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Orthotopic heart transplantation with concurrent aortic valve replacement and coronary artery bypass grafting
J N Rao1, B Prendergast, J H Dark
1Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Insights
This case study details a successful heart transplant using a donor heart with coronary artery disease and a bicuspid aortic valve. It highlights the use of marginal donor hearts to address organ shortages in heart transplantation.
Area of Science:
- Cardiology
- Transplantation Surgery
- Cardiac Surgery
Background:
- The demand for donor hearts significantly exceeds supply, leading to challenges in organ allocation.
- Marginal donor hearts, previously considered unsuitable, are increasingly being evaluated for transplantation.
- Standard criteria for donor heart acceptance are being re-examined to expand the donor pool.
Observation:
- A donor heart with normal ventricular function but significant coronary artery disease (2-vessel) and a bicuspid aortic valve was identified.
- The recipient required concurrent aortic valve replacement and coronary artery bypass grafting during the orthotopic heart transplantation.
- The surgical team proceeded with transplantation despite the identified donor heart conditions.
Findings:
- Successful orthotopic heart transplantation was achieved with the marginal donor heart.
- The recipient demonstrated stable post-transplant recovery with the repaired and bypassed coronary arteries and the new aortic valve.
- This case demonstrates the feasibility of utilizing donor hearts with specific comorbidities.
Implications:
- This successful transplantation suggests that carefully selected marginal donor hearts can be safely used, expanding the donor pool.
- It challenges traditional donor heart acceptance criteria and supports a more individualized approach to organ selection.
- Considering marginally acceptable donor hearts is crucial for addressing organ shortages and improving outcomes for critically ill patients awaiting heart transplantation.
Abstract:
We report a case of successful orthotopic heart transplantation of a donor heart with normal ventricular function, 2-vessel coronary artery disease, and a bicuspid aortic valve, which required concurrent aortic valve replacement and coronary artery bypass grafting. In confronting the disparities in demand and supply, we must consider the so-called marginally acceptable heart for either critically ill recipients or those who may be disadvantaged on the waiting list.