Perioperative Management of a Donation After Circulatory Death Heart Transplant in a Recipient With a Persistent Left Superior Vena Cava.

A 60-year-old male with end-stage heart failure due to non-ischemic cardiomyopathy and mitral regurgitation presented for a donation after circulatory death (DCD) orthotopic heart transplantation. Intraoperatively, a persistent left superior vena cava (PLSVC), absent innominate vein, and small right superior vena cava were discovered. A bicaval technique was performed, using an interconnecting prosthetic conduit to anastomose the PLSVC with the right atrial appendage and an interposition graft to the native R SVC.

Reoperative sternotomy is associated with primary graft dysfunction following heart transplantation.

Objectives: Prior sternotomy is associated with increased morbidity and mortality following heart transplantation. However, its effect on primary graft dysfunction (PGD), a major contributor to early mortality, is unknown. Herein, this effect is studied using the International Society for Heart and Lung Transplantation consensus definition for PGD.

Asymptomatic Ascending Aorta Aneurysm With Severe Aortic Regurgitation Caused by Multiple Intimal-Medial Tears Unassociated With Aortic Dissection.

A 62-year-old man was found to have an asymptomatic ascending aortic aneurysm (6.6 cm) associated with severe aortic regurgitation. Operative resection of the wall of the aneurysm disclosed its cause to be multiple healed intimal-medial tears without dissection involving a previously normal aorta.

Comparison of Clinical Characteristics, Complications, and Outcomes in Recipients Having Heart Transplants <65 Years of Age Versus ≥65 Years of Age.

Advanced recipient age remains a limiting factor for heart transplant candidacy, with many centers reluctant to transplant older patients. Here, we report our experience with recipients aged ≥65 years compared with younger recipients in terms of baseline characteristics, intraoperative and immediate postoperative experiences, and post-transplant morbidity and survival. The main study outcome was primary graft dysfunction (PGD), which has not been widely studied in this population.

Utilization of high donor sequence number grafts in cardiac transplantation.

Donor sequence number (DSN) represents the number of candidates to whom a graft was offered and declined prior to acceptance for transplantation. We sought to investigate the outcomes of patients receiving high DSN grafts. Consecutive isolated adult cardiac transplantations performed at a single-center were reviewed.

Ambulatory extracorporeal membrane oxygenation with subclavian venoarterial cannulation to increase mobility and recovery in a patient awaiting cardiac transplantation.

Venoarterial extracorporeal membrane oxygenation (ECMO) can provide temporary cardiopulmonary support for patients in hemodynamic extremis or refractory heart failure until more durable therapies-such as cardiac transplantation or a left ventricular assist device-can be safely implemented. Conventional ECMO cannulation strategies commonly employ the femoral artery and vein, constraining the patients to the supine position for the duration of ECMO support. We have recently adopted a modified cannulation approach to promote patient mobility, rehabilitation, and faster recovery and to mitigate complications associated with femoral arterial cannulation, such as limb ischemia and compartment syndrome.

Application of the International Society for Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation: outcomes from a high-volume centre†.

Objectives: A standardized definition for primary graft dysfunction (PGD) after cardiac transplantation was recently proposed by the International Society of Heart and Lung Transplantation (ISHLT). We sought to characterize the outcomes associated with and identify risk factors for PGD following cardiac transplantation using these criteria at a high volume centre.

Methods: Donor and recipient medical records of 201 consecutive adult cardiac transplantations performed between November 2012 and March 2015 were retrospectively reviewed.

How to Do It: The Commando Operation for Reconstruction of the Fibrous Skeleton with Double Valve Replacement.

Infiltrative processes that extend into the intervalvular fibrosa, such as infection or calcification, often mandate a complex reconstructive procedure known as the Commando operation. First described less than 20 years ago, this operation is not widely implemented, with experience limited to a few select centers. This report provides a detailed summary of our approach to this intricate procedure.

Comparison of Outcomes of Operative Therapy for Acute Type A Aortic Dissections Provided at High-Volume Versus Low-Volume Medical Centers in North Texas.

Immediate surgery is standard therapy for acute type A aortic dissections (TAAD). Because of its low incidence, many smaller cardiac surgery programs do not routinely perform this procedure because it may negatively affect outcomes. Many high-risk, low-volume (LV) surgical procedures are now preferentially performed in reference centers.

Using extracorporeal membrane oxygenation support preoperatively and postoperatively as a successful bridge to recovery in a patient with a large infarct-induced ventricular septal defect.

Rupture of the ventricular septum during acute myocardial infarction usually occurs within the first week. The event is usually followed by low cardiac output, heart failure, and multiorgan failure. Despite the many advances in the nonoperative treatment of heart failure and cardiogenic shock, including the intra-aortic balloon pump and a multitude of new inotropic agents and vasodilators, these do not supplant the need for operative intervention in these critically ill patients.

Impact of donor age on cardiac transplantation outcomes and on cardiac function.

Objectives: Although the impact of older donors on heart transplant outcomes has been previously published, the survival results are conflicting. We herein analyse the impact of older donors on transplant survival and myocardial function.

Methods: The records of the patients who underwent heart transplant at Baylor University Medical Center at Dallas from November 2012 until March 2015 were reviewed and the data were extracted.

Utility of cardiac computed tomography for inflow cannula patency assessment and prediction of clinical outcome in patients with the HeartMate II left ventricular assist device.

Objectives: Proper inflow cannula orientation during implantation of the HeartMate II (HMII) left ventricular assist device (LVAD) is important for optimal pump function. This article describes our experience with cardiac computed tomography (CCT) to evaluate inflow cannula patency and predict future adverse outcomes (AE) after HMII LVAD implantation.

Methods: Ninety-three patients underwent HMII LVAD implantation for end-stage cardiomyopathy from January 2010 until March 2014.