scholarly journals Neurologic complications after heart transplantation

2002 ◽  
Vol 60 (2A) ◽  
pp. 192-197 ◽  
Author(s):  
Suzana M.F. Malheiros ◽  
Dirceu R. Almeida ◽  
Ayrton R. Massaro ◽  
Adauto Castelo ◽  
Rosiane V.Z. Diniz ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Prospective Observational Study ◽  
Cord Compression ◽  
Orthotopic Heart Transplantation ◽  
Cns Infection ◽  
Neurologic Complications ◽  
Neurologic Disability ◽  
End Stage ◽  
Neurologic Event

OBJECTIVE: Neurologic complications are known as important cause of morbidity and mortality in orthotopic heart transplantation. Our aim was to identify the frequency and outcome of neurologic complications after heart transplantation in a prospective observational study. METHOD: From September 93 to September 99, as part of our routine heart transplantation protocol all patients with end-stage cardiac failure were evaluated by the same neurologist before and at the time of any neurologic event (symptom or complaint) after transplantation. RESULTS: Out of 120 candidates evaluated, 62 were successfully transplanted (53 male; median age 45.5 years, median follow-up 26.8 months). Fifteen patients (24%) had ischemic, 22 (35%) idiopathic, 24 (39%) Chagas' disease and 1 (2%) had congenital cardiomyopathy. Neurologic complications occurred in 19 patients (31%): tremor, severe headache, transient encephalopathy and seizures related to drug toxicity or metabolic changes in 13; peripheral neuropathy in 4; and spinal cord compression in two (metastatic prostate cancer and epidural abscess). No symptomatic postoperative stroke was observed. CONCLUSIONS: Although frequent, neurologic complications were seldom related to persistent neurologic disability or death. Most of the complications resulted from immunosuppression, however, CNS infection was rare. The absence of symptomatic stroke in our series may be related to the lower frequency of ischemic cardiomyopathy.

Coronary sinus catalase and ceruloplasmin levels predict all-cause mortality in patients with end-stage heart failure awaiting heart transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Szczurek ◽  
M Gasior ◽  
M Skrzypek ◽  
G Kubiak ◽  
A Kuczaj ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Coronary Sinus ◽  
Public Institution ◽  
Funding Source ◽  
Organ Shortage ◽  
Number Of Patients ◽  
End Stage ◽  
Medical University

Abstract   Background, As a consequence of the worldwide increase in life expectancy and due to significant progress in the pharmacological and interventional treatment of heart failure (HF), the proportion of patients that reach an advanced phase of disease is steadily growing. Hence, more and more numerous group of patients is qualified to the heart transplantation (HT), whereas the number of potential heart donors has remained invariable since years. It contributes to deepening in disproportion between the demand for organs which can possibly be transplanted and number of patients awaiting on the HT list. Therefore, accurate identification of patients who are most likely to benefit from HT is imperative due to an organ shortage and perioperative complications. Purpose The aim of this study was to identify the factors associated with reduced survival during a 1.5-year follow-up in patients with end-stage HF awating HT. Method We propectively analysed 85 adult patients with end-stage HF, who were accepted for HT at our institution between 2015 and 2016. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine the panel of oxidative stress markers. Oxidative-antioxidant balance markers included glutathione reductase (GR), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD) and its mitochondrial isoenzyme (MnSOD) and cytoplasmic (Cu/ZnSOD), catalase (CAT), malondialdehyde (MDA), hydroperoxides lipid (LPH), lipofuscin (LPS), sulfhydryl groups (SH-), ceruloplasmin (CR). The study protocol was approved by the ethics committee of the Medical University of Silesia in Katowice. The endpoint of the study was mortality from any cause during a 1.5 years follow-up. Results The median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. All included patients were treated optimally in accordance with the guidelines of the European Society of Cardiology. Mortality rate during the follow-up period was 40%. Multivariate logistic regression analysis showed that ceruloplasmin (odds ratio [OR] = 0.745 [0.565–0.981], p=0.0363), catalase (OR = 0.950 [0.915–0.98], p=0.0076), as well as high creatinine levels (OR = 1.071 [1.002–1.144], p=0.0422) were risk factors for death during 1.5 year follow-up. Conclusions Coronary sinus lower ceruloplasmin and catalase levels, as well as higher creatinine level are independently associated with death during 1.5 year follow-up. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, POland

scholarly journals Orthotopic Heart Transplantation for Congenital Heart Disease with Dextrocardia: A Single-Center Clinic Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Guohua Wang ◽  
Yixuan Wang ◽  
Jing Zhang ◽  
Yongfeng Sun ◽  
Jie Cai ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Mirror Image ◽  
Orthotopic Heart Transplantation ◽  
Ischemic Time ◽  
Cold Ischemic Time ◽  
End To End ◽  
The Right ◽  
End Stage

Background. We report a modified transplantation surgical technique for CHD with dextrocardia which is rare and surgically challenging. Methods. From January 2015 to May 2018, 5 patients with end-stage CHD with dextrocardia underwent heart transplantation at our institute. They were 10, 29, 13, 15, and 22 years old, respectively; 3 of them had dextroversion, and the other 2 had mirror-image dextrocardia and post-TCPC. The atrial-atrial anastomosis was performed first between the donor’s upper-left PVO and the recipient’s lower-left PVO. The apex thereby rotated approximately 90° clockwise (to the right). The end-to-end donor and recipient aortas, vena cava, and pulmonary arteries were then anastomosed. Results. The cold ischemic time of the donor heart was 284.6±108.3 min, and the CPB time was 190.2±43.8 min. The postoperative X-ray showed the apex on the right. Four patients were successfully discharged, and the follow-up times were 47 months, 36 months, 12 months, and 12 months. One post-TCPC patient died because of pneumonia and hypoxia at 59 postoperative days. Conclusions. Heart transplantation with dextrocardial CHD is rare. A 90° rotation at the left atrial level, aortic end-to-end anastomosis, and vena cava reconstruction by vascular prosthesis or systemic atrial cuff is a simple and effective surgical strategy.

Heart Transplantation

2015 ◽  
pp. 756-779
Author(s):  
Ahmed El-Eshmawi ◽  
Anelechi Anyanwu
Keyword(s):  
Postoperative Complications ◽  
Heart Transplantation ◽  
Gold Standard ◽  
Standard Therapy ◽  
Standard Care ◽  
Surgical Techniques ◽  
Orthotopic Heart Transplantation ◽  
Infection Prophylaxis ◽  
Experimental Intervention ◽  
End Stage

Orthotopic heart transplantation (OHT) has evolved as the “gold standard” therapy for end stage cardiomyopathy, Advances in the fields of immunosuppression, infection prophylaxis and treatment, surgical techniques as well as intensice care management have transformed heart transplantation from what was once considered an experimental intervention into a standard therapy. This chapter focuses on the standard care for OHT including surgical techniques, perioperative management and management of common postoperative complications.

Combined Heart Transplantation and Thoracic Endovascular Aortic Repair for Heart Failure Secondary to Tricuspid Atresia Palliated with Potts Shunt

2013 ◽  
Vol 8 (3) ◽  
pp. 242-244 ◽  
Author(s):  
Bobby Yanagawa ◽  
Lucas Collazo ◽  
Nelson Burton ◽  
Niv Ad ◽  
Alan M. Speir
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Heart Function ◽  
Normal Activity ◽  
Tricuspid Atresia ◽  
Orthotopic Heart Transplantation ◽  
Endovascular Stent ◽  
Endovascular Stent Graft ◽  
Progressive Heart Failure

A 57-year-old-man with known tricuspid atresia previously palliated with a Potts shunt had developed progressive heart failure refractory to medical management. He underwent a combined thoracic endovascular stent graft procedure to eliminate the Potts shunt and orthotopic heart transplantation. At 3-month follow-up, right-sided heart function and pulmonary artery pressures as well as pulmonary vascular resistance had normalized, and at 7 months, the patient had returned to normal activity. The surgical management and its principles as well as postoperative follow-up are described.

Coronary sinus fetuin and sodium levels are independently associated with all-cause mortality in patients awaiting heart transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Szczurek ◽  
M Gasior ◽  
M Skrzypek ◽  
E Romuk ◽  
M Zembala ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Heart Transplantation ◽  
Coronary Sinus ◽  
Funding Source ◽  
Right Heart ◽  
Right Heart Catheterisation ◽  
All Cause Mortality ◽  
End Stage ◽  
Medical University

Abstract Background Risk stratification is a critical component of selection process of the patients with end-stage heart failure (HF) who are considered for heart transplantation (HT). Due to the constantly increasing number of the patients placed on the transplant waiting lists and a global shortage of organs available for HT, the key issue becomes an accurate risk stratification of death and proper organ allocation to these patients who will benefit the most from this form of treatment. Purpose The aim of this study was to identify the factors associated with mortality during a 1.5-year follow-up in patients with end-stage HF awaiting HT. Methods We prospectively analysed 72 patients with advanced HF awaiting HT at our institution between 2015 and 2016. At the time of inclusion in the study routine laboratory tests, cardiopulmonary exercise test, echocardiography, and right heart catheterisation were performed in all patients. During right heart catheterisation, 10 ml of coronary sinus blood was collected. Fetuin serum concentration was measured by the sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit.The end-point was defined as all-cause mortality during a 1.5 years follow-up. Our medical university local Institutional Review Board approved the study protocol, and all patients provided informed consent. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Results Patients' median age was 53.00 (46.00–58.00) years, and 91.7% were men. During the 1.5-year follow-up, 31 (43.1%) patients died. The area under the receiver operating characteristic curve indicated a good discriminatory power of fetuin (AUC: 0.917 [95% CI: 0.858–0.977]). The cut-off point for fetuin (<632.36) had a sensitivity of 87% and a specificity of 83%. Patients with a lower fetuin level had a significantly worse 1.5-year survival compared to the group with a higher fetuin level (20.6% versus 89.5%; (long rank p<0.001). Fetuin OR 0.990 (0.986–0.996); p<0.001) and plasma sodium levels (OR, 0.640 [0.464–0.882]; p<0.001) were independent predictors of death during 1.5-year follow-up period. Conclusions Our study demonstrated that a low coronary sinus fetuin and peripheral blood sodium levels are associated with mortality patients with advanced HF accepted for HT. In addition, fetuin level, with excellent prognostic strength, allows for the risk stratification of death in analysed group of patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia

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