Heart Transplantation After Bentall Procedure and Extra-Anatomic Bypass: An Individualized Surgical Approach

Heart transplantation after complex cardiac surgeries poses significant technical challenges owing to distorted anatomy and adhesions. This case illustrates how multidisciplinary planning can overcome such obstacles.

A 44-year-old man with prior Bentall procedure and aortic bypass developed end-stage heart failure. Preoperative computed tomography angiography revealed a distorted anatomy, with an anteriorly displaced Dacron graft. A staged approach was adopted, first excluding the bypass with thoracic endoprosthesis placement, followed by transplantation using femoral cannulation and meticulous dissection. The patient recovered well and was discharged from the hospital on postoperative day 20.

This case demonstrates innovative strategies for high-risk transplants, including preoperative vascular interventions and advanced imaging, providing a reproducible model for complex transplant cases. Technical flexibility and multidisciplinary planning were crucial to success.

Complex heart transplants demand meticulous preoperative planning with advanced imaging, consideration of staged interventions, and multidisciplinary planning.