aortic valve replacement in non-operable and high-risk surgical patients. As the population of heart donors and recipients ages, the prevalence of degenerative valvular disease after transplantation will increase. The optimal treatment strategy of valvulopathies in these patients with extensive comorbidity is still unknown because of insufficient published experience. We present a heart transplant recipient with renal failure, systolic heart failure and severe aortic stenosis who was successfully treated with transapical TAVI.
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