Reducing Neurological Complications After Cardiac Transplantation: Technical Considerations

Jessen, Michael E.; Meyer, Dan M.; Moncrief, Christian L.; Wait, Michael A.; Melamed, Norma; Ring, W. Steves

doi:10.1111/j.1540-8191.1993.tb00411.x

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…During implantation, topical cooling was applied to the hearts in both groups with the infusion of cold Ringer's lactate, as has been described clinically. 10 Animals received 1 g of methylprednisolone before the aorta was unclamped. After the aortic clamp was removed, hearts were defibrillated with 5 to 20 J, if necessary.…”

Section: Recipient Protocolmentioning

confidence: 99%

Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

Rosenbaum

Peltz

DiMaio

et al. 2008

The Journal of Heart and Lung Transplantation

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Section: Recipient Protocolmentioning

confidence: 99%

Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

Rosenbaum

Peltz

DiMaio

et al. 2008

The Journal of Heart and Lung Transplantation

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“…Moreover, the suture line can be thrombogenic, particularly when the non‐endothelialized myocardium is exposed inside the atrium. To avoid this, we perform our venous anastomoses using an everting technique, as previously described for cardiac transplantation 18 . This technique focuses on endocardium to endocardium approximation, excluding the thrombogenic myocardium from the suture line.…”

Section: Discussionmentioning

confidence: 99%

“…To avoid this, we perform our venous anastomoses using an everting technique, as previously described for cardiac transplantation. 18 This…”

Section: Baseline Characteristics Are Shown Inmentioning

confidence: 99%

Impact of cerebrovascular accidents on lung transplant survival

Kalsbeek

Chuckaree

Khoury

et al. 2022

Journal of Cardiac Surgery

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Background: Cerebrovascular accidents (CVA) are a source of postoperative morbidity. Existing data on CVA after lung transplantation (LT) are limited. We aimed to evaluate the impact of CVA on LT survival. Methods: A retrospective analysis of LT recipients at the University of Texas Southwestern Medical Center was performed. Data was obtained from the institutional thoracic transplant database between January 2012 and December 2018, which consisted of 476 patients. Patients were stratified by the presence of a postoperative CVA. Univariate comparisons of baseline characteristics, operative variables, and postoperative outcomes between the cohorts were performed.Survival was analyzed by Kaplan-Meier method. Aalen's additive regression model was utilized to assess mortality hazard over time.Results: The incidence of CVA was 4.2% (20/476). Lung allocation score was higher in the CVA cohort (46.2 [41.7, 57.3] vs. 41.5 [35.8, 52.2], p = 0.04). There were no significant differences in operative variables. CVA patients had longer initial intensive care unit (ICU) stays (316 h [251, 557] vs. 124 [85, 218], p < 0.001) and longer length of stay (22 days [17, 53] vs. 15 [11, 26], p = 0.007). CVA patients required more ICU readmissions (35% vs. 15%, p = 0.02) and had a lower rates of home discharge (35% vs. 71%, p < 0.001). Thirty-day mortality was higher in the CVA cohort (20% vs. 1.3%, p < 0.001). Overall survival was lower in the CVA cohort (log rank p = 0.044).Conclusions: Postoperative CVA following LT was associated with longer ICU stays, more ICU readmissions, longer length of stay, and fewer home discharges. Thirty day and long-term mortality were significantly higher in the CVA group.

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“…Preventive measures are probably the best strategy to avoid CVD after CTX, and new surgical techniques should be researched to reduce the incidence in the immediate postoperative period [27]. A recent transesophageal echocardiographic study [16] reported a high presence of spontaneous echo contrast and thrombi in the left atrium in CTX patients by means of standard surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Disease as a Complication of Cardiac Transplantation

Belvís¹,

Martí‐Fàbregas²,

Cocho³

et al. 2005

Cerebrovasc Dis

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Background and Objectives: To characterize the frequency, risk factors, clinical presentation and etiological subtypes of cerebrovascular diseases (CVD) following cardiac transplantation (CTX). Methods: In a retrospective review of our CTX database (period 1984–2002), we assessed demographic data, vascular risk factors, surgery and donor details. We classified ischemic stroke (IS) using the clinical criteria of the Oxfordshire Community Stroke Project and the etiological criteria of the TOAST study. Logistic regression analysis and survival curves were carried out. Results: CTX was performed in a total of 314 patients (age 46 ± 14 years, 78% male) and mean follow-up was 54 ± 57 months. Twenty-two patients (7%) presented CVD: hemorrhagic stroke in 12%, transient ischemic attack in 28% and IS in 60%. CVD were early postoperative (less than 2 weeks) in 20% of patients and late in 80%. The clinical presentation in patients with IS was total anterior circulation (23.1%), partial anterior (38.4%), lacunar (15.4%) and posterior circulation (23.1%), and the etiological classification was large artery atherosclerosis (15.4%), cardioembolism (14.4%), small vessel disease (15.4%), unusual causes (15.4%) and undetermined cause (38.4%). The only independent predictor of CVD was a prior CVD event with an odds ratio of 8.2 (95% CI, 2.2–30.2, p < 0.02). The estimated risk of CVD at 5 years was greater (p < 0.02) in patients with prior CVD (4.1%) than in those without (1.1%). Conclusions: CVD are a relatively frequent complication after CTX (7%) and usually occur in the late postoperative phase. CVD prior to transplantation increase the risk of CVD after this procedure.

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Reducing Neurological Complications After Cardiac Transplantation: Technical Considerations

Cited by 4 publications

References 7 publications

Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

Impact of cerebrovascular accidents on lung transplant survival

Cerebrovascular Disease as a Complication of Cardiac Transplantation

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