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Zaleski KL, Matte GS, Kleinman ME, Prakash A, Stein ML. Anesthetic Management of Cardiopulmonary Bypass in Hutchinson-Gilford Progeria Syndrome: A Case Report. A A Pract 2024; 18:e01842. [PMID: 39177382 DOI: 10.1213/xaa.0000000000001842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Hutchinson-Gilford Progeria Syndrome (HGPS) is an ultrarare disorder of segmental premature aging that is associated with the development of advanced atherosclerosis and significant cardiovascular and cerebrovascular disease. Treatment with lonafarnib has improved survival in patients with HGPS; however, in extended longitudinal follow-up, there has been an increase in the prevalence of rapidly progressive calcific aortic stenosis. The evolving course of HGPS has prompted reconsideration of conservative management and led to the development of strategies for anatomic treatment. In this case report, we describe the anesthetic management of patients with HGPS undergoing surgical management of aortic stenosis with cardiopulmonary bypass.
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Affiliation(s)
| | | | - Monica E Kleinman
- From the Departments of Anesthesiology, Critical Care and Pain Medicine
| | - Ashwin Prakash
- Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Mary Lyn Stein
- From the Departments of Anesthesiology, Critical Care and Pain Medicine
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Gordon LB, Basso S, Maestranzi J, Aikawa E, Clift CL, Cammardella AG, Danesi TH, del Nido PJ, Edelman ER, Hamdy A, Hegde SM, Kleinman ME, Maschietto N, Mehra MR, Mukundan S, Musumeci F, Russo M, Rybicki FJ, Shah PB, Suarez WA, Tuminelli K, Zaleski K, Prakash A, Gerhard-Herman M. Intervention for critical aortic stenosis in Hutchinson-Gilford progeria syndrome. Front Cardiovasc Med 2024; 11:1356010. [PMID: 38725831 PMCID: PMC11079313 DOI: 10.3389/fcvm.2024.1356010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Hutchinson-Gilford Progeria Syndrome (HGPS) is an ultra-rare genetic premature aging disease that is historically fatal in teenage years, secondary to severe accelerated atherosclerosis. The only approved treatment is the farnesyltransferase inhibitor lonafarnib, which improves vascular structure and function, extending average untreated lifespan of 14.5 years by 4.3 years (30%). With this longer lifespan, calcific aortic stenosis (AS) was identified as an emerging critical risk factor for cardiac death in older patients. Intervention to relieve critical AS has the potential for immediate improvement in healthspan and lifespan. However, HGPS patient-device size mismatch, pervasive peripheral arterial disease, skin and bone abnormalities, and lifelong failure to thrive present unique challenges to intervention. An international group of experts in HGPS, pediatric and adult cardiology, cardiac surgery, and pediatric critical care convened to identify strategies for successful treatment. Candidate procedures were evaluated by in-depth examination of 4 cases that typify HGPS clinical pathology. Modified transcatheter aortic valve replacement (TAVR) and left ventricular Apico-Aortic Conduit (AAC) placement were deemed high risk but viable options. Two cases received TAVR and 2 received AAC post-summit. Three were successful and 1 patient died perioperatively due to cardiovascular disease severity, highlighting the importance of intervention timing and comparative risk stratification. These breakthrough interventions for treating critical aortic stenosis in HGPS patients could rewrite the current clinical perspective on disease course by greatly improving late-stage quality of life and increasing lifespan. Expanding worldwide medical and surgical competency for this ultra-rare disease through expert information-sharing could have high impact on treatment success.
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Affiliation(s)
- Leslie B. Gordon
- Division of Genetics, Department of Pediatrics, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- The Progeria Research Foundation, Peabody, MA, United States
| | - Sammy Basso
- The Progeria Research Foundation, Peabody, MA, United States
- Associazione Italiana Progeria Sammy Basso, Tezze sul Brenta, Vicenza
- CNR - National Research Council of Italy, Institute of Molecular Genetics Luigi Luca Cavalli-Sforza,Unit 9 of Bologna, Bologna, Italy
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Elena Aikawa
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States
| | - Cassandra L. Clift
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Tommaso Hinna Danesi
- Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Pedro J. del Nido
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Elazer R. Edelman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Abeer Hamdy
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Sheila M. Hegde
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Monica E. Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Nicola Maschietto
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Mandeep R. Mehra
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States
- Department of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Roma, Italy
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Roma, Italy
| | - Frank J. Rybicki
- Department of Radiology, University of Arizona - Phoenix, Phoenix, AZ, United States
| | - Pinak Bipin Shah
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States
| | - William A. Suarez
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toledo Medical Center, Toledo, OH, United States
| | | | - Katherine Zaleski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Marie Gerhard-Herman
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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