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Transplantation of an oversized heart
G Trummer1, M Berchtold-Herz, R Hillmann
1Department of Cardiovascular Surgery, Albert-Ludwigs-University Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. georg_trummer@yahoo.com
Insights
Expanded criteria for heart transplantation allow the use of oversized donor hearts. A pericardectomy procedure resolved postoperative circulatory issues, enabling a successful recovery and good long-term cardiac function.
Area of Science:
- Cardiology
- Transplantation Surgery
Background:
- Donor organ shortages necessitate expanded criteria for heart transplantation.
- Recipient: 46-year-old female (BSA 1.58 m²). Donor: 34-year-old male (BSA 2.58 m²).
Observation:
- Orthotopic heart transplantation performed with a significantly oversized donor heart.
- Postoperative period complicated by severe circulatory problems due to right heart impression.
Findings:
- A pericardectomy (excision of the pericardium) resolved the hemodynamic instability.
- The patient stabilized, experienced no further cardiopulmonary issues, and was discharged 20 days post-surgery.
- Twelve-month follow-up confirmed good cardiac function and physical condition.
Implications:
- Oversized donor hearts can be safely transplanted by leaving the pericardium open and performing a pericardectomy.
- This approach may increase the donor pool and improve outcomes for heart transplant recipients.
Abstract:
In response to the limited number of available donors, the criteria for accepting hearts have been expanded. In a 46-year-old female (160 cm, 56 kg) with a body surface area (BSA) of 1.58 m(2), an orthotopic heart transplantation was performed. She received the heart from a 34-year-old male donor (190 cm, 90 kg, BSA 2.58 m(2)). During transplantation, the obvious difference between the donor's heart and the recipient's pericardium did not cause a technical problem. However, the postoperative course was characterized by severe circulation problems. Due to a hemodynamically significant right heart impression, a consecutive pericardectomy had to be performed. After excision of the left and the right side of the pericardium, the patient returned to a stable condition. The consecutive course was without cardiopulmonary problems and the patient was discharged from the hospital 20 days later. The last twelve-month follow-up showed good cardiac function and excellent physical condition. We conclude that an oversized donor heart can be used for heart transplantation as long as the pericardium is left open and a left and right pericardectomy is performed.