Background Adult congenital heart disease (CHD) transplant recipients historically experienced worse survival early after transplantation. We aim to review updated trends in adult CHD transplantation. Methods We performed a single center case series of adult cardiac transplants from January 2013 through July 2020. Outcomes of patients with CHD were compared to non‐CHD. The primary outcome was overall survival. Secondary outcomes included a variety of post‐operative complications. Results 18/262 (7%) transplants were CHD recipients. CHD patients were younger with median age 41 (32—47) versus 58 (48–65) (P < .001). Fontan circulation for single ventricle physiology was present in 4/18 (22%) of CHD recipients, while 16/18 (89%) had systemic right ventricles. CHD recipients had higher rates of previous cardiovascular operations (94% vs. 51%, P < .001). 9/18 (50%) of CHD patients required reconstructive procedures at the time of transplant. Operative and cardiopulmonary bypass times were longer for the CHD cohort (7.5 h [6.6–8.5] vs. 5.6 h [4.6–7] P < .001) and (197 min [158–240] vs. 130 [105–167] P < .001), respectively. There were no differences in operative complications or survival between CHD and non‐CHD recipients. Conclusions These data highlight the added technical challenges of performing adult CHD transplants. However, similar outcomes can be achieved as for non‐CHD recipients. Summary Modern advances in palliation of congenital heart defects (CHD) has led to increased survival into adulthood. Many of these patients require heart transplantation as adults. There are limited data on adult CHD transplantation. Historically, these patients have had worse perioperative outcomes with improved long‐term survival. We retrospectively analyzed 262 heart transplants at a single center, 18 of which were for adult CHD. Here, we report our series of 18 CHD recipients. We detail the palliative history of all CHD patients and highlight the added technical challenges for each of the 18 patients at transplant. In our analysis, CHD patients had more prior cardiovascular surgeries as well as longer transplant operative and bypass times. Despite this, there were no differences in perioperative and long‐term outcomes. We have added patient and institution specific data for transplanting patients with adult CHD. We hope that our experience will add to the growing body of literature on adult CHD transplantation.
Objectives This study was performed to investigate the feasibility and safety of complete ultrasound (US)-guided percutaneous nephrolithotomy (PNL) in morbidly obese patients and to introduce the US skills used in a high-volume stone management center. Methods We retrospectively reviewed consecutive patients with a body mass index (BMI) of ≥ 40 kg/m2 who underwent X-ray-free PNL for treatment of upper urinary tract stones from October 2013 to March 2020. The patients’ demographic information and intraoperative and postoperative parameters were collected and analyzed. Surgical complications were recorded and classified according to the modified Clavien classification system. Results In total, 52 patients were included. Their mean BMI was 45.5 kg/m2 (range, 40.3–61.6 kg/m2), and their mean age was 46 years (range, 28–58 years). The mean stone burden was 2.8 cm (range, 2.1–8.8 cm). Thirty-nine patients underwent surgery in the prone position, and the remaining 13 underwent surgery in the lateral position. All procedures were completed successfully with no major intraoperative complications. The mean operative duration was 68 min (range, 38–97 min). The mean time required for establishment of each access was 6.6 min (range, 3.5–14.7 min). No blood transfusion or embolization was needed for any patient. The initial stone-free rate was 80.8% (42/52 patients). Five patients required second-look PNL. Two patients underwent flexible ureteroscopic lithotripsy. The final stone-free rate was 90.4% (47/52 patients). Conclusions Complete US-guided PNL was technically feasible and safe in morbidly obese patients. The stone-free rate and complication rate were acceptable and comparable with those in non-obese patients.
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