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Kasinpila P, Ruaengsri C, Koyano T, Shudo Y. Case report: Heart retransplant from a donor after circulatory death and extended transport period with normothermic perfusion. Front Cardiovasc Med 2023; 10:1212886. [PMID: 37636312 PMCID: PMC10457678 DOI: 10.3389/fcvm.2023.1212886] [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: 04/27/2023] [Accepted: 06/27/2023] [Indexed: 08/29/2023] Open
Abstract
A 55-year-old man with end-stage heart failure, who had an orthotopic heart transplant 21 years prior, underwent heart retransplantation using a heart from a donor with circulatory death in a distant location and an extended transport period with normothermic ex vivo perfusion. Owing to the persistent and worsening shortage of donor hearts, this case illustrates that expanding the donor acceptance criteria to include more distant donor locations and enrolling recipients with extended criteria (e.g., heart retransplantation) is feasible.
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Affiliation(s)
| | | | | | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
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Kasinpila P, Krishnam M, Woo YJ. Heart transplantation with concomitant reoperative total aortic arch replacement in a patient with end-stage heart failure and chronic aortic arch dissection. JTCVS Tech 2022; 15:144-146. [PMID: 36276674 PMCID: PMC9579796 DOI: 10.1016/j.xjtc.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022] Open
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Elde S, Brubaker AL, Than PA, Rinewalt D, MacArthur JW, Alassar A, Bonham CA, Esquivel CO, Shudo Y, Concepcion W, Woo YJ. Operative Technique of Donor Organ Procurement for En Bloc Heart-liver Transplantation. Transplantation 2021; 105:2661-2665. [PMID: 33606485 DOI: 10.1097/tp.0000000000003697] [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: 11/25/2022]
Abstract
Combined heart-liver transplant is an emerging option for patients with indications for heart transplantation and otherwise prohibitive hepatic dysfunction. Heart-liver transplantation is particularly relevant for patients with single ventricle physiology who often develop Fontan-associated liver disease and fibrosis. Although only performed at a limited number of centers, several approaches to combined heart-liver transplantation have been described. The en bloc technique offers several potential advantages over the traditional sequential technique. Specifically, en bloc heart-liver transplantation may allow improved hemodynamics, decreased bleeding, reduced liver allograft ischemic time, and may result in reduced rates of graft dysfunction. Here we describe our center's en bloc heart-liver procurement technique in detail, with the aim of allowing broader use and standardization of this technique.
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Affiliation(s)
- Stefan Elde
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA
| | - Aleah L Brubaker
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, CA
| | - Peter A Than
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, CA
| | - Daniel Rinewalt
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA
| | - Aiman Alassar
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA
| | - Clark A Bonham
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, CA
| | - Carlos O Esquivel
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, CA
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA
| | - Waldo Concepcion
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, CA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA
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Guenthart BA, Krishnan A, Koyano T, La Francessca S, Chan J, Alassar A, Macarthur JW, Shudo Y, Hiesinger W, Woo YJ. Extended Static Hypothermic Preservation In Cardiac Transplantation: A Case Report. Transplant Proc 2021; 53:2509-2511. [PMID: 34521542 DOI: 10.1016/j.transproceed.2021.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The donor shortage poses a major limitation to use of heart transplantation. Novel strategies such as use of expanded-criteria donors with prolonged ischemia times are being employed to address this need. Recent developments in static hypothermia have allowed for the safe use of cardiac allografts with prolonged ischemic times. CASE REPORT We present the case of a 68-year-old woman with valvular cardiomyopathy refractory to medical therapy who underwent orthotopic heart transplantation with a cardiac allograft exposed to elevated ischemic times. This was achieved through use of the federally approved SherpaPak Cardiac Transport System for transportation of the allograft. This method of static hypothermic organ preservation allowed for a 330-minute total ischemic time, including 283 minutes of storage within the preservation system. The patient tolerated the procedure well and was discharged on postoperative day 10, with excellent graft function and no evidence of rejection 3 months postoperatively. CONCLUSIONS Though traditionally ischemic times of 240 minutes or less are recommended for cardiac allografts, we demonstrate, to our knowledge, the longest reported ischemic time of 330 minutes via use of a novel method of static hypothermia for organ preservation. The recipient had an excellent outcome postoperatively, demonstrating the potential for this new organ preservation system to expand the donor pool and improve access and use of heart transplantation.
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Affiliation(s)
- Brandon A Guenthart
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
| | - Aravind Krishnan
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Tiffany Koyano
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | | | - Joshua Chan
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Aiman Alassar
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - John W Macarthur
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
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Zhu Y, Lingala B, Baiocchi M, Toro Arana V, Williams KM, Shudo Y, Oyer PE, Woo YJ. The Stanford experience of heart transplantation over five decades. Eur Heart J 2021; 42:4934-4943. [PMID: 34333595 DOI: 10.1093/eurheartj/ehab416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/03/2021] [Accepted: 06/18/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Since 1968, heart transplantation has become the definitive treatment for patients with end-stage heart failure. We aimed to summarize our experience in heart transplantation at Stanford University since the first transplantation performed over 50 years ago. METHODS AND RESULTS From 6 January 1968 to 30 November 2020, 2671 patients presented to Stanford University for heart transplantation, of which 1958 were adult heart transplantations. Descriptive analyses were performed for patients in 1968-95 (n = 639). Stabilized inverse probability weighting was applied to compare patients in 1996-2006 (n = 356) vs. 2007-19 (n = 515). Follow-up data were updated through 2020. The primary endpoint was all-cause mortality. Prior to weighting, recipients in 2007-19 vs. those in 1996-2006 were older and had heavier burden of chronic diseases. After the application of stabilized inverse probability weighting, the distance organ travelled increased from 84.2 ± 111.1 miles to 159.3 ± 169.9 miles from 1996-2006 to 2007-19. Total allograft ischaemia time also increased over time (199.6 ± 52.7 vs. 225.3 ± 50.0 min). Patients in 2007-19 showed superior survival than those in 1996-2006 with a median survival of 12.1 vs. 11.1 years. CONCLUSION In this half-century retrospective descriptive study from one of the largest heart transplant programmes in the USA, long-term survival after heart transplantation has improved over time despite increased recipient and donor age, worsening comorbidities, increased technical complexity, and prolonged total allograft ischaemia time. Further investigation is warranted to delineate factors associated with the excellent outcomes observed in this study.
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Affiliation(s)
- Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Bharathi Lingala
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA and
| | - Veronica Toro Arana
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA
| | - Kiah M Williams
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Philip E Oyer
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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Dalal AR, Rinewalt DE, MacArthur JW, Shudo Y, Woo YJ. Operative Techniques and Pitfalls in Donor Bilateral Lung Procurement. Transplant Proc 2020; 52:954-957. [PMID: 32139275 DOI: 10.1016/j.transproceed.2020.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Demand for lung transplant continues to grow nationally, and the number of donation after brain death and donation after circulatory death lung procurements increases each year. METHODS We describe the Stanford technique for bilateral lung procurement for donation after brain death and donation after circulatory death and highlight the pitfalls and common mistakes to standardize the procurement process and ensure proper harvesting to prevent organ loss. RESULTS Damage to the lung graft during bilateral en bloc procurement most commonly results from either poor preservation or injury to a pulmonary vein during division of the left atrial cuff. CONCLUSION En bloc bilateral lung procurement should be standardized to ensure reproducible graft harvesting and preservation while teaching new generations of transplant surgeons.
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Affiliation(s)
- Alex R Dalal
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Daniel E Rinewalt
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
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Currie M, Shudo Y, Woo Y. Successful Outcome Following Orthotopic Heart Transplantation With a Donor Half Way Across The Country. Transplant Proc 2018; 50:4062-4063. [DOI: 10.1016/j.transproceed.2018.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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