Mechanical Circulatory Support for Perioperative Donor Heart Failure

Radovancĕvíc, B; Nakatani, Toshio; Oh, Frazier; Moncrief, Christian L.; Vega, J. David; Haupt, H.‐J.; Jm, Duncan

doi:10.1097/00002480-198907000-00118

Cited by 13 publications

(1 citation statement)

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“…Although a rare complication of orthotopic HT, RV failure after HT often carries a grave prognosis. [2][3][4] Despite advances in perioperative management, RV failure accounts for 50% of all cardiac complications and 19% of all early deaths in patients after HT. 5 Patients with congenital heart disease (CHD) undergoing HT, such as this patient with d-TGA, are at particular risk for systemic RV failure.…”

Section: Case Discussionmentioning

confidence: 99%

Dynamic Pulmonary Artery Obstruction Causing Right Ventricular Failure after Cardiac Transplantation in a Patient with Mustard-Senning Corrected d-Transposition of the Great Arteries

Poterucha¹,

Haglund²,

Um³

et al. 2011

Congenit Heart Dis

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Patients with congenital d-transposition of the great arteries (d-TGA) undergoing palliative atrial baffle surgery in infancy often develop systemic ventricular failure in adulthood. If they undergo cardiac transplantation, they are prone to morphologic right ventricular (RV) failure secondary to severe pulmonary hypertension as a result of systemic ventricular failure. We report a case of a patient with d-TGA and biventricular ventricular failure requiring heart transplantation (HT) that developed RV failure postoperatively because of dynamic pulmonary artery (PA) obstruction at the anastomotic site of PA. Obstruction at the site of PA anastomosis due to torsion or redundancy of the donor or recipient PA is a rare but treatable cause of postoperative RV failure. In this case, rapid identification of the etiology of RV failure and implementation of corrective therapies before the development of end-organ dysfunction, resulted in complete RV recovery and normal allograft function. This case represents the first known report of dynamic PA anastomoticobstruction resulting in RV failure after HT that was corrected with pulmonary arterioplasty, and RV assist device resulting in complete recovery.

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Section: Case Discussionmentioning

confidence: 99%

Dynamic Pulmonary Artery Obstruction Causing Right Ventricular Failure after Cardiac Transplantation in a Patient with Mustard-Senning Corrected d-Transposition of the Great Arteries

Poterucha¹,

Haglund²,

Um³

et al. 2011

Congenit Heart Dis

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Surgical Treatment of Advanced Heart Failure

Mallidi

Cohn

Frazier

2015

Coronary Artery Disease

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Improved medical therapy is enabling a growing number of patients to survive previously fatal cardiovascular conditions, but many of these patients later succumb to advanced heart failure. Cardiac transplantation is an established surgical treatment option for advanced heart failure, but despite expansion of the criteria for donor selection, the number of hearts available for transplantation remains limited. Mechanical circulatory support with left ventricular assist devices is being used both as a bridge to transplantation and as destination therapy, and it may promote recovery of cardiac function in patients with advanced heart failure. Attempts to develop a transcutaneously powered total artifi cial heart are ongoing. Other treatments under investigation include surgical restoration of the left ventricular wall (Dor procedure) and passive left ventricular reshaping to reverse ventricular dilation, thereby preventing further myocardial cell death, and allowing hypertrophied cardiac cells to resume normal function. Mitral valve repair or replacement for severe secondary mitral regurgitation might also be useful in treating advanced heart failure. In contrast, partial left ventriculectomy is not recommended.

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