Case report - Transplantation Early acute aortic dissection of the donor aorta after orthotopic heart transplantation (original) (raw)
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The spectrum of aortic complications after heart transplantation
Annals of Thoracic Surgery, 1999
Background. The connection between the donor and the recipient aorta is a potential source of early and late complications as a result of infection, compliance mismatch, and technical and hemodynamic factors. Moreover, the abrupt change in systolic pressure after heart transplantation involves the entire thoracic aorta in the risk of aneurysm formation. The aim of this study was to analyze the types of aortic complications encountered in our heart transplantation series and to discuss etiology, diagnostic approach, and modes of treatment.Methods. Of the 442 patients having orthotopic heart transplantation and the 11 patients having heterotopic heart transplantation at our center, 9 (2%) sustained complications involving the thoracic aorta. These 9 patients were divided into four groups according to the aortic disease: acute aortic rupture (2 patients); infective pseudoaneurysm (3 patients); true aneurysm and dissection of native aorta (2 patients); and aortic dissection after heterotopic heart transplantation (2 patients). Surgical intervention was undertaken in 8.Results. Five (83%) of 6 patients who underwent surgical treatment for noninfective complications survived the operation, and 4 are long-term survivors. One patient who underwent a Bentall procedure 7 years after heterotopic heart transplantation died in the perioperative period of low-output syndrome secondary to underestimated chronic rejection of the graft. One patient with pseudoaneurysm survives without surgical treatment but died several years later of cardiac arrest due to chronic rejection. Both patients operated on for evolving infective pseudoaneurysm died in the perioperative period.Conclusions. Infective pseudoaneurysms of the aortic anastomosis are associated with a significant mortality. In noninfective complications, an aggressive surgical approach offers good long-term results. The possibility of retransplantation in spite of complex surgical repair should be considered in the late follow-up after heart transplantation, due to the increasing incidence of chronic rejection.
Composite graft replacement of the aortic root in acute dissection
European Journal of Cardio-Thoracic Surgery, 1998
Objective: In acute type A dissection the indication for composite graft replacement of the aortic root and the optimal implantation technique are a matter of debate. In this study early and late results of root replacement in acute dissection are determined and compared with supracoronary graft replacement. Two implantation techniques (open vs. inclusion) are evaluated. Methods: Between 1985 and 1995, 207 consecutive patients (mean age 58912 years, 78% men) were operated for acute type A dissection of the aorta. Root replacement in 50 patients (inclusion technique in 34/50 patients with Cabrol shunt in 15/34 patients, open technique in 16/50 patients) was compared with more conservative procedures in 157 patients: supracoronary graft replacement in 143 patients (with aortic valve replacement in 23 patients) and local repair without graft interposition in 14 patients. Preoperative risk factors, like hemodynamic instability, renal failure, neurologic disorder and coronary artery disease did not differ in the two treatment groups. Results: Early results, survival and reoperation-free survival after 5 years were insignificantly better after root replacement; mortality 10/50 (20%) vs. 38/157 (24%) P = n.s.; hemorrhage 10/50 (20%) vs. 39/157 (25%) P=n.s.; stroke 5/50 (10%) vs. 27/157 (17%) P=n.s.; survival 70 97% vs. 63 9 4%, reoperation free survival 92 96% vs. 789 5% P =0.0815). For the open technique, early mortality was 18.8 vs. 20.6%, P =n.s. and reoperation free survival at 5 years was 80.7 vs. 65.2%, P=n.s. Perioperative complications did not differ in the two technical groups and a single pseudoaneurysm occurred in the Bentall group. Conclusion: In acute dissection composite graft replacement of the aortic root can be carried out with good early and late results not inferior to more conservative procedures. The open technique is the implantation method of choice and the modified Bentall technique is indicated in situations with increased risk of bleeding.
Recipient Type A Aortic Dissection After Orthotopic Heart Transplantation
Very few aortic dissections have been published following a heart transplant. Most of these have been reported as donor aortic dissections. Recipient aortic dissection is extremely rare. Here, surgical treatment of chronic Stanford type A recipient aortic dissection in a 40-year-old patient who underwent an orthotopic heart transplant 10 years ago will be discussed in the light of the literature.
Bench Replacement of Donor Aortic Valve Before Orthotopic Heart Transplantation
Journal of Heart and Lung Transplantation, 2009
Organic valve disease has been considered an absolute contraindication for acceptance as a donor heart. However, the severe shortage of donor hearts has prompted the use of marginally acceptable hearts to maximize the use of donor hearts. This report concerns a patient with repeated left ventricular assist system complications who underwent successful heart transplantation with a marginal donor heart requiring concomitant aortic valve replacement for mild aortic stenosis due to a calcified congenitally bicuspid valve.
European Journal of Cardio-Thoracic Surgery, 2002
Objective: The aims of this study were: (i) to evaluate the early and long-term outcome in patients undergoing aortic root replacement (ARR) with a composite graft; (ii) to identify the predictors for poor overall survival in this pool of patients. Material and methods: Between January 1989 and December 2000, 212 patients underwent ARR with a CG. Mean age was 56^14 years, ranging from 16 to 77. Annuloaortic ectasia was the most frequent cause of aortic disease in this series, 81 (38%) patients, followed by atherosclerotic aneurysm 57 (27%) and type A acute aortic dissection 52 (24.5%). Marfan's syndrome was present in 37 (17.5%) patients. Duration of follow-up ranged from 1 to 120 months, mean 59^35 months. Results: The overall hospital mortality was 16 (7.5%) patients. Eight of them had aortic dissection and four Marfan syndrome. The most frequently found complication resulted to be renal failure in 22 (10%) patients and low cardiac output in 15 (7%) patients. The incidence of perioperative myocardial infarction, neurological complications, respiratory complications, renal failure and coagulopathy incidence were significantly higher in patients with cardiopulmonary bypass (CPB) time .170 min, CA .40 min, and total aortic arch replacement. The actuarial survival at 1, 3 and 5 years resulted to be 91.8, 86 and 81.5%, instead the actuarial survival without re-operation resulted to be 89, 82 and 78%. The actuarial survival in patients with aortic dissection was significantly lower versus non-dissection (P ¼ 0:022). The multivariate analysis revealed the aortic dissection (P ¼ 0:03), age .65 years (P ¼ 0:014), associated coronary artery disease (P ¼ 0:002), NYHA functional class $ 3 (P ¼ 0:027), LVEF ,35% (P ¼ 0:002) and total arch reconstruction (P ¼ 0:003) as strong predictors for poor overall survival in patients undergoing ARR. Conclusions: The ARR with a CG offers acceptable early and long-term outcome. The predictors for poor overall survival in patients undergoing ARR seems to be preoperative aortic dissection extended into the aortic arch, older age, depressed left ventricular function and associated coronary artery disease. q
Twenty-seven-year experience with composite valve graft replacement of the aortic root
The Journal of heart valve disease, 2007
The study aim was to assess early and late outcome in patients undergoing composite valve graft replacement (CVGR) of the aortic root by means of the Bentall procedure, and to identify predictors of early and late death associated with this surgical approach. Between August 1975 and July 2002, 162 consecutive patients underwent a Bentall procedure for CVGR. Demographic, treatment and clinical outcome data from these patients were gathered, reviewed, and analyzed. Potential predictors of early and late mortality were analyzed. The study population was predominantly male (n = 132; 81.5%) and middle-aged (mean age 51.3 +/- 15.8 years; range: 10-79 years). The main indications for surgery were annuloaortic ectasia (n = 75; 46.3%), aortic dissection (n = 44; 27.2%) and Marfan syndrome (n = 34; 21%). Reoperation was required in 37 cases (22.8%). The mean follow up was 74 months. Early (in-hospital) mortality was 1.9% (n = 3). The only independent determinant of early mortality was cardiop...