Not All Septal Defects Are Equal

Sertic, F.; Han, Jason J.; Diagne, Dieynaba; Richards, Thomas J.; Chavez, Lexy; Berg, Ashley; Wald, Joyce; Rame, J. Eduardo; Crespo, Maria; Bermúdez, C.

doi:10.1016/j.chest.2020.05.597

Cited by 20 publications

(9 citation statements)

References 20 publications

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“…In theory, the shunt across the ASD provides volume-unloading to the right ventricle and may assist in post-LTx recovery, which is why the authors do not close ASDs (congenital or created) in their patients. Notably, an analysis of adult patients with Eisenmenger syndrome found superior outcomes in those patients after LTx who had a concomitant ASD repair but not a concomitant VSD repair, as compared to HLTx [7].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Concomitant Cardiac Surgical Procedures Performed During Pediatric Lung Transplantation in the United States

Ramineni,

Faateh,

Mehdizadeh-Shrifi

et al. 2024

Preprint

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Data on concomitant cardiac surgery (CCS) performed during pediatric lung transplantation (LTx) is limited. Therefore, we conducted a multi-institutional analysis to identify the incidence and outcomes of CCS in pediatric (< 18 yrs) LTx recipients by merging data (2004–2023) from the United Network for Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) databases. Of the total of 596 pediatric LTx recipients, 87 (15%) underwent CCS. The majority were atrial septal defect (ASD) closure (90%) followed by aortic arch/descending aortic repair (3%), atrial repair (3%), ventricular septal defect closure (2%), patent ductus arteriosus ligation (2%), and tricuspid valve repair (2%). The median age at LTx was 3 years (IQR:0–12). Pulmonary hypertension (PHT) was the predominant indication for LTx (54%). In-hospital mortality was 6% and 5-year mortality was 64%. Importantly, CCS in children undergoing LTx has acceptable outcomes.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Concomitant Cardiac Surgical Procedures Performed During Pediatric Lung Transplantation in the United States

Ramineni,

Faateh,

Mehdizadeh-Shrifi

et al. 2024

Preprint

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“…Госпитальная летальность составила 11%, а 1, 5, 10 и 15-летняя выживаемость -84,1%, 69,7%, 55,8% и 40,6% соответственно; разницы выживаемости после трансплантации легких и сердечно-легочного комплекса не было. Согласно данным национального регистра США [49], с 1987 по 2018 год трансплантации подверглись 442 взрослых с СЭ: 316 -трансплантации комплекса сердце-легкие и 126 -двусторонней трансплантации легких с коррекцией ВПС; 1, 5 и 10-летняя выживаемость после двусторонней трансплантации легких составила 63,1%, 38,5% и 30,2%, после трансплантации комплекса сердце-легкие -68,0%, 47,3% и 30,5% соответственно (р=0,6).…”

Section: показания и ограничения для хирургического и интервенционног...unclassified

“…Имеются отдельные сообщения об имплантации пациентам с СЭ устройств механической поддержки сердца и легких в качестве «моста» к трансплантации [48,49] или же для лечения декомпенсации кровообращения (на фоне тяжелой пневмонии, легочного кровотечения и др.) с последующим восстановлением самостоятельной гемодинамики [31].…”

Section: показания и ограничения для хирургического и интервенционног...unclassified

Nonspecific therapy for Eisenmenger syndrome

Shmalts,

Chernogrivov

2024

Evrazijskij kardiologičeskij žurnal

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Eisenmenger syndrome (ES) is systemic pulmonary hypertension with venoarterial or bidirectional shunting of blood between the ventricles, atria or great arteries due to the progression of pulmonary vascular disease in the natural course of “simple” and “complex” congenital heart defects.Patients with ES require constant attention from a multidisciplinary team of specialists. One of the main tasks is not to destabilize the fragile pathological physiology, which relies on the balance of pulmonary and peripheral vascular resistance. Surgical interventions with anesthesia, if they cannot be avoided, should be performed in specialized centers. Pregnancy is contraindicated in patients with ES. Clinical symptoms of blood hyperviscosity in ES are rare.The anachronistic practice of venesections, which leads to a decrease in the oxygen transport function of the blood, iron deficiency and an increased risk of cerebrovascular complications, should be avoided. Oral and intravenous replenishment of iron deficiency improves exercise tolerance and quality of life. Routine administration of anticoagulants for ES is not indicated. In most cases, endovascular embolization of pathological collateral arteries can eliminate hemoptysis. The use of venous access requires careful prevention of embolism. Therapeutic tactics for ES are discussed in detail in this review

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“…There has been a survival advantage demonstrated for HLTX in ES patients with complex congenital heart defects compared to cardiac repair and LTX. 14,15 Although the heart in PPH is otherwise structurally normal, the heart in ES is structurally abnormal, with some patients having complex cardiac defects. This can increase the complexity of the HLTX due to constraints imposed by the anatomy on size match and implantation technique, particularly if the patient has undergone prior cardiac surgery.…”

Section: Commentmentioning

confidence: 99%

Outcomes of heart-lung transplantation in Eisenmenger syndrome compared to primary pulmonary hypertension

Sainathan

Ryan

Said

et al. 2023

Asian Cardiovasc Thorac Ann

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Objective Heart-Lung Transplantation (HLTX) is required both in primary pulmonary hypertension (PPH) and Eisenmenger syndrome (ES) when there is associated end-stage heart disease. Although PPH is associated with an otherwise structurally normal heart, ES is associated with congenital heart defects, which may increase the complexity of the operation. This study analyzes if the diagnosis (PPH vs. ES) is related to short-term outcomes after HLTX. Methods Patients ≥18 years of age with PPH and ES who underwent HLTX were identified in the United Network for Organ Sharing database from 2005 to 2021. Patients were propensity score matched on heart and lung listing status at the time of transplant. Univariable, multivariable, and Kaplan–Meir survival analyses were performed. Results The unmatched cohort had 128 PPH and 44 ES patients, and the matched cohort had 44 patients in each group. PPH patients had lower waitlist times and PA pressures but higher FEV1, heart, and lung listing status and ECMO bridge. There were no differences in immediate postoperative outcomes such as dialysis, stroke, and airway dehiscence. PPH patients had a higher treatment rejection in the first year. The 30-day, 1-year, and 3-year survival were better in the PPH group. However, a landmark analysis excluding deaths within 30 days eliminated differences in survival between the groups. Post-transplant dialysis and postoperative mechanical ventilation >5 days were risk factors for 1-year mortality in ES. Conclusion The short-term outcomes of HLTX are inferior in ES compared to PPH and much of the attrition in ES occurs in the immediate postoperative period.

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Not All Septal Defects Are Equal

Cited by 20 publications

References 20 publications

Outcomes of Concomitant Cardiac Surgical Procedures Performed During Pediatric Lung Transplantation in the United States

Outcomes of Concomitant Cardiac Surgical Procedures Performed During Pediatric Lung Transplantation in the United States

Nonspecific therapy for Eisenmenger syndrome

Outcomes of heart-lung transplantation in Eisenmenger syndrome compared to primary pulmonary hypertension

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