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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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Mongodi S, Via G, Riccardi M, Tavazzi G, D'Armini AM, Maurelli M, Braschi A, Mojoli F. Patent foramen ovale diagnosis: The importance of provocative maneuvers. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:58-61. [PMID: 27444317 DOI: 10.1002/jcu.22383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 06/06/2023]
Abstract
Patent foramen ovale (PFO) is a frequent congenital anomaly, but massive right-to-left shunt (RTLS) is normally prevented by higher pressures in left heart chambers. However, mechanical ventilation with positive end-expiratory pressure (PEEP) can significantly increase right atrial pressure, accentuating the RTLS, mainly after major cardiothoracic surgery. We report a patient admitted to the intensive care unit after cardiac surgery. Pre- and intraoperative transesophageal echocardiography only described an aneurysmal interatrial septum with no shunt. However, high-PEEP ventilation induced a paradoxical response with life-threatening hypoxemia, triggering further echocardiographic evaluation, revealing massive RTLS across a stretch PFO. Provocative maneuvers (Valsalva/PEEP) significantly increase echocardiographic sensitivity, unmasking silent PFO. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:58-61, 2017.
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Affiliation(s)
- Silvia Mongodi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Gabriele Via
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Mariachiara Riccardi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Guido Tavazzi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Andrea Maria D'Armini
- Cardiothoracic Surgery, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Marco Maurelli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Antonio Braschi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Francesco Mojoli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
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Ramakrishna H, Patel PA, Gutsche JT, Kohl BA, Savino JS, Augoustides JG. Incidental Patent Foramen Ovale in Adult Cardiac Surgery: Recent Evidence and Management Options for the Perioperative Echocardiographer. J Cardiothorac Vasc Anesth 2014; 28:1691-5. [DOI: 10.1053/j.jvca.2014.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Indexed: 11/11/2022]
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Martín M, Molina BD, de la Hera JM, Bernardo MJR, Hevia S, Barriales R, de la Tassa CM. Development of severe and persistent hypoxemia seven months after orthotopic heart transplantation. Int J Cardiol 2009; 133:e6-8. [DOI: 10.1016/j.ijcard.2007.08.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Accepted: 08/04/2007] [Indexed: 11/28/2022]
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Rigatelli G, Faggian G, Cardaioli P, Mazzucco A. Contemporary management of patent foramen ovale in patients undergoing ventricular assisting devices or heart transplantation. J Cardiovasc Med (Hagerstown) 2009; 10:9-12. [DOI: 10.2459/jcm.0b013e32830a4a14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rigatelli G, Cardaioli P, Faggian G. Patent foramen ovale management before and after heart transplantation: a simple algorithm. J Heart Lung Transplant 2007; 26:961-2. [PMID: 17845938 DOI: 10.1016/j.healun.2007.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 06/05/2007] [Accepted: 07/03/2007] [Indexed: 11/28/2022] Open
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Maltais S, Carrier M, Pellerin M, Perrault LP. Closure of ventricular septal defects in the donor heart before transplantation: Toward expanded acceptance criteria. J Thorac Cardiovasc Surg 2005; 129:1187-8. [PMID: 15867806 DOI: 10.1016/j.jtcvs.2004.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Maltais
- Research Center, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec H1T 1C8, Canada
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8
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Abstract
Over the past 30 years, heart transplantation has evolved into a definitive therapy for patients with end-stage cardiomyopathy. However, perioperative management of patients undergoing heart transplantation remains a challenge for anesthesiologists. The presence of biventricular failure, arrhythmias and associated multisystem organ dysfunction may contribute to significant intraoperative hemodynamic instability prior to the initiation of cardiopulmonary bypass (CPB). Even after an uneventful transplantation, weaning from CPB may be difficult. Acute right ventricular failure can develop in the recipient secondary to pre-existing pulmonary hypertension. Treatment options frequently focus on therapeutic interventions directed towards decreasing pulmonary vascular resistance and improving right ventricular contractility. Intraoperative use of transesophageal echocardiography (TEE) enables the anesthesiologist to diagnose acute right ventricular failure early on and guide therapy. Concurrent pathology including kinking of the pulmonary artery anastomosis or valvular insufficiency in the transplanted heart can also be recognized and addressed. The number of patients undergoing cardiac transplantation is continually increasing. In addition, the use of more effective immunosuppressive agents has curtailed transplant rejection and permitted longer survival. Consequently, heart transplant recipients are more frequently presenting for non-cardiac surgical procedures. Thus, an understanding of physiological and pharmacological implications associated with heart transplantation is crucial for managing these patients in the perioperative period.
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Affiliation(s)
- H K Eltzschig
- Klinik für Anaesthesiologie und Intensivmedizin, Eberhard-Karls-Universität Tübingen.
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9
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Sullebarger JT, Mester SW, Fontanet HL, Strom J, Albakri E, Bugni W, Dray D, Gloer KL. Transcatheter closure of residual atrial septal defect after cardiac transplantation. J Heart Lung Transplant 2003; 22:600-3. [PMID: 12742426 DOI: 10.1016/s1053-2498(02)01183-x] [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: 11/22/2022] Open
Abstract
A 55-year-old male patient experienced 2 acute neurologic events 3 weeks after orthotopic cardiac transplantation. Transesophageal echocardiography demonstrated a patent foramen ovale in the native portion of the interatrial septum with bidirectional shunting by Doppler and microbubble contrast. The defect was closed successfully with a CardioSeal transcatheter septal closure device. This case demonstrates the advantages of the percutaneous approach for closure of residual defects in the post-operative patient.
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Sánchez Mata N, Ruano Calvo J, Celemín Larroque I, Maguregui Ituñoa J, Martín Durán R. [Patent foramen oval as a cause of severe hypoxia during the immediate postoperative period following heart transplantation]. Rev Esp Cardiol 2001; 54:522-4. [PMID: 11282060 DOI: 10.1016/s0300-8932(01)76343-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a 44-year-old man with dilated cardiomyocardiopathy, pulmonary hypertension and high pulmonary resistance who underwent orthotopic heart transplant. Following transplantation severe hypoxia was observed after weaning of cardiopulmonary bypass secondary to a patent foramen oval in the donor heart. This situation does not usually lead to problems in the donor, however taking into account the special hemodynamic conditions of the transplanted patient, with high pressure in the right side, an opening occurred producing a significant right-left shunt causing severe receptor hypoxia. Successful closure of the patent foramen oval was performed.
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Affiliation(s)
- N Sánchez Mata
- Servicios de Cardiología y de Anestesia, Hospital Universitario Marqués de Valdecilla, Santander
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11
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Ouseph R, Stoddard MF, Lederer ED. Patent foramen ovale presenting as refractory hypoxemia after heart transplantation. J Am Soc Echocardiogr 1997; 10:973-6. [PMID: 9440075 DOI: 10.1016/s0894-7317(97)80014-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hypoxemia can be an early life-threatening complication of orthotopic heart transplantation. Commonly, hypoxemia after orthotopic heart transplantation is due to pulmonary hypertension or pulmonary complications. Rarely, structural defects either in the donor or recipient heart can lead to life-threatening hypoxemia. This case illustrates hypoxemia after orthotopic heart transplantation caused by the development of a right-to-left shunt through a patent foramen ovale in the recipient which had preoperatively been hemodynamically insignificant. The refractory hypoxemia required emergency surgical correction of the patent foramen ovale within the first postoperative week. In addition, this case illustrates the unique application of different methods of echocardiograms providing noninvasive diagnosis of structural defects in orthotopic heart transplantation.
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Affiliation(s)
- R Ouseph
- Department of Medicine, University of Louisville, KY, USA
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12
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Yun KL, Reichenspurner H, Schmoker J, Hu B, Stinson EB. Heart Transplantation Complicated by a Patent Foramen Ovale of the Recipient Atrial Septum. Ann Thorac Surg 1996. [DOI: 10.1016/s0003-4975(96)00292-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Weston MW, Vijayanagar R, Sastry NS. Closure of a patent foramen ovale and tricuspid valve replacement after heart transplantation. Ann Thorac Surg 1996; 61:717-9. [PMID: 8572798 DOI: 10.1016/0003-4975(95)00783-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patent foramen ovale has been noted after cardiac transplantation. Rarely is surgical intervention warranted. In this communication we report a case of severe tricuspid regurgitation and paradoxical embolism secondary to a patent foramen ovale in a patient 19 months after heart transplantation. The patient underwent successful closure of the patent foramen ovale and tricuspid valve replacement.
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Affiliation(s)
- M W Weston
- Heart Transplant Program, Tampa General Hospital, Florida, USA
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Robert R, Ferrandis J, Malin F, Herpin D, Pourrat O. Enhancement of hypoxemia by right-to-left atrial shunting in severe asthma. Intensive Care Med 1994; 20:585-7. [PMID: 7706573 DOI: 10.1007/bf01705727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report two cases of severe hypoxemia due to right-to-left shunt in acute asthmatic patients. During acute asthma, the transmural right atrial pressure can be higher than left atrial pressure during inspiration and then induce a right-to-left shunt through inter-atrial communication leading to hypoxemia. Contrast echography as well as Doppler analysis can easily confirm the diagnosis.
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Affiliation(s)
- R Robert
- Service de Réanimation Médicale, Hôpital Jean Bernard, Poitiers, France
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O'Laughlin MP, Bricker JT, Mullins CE, Cabalka AK, Gelb BD, Towbin JA. Transcatheter closure of residual atrial septal defect following cardiac transplantation. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1993; 28:162-3. [PMID: 8448802 DOI: 10.1002/ccd.1810280214] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
An almost 3-year-old boy had a residual atrial septal defect after cardiac transplantation. The patient was symptomatic and had arrhythmia and cardiac enlargement. An atrial septal defect occlusion device was employed to close the communication with excellent results. Transcatheter occlusion enabled the patient to avoid further surgery and did not interfere with follow-up endomyocardial biopsies.
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Affiliation(s)
- M P O'Laughlin
- Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Waco
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Schulman LL, Smith CR, Drusin R, Rose EA, Enson Y, Reemtsma K. Respiratory complications of cardiac transplantation. Am J Med Sci 1988; 296:1-10. [PMID: 3044104 DOI: 10.1097/00000441-198807000-00002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The authors evaluated all respiratory complications of cardiac transplantation in a 10-year study of 94 consecutive recipients. Mean follow-up time was 20 +/- 17 months. The initial 20 patients were treated with azathioprine and prednisone, while the subsequent 74 patients received cyclosporine and prednisone. In the azathioprine group, respiratory infections accounted for 24 of 60 (40%) infections. Two-thirds of the respiratory infections occurred in the first 3 postoperative months and were generally localized processes (focal pneumonitis, nodule(s), abscess, or empyema). Gram-positive and gram-negative bacteria (8/30) and aspergillus (8/30) were the predominant pathogens. Respiratory failure occurred in 29% of infectious episodes. In the cyclosporine group, there were significantly fewer respiratory infections. There was also a reduction in the number of nonrespiratory infections; hence, the percentage of total infections due to respiratory causes, 26 of 50 (52%), was not significantly different. In contrast, however, nearly two-thirds of the respiratory infections in cyclosporine-treated patients occurred after the first 3 postoperative months, and were usually diffuse processes. Despite diffuse disease, respiratory failure was observed with similar frequency (19%). Pneumocystis carinii (9/31) and cytomegalovirus (CMV) (7/31) were the predominant pathogens. CMV pneumonitis tended to occur earlier than that due to P. carinii (2.9 +/- 1.9 mo vs. 9.8 +/- 11.2 mo, respectively), but there was considerable overlap. In comparison with infectious processes, there were 50% fewer noninfectious respiratory complications in both groups. These were primarily pleural (46%) or thromboembolic (18%) disorders. Four of five pulmonary emboli occurred in patients with intercurrent cardiorespiratory illness, and were detected only at autopsy. The authors conclude that respiratory infections account for one-half of all infections observed in cardiac transplant recipients, despite the reduced infection rate associated with the use of cyclosporine. Furthermore, respiratory infections in cyclosporine-treated patients exhibit different clinical and etiologic features than those seen in azathioprine-treated patients. Finally, occult thromboemboli may be difficult to recognize in cardiac transplant recipients because of the high incidence of coexisting cardiorespiratory disease.
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Affiliation(s)
- L L Schulman
- Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY 10032
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