Heterotopic heart transplantation for selected high-risk patients

Nakatani, Takeshi; Frazier, O. H.; Radovančević, Branislav; Lammermeier, David E.; Duncan, James M.

doi:10.1007/978-4-431-68126-7_34

Cited by 6 publications

(7 citation statements)

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“…Potenza et al reported ventricular fibrillation of the native heart and sinus rhythm of the donor heart in a patient with heterotopic transplantation [2]. HHT was a more useful technique before improvement in immunosuppression regimes and mechanical circulatory support, as it helped to maintain circulation in the cases of acute graft failure [3]. Now it is rarely used and limited to selected patients including cases with irreversible pulmonary hypertension and patients with marked donor-recipient-size mismatch [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…HHT was a more useful technique before improvement in immunosuppression regimes and mechanical circulatory support, as it helped to maintain circulation in the cases of acute graft failure [3]. Now it is rarely used and limited to selected patients including cases with irreversible pulmonary hypertension and patients with marked donor-recipient-size mismatch [3][4][5]. Disadvantages of this technique include prolonged duration and complexity of operation, atelectasis due to compression of the lower lobe of right lung by the donor's heart, increased rate of thromboembolism, recurrence of angina, arrhythmia, difficulty in endomyocardial biopsies, and endocarditis [4,5].…”

Section: Discussionmentioning

confidence: 99%

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Electrocardiography in Post-heart Transplant

Toofaninejad

2019

ijcp

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Electrocardiography in Post-heart Transplant

Toofaninejad

2019

ijcp

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“…In heterotopic heart transplantation, the native heart remains as the natural cardiac assist device, especially in the early postoperative period [11]. However, if the native left ventricular functions deteriorate after transplantation, the donor heart provides the patient with the greater percentage of his or her systemic cardiac output [12]. De- spite recent advances in myocardial protection techniques, heterotopic heart transplantation with CPB in patients with persistent pulmonary hypertension may have a suboptimal outcome due to the damaging effect of CPB, especially after prolonged pump runs.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of heterotopic heart transplantation on beating heart

Kiliçkan

Baykara

Toker

et al. 2000

Journal of Anesthesia

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A 58-year-old man (weight 55 kg, body surface area 1.58 m 2 ) had end-stage dilated cardiomyopathy. A left ventricular ejection fraction of 20% was measured by two-dimensional echocardiography. Cardiac catheterization documented severe pulmonary hypertension with pulmonary arterial pressures of 86/40 mmHg (mean, 48 mmHg), pulmonary capillary wedge pressure of 29 mmHg, and pulmonary vasculary resistance of 7.3 Wood units, which decreased to a level of 4.0 Wood units with multiple drug manipulations (isoproterenol, prostoglandin E 1 , nitroprusside, and oxygen inhalation). Cardiac output and cardiac index were 2.4 l·min Ϫ1 and 1.51 l·mm Ϫ1 ·m Ϫ2 , respectively. Coronary angiography was normal, but left ventriculography confirmed moderate mitral regurgitation and dilated cardiomyopathy. The patient was placed on our waiting list and the decision was made to repeat right heart catheterization at the time of transplantation for the definitive operative procedure. Since the patient had NYHA class IV congestive heart failure, he was hospitalized for high-dose inotropic support with (dopamine 10 µg·kg Ϫ1 ·min Ϫ1 , dobutamine 10 µg·kg Ϫ1 ·min Ϫ1 , and isoprenaline 0.5 µg·kg Ϫ1 ·min Ϫ1 ), During his hospitalization, a young female donor (52 kg body weight and 1.50 m 2 body surface area) was referred to us. The patient received premedication with midazolam 5 mg intramuscularly 30 min preoperatively. In the operating room, the patient was monitored with a five-lead ECG, and ST segment analysis, SpO 2 , ETCO 2 , invasive radial artery blood pressure, and rectal and esophageal temperature were measured. In the operating room, a pulmonary artery catheter was placed. The pulmonary artery pressure and calculated pulmonary vascular resistance were 80/38 (mean, 46 mmHg) and 6.4 Wood units, respectively. Anesthesia was induced with 5 mg midazolam, 1 mg fentanyl, and 0.1 mg·kg Ϫ1 vecuronium to facilitate tracheal intubation. Anesthesia was maintained with a

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“…All recordings were made in triplicate, and the mean value was determined. Coronary sinus flow was determined using established techniques as described by Ganz et al"' Paired arterial and coronary sinus blood samples were taken after 5 minutes in each baseline or paced setting for (1) saturations, analyzed on a hemoxymeter OSM2 (Radiometer) and (2) analysis of the purine hypoxanthine.11, '2 Pacing Intervals…”

Section: Baseline Measurementsmentioning

confidence: 99%

Hemodynamic and metabolic effects of paced linkage following heterotopic cardiac transplantation.

et al. 1994

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BACKGROUND AND PURPOSE Heterotopic cardiac transplantation is a valuable surgical technique that maximizes the use of donor organs. However, recipient heart function may decline steadily postoperatively with resulting clinical deterioration. Paced linkage has the potential of reducing afterload and enhancing coronary flow of both hearts, thereby improving recipient- and donor-heart function. This may have long-term as well as short-term benefits. METHODS AND RESULTS The study was performed on 11 heterotopic transplant recipients. The two hearts were linked with a pacemaker (paced linkage) to produce recipient heart systole during different periods of donor-heart diastole. The recipient ventricular contraction was timed to occur during early, mid, and late diastole of the donor heart. Hemodynamic baseline measurements were compared with the optimal counterpulsated data. Paced linkage produced significant improvements in total cardiac output, 5.0 +/- 0.9 compared with baseline 4.5 +/- 0.8 L/min (P = .021); recipient coronary sinus flow, 278 +/- 145 versus 186 +/- 108 mL/min (P = .022); and aortic systolic pressure, 135 +/- 27 versus 123 +/- 27 mm Hg (P = .005). There was an overall improvement in systolic ventricular performance in the recipient heart when pace linked, as evidenced by a significant increase in left ventricular systolic pressure of 118 +/- 36 compared with the baseline value of 108 +/- 33 mm Hg (P = .016), an increase in ejection period from 174 +/- 30 versus 203 +/- 48 (P = .046), and a decrease in the pre-ejection period of 147 +/- 37 when paced versus 181 +/- 39 milliseconds (P = .013). The metabolic studies showed a significant decrease in hypoxanthine release from a baseline level of 0.4 mumol/L to a paced value of -0.06 mumol/L (P = .002); these very low values would suggest that there is no evidence of ischemia. Hemodynamic changes in the donor heart included a significant reduction in the left ventricular end-diastolic pressure from 6.8 +/- 4.4 versus baseline of 10.5 +/- 5.8 mm Hg (P = .029) and in maximum -dP/dT from 3.2 +/- 1.7 versus baseline of 2.1 +/- 1.1. CONCLUSIONS Paced linkage after heterotopic cardiac transplant produces significant functional improvements in both hearts. Permanent pacemaker implantation may sustain these acute benefits and prevent the premature deterioration of the recipient heart.

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Heterotopic heart transplantation for selected high-risk patients

Cited by 6 publications

References 4 publications

Electrocardiography in Post-heart Transplant

Electrocardiography in Post-heart Transplant

Anesthetic management of heterotopic heart transplantation on beating heart

Hemodynamic and metabolic effects of paced linkage following heterotopic cardiac transplantation.

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