Background: Heart failure is an epidemic affecting over 6 million people in the United States. Eighty percent of all heart failure patients are older than 65 years of age. Heart transplant is the gold standard treatment for patients suffering advanced heart failure, but only 18.5% of patients receiving heart transplant in the United States are 65 years of age or older. Continuous-flow left ventricular assist devices are a safe and effective therapy for patients with advanced heart failure, and can be used to bridge patients to a heart transplant or to support patients long-term as destination therapy. Material and Methods: We sought to characterize long-term outcomes of elderly patients receiving continuous-flow left ventricular support in our program. Conclusion: Elderly patients with advanced heart failure presented comparable operative results to those of younger patients. The rate of complications up to 6 years of support was low, and comparable to those of younger patients. An
Cardiac disease is a leading cause of early mortality for patients undergoing liver transplantation (LT), and severe coronary artery disease (CAD) is usually considered a contraindication for LT in patients with cirrhosis. Incidence of CAD in LT candidates has increased in recent years. While stable patients might be candidates for percutaneous interventions, patients with decompensated liver failure, or critical coronary lesions present a therapeutic challenge, and are often not considered candidates for LT. We present the case of a 60 year old male patient with decompensated liver failure, and critical CAD, who received successful combined offpump coronary bypass grafting without heparin and LT using ex vivo normothermic liver perfusion machine. This approach represents a novel strategy to offer LT to this very selective group of patients. K E Y W O R D S coronary artery disease, liver transplant, OPCABG
Objetives: ECMO is progressively being adopted as a last resort to stabilize patients receiving cardiopulmonary resuscitation (ECMO CPR). A significant number of these patients will present recovery of end-organ function, but evolve with brain death, accounting for only 30% of patients discharged from the hospital alive. Harvesting organs from donors on VA ECMO has recently been proposed as a strategy to expand the pool of available organs for transplantation. Methods: We present a case of combined heart and kidney transplantation from a brain death donor with recent out of hospital cardiac arrest rescued with eCPR. Results: A 31 year old male patient was admitted to local hospital with diagnosis of drowning after seizure episode. Patient received two rounds of CPR for 8 and 30 minutes respectively, and required emergency insertion of VA ECMO. Patient developed compartment syndrome of right lower extremity (RLE) with CPK = 30,720, prompting discontinuation of ECMO support within 48 hours as cardiac function had recovered, reflected on echocardiographic and enzymatic parameters. Patient was declared brain death and became organ donor. Multiple organ procurement was performed. Combined heart and right kidney transplant was then performed on a 61-year-old male with uneventful course, and with normal function of all implanted allografts at 3 months follow up. Conclusion: Our experience supports the concept that VA ECMO is not a contraindication for solid organ donation. Individual evaluation of organ function can lead to successful transplantation of multiple organs from donors with recent history of VA ECMO support.
Since 1971, when Dr. Francis Fontan and collaborators described a surgical technique that restored pulmonary flow in patients with tricuspid atresia and despite the fact that it has had modifications over time, the impact on the survival of these patients has been notable. It is currently known as the Fontan procedure and is indicated to treat single ventricle congenital heart defects. Thanks to the great advances in the field of congenital heart surgery, as well as better pediatric cardiology and intensive care management, the survival of patients with congenital heart defects has increased significantly, among whom are patients with univentricular or single ventricle physiology. The objective of this chapter is to provide the anesthesiologist with useful and applicable concepts in the evaluation and perioperative management of patients with a Fontan repair, especially for noncardiac surgeries.
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