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Rojas SV, Haverich A. [Heart failure: ventricular assist devices and cardiac transplantation : A review of current surgical innovations]. Chirurg 2019; 90:110-116. [PMID: 30607463 DOI: 10.1007/s00104-018-0774-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND End-stage heart failure is one of the leading causes of death in Germany. Cardiac transplantation is still considered the gold standard for the treatment of terminal heart failure; however, there is a discrepancy between patients on the waiting list and yearly performed transplantations. As an alternative, ventricular assist devices have achieved a high level of importance but treatment is still associated with challenges. Novel systems as well as innovative surgical techniques contribute to improving the safety and effectiveness of the treatment. OBJECTIVE To generate an overview of current surgical innovations in cardiac transplantation and mechanical circulatory support. MATERIAL AND METHODS A Medline search was conducted regarding innovations in cardiac transplantation and mechanical circulatory support. RESULTS AND CONCLUSION Not only the number of yearly performed cardiac transplantations has changed but also recipient profiles. While in the pioneering era of transplantation the typical candidate was young, not previously operated on and with lower levels of comorbidities, today's patients are significantly older, have been fitted with ventricular assist devices and have increased operative risk profiles. Modern methods of organ preservation enable longer transportation and operation times as well as an improved assessment of graft function and perspectives for graft optimization in the future. In the area of ventricular assist devices, advances in the reduction of the stroke rate seem to have been achieved by the latest generation devices. From a surgical perspective, less invasive surgical techniques with promising initial results have been established at numerous centers.
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Affiliation(s)
- S V Rojas
- Klinik für Herz‑, Thorax‑, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - A Haverich
- Klinik für Herz‑, Thorax‑, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Smits JM, De Pauw M, Schulz U, Van Cleemput J, Raake P, Knezevic I, Caliskan K, Sutlic Z, Knosalla C, Schoenrath F, Szabolcs Z, Gottlieb J, Hagl C, Doesch A, Baric D, Rudez I, Strelniece A, De Vries E, Green D, Samuel U, Milicic D, Hartyanszky I, Berchtold-Herz M, Schulze PC, Mohr F, Meiser B, Haverich A, Reichenspurner H, Gummert J, Laufer G, Zuckermann A. Heart re-transplantation in Eurotransplant. Transpl Int 2018; 31:1223-1232. [PMID: 29885002 DOI: 10.1111/tri.13289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/23/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
Internationally 3% of the donor hearts are distributed to re-transplant patients. In Eurotransplant, only patients with a primary graft dysfunction (PGD) within 1 week after heart transplantation (HTX) are indicated for high urgency listing. The aim of this study is to provide evidence for the discussion on whether these patients should still be allocated with priority. All consecutive HTX performed in the period 1981-2015 were included. Multivariate Cox' model was built including: donor and recipient age and gender, ischaemia time, recipient diagnose, urgency status and era. The study population included 18 490 HTX, of these 463 (2.6%) were repeat transplants. The major indications for re-HTX were cardiac allograft vasculopathy (CAV) (50%), PGD (26%) and acute rejection (21%). In a multivariate model, compared with first HTX hazards ratio and 95% confidence interval for repeat HTX were 2.27 (1.83-2.82) for PGD, 2.24 (1.76-2.85) for acute rejection and 1.22 (1.00-1.48) for CAV (P < 0.0001). Outcome after cardiac re-HTX strongly depends on the indication for re-HTX with acceptable outcomes for CAV. In contrast, just 47.5% of all hearts transplanted in patients who were re-transplanted for PGD still functioned at 1-month post-transplant. Alternative options like VA-ECMO should be first offered before opting for acute re-transplantation.
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Affiliation(s)
| | - Michel De Pauw
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Uwe Schulz
- Department of Thoracic and Cardiavascular Surgery, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Johan Van Cleemput
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Philip Raake
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ivan Knezevic
- Department of Cardiothoracic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Kadir Caliskan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Zeljko Sutlic
- Department of Cardiac Surgery, University Hospital, Zagreb, Croatia
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, German Center for Cardiovascular Research, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, German Center for Cardiovascular Research, Berlin, Germany
| | - Zoltan Szabolcs
- Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Transplant Center Munich, Munich, Germany
| | - Andreas Doesch
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Davor Baric
- Department of Cardiac Surgery, University Hospital, Zagreb, Croatia
| | - Igor Rudez
- Department of Cardiac Surgery, University Hospital, Zagreb, Croatia
| | - Agita Strelniece
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Erwin De Vries
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Dave Green
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Istvan Hartyanszky
- Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - P Christian Schulze
- Division of Cardiology, Department of Internal Medicine, University Hospital Jena, Jena, Germany
| | - Friedrich Mohr
- Department of Cardiothoracic Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Bruno Meiser
- Department of Cardiac Surgery, Transplant Center Munich, Munich, Germany
| | - Axel Haverich
- Department of Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Jan Gummert
- Department of Thoracic and Cardiavascular Surgery, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Guenter Laufer
- Department of Cardiac Surgery, University Hospital Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, University Hospital Vienna, Vienna, Austria
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Abstract
This article summarizes recent knowledge and clinical advances in machine perfusion (MP) of thoracic organs. MP of thoracic organs has gained much attention during the last decade. Clinical studies are investigating the role of MP to preserve, resuscitate, and assess heart and lungs prior to transplantation. Currently, MP of the cardiac allograft is essential in all type DCD heart transplantation while MP of the pulmonary allograft is mandatory in uncontrolled DCD lung transplantation. MP of thoracic organs also offers an exciting platform to further investigate downregulation of the innate and adaptive immunity prior to reperfusion of the allograft in recipients. MP provides a promising technology that allows pre-transplant preservation, resuscitation, assessment, repair, and conditioning of cardiac and pulmonary allografts outside the body in a near physiologic state prior to planned transplantation. Results of ongoing clinical trials are awaited to estimate the true clinical value of this new technology in advancing the field of heart and lung transplantation by increasing the total number and the quality of available organs and by further improving recipient early and long-term outcome.
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Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, KU Leuven University, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium
| | - Steffen Rex
- Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium.,Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium.,Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
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