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López-Vilella R, Pérez Guillén M, Guerrero Cervera B, Gimeno Costa R, Zarragoikoetxea Jauregui I, Pérez Esteban F, Carmona P, Heredia Cambra T, Talavera Peregrina M, Pajares Moncho A, Domínguez-Massa C, Donoso Trenado V, Martínez Dolz L, Argente P, Castellanos Á, Martínez León J, Torregrosa Puerta S, Almenar Bonet L. Comparative Temporal Analysis of Morbidity and Early Mortality in Heart Transplantation with Extracorporeal Membrane Oxygenation Support: Exploring Trends over Time. Biomedicines 2024; 12:2109. [PMID: 39335622 PMCID: PMC11428817 DOI: 10.3390/biomedicines12092109] [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: 08/07/2024] [Revised: 09/03/2024] [Accepted: 09/08/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES The direct bridge to urgent heart transplant (HT) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support has been associated with high morbidity and mortality. The objective of this study is to analyze the morbidity and mortality of patients transplanted with VA-ECMO and compare the presumed differences between various eras over a 17-year timeline. METHODS This is a prospective, observational study on consecutive patients stabilized with VA-ECMO and transplanted with VA-ECMO from July 2007 to December 2023 at a reference center (98 patients). Objective variables were mortality and morbidity from renal failure, venous thromboembolic disease (VTD), primary graft dysfunction (PGD), the need for tracheostomy, severe myopathy, reoperation, post-transplant ECMO, vascular complications, and sepsis/infection. RESULTS The percentage of patients who reached transplantation without the need for mechanical ventilation has increased over the periods studied. No significant differences were found between the study periods in 30-day mortality (p = 0.822), hospital discharge (p = 0.972), one-year mortality (p = 0.706), or five-year mortality (p = 0.797). Survival rates in these periods were 84%, 75%, 64%, and 61%, respectively. Comorbidities were very frequent, with an average of 3.33 comorbidities per patient. The most frequent were vascular complications (58%), the need for post-transplant ECMO (57%), and myopathy (55%). The development of myopathy and the need for post-transplant ECMO were higher in recent periods (p = 0.004 and p = 0.0001, respectively). CONCLUSIONS VA-ECMO support as a bridge to HT allows hospital discharge for 3 out of 4 transplanted patients. This survival rate has not changed over the years. The comorbidities associated with this device are frequent and significant.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (V.D.T.); (L.A.B.)
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.G.C.); (L.M.D.)
| | - Manuel Pérez Guillén
- Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (M.P.G.); (T.H.C.); (C.D.-M.); (J.M.L.); (S.T.P.)
| | - Borja Guerrero Cervera
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.G.C.); (L.M.D.)
| | - Ricardo Gimeno Costa
- Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (R.G.C.); (F.P.E.); (M.T.P.); (Á.C.)
| | - Iratxe Zarragoikoetxea Jauregui
- Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (I.Z.J.); (P.C.); (A.P.M.); (P.A.)
| | - Francisca Pérez Esteban
- Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (R.G.C.); (F.P.E.); (M.T.P.); (Á.C.)
| | - Paula Carmona
- Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (I.Z.J.); (P.C.); (A.P.M.); (P.A.)
| | - Tomás Heredia Cambra
- Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (M.P.G.); (T.H.C.); (C.D.-M.); (J.M.L.); (S.T.P.)
| | - Mónica Talavera Peregrina
- Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (R.G.C.); (F.P.E.); (M.T.P.); (Á.C.)
| | - Azucena Pajares Moncho
- Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (I.Z.J.); (P.C.); (A.P.M.); (P.A.)
| | - Carlos Domínguez-Massa
- Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (M.P.G.); (T.H.C.); (C.D.-M.); (J.M.L.); (S.T.P.)
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (V.D.T.); (L.A.B.)
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.G.C.); (L.M.D.)
| | - Luis Martínez Dolz
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.G.C.); (L.M.D.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pilar Argente
- Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (I.Z.J.); (P.C.); (A.P.M.); (P.A.)
| | - Álvaro Castellanos
- Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (R.G.C.); (F.P.E.); (M.T.P.); (Á.C.)
| | - Juan Martínez León
- Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (M.P.G.); (T.H.C.); (C.D.-M.); (J.M.L.); (S.T.P.)
| | - Salvador Torregrosa Puerta
- Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (M.P.G.); (T.H.C.); (C.D.-M.); (J.M.L.); (S.T.P.)
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (V.D.T.); (L.A.B.)
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.G.C.); (L.M.D.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
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2
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Boluk A, Sokolski M, Rakowski M, Jura M, Bochenek M, Cielecka M, Przybylski R, Zakliczyński M. Pacemaker Implantation Following Heart Transplantation - Incidence and Risk Factors. Single-Center Experience. Transplant Proc 2024; 56:851-853. [PMID: 38697907 DOI: 10.1016/j.transproceed.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Bradyarrhythmias, requiring pacemaker (PM) implantation, are common complications following orthotopic heart transplantation (HTx). Currently used heart transplantation methods are primarily the bicaval technique and the total heart transplantation technique. The aim of the study was to assess the incidence and risk factors, including donor parameters, of conduction disorders requiring pacing after HTx. METHODS A population of 111 (52 ± 13 years, 91 (82%) men) heart recipients was divided into a group requiring PM implantation post-HTx and a group not requiring PM. We compared groups in terms of donor parameters, time of graft ischemia, transport and transplantation, and surgical techniques as the potential risk factors for significant bradyarrhythmias. RESULTS Ten of 111 patients with HTx (9%) required PM implantation. The indication in 7 cases was sinus node dysfunction (SND), in 3 patients it was complete atrioventricular block (AV-block). In the PM group, the age of 48 ± 6 vs 40 ± 11 years (P = .0227) and the body mass index (BMI) 28 ± 3 vs 26 ± 4 kg/m2 (P = .0297) of the donor were significantly higher. There was no influence of organ transport time, ischemia time, and transplantation time. All patients requiring PM implantation were transplanted using the bicaval anastomosis: 10 (100%) vs 71 (70%) in the group not requiring PM (P = .044). CONCLUSIONS The need for PM implantation post-HTx despite using new techniques is still common, especially in the group operated with the bicaval method. In addition, higher donor's age and BMI are risk factors of PM implantation, what is of importance as qualification criteria of donor hearts have been gradually extended.
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Affiliation(s)
- Anna Boluk
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland.
| | - Mateusz Sokolski
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Rakowski
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland
| | - Maksym Jura
- Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland; Institute of Heart Disease, Cardiology Department, University Hospital, Wroclaw, Poland
| | - Maciej Bochenek
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Cielecka
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Roman Przybylski
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Zakliczyński
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
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3
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Fiala A, Breitkopf R, Sinner B, Mathis S, Martini J. [Anesthesia for organ transplant patients]. DIE ANAESTHESIOLOGIE 2023; 72:773-783. [PMID: 37874343 PMCID: PMC10615924 DOI: 10.1007/s00101-023-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/25/2023]
Abstract
Organ transplant patients who must undergo nontransplant surgical interventions can be challenging for the anesthesiologists in charge. On the one hand, it is important to carefully monitor the graft function in the perioperative period with respect to the occurrence of a possible rejection reaction. On the other hand, the ongoing immunosuppression may have to be adapted to the perioperative requirements in terms of the active substance and the route of administration, the resulting increased risk of infection and possible side effects (e.g., myelosuppression, nephrotoxicity and impairment of wound healing) must be included in the perioperative treatment concept. Furthermore, possible persistent comorbidities of the underlying disease and physiological peculiarities as a result of the organ transplantation must be taken into account. Support can be obtained from the expertise of the respective transplantation center.
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Affiliation(s)
- Anna Fiala
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Robert Breitkopf
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Barbara Sinner
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Simon Mathis
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Judith Martini
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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4
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Goerlich CE, Griffith BP, Shah A, Treffalls JA, Zhang T, Lewis B, Tatarov I, Hershfeld A, Sentz F, Braileanu G, Ayares D, Singh AK, Mohiuddin MM. A Standardized Approach to Orthotopic (Life-supporting) Porcine Cardiac Xenotransplantation in a Nonhuman Primate Model. Transplantation 2023; 107:1718-1728. [PMID: 36706064 DOI: 10.1097/tp.0000000000004508] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cardiac xenotransplantation from swine has been proposed to "bridge the gap" in supply for heart failure patients requiring transplantation. Recent preclinical success using genetically modified pig donors in baboon recipients has demonstrated survival greater than 6 mo, with a modern understanding of xenotransplantation immunobiology and continued experience with large animal models of cardiac xenotransplantation. As a direct result of this expertise, the Food and Drug Administration approved the first in-human transplantation of a genetically engineered cardiac xenograft through an expanded access application for a single patient. This clinical case demonstrated the feasibility of xenotransplantation. Although this human study demonstrated proof-of-principle application of cardiac xenotransplantation, further regulatory oversight by the Food and Drug Administration may be required with preclinical trials in large animal models of xenotransplantation with long-term survival before approval of a more formalized clinical trial. Here we detail our surgical approach to pig-to-primate large animal models of orthotopic cardiac xenotransplantation, and the postoperative care of the primate recipient, both in the immediate postoperative period and in the months thereafter. We also detail xenograft surveillance methods and common issues that arise in the postoperative period specific to this model and ways to overcome them. These studies require multidisciplinary teams and expertise in orthotopic transplantation (cardiac surgery, anesthesia, and cardiopulmonary bypass), immunology, genetic engineering, and experience in handling large animal donors and recipients, which are described here. This article serves to reduce the barriers to entry into a field with ever-growing enthusiasm, but demands expertise knowledge and experience to be successful.
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Affiliation(s)
- Corbin E Goerlich
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bartley P Griffith
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - John A Treffalls
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Tianshu Zhang
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Billeta Lewis
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Ivan Tatarov
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Alena Hershfeld
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Faith Sentz
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Gheorghe Braileanu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | | | - Avneesh K Singh
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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5
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Benvenuti LA, Mangini S, Gaiotto FA, Bacal F. Parasitic persistence in left atrium remnants of chronic chagasic patients submitted to bicaval heart transplantation. Transpl Infect Dis 2023; 25:e14061. [PMID: 37020395 DOI: 10.1111/tid.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023]
Affiliation(s)
- Luiz A Benvenuti
- Instituto do Coraçao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Sandrigo Mangini
- Instituto do Coraçao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Fabio A Gaiotto
- Instituto do Coraçao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Fernando Bacal
- Instituto do Coraçao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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Immohr MB, Boeken U, Bruno RR, Sugimura Y, Mehdiani A, Aubin H, Westenfeld R, Tudorache I, Lichtenberg A, Akhyari P. Optimizing Anastomoses Technique in Orthotopic Heart Transplantation: Comparison of Biatrial, Bicaval and Modified Bicaval Technique. J Cardiovasc Dev Dis 2022; 9:jcdd9110404. [PMID: 36421939 PMCID: PMC9693903 DOI: 10.3390/jcdd9110404] [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: 10/24/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Implantation techniques for orthotopic heart transplantation (HTx) have evolved over the centuries. Recently new approaches of modified bicaval techniques to minimize warm ischemia are gaining popularity in the literature. Between 2010 and 2022 n = 238 patients underwent HTx in our department. The recipients were retrospectively reviewed and divided regarding their anastomoses’ technique. Anastomoses were sutured either in biatrial (n = 37), bicaval (n = 191) or in a modified bicaval (n = 10) manner with suturing of the superior cava vein and A. pulmonalis anastomosis after removing the aortic cross-clamp during the reperfusion. Warm ischemia was 62 ± 11 min for biatrial, 66 ± 15 min for bicaval, but only 48 ± 10 min for modified bicaval technique (p < 0.001). The incidence of severe primary graft dysfunction (PGD) was comparable between biatrial (27.0%) and bicaval (28.8%) anastomoses. In contrast, in patients with modified bicaval technique PGD occurred only in a single patient (10.0%). The incidence of postoperative pacemaker implantation was 18.2% for biatrial compared to 3.0% for bicaval and 0.0% for modified bicaval technique (p = 0.01). The modified bicaval technique enables to decrease the crucial warm ischemia during HTx compared to both biatrial and regular bicaval techniques. Therefore, we strongly recommend bicaval anastomoses, ideally in a modified manner.
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Affiliation(s)
- Moritz Benjamin Immohr
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
- Correspondence: ; Tel.: +49-211-8118331
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Angiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Yukiharu Sugimura
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Arash Mehdiani
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Angiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
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Rangel-Ugarte PM, Ramirez-Castañeda S, Mendoza-Lopez AC, Gonzalez-Hermosillo LM, Flores-Calderon O, Salazar-Hernandez I, Ramirez-Castañeda A, Roldan-Valadez E. Evolution and current circumstances of heart transplants: Global and Mexican perspective. Curr Probl Cardiol 2022; 47:101316. [PMID: 35817156 DOI: 10.1016/j.cpcardiol.2022.101316] [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: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
A cardiac transplant is an irreplaceable alternative for patients with terminal chronic heart failure refractive to treatment. Heart failure results from an imbalance between cardiac output and organic demand, the prominent etiology is ischemic heart disease and arterial hypertension. In developed countries, it has a prevalence of 4.2%, reaching over 11.8% in adults over 65. It affects around 64.3 million people worldwide, with 9 cases for every 1000 people. This syndrome has a death rate of 56% in 5 years, making heart transplants relevant. The procedure has dramatically evolved from the beginning of animal experimentation in the early 20th century to now, where significant advances are still being made. The purpose of this review is to compile the central aspects of international and Mexico's local heart transplant history and current status, as well as a general view of what this procedure entails and possible prospective outcomes for this practice.
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Affiliation(s)
| | - Serafin Ramirez-Castañeda
- Cardiothoracic Surgery Department, Hospital General de México "Dr Eduardo Liceaga", 06720, Mexico City, Mexico..
| | - Abril-Carolina Mendoza-Lopez
- Directorate of Research, Hospital General de Mexico "Dr. Eduardo Liceaga, 06720, Mexico City, Mexico.; Faculty of Medicine, Benemérita Universidad Autonoma de Puebla, 72410, Puebla, Puebla.
| | | | - Octavio Flores-Calderon
- Cardiothoracic Surgery Department, Hospital General de México "Dr Eduardo Liceaga", 06720, Mexico City, Mexico
| | - Ignacio Salazar-Hernandez
- Cardiothoracic Surgery Department, Hospital General de México "Dr Eduardo Liceaga", 06720, Mexico City, Mexico..
| | - Alberto Ramirez-Castañeda
- Cardiothoracic Surgery Department, Hospital General de México "Dr Eduardo Liceaga", 06720, Mexico City, Mexico..
| | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico "Dr. Eduardo Liceaga, 06720, Mexico City, Mexico.; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, 119992, Moscow, Russia.
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8
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Alyaydin E, Pogoda C, Dell'Aquila A, Frommeyer G, Sindermann JR, Reinecke H, Tuleta I. Permanent pacing in a very long-term follow-up after orthotopic heart transplantation: A matter of when or why? Ann Noninvasive Electrocardiol 2022; 27:e12979. [PMID: 35670209 PMCID: PMC9296793 DOI: 10.1111/anec.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background Orthotopic heart transplantation (OHT) is associated with a high incidence of conduction disturbances (CD) leading to permanent pacemaker (PPM) implantation. However, the improved posttransplant survival raises the question about the pacemaker dependence (PD) in a prolonged follow‐up. Hypothesis The prevalence of PPM in OHT is high but not all patients are PD in a very long‐term follow‐up. Device implantation has no prognostic relevance. Methods We performed a retrospective analysis of patient medical records focusing on device interrogation data at the most recent follow‐up. Results The study population consisted of 183 patients with a mean follow‐up of 15.0 ± 6.8 years. One‐fourth of the patients had undergone PPM implantation (n = 49, 26.8%). Among these, two‐thirds were PD at last follow‐up (n = 32, 65.3%). PPM was more often in biatrial OHT and cardiac allograft vasculopathy (OR 3.0, 95% CI 1.26–7.29, p = .013 and OR 2.0, 95% CI 1.03–3.87, p = .041, respectively). Early sinus node dysfunction (SND) was the most persistent CD. PPM was associated with a poorer outcome in OHT (HR 1.9, 95% CI 1.06–3.46, p = .031) and a higher rate of fatal septicemia (HR 5.1, 95% CI 1.41–18.14, p = .013). Conclusions One‐fourth of the OHT recipients develop CD requiring PPM implantation, although one‐third among these are not PD in follow‐up. Early SND is associated with a higher rate of PD. PPM is associated with an inferior prognosis.
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Affiliation(s)
- Emyal Alyaydin
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Christian Pogoda
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Angelo Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Juergen R Sindermann
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany.,Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Izabela Tuleta
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
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9
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Darche FF, Helmschrott M, Rahm AK, Thomas D, Schweizer PA, Bruckner T, Ehlermann P, Kreusser MM, Warnecke G, Frey N, Rivinius R. Atrial fibrillation before heart transplantation is a risk factor for post-transplant atrial fibrillation and mortality. ESC Heart Fail 2021; 8:4265-4277. [PMID: 34453484 PMCID: PMC8497346 DOI: 10.1002/ehf2.13552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Atrial fibrillation (AF) after heart transplantation (HTX) is associated with worse clinical outcomes. The current study aimed to analyse the association between AF before HTX and AF within 30 days after HTX. METHODS AND RESULTS This study included 639 adults who received HTX at Heidelberg Heart Center. Patients were subdivided into four groups depending on the status of AF before and after HTX. Analyses comprised recipient and donor data, medication, echocardiographic features, permanent pacemaker implantation, stroke, and mortality after HTX. Three hundred thirty-two patients (52.0%) had neither AF before nor after HTX, 15 patients (2.3%) had no AF before HTX but showed AF after HTX, 219 patients (34.3%) showed AF before HTX but had no AF after HTX, and 73 patients (11.4%) had AF before and after HTX. Patients with AF before and after HTX had a higher 1 year post-transplant mortality (39.7%) than patients without AF before or after HTX (18.1%, P < 0.01). Secondary outcomes showed a higher percentage of enlarged atria, ventricular dysfunction, mitral regurgitation, 1-year stroke, and 1-year permanent pacemaker implantation in patients with AF before and after HTX. Multivariate analysis revealed a six-fold elevated risk for post-transplant AF in patients with AF before HTX (hazard ratio: 6.59, confidence interval: 3.72-11.65; P < 0.01). Further risk factors for post-transplant AF were higher donor age and prolonged ischaemic time, whereas total orthotopic HTX was associated with a two-fold lower risk for post-transplant AF. CONCLUSIONS Atrial fibrillation before HTX is a risk factor for post-transplant AF, permanent pacemaker implantation, and mortality after HTX.
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Affiliation(s)
- Fabrice F Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Ann-Kathrin Rahm
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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10
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Abudan A, Kidd B, Hild P, Gupta B. Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series. Eur Heart J Case Rep 2021; 5:ytab046. [PMID: 33738420 PMCID: PMC7954254 DOI: 10.1093/ehjcr/ytab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/27/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Inferior vena cava (IVC) obstruction is a rare complication of orthotopic heart transplantation (OHT) and is unique to bicaval surgical technique. The clinical significance, diagnosis, complications, and management of post-operative IVC anastomotic obstruction have not been adequately described. CASE SUMMARY Two patients with end-stage heart failure presented for bicaval OHT. Post-operative course was complicated with shock refractory to fluid resuscitation and inotropic/vasopressor support. Obstruction at the IVC-right atrial (RA) anastomosis was diagnosed on transoesophageal echocardiography (TOE), prompting emergent reoperation. In both cases, a large donor Eustachian valve was found to be restricting flow across the IVC-RA anastomosis. Resection of the valve resulted in relief of obstruction across the anastomosis and subsequent improvement in haemodynamics and clinical outcome. DISCUSSION Presumably rare, we present two cases of IVC obstruction post-bicaval OHT. Inferior vena cava obstruction is an under-recognized cause of refractory hypotension and shock in the post-operative setting. Prompt recognition using TOE is crucial for immediate surgical correction and prevention of multi-organ failure. Obstruction can be caused by a thickened Eustachian valve caught in the suture line at the IVC anastomosis, which would require surgical resection.
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Affiliation(s)
- Anas Abudan
- Department of Medicine, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Brent Kidd
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Peter Hild
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Bhanu Gupta
- Department of Cardiovascular Diseases, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
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11
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Navas-Blanco JR, Modak RK. Perioperative care of heart transplant recipients undergoing non-cardiac surgery. Ann Card Anaesth 2021; 24:140-148. [PMID: 33884968 PMCID: PMC8253024 DOI: 10.4103/aca.aca_130_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The life expectancy of patients with end-stage heart disease undergoing Orthotopic Heart Transplantation (OHT) has increased significantly in the recent decades since its original introduction into the medical practice in 1967. Substantial advances in post-operative intensive care, surgical prophylaxis, and anti-rejection drugs have clearly impacted survivability after OHT, therefore the volume of patients presenting for non-cardiac surgical procedures is expected to continue to escalate in the upcoming years. There are a number of caveats associated with this upsurge of post-OHT patients requiring non-cardiac surgery, including presenting to healthcare facilities without the resources and technology necessary to manage potential perioperative complications or that may not be familiar with the care of these patients, facilities in which a cardiac anesthesiologist is not available, patients presenting for emergency procedures and so forth. The perioperative care of patients after OHT introduces several challenges to the anesthesiologist including preoperative risk assessments different to the general population and intraoperative management of a denervated organ with altered response to medications and drug-drug interactions. The present review aims to synopsize current data of patients presenting for non-cardiac surgery after OHT, surgical aspects of the transplant that may impact perioperative care, physiology of the transplanted heart as well as anesthetic considerations.
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Affiliation(s)
- Jose R Navas-Blanco
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Raj K Modak
- Department of Anesthesia, Pain Management and Perioperative Medicine, Divisions of Cardiothoracic Anesthesia and Critical Care Anesthesiology, Henry Ford Hospital, Detroit, Michigan, USA
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12
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Biatrial Versus Bicaval Orthotopic Heart Transplantation: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2020; 110:684-691. [DOI: 10.1016/j.athoracsur.2019.12.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/14/2019] [Accepted: 12/17/2019] [Indexed: 11/23/2022]
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13
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Maning J, Blumer V, Hernandez G, Acuna E, Li H, Chaparro SV. Bicaval vs biatrial anastomosis techniques in orthotopic heart transplantation: An updated analysis of the UNOS database. J Card Surg 2020; 35:2242-2247. [PMID: 32720472 DOI: 10.1111/jocs.14887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the significant increase in the number of orthotopic heart transplants (OHT) performed yearly using the bicaval anastomosis technique, the impact on long-term outcomes remains a topic of debate. We analyzed the United Network for Organ Sharing (UNOS) database in search of the latest insight. METHODS We performed a retrospective analysis of the UNOS database from 2006 to 2016 to identify first-time OHT recipients. Patients were primarily stratified according to anastomosis technique: bicaval vs biatrial. Baseline characteristics and clinical status were recorded. The primary endpoint was all-cause mortality. Secondary outcomes included need for permanent pacemaker (PPM), and length of hospital stay (LOS). The Kaplan-Meier method was used to compare survival between the two groups. The Cox proportional hazards regression model was used to conduct multivariable analysis. Statistical significance established at P < .0001. RESULTS A total of 26 990 patients were identified. Of those who met the inclusion criteria (21 597), 16 573 (77%) underwent bicaval anastomosis. There were no major differences in baseline characteristics between the two groups. The bicaval anastomosis technique was not associated with increased survival during the study period (hazard ratio: 0.97; P = .3557), but the bicaval group required postoperative PPM less often (2.51% vs 5.79%, P < .0001) and was associated with shorter LOS on multivariable analysis. CONCLUSIONS The use of either bicaval or biatrial anastomosis during OHT offers comparable survival advantage. Nonetheless, bicaval anastomosis is associated with less need for postoperative PPM and slightly shorter LOS.
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Affiliation(s)
- Jennifer Maning
- Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Vanessa Blumer
- Cardiovascular Division, Duke University Hospital, Durham, North Carolina
| | - Gabriel Hernandez
- Cardiovascular Division, University of Mississippi, Jackson, Mississippi
| | - Edgar Acuna
- Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Hua Li
- Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Sandra V Chaparro
- Advanced Heart Failure and Transplantation Cardiology Division, Miami Cardiac and Vascular Institute at Baptist Health South Florida, Miami, Florida
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14
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Abstract
Background: With an aging population, the prevalence of heart failure continues to rise. The use of guideline-directed medical therapy and mechanical circulatory support devices has helped to improve outcomes, but cardiac transplantation remains the definitive treatment for end-stage heart failure. Methods: We provide an update on cardiac transplantation and review indications, contraindications, and important aspects of perioperative and postoperative management. We also highlight the current challenges faced by the transplant community. Results: Advances in surgical techniques and immunosuppression have increased survival rates posttransplant. However, the risk of rejection and adverse effects from chronic immunosuppression continue to affect long-term outcomes. Conclusion: Despite tremendous progress in the management of cardiac transplant patients, we have much opportunity to further optimize cardiac transplant waitlisting and improve posttransplant outcomes.
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15
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Tan Z, Roscoe A, Rubino A. Transesophageal Echocardiography in Heart and Lung Transplantation. J Cardiothorac Vasc Anesth 2019; 33:1548-1558. [DOI: 10.1053/j.jvca.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 02/04/2023]
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16
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Abrams B, Hoffman J, Aftab M, Evers J, Seres T. A Rare Case of Stenosis at the Inferior Vena Cava to Right Atrium Anastomosis After Bicaval Orthotopic Heart Transplantation. Semin Cardiothorac Vasc Anesth 2019; 23:418-421. [DOI: 10.1177/1089253219832608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stenosis at either the superior or inferior caval anastomosis is a rare complication of orthotopic heart transplantation (OHT) and is unique to the bicaval surgical technique. The severity of stenosis dictates the degree of clinical significance, varying from asymptomatic to congestive end-organ injury and hemodynamic instability from impaired preload. Due to differences in the anatomic location of organ congestion, the clinical presentation also depends on which of the 2 anastomoses is involved. In this article, the authors describe a case of stenosis at the inferior vena cava to right atrium anastomosis, which was diagnosed intraoperatively during OHT after weaning from cardiopulmonary bypass. Transesophageal echocardiography provided an accurate and timely diagnosis of this complication, which allowed for immediate surgical correction. Surprisingly, a large, native Eustachian valve was found to be obstructing the anastomosis. Resection of the valve relieved the previously significant narrowing across the anastomosis. This case highlights the importance of thorough intraoperative transesophageal echocardiographic evaluation of graft anastomoses during OHT, as well as an understanding on the part of the echocardiographer of the specific surgical techniques employed during OHT.
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17
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Chaney MA, Lowe ME, Minhaj MM, Santise G, Jacobsohn E. Inferior Vena Cava Stenosis After Bicaval Orthotopic Heart Transplantation. J Cardiothorac Vasc Anesth 2019; 33:2561-2568. [PMID: 31142438 DOI: 10.1053/j.jvca.2019.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
| | - Michael E Lowe
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mohammed M Minhaj
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Gianluca Santise
- Department of Cardiac Surgery, Sant'Anna Hospital, Catanzaro, Italy
| | - Eric Jacobsohn
- University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
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18
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Kim HR, Jung SH, Kim JJ, Yang DH, Yun TJ, Lee JW. Modified Bicaval Technique in Orthotopic Heart Transplantation - Comparison With Conventional Bicaval Technique. Circ J 2018; 83:117-121. [PMID: 30369590 DOI: 10.1253/circj.cj-18-0567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Orthotopic heart transplantation (HT) is the treatment of choice for patients with end-stage heart failure (HF). The bicaval technique was introduced as a safe alternative minimizing modification of atrial geometry. The modification of bicaval anastomosis is suggested to compensate for caliber mismatch and small donor. The present study was performed to compare these 2 techniques in terms of postoperative CT scan and clinical outcomes. Methods and Results: Retrospectively, 158 consecutive patients with end-stage HF underwent orthotopic HT between January 2009 and June 2013 were analyzed. Of these, we excluded 3 patients with total HT. The study group was divided into modified technique (n=37) or conventional technique (n=118). A total of 113 patients (modified: n=29, conventional: n=84) were examined with cardiac CT. Discrepancy in the size of the vena cava compared with that of the anastomosis site was assessed. There was no significant difference in the complication and survival rates. There was 1 incident of moderate-to-severe tricuspid valve regurgitation in the modified group (n=1, 2.7%). Both the SVC ratio (1.07±0.13 vs. 1.28±0.32, P=0.001) and IVC ratio (1.06±0.07 vs. 1.13±0.19, P=0.009) were higher in the conventional group, which meant more stenotic imaging findings were observed in the conventional group. CONCLUSIONS Orthotopic HT with modified bicaval anastomosis is an attractive alternative with easy orientation and equivocal outcomes.
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Affiliation(s)
- Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Tae-Jin Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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19
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See VY. Organized atrial arrhythmias after cardiac transplantation: The overlooked value of the 12-lead electrocardiogram and cavotricuspid atrial flutter isthmus. J Heart Lung Transplant 2017; 37:S1053-2498(17)32084-3. [PMID: 29129369 DOI: 10.1016/j.healun.2017.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/18/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Vincent Y See
- Cardiovascular Medicine Division, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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20
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Kumar TKS, Mathis C, Sathanandam S, Zurakowski D, Subramanian S, Allen J, Solimine M, Berrios L, Jackson S, Landers M, Sullivan R, Barnett S, Rayburn M, Loftis C, Price L, Tansey JB, Hoskoppal D, Knott-Craig C. Effect of thyroid hormone on cardiac function following orthotopic heart transplantation in piglets. Pediatr Transplant 2017; 21. [PMID: 28710785 DOI: 10.1111/petr.13002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
Abstract
Studies in adult HT have demonstrated improved cardiac function in the recipient following administration of T3 to the donor. The purpose of this experiment was to assess the effects of T3 on the function of the immature donor heart following HT in a piglet model. A total of 32 piglets were divided into 16 donors and 16 recipients. Following creation of brain death, half of the donor piglets were randomized to receive three doses of T3 (0.2 μg/kg) along with hydrocortisone (1 mg/kg). The donor hearts were then transplanted into the recipient piglets on CPB. Duration of survival off CPB, inotrope score, and EF of heart following CPB were evaluated. There were no differences between the two groups in age, weight, pre-brain death EF, T3 levels, and CPB times. Post-CPB survival times were inversely related to the ischemic times in both groups (Pearson r=-0.80, P<.001), and this relationship was not influenced by T3. There was no difference in inotrope score, EF, or biochemical assessment between the two groups. Administration of T3 in combination with hydrocortisone to the brain-dead donor confers no beneficial effect on myocardial function or survival following HT in a piglet model.
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Affiliation(s)
- T K Susheel Kumar
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - Craig Mathis
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - Shyam Sathanandam
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Saradha Subramanian
- Department of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - Jerry Allen
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - Michael Solimine
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - Lindsay Berrios
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - Scott Jackson
- Department of Comparative Medicine, University of Tennessee, Memphis, TN, USA
| | - Mark Landers
- Department of Comparative Medicine, University of Tennessee, Memphis, TN, USA
| | - Ryan Sullivan
- Department of Comparative Medicine, University of Tennessee, Memphis, TN, USA
| | - Stacey Barnett
- Department of Comparative Medicine, University of Tennessee, Memphis, TN, USA
| | - Mark Rayburn
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - Christopher Loftis
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - Lauren Price
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | - James B Tansey
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
| | | | - Christopher Knott-Craig
- Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital, University of Tennessee, Memphis, TN, USA
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21
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Rivinius R, Helmschrott M, Ruhparwar A, Erbel C, Gleissner CA, Darche FF, Thomas D, Bruckner T, Katus HA, Doesch AO. The influence of surgical technique on early posttransplant atrial fibrillation - comparison of biatrial, bicaval, and total orthotopic heart transplantation. Ther Clin Risk Manag 2017; 13:287-297. [PMID: 28331331 PMCID: PMC5352240 DOI: 10.2147/tcrm.s126869] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Early posttransplant atrial fibrillation (AF) has been associated with worse clinical outcomes after heart transplantation (HTX). The type of surgical technique may constitute a relevant risk factor for AF. PATIENTS AND METHODS This retrospective single-center study included 530 adult patients. Patients were stratified by surgical technique (biatrial, bicaval, or total orthotopic HTX) and early posttransplant heart rhythm (AF or sinus rhythm). Univariate and multivariate analyses were performed to evaluate risk factors for AF. RESULTS A total of 161 patients received biatrial HTX (30.4%), 115 bicaval HTX (21.7%), and 254 total orthotopic HTX (47.9%). Sixty-one of 530 patients developed early posttransplant AF (11.5%). Patients with AF showed a statistically inferior 5-year survival compared to those with sinus rhythm (P<0.0001). Total orthotopic HTX had the lowest rate of AF (total orthotopic HTX [6.3%], bicaval HTX [14.8%], biatrial HTX [17.4%], P=0.0012). Multivariate analysis showed pretransplant valvular heart disease (P=0.0372), posttransplant enlarged left atrium (P=0.0066), posttransplant mitral regurgitation (P=0.0370), and non-total orthotopic HTX (P=0.0112) as risk factors for AF. CONCLUSION Early posttransplant AF was associated with increased mortality (P<0.0001). Total orthotopic HTX showed the lowest rate of AF compared to biatrial or bicaval HTX (P=0.0012).
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Affiliation(s)
| | | | | | | | | | | | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology
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22
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Farid TA, Omer MA, Gosch K, Moser A, Austin B, Magalski A, Wimmer AP. Stability of pacing indices and need for pacing in cardiac transplant patients over 1 year of follow-up. J Interv Card Electrophysiol 2017; 49:27-32. [PMID: 28181107 DOI: 10.1007/s10840-017-0226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/24/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND A significant minority of cardiac transplant patients require permanent pacemaker (PPM) implant, primarily for sinus node dysfunction. The stability of pacing indices has not been determined in this unique patient population, and data regarding ongoing need for pacing are limited. METHODS Pacing indices (sensing, threshold, and impedance) as well as the percentage of time patients required pacing were recorded, from 30 cardiac transplant patients that underwent PPM implant, over 1 year of follow-up. Repeated measure ANOVA (analysis of variance) was used to compare pacing indices and the percentage of time patients required pacing in each cardiac chamber (right atrium (RA) and right ventricle (RV)) and at different time points. RESULTS There was no difference in sensing among the follow-up time points (p = 0.9). Thresholds at 3 months were significantly higher compared to the day of implant (p = 0.005) and the day after implant (p = 0.03). Impedances at implant were significantly higher compared to day 1 (p < 0.001), 3 months (p < 0.003), and 12 months (p < 0.001) post-implant. The mean percentage of RA pacing was 85 ± 6% the day after implant, 74 ± 6% at 3 months, and 80 ± 6% at 1 year (p = 0.17). CONCLUSION In cardiac transplant patients, pacing impedances decrease and thresholds trend up in short-term follow-up, but subsequent sensing, threshold, and impedance remain stable at 1 year. This is comparable to the pattern observed among noncardiac transplant PPM recipients. The atrial pacing percentage was stable over 1 year, suggesting continued relative sinus node dysfunction.
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Affiliation(s)
- Talha A Farid
- Department of Internal Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA. .,Department of Cardiovascular Medicine, University of Louisville, 201 Abraham Flexner Way, Louisville, KY, 40292, USA.
| | - Mohamed A Omer
- Department of Internal Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA
| | - Kensey Gosch
- St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Ashley Moser
- Department of Internal Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA.,St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Bethany Austin
- Department of Internal Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA.,St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Anthony Magalski
- Department of Internal Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA.,St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Alan P Wimmer
- Department of Internal Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA.,St. Luke's Mid America Heart Institute, Kansas City, MO, USA
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Barge-Caballero E, Jiménez-López J, Chávez-Leal S, Barge-Caballero G, Paniagua-Martin MJ, Marzoa Rivas R, Grille-Cancela Z, Cuenca-Castillo JJ, Castro-Beiras A, Crespo-Leiro MG. Significado pronóstico y evolución a largo plazo de la frecuencia cardiaca en los pacientes con trasplante cardiaco. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reid AB, Waldron N, Schmitt M, Miller CA. The Value of Cardiovascular Magnetic Resonance in Heart Transplant Patients. Curr Cardiol Rep 2015; 17:612. [PMID: 26055963 DOI: 10.1007/s11886-015-0612-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heart transplant patients present a unique set of anatomical and pathophysiological considerations. Patients often present non-specifically, requiring a low index for further investigation. Accurate assessment with standard imaging modalities can be difficult, and cardiovascular magnetic resonance (CMR) is becoming an increasingly useful modality in the assessment of heart transplant patients. This review describes the anatomy of the transplanted heart and typical CMR appearances and discusses the role of CMR in heart transplant disease.
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Affiliation(s)
- Anna B Reid
- North West Heart Centre, University Hospital of South Manchester, Wythenshawe, Manchester, UK,
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Singh D, Taylor DO. Advances in the understanding and management of heart transplantation. F1000PRIME REPORTS 2015; 7:52. [PMID: 26097725 PMCID: PMC4447052 DOI: 10.12703/p7-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cardiac transplantation represents one of the great triumphs in modern medicine and remains the cornerstone in the treatment of advanced heart failure. In this review, we contextualize pivotal developments in our understanding and management of cardiac transplant immunology, histopathology, rejection surveillance, drug development and surgery. We also discuss current limitations in their application and the impact of the left ventricular assist devices in bridging this gap.
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Affiliation(s)
- Dhssraj Singh
- Department of Cardiovascular Medicine, Heart and Vascular InstituteCleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195USA
| | - David O. Taylor
- Department of Cardiovascular Medicine, Heart and Vascular InstituteCleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195USA
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Prognostic Significance of Heart Rate and its Long-term Trend in Cardiac Transplant Patients. ACTA ACUST UNITED AC 2015; 68:943-50. [PMID: 25869124 DOI: 10.1016/j.rec.2014.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/19/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of the present study was to examine the prognostic significance of heart rate and its trend in heart transplantation. METHODS This observational study enrolled 170 patients who received a bicaval heart transplant between 1995 and 2005; all were in sinus rhythm. The resting heart rate was determined via electrocardiography at the end of the first posttransplant year and annually until the tenth year. Cox analysis was used to evaluate the incidence of adverse events with a mean (standard deviation) follow-up of 8.9 (3.1) years. The primary study end point was the composite outcome of death or graft dysfunction. RESULTS The resting heart rate at the end of the first posttransplant year was an independent predictor of the primary composite end point (hazard ratio=1.054; 95% confidence interval, 1.028-1.080; P<.001) and was significantly associated with total mortality (hazard ratio=1.058; 95% confidence interval, 1.030-1.087; P<.001) and mortality from cardiac causes (hazard ratio=1.069; 95% confidence interval, 1.026-1.113; P=.001), but not with graft dysfunction (hazard ratio=1.028; 95% confidence interval, 0.989-1.069; P=.161). For patients with a heart rate ≥ 105 or<90 bpm vs those with 90-104 bpm, the hazard ratios of the primary end point were 2.233 (95% confidence interval, 1.250-3.989; P=.007) and 0.380 (95% confidence interval, 0.161-0.895; P=.027), respectively. Heart rate tended to decrease in the first 10 years after transplantation (P=.001). Patients with a net increase in heart rate during follow-up showed a higher incidence of adverse events. CONCLUSIONS An elevated heart rate is an adverse prognostic marker after heart transplantation.
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Surgical Treatment of Advanced Heart Failure. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Frequency of superior vena cava obstruction in pediatric heart transplant recipients and its relation to previous superior cavopulmonary anastomosis. Am J Cardiol 2013; 112:286-91. [PMID: 23587279 DOI: 10.1016/j.amjcard.2013.03.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/06/2013] [Accepted: 03/06/2013] [Indexed: 11/20/2022]
Abstract
The risk factors for superior vena cava (SVC) obstruction after pediatric orthotopic heart transplantation (OHT) have not been identified. This study tested the hypothesis that pretransplant superior cavopulmonary anastomosis (CPA) predisposes patients to SVC obstruction. A retrospective review of the Pediatric Cardiac Care Consortium registry from 1982 through 2007 was performed. Previous CPA, other cardiac surgeries, gender, age at transplantation, and weight at transplantation were assessed for the risk of developing SVC obstruction. Death, subsequent OHT, or reoperation involving the SVC were treated as competing risks. Of the 894 pediatric OHT patients identified, 3.1% (n = 28) developed SVC obstruction during median follow-up of 1.0 year (range: 0 to 19.5 years). Among patients who developed SVC obstruction, 32% (n = 9) had pretransplant CPA. SVC surgery before OHT was associated with posttransplant development of SVC obstruction (p <0.001) after adjustment for gender, age, and weight at OHT and year of OHT. Patients with previous CPA had increased risk for SVC obstruction compared with patients with no history of previous cardiac surgery (hazard ratio 10.6, 95% confidence interval: 3.5 to 31.7) and to patients with history of non-CPA cardiac surgery (hazard ratio 4.7, 95% confidence interval: 1.8 to 12.5). In conclusion, previous CPA is a significant risk factor for the development of post-heart transplant SVC obstruction.
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Sattiraju S, Vats S, Krishnan B, K Kim S, Austin E, Can I, Tholakanahalli V, G Benditt D, Y Chen L. Operative Technique and Atrial Tachyarrhythmias After Orthotopic Heart Transplantation. J Atr Fibrillation 2012; 5:690. [PMID: 28496794 DOI: 10.4022/jafib.690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 09/26/2012] [Accepted: 11/06/2012] [Indexed: 11/10/2022]
Abstract
There is conflicting evidence that operative technique affects the risk of atrial tachyarrhythmia after orthotopic heart transplantation (OHT). We sought to determine whether OHT by bicaval (BC) technique is associated with a lower risk of atrial tachyarrhythmia than biatrial (BA) technique. Consecutive patients who underwent OHT between 1997 and 2007 at the University of Minnesota were included in this retrospective cohort study with follow-up through December 31, 2011. We included 260 OHT recipients (BA, 155; BC, 105). Fifty-nine patients (22.7%) developed early atrial tachyarrhythmias. The multivariable odds ratio (95% confidence interval [CI]) of BC technique for early atrial tachyarrhythmias was 0.85 (0.46-1.57), P=0.59. After a median follow-up of 4.9 years, 40 (15.4%) patients developed late atrial tachyarrhythmias. The multivariable hazard ratio (HR) (95% CI) of BC technique for late atrial tachyarrhythmias was 0.99 (0.50-1.96), P=0.98. Graft rejection was found to be a multivariate predictor of late atrial tachyarrhythmias (HR, 2.89; 95% CI, 1.48-5.65; P=0.002). In contrast to prior reports, we did not find an association between operative technique and early or late atrial tachyarrhythmias after OHT. Graft rejection is a risk factor for late atrial tachyarrhythmias after OHT.
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Affiliation(s)
- Srinivasan Sattiraju
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Shashank Vats
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Balaji Krishnan
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Sun K Kim
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Erin Austin
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ilknur Can
- Konya Üniversitesi Meram Tıp Fakultesi Kardiyoloji Konya, Turkey
| | - Venkatakrishna Tholakanahalli
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - David G Benditt
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Lin Y Chen
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Sattiraju S, Vats S, Krishnan B, K Kim S, Austin E, Can I, Tholakanahalli V, G Benditt D, Y Chen L. Operative Technique and Atrial Tachyarrhythmias After Orthotopic Heart Transplantation. J Atr Fibrillation 2012. [PMID: 28496794 DOI: 10.4022/jafib.690.ecollection] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There is conflicting evidence that operative technique affects the risk of atrial tachyarrhythmia after orthotopic heart transplantation (OHT). We sought to determine whether OHT by bicaval (BC) technique is associated with a lower risk of atrial tachyarrhythmia than biatrial (BA) technique. Consecutive patients who underwent OHT between 1997 and 2007 at the University of Minnesota were included in this retrospective cohort study with follow-up through December 31, 2011. We included 260 OHT recipients (BA, 155; BC, 105). Fifty-nine patients (22.7%) developed early atrial tachyarrhythmias. The multivariable odds ratio (95% confidence interval [CI]) of BC technique for early atrial tachyarrhythmias was 0.85 (0.46-1.57), P=0.59. After a median follow-up of 4.9 years, 40 (15.4%) patients developed late atrial tachyarrhythmias. The multivariable hazard ratio (HR) (95% CI) of BC technique for late atrial tachyarrhythmias was 0.99 (0.50-1.96), P=0.98. Graft rejection was found to be a multivariate predictor of late atrial tachyarrhythmias (HR, 2.89; 95% CI, 1.48-5.65; P=0.002). In contrast to prior reports, we did not find an association between operative technique and early or late atrial tachyarrhythmias after OHT. Graft rejection is a risk factor for late atrial tachyarrhythmias after OHT.
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Affiliation(s)
- Srinivasan Sattiraju
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Shashank Vats
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Balaji Krishnan
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Sun K Kim
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Erin Austin
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ilknur Can
- Konya Üniversitesi Meram Tıp Fakultesi Kardiyoloji Konya, Turkey
| | - Venkatakrishna Tholakanahalli
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - David G Benditt
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Lin Y Chen
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Dell'Aquila AM, Mastrobuoni S, Bastarrika G, Praschker BL, Agüero PA, Castaño S, Herreros J, Rabago G. Bicaval versus standard technique in orthotopic heart transplant: assessment of atrial performance at magnetic resonance and transthoracic echocardiography. Interact Cardiovasc Thorac Surg 2012; 14:457-62. [PMID: 22217865 DOI: 10.1093/icvts/ivr084] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite a more physiological morphology of atrial anastomosis in the bicaval technique with respect to standard biatrial anastomosis in orthotopic heart transplantation (OHT), the impact on the long-term outcome is still not clear. In this retrospective study, we sought to investigate the morphology and function of the atria through magnetic resonance imaging (MRI) and transthoracic echocardiography (TTE). Moreover, we aimed to analyse the accuracy of TTE with respect to MRI. Cox regression analysis of 216 consecutive patients receiving OHT between August 1987 and January 2010 identified only recipient age at the time of transplant to be an independent predictor of mortality (P = 0.048, odds ratio = 1.04). After a mean follow-up of 96.6 ± 77.7 months, 108 patients were alive, of which 35 were found to be eligible for MRI assessment. In this analysis, left and right atrial volumes were found to be significantly larger in the standard group in comparison with the bicaval group (P = 0.001), and no significant difference between the two techniques was observed in left and right atrio-ventricular output. Moreover, a significantly reduced accuracy was observed (CCC < 0.3) when TTE results were compared with MRI assessment in evaluating atrial dimensions. Although left and right atrial volumes are significantly larger in the standard group in comparison with the bicaval group, we concluded that no significant difference in the atrial output and survival between the two techniques could be demonstrated.
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Nawaz MA, Curry P, Patni R, Punjabi P, Murday A. An audit of a steriod withdrawal regimen in cardiac transplantation patients. Transplant Proc 2011; 43:623-8. [PMID: 21440780 DOI: 10.1016/j.transproceed.2011.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Heart transplantation is optimal treatment for many patients with end-stage heart failure. Current data report 1-year graft survival rates of 85% after transplantation. The success of transplantation in large part is attributable to immunosuppression, including steroids, one of the mainstay agents. Despite its efficacy to treat acute graft rejection, steroids show numerous adverse effects. With newer immunosuppressive agents, steroid withdrawal is possible. MATERIAL AND METHODS We compared cardiac transplant patients who died versus survived between 2001 and 2006. We obtained Personal, transplant, occurrence of and cause of death data as well as postoperative intervals. Steroid therapy details were gathered, particularly whether the patient had been weaned off these agents. We calculated steroid doses and steroid-free years, as well as the steroid therapy status of posttransplant patients who remained alive in 2006. RESULTS Fifty cardiac transplant patients died between 2001 and 2006 excluding 6 who had graft failure and 2 who died of multiorgan failure before initial discharge. Of the 42 patient who died, 29 (69%) were on and 13 (31%) had been withdrawn from steroid therapy at time of death. There were 132 posttransplant patients currently alive in April 2006, including 43 (33%) on and 89 (67%) withdrawn from steroids. The percentages of patients who were on versus off steroids were compared for main causes of death. Thirty-eight percent of patients on steroids at the time of death died of graft vasculopathy compared with 46% of patients who had been weaned off steroids. Fifteen percent of deceased patients taking steroids at the time of death died of chronic rejection. DISCUSSION The current literature focuses on early withdrawal or reduction of steroids or steroid avoidance after organ transplantation. Although steroid avoidance remains controversial, steroid withdrawal has been generally incorporated into immunosuppressive protocols. Early steroid withdrawal has a positive influence on the emergence of de novo osteoporosis and cataracts. The benefits of steroid avoidance versus withdrawal are controversial topics being currently debated.
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Affiliation(s)
- M Asghar Nawaz
- Golden Jubilee National Hospital Glasgow, United Kingdom.
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Davies RR, Russo MJ, Morgan JA, Sorabella RA, Naka Y, Chen JM. Standard versus bicaval techniques for orthotopic heart transplantation: An analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg 2010; 140:700-8, 708.e1-2. [DOI: 10.1016/j.jtcvs.2010.04.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 01/12/2010] [Accepted: 04/26/2010] [Indexed: 01/15/2023]
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Vande Kappelle RP, Gambetta K, Deal BJ, Backer CL, Sullivan CL, Pahl E. Late sinus and atrial tachycardia after pediatric heart transplantation might predict poor outcome. Pediatr Cardiol 2010; 31:643-9. [PMID: 20165843 DOI: 10.1007/s00246-010-9662-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 01/20/2010] [Indexed: 11/29/2022]
Abstract
Our objective was to examine clinical/electrocardiogram (ECG) predictors and outcomes of arrhythmias beyond 1 year after pediatric heart transplantation (HTx). We performed a retrospective chart review of 94 1-year HTx survivors, 1988-2006. Clinical records identified patients with arrhythmias occurring >1 year after HTx requiring pharmacotherapy, excluding acute rejection. We reviewed preoperative diagnosis, gender, age at HTx, operative details, transplant coronary artery disease (TCAD), and mortality. We analyzed serial ECGs after HTx for HR, PR, QRS, QT, and QTc intervals. Our results found complete data in 58 patients, 14 (24%) with arrhythmia and 44 controls. Arrhythmias occurred 1.1-17.9 years after HTx (mean = 6.8): 11 focal atrial tachycardia, 1 atrial fibrillation/flutter, 1 atrioventricular node reentry tachycardia; only 1 patient had ventricular tachycardia (VT). Serial ECG intervals were similar between groups, as well as surgical technique, ischemic time, and rejection history. Seven patients (50%) with arrhythmias had death or graft death versus 11% of the controls (P = 0.006). Patients with arrhythmias were more likely to be diagnosed with TCAD (P = 0.007). The patient with VT had no TCAD. In conclusion, supraventricular arrhythmias were frequent (22%) in 1-year survivors of pediatric HTx. These patients were more likely to develop TCAD and/or graft loss/mortality.
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Frogel J, Vodur S, Applefield D, Kruba R, Raman J, Mitter N. Case 6--2008. An unusual case of right ventricular failure after orthotopic heart transplantation. J Cardiothorac Vasc Anesth 2008; 22:913-9. [PMID: 19038739 DOI: 10.1053/j.jvca.2008.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan Frogel
- Department of Anesthesiology, Henry Ford Hospital, Detroit, MI 48202, USA.
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Gupta R, Latif F, Dasari TW, Lozano P. Coexisting normal sinus rhythm and atrial fibrillation 18 years after heart transplant. J Card Surg 2008; 23:792-4. [PMID: 19017017 DOI: 10.1111/j.1540-8191.2008.00670.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atrial fibrillation is an important cardiogenic cause of embolic phenomenon to the brain leading to stroke and long-term disability. Recognition of atrial fibrillation is of cardinal importance in the workup of stroke and transient ischemic attack (to prevent future strokes) by the timely institution of anticoagulation therapy. We describe a patient with history of standard orthotopic heart transplant (st.OHT) who had no clinical or electrocardiographic signs of atrial fibrillation. He presented with a transient ischemic attack (TIA) and subsequently was found to have two distinct left atrial appendages (LAA) in two different rhythms based on transesophageal echocardiography (TEE) and pulse wave (PW) Doppler. The donor LAA was in normal sinus rhythm (NSR) and recipient LAA in atrial fibrillation (AF). This was an extremely rare but important diagnosis in our patient, which led to the institution of anticoagulation therapy rather than aspirin and dipyridamole as described in neurological literature. We discuss different types of heart transplant techniques and their causatum on postoperative atrial tachycardias. Significance of TEE in the scenario of TIA and follow-up in heart transplant patients is also canvassed.
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Affiliation(s)
- Raghav Gupta
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Tsai HE, Wang SS, Chou NK, Chi NH, Chen YS, Yu HY, Wang CH, Ko WJ, Tsao CI, Sun CD. Heart transplantation using bicaval anastomosis to concomitantly relieve superior vena caval obstruction in a pediatric patient with heart failure. Transplant Proc 2008; 40:2854-5. [PMID: 18929884 DOI: 10.1016/j.transproceed.2008.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe a case of complex congenital heart disease treated using balloon septostomy, pulmonary artery banding. Blalock-Taussig shunt, and cardiac resynchronization therapy; however, heart failure developed. A bicaval anastomosis was used to relieve superior vena cava (SVC) obstruction despite possible anastomotic stenosis. The postoperative course was uneventful and the patient recovered rapidly. Thus, we recommend bicaval anastomosis using a longer donor SVC concomitantly performed during heart transplantation to relieve both heart failure and SVC obstruction in pediatric patients.
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Affiliation(s)
- H-E Tsai
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
Anesthesiologists increasingly encounter patients who have a spectrum of heart failure ranging from stable chronic heart failure to acute heart failure to cardiogenic shock. Improved medical therapy has increased the survival of patients who have chronic heart failure but not of patients who have acute heart failure. New surgical techniques and mechanical devices may offer alternatives to certain patients who have refractory heart failure This article provides an overview of established and newer pharmacologic and nonpharmacologic therapies and surgical interventions to manage patients who have heart failure, including the perioperative management of heart transplantation and ventricular assist devices.
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Affiliation(s)
- Annette Vegas
- Anesthesiology, University of Toronto, Toronto, Ontario, Canada.
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Grande AM, Gaeta R, Campana C, Klersy C, Riva L, D'Armini AM, Viganò M. Comparison of standard and bicaval approach in orthotopic heart transplantation: 10-year follow-up. J Cardiovasc Med (Hagerstown) 2008; 9:493-7. [DOI: 10.2459/jcm.0b013e3282f19365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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40
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Incidence, Predictors, and Outcomes of Cardiac Pacing After Cardiac Transplantation: An 11-Year Retrospective Analysis. Transplantation 2008; 85:1216-8. [DOI: 10.1097/tp.0b013e31816b677c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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41
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Schnoor M, Schäfer T, Lühmann D, Sievers HH. Bicaval versus standard technique in orthotopic heart transplantation: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2007; 134:1322-31. [DOI: 10.1016/j.jtcvs.2007.05.037] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 04/11/2007] [Accepted: 05/11/2007] [Indexed: 11/25/2022]
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Affiliation(s)
- L B Balsam
- Stanford University School of Medicine, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Building, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Lo CY, Chang HH, Hsu CP, Lai ST, Shih CC. Endomyocardial biopsy-related tricuspid regurgitation after orthotopic heart transplantation: single-center experience. J Chin Med Assoc 2007; 70:185-92. [PMID: 17524995 DOI: 10.1016/s1726-4901(09)70356-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Damage of tricuspid valve (TV) with resultant tricuspid regurgitation (TR) induced by endomyocardial biopsy (EMB) following heart transplantation has been reported in several studies. This study tried to determine the prevalence of EMB-related iatrogenic damage over tricuspid apparatus following orthotopic heart transplantation and to evaluate its impact on the patients. METHODS Fifty patients received orthotopic heart transplantation between July 1987 and March 2005. Eleven patients were excluded from the study due to early postoperative mortality or inadequate follow-up. The medical records of the remaining 39 patients were reviewed retrospectively for basic characteristics as well as each attempted EMB. The iatrogenic damage of tricuspid apparatus and serial change of TR were accessed with 2-D and Doppler echocardiography. The obtained data were analyzed for their statistical significance with SPSS (version 12.0). RESULTS A total of 373 biopsies were performed on the 39 patients between 1987 and 2005. The follow-up duration was 42.9+/-26.7 months. The prevalence of TR immediately following heart transplantation was 84.6%, with only 25.6% of patients having moderate or severe TR. At the end of the follow-up, the prevalence of TR increased to 92.3% and 61.5% of patients having moderate or severe TR, respectively. Eight patients (20.5%) had small chordae rupture (SCR) noted after 6.6+/-3.2 biopsies, and 10 patients (25.6%) had flail tricuspid valve (FTV) after 5.7+/-5.1 biopsies. Of patients with SCR, 62.5% had progression of TR, and 70% of patients with FTV showed significant TR change. CONCLUSION The prevalence of iatrogenic tricuspid apparatus damage was high in this study. It contributed to the progression of TR significantly regardless of the damage severity. Measurements should be taken for prevention of iatrogenic tricuspid apparatus damage induced by EMB.
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Affiliation(s)
- Chung-Yu Lo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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44
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Mathier MA, Murali S. Cardiac Transplantation and Circulatory Support Devices. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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45
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Frazier OH, Gregoric ID, Cohn WE. Surgical Treatment of Advanced Heart Failure. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Jacobsohn E, Avidan MS, Hantler CB, Rosemeier F, De Wet CJ. Case report: Inferior vena-cava right atrial anastomotic stenosis after bicaval orthotopic heart transplantation. Can J Anaesth 2006; 53:1039-43. [PMID: 16987860 DOI: 10.1007/bf03022534] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This case report describes the occurrence of acute postoperative liver and renal failure after bicaval orthotopic heart transplantation (OHT) due to stenosis of the inferior vena cava (IVC)-right atrial (RA) anastomosis. We also discuss the role of measuring femoral venous pressure and transesophageal echocardiography (TEE) in establishing the diagnosis. CLINICAL FEATURES A 42-yr-old female patient with idiopathic dilated cardiomyopathy underwent an OHT, using the bicaval anastomotic technique. During the first 12 hr postoperatively she developed unexplained kidney and liver failure. Her left and right ventricular functions were excellent and the right and left sided filling pressures were normal. The femoral pressure was elevated while the RA pressure was normal. An emergent TEE showed colour-flow and Doppler characteristics consistent with IVC-RA anastomotic stenosis. Emergent surgical re-exploration was undertaken; a hemostatic suture was found at the RA cannulation site that had caused the constriction of the IVC-RA anastomosis. CONCLUSIONS Acute liver and renal failure after OHT can have multiple causes including ischemia due to a low flow state. This case demonstrates the importance of doing a detailed intraoperative TEE after OHT, and the importance of repeating the intraoperative examination after any hemostatic sutures are placed. Femoral venous pressure monitoring can be a useful diagnostic tool in detecting IVC-RA stenosis.
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Affiliation(s)
- Eric Jacobsohn
- Department of Anesthesiology, Washington University School of Medicine, 660 S. Euclid Ave - Campus Box 8054, St Louis, MO 63110, USA.
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Healy DG, Akbar MT, Baktiari N, Egan JJ, Mahon N, Veerasingam D, McCarthy J, Hurley J, Neligan M, Wood AE. The first 20 years of heart transplantation in Ireland. Ir J Med Sci 2006; 175:5-9. [PMID: 16615220 DOI: 10.1007/bf03168991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The first Irish heart transplant was performed on the 10th of September 1985. Over the next 20 years, 229 transplants were performed in 228 recipients. AIMS To evaluate the success of the first generation of cardiac transplantation in Ireland. METHODS Analysis of clinical outcomes and survival statistics for patients undergoing heart transplantation in Ireland and comparison with international standards. RESULTS There has been a steady improvement in transplant outcome over this time and survival figures for recipients between 2000 and 2004 show a hospital, 1-year and 5-year survival rate of 85.7%, 84.1% and 76.8% respectively. Thirty-eight of the 99 heart transplants performed between 1985 and 1994 are still alive more than 10 years later and the longest survivor is now 19 years post transplantation. CONCLUSIONS The results compare favourably with international figures. Heart transplantation offers excellent longterm survival and quality of life but remains challenged by a shortage of suitable donor organs.
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Affiliation(s)
- D G Healy
- Irish Heart & Lung Transplant Programme, Prof Eoin O'Malley National Centre For Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin.
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Boettger R, Lee J, Rifkin C, Kayser S. Heart transplantation and altered drug response, part I: heart transplantation and innervation. PROGRESS IN CARDIOVASCULAR NURSING 2006; 21:100-3. [PMID: 16760694 DOI: 10.1111/j.0889-7204.2006.04983.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Rebecca Boettger
- Department of Pharmaceutical Services, School of Pharmacy, University of California San Francisco, CA 94143-0622, USA
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