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Bioprosthetic Aortic Valve Replacement in a Donor Heart before Orthotopic Heart Transplantation
Insights
Donor hearts with moderate aortic valve regurgitation can be successfully transplanted. This case study shows that expanding donor criteria may increase heart availability for patients awaiting transplantation.
Area of Science:
- Cardiology
- Transplantation Surgery
Background:
- Current donor heart selection criteria limit organ availability for a growing number of heart transplant recipients.
- Patients with advanced heart failure and refractory ventricular tachycardia often face limited treatment options.
Observation:
- A 71-year-old male patient with ischemic cardiomyopathy and ventricular tachycardia was listed for heart transplantation.
- A donor heart with moderate aortic valve regurgitation was identified as a potential match.
Findings:
- Orthotopic heart transplantation was successfully performed using the donor heart after concurrent aortic valve replacement.
- The patient experienced a positive recovery and was discharged on postoperative day 11.
Implications:
- This case demonstrates the feasibility of utilizing donor hearts with moderate aortic valve regurgitation.
- Expanding donor criteria, with appropriate surgical expertise, could increase the supply of transplantable hearts.
Abstract:
Current criteria for donor hearts limit the number of hearts available for transplantation, despite an increasing number of recipients on waiting lists. We report the case of a patient with ischemic cardiomyopathy and refractory ventricular tachycardia who underwent successful orthotopic heart transplantation and concurrent aortic valve replacement with a donor heart that had displayed moderate aortic valve regurgitation. The patient was a 71-year-old man with a history of advanced heart failure, 5-vessel coronary artery bypass grafting, and paroxysmal ventricular tachycardia. He was not a candidate for repeat revascularization or myocardial ablation, so he was placed on the heart-transplant list as status 1A. On intra-aortic balloon pump support, the patient waited 51 days for a donor match to be identified. Despite the donor heart's having moderate aortic valve regurgitation, the decision was made to use that heart. We performed a back-table aortic valve replacement with a 23-mm St. Jude Epic bioprosthesis, and then performed the orthotopic heart transplantation. The patient did well and was discharged from the hospital on postoperative day 11. This case indicates that expanding donor criteria to include otherwise healthy hearts with certain aortic valve defects is feasible, if surgical experience and expertise permit.
