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A Modified Murine Heterotopic Heart Transplant Protocol Matching Contemporary Standards of Aseptic Technique, Anesthesia, and Analgesia
Published on: September 28, 2022
Acute care surgery in heart transplant recipients
Zane Ashman1, Elizabeth Lancaster, Nancy Satou
1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Insights
Acute care surgery consultations and procedures after orthotopic heart transplantation (OHT) are infrequent but carry high mortality. Patients bridged with medical therapy (MT) or ventricular assist devices (VADs) had similar rates, with MT patients more prone to abdominal issues.
Area of Science:
- Cardiology
- Surgical Oncology
- Transplantation
Background:
- Orthotopic heart transplantation (OHT) is the gold standard for end-stage heart failure.
- Bridging strategies include medical therapy (MT) and ventricular assist devices (VADs).
- Acute care surgery (ACS) complications post-OHT require careful evaluation.
Purpose of the Study:
- To analyze the incidence, characteristics, and outcomes of ACS consultations and procedures within one year of OHT.
- To compare ACS events in patients bridged with MT versus VADs.
Main Methods:
- Retrospective review of institutional OHT recipients from 2008-2012.
- Analysis of ACS consultations and procedures within 1 year post-OHT.
- Comparison between MT (n=169) and VAD (n=74) bridging groups.
Main Results:
- 21 patients (9%) required 28 ACS consultations; 11 patients (5%) underwent 16 ACS procedures.
- MT patients had shorter time to consultation (50 vs 82 days) but longer time to operation (5 vs 1 day).
- MT patients were more likely to need consultation for abdominal issues (88% vs 27%); 31% of ACS procedures resulted in complications, with 24% overall mortality.
Conclusions:
- ACS consultations and procedures are infrequent but associated with high morbidity and mortality in OHT recipients.
- Incidence of ACS events is similar between MT and VAD bridged patients.
- Abdominal pathology is a significant concern for MT bridged patients requiring ACS evaluation.
Abstract:
Orthotopic heart transplantation (OHT) is the optimal treatment for end-stage heart failure. We reviewed our institutional experience between 2008 and 2012 with acute care surgery (ACS) consultations and procedures within 1 year of OHT in recipients bridged to transplantation with medical therapy (MT, n = 169), including intravenous inotropes, and ventricular assist devices (VADs, n = 74). In total, 28 consultations were required in 21 patients (9%) and 16 procedures were performed in 11 patients (5%). The interval from transplantation to consultation was shorter for the MT group (50 vs 82 days; P = 0.015), whereas the interval from consultation to operation was longer (5 vs 1 day; P = 0.03). Patients undergoing MT were more likely to require consultation for abdominal problems (88 vs 27%; P = 0.004). All but one of the seven ischemic/inflammatory abdominal problems occurred in the MT group. Complications occurred after five ACS procedures (31%) in two patients undergoing MT and three patients undergoing VAD. Mortality was 24 per cent with five deaths occurring within 30 days of ACS consultation and/or operation. In summary, this is one of the largest series of ACS problems in patients undergoing OHT bridged to transplant with MT or VAD. With similar incidence in MT and VAD groups, ACS consultations and operations are infrequent with high mortality and morbidity.
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