Sternal sparing bilateral symmetrical thoracotomy for implantation of left ventricular assist device.

Reopening the chest in patients with left ventricular assist devices at the time of a heart transplant is challenging due to adhesions and the possibility of injury to vital structures. The sternal sparing bilateral thoracotomy approach utilized to implant a left ventricular assist device minimizes the chances of such injuries and offers a cosmetically better outcome. We demonstrate a procedure for implanting a left ventricular assist device in a 54-year-old man diagnosed with dilated cardiomyopathy who suffered rapid decompensation despite maximum medical therapy.

Utilization of Paragonix SherpaPak for human donor heart preservation.

A heart transplant is the gold standard treatment for end stage heart failure. Preservation of the donor heart during its transfer from the hospital of the donor to that of the recipient has a significant impact on the outcome of the transplant procedure. Icebox storage is a conventional method utilized for this purpose that may not provide uniform cooling of the donor heart and does not allow monitoring of the temperature of the donor heart during preservation.

Ex vivo lung perfusion made easy.

Ex vivo lung perfusion is an indispensable tool in the armamentarium of any lung transplant center. It helps to increase an already shrinking donor pool by offering a chance to assess suboptimal donor lungs in a systematic manner and improve them by treating them with low-molecular-weight perfusate. We offer a stepwise guide to carry out ex vivo lung perfusion on the donor lungs and criteria to accept them for transplants.

The role of extracorporeal life support in the management with severe idiopathic pulmonary artery hypertension undergoing lung transplantation: are those patients referred too late?

Background: Idiopathic pulmonary artery hypertension (iPAH) is a relatively minor indication for lung transplantation (LTx) with comparatively poorer outcomes. Extracorporeal life support (ECLS) in various forms is increasingly being used in the management of this entity. However, the data and experience with this therapy remains limited.

Direct Procurement of Donor Heart With Normothermic Regional Perfusion of Abdominal Organs.

Purpose: We wanted to evaluate if direct procurement of the heart is possible in combination with normothermic regional perfusion of abdominal organs in donors after circulatory death.

Description: A donation after circulatory death pathway was used for a 41-year-old woman after an irreversible brain injury. After meeting criteria for the organ donation, the heart was retrieved and re-animated on ex situ perfusion system, and abdominal organs were perfused with normothermic regional perfusion.

Minimally Invasive Left Ventricular Assist Device Implantation: A Comparative Study.

Left ventricular assist device (LVAD) is now a routine therapy for advanced heart failure. Minimally invasive approach via thoracotomy for LVAD implantation is getting popular due to its potential advantage over the conventional sternotomy approach in terms of reduced risk at re-operation due to sternal sparing. We compared the approaches (thoracotomy and sternotomy) to determine the superiority.

Comparison of temporary ventricular assist devices and extracorporeal life support in post-cardiotomy cardiogenic shock.

Objectives: Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support (MCS). The aim of the study was to compare extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs) utilized in the management of PCCS.

Methods: In total, 56 consecutive patients who developed PCCS from 2005 to 2014 required MCS as a bridge to decision-24 were supported with a VAD and 32 with an ECMO.

Direct Heart Procurement After Donation After Circulatory Death With Ex Situ Reperfusion.

The most extended technique of heart procurement from donors after circulatory death involves direct procurement and reperfusion in an ex situ normothermic platform using the Organ Care System (TransMedics, Inc, Andover, MA). This report describes a modified technique (at the Harefield Hospital, London, United Kingdom) with rapid donor blood drainage using a cell-saving device and synchronized perfusion on the Organ Care System.

Use of taurolidine in lung transplantation for cystic fibrosis and impact on bacterial colonization.

Objectives: The presence of bacterial colonization that causes chronic pulmonary infections in cystic fibrosis (CF) patients remains a key issue before lung transplantation. We sought to assess the impact of intraoperative taurolidine lavage on bacterial colonization and long-term outcomes following lung transplantation in CF patients.

Methods: Between 2007 and 2013, 114 CF patients underwent lung transplantation at our institute, and taurolidine 2% bronchial lavage was applied in a substantial proportion of patients (n = 42).

Escalation of extracorporeal life support as a bridge to lung transplantation in end-stage lung disease.

Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTx) is not uncommon, but it is not commonplace yet. We present a case of a 45-year-old man with cystic fibrosis with recent deterioration in lung function who was initially supported with veno-venous (VV) ECMO. However, he subsequently required conversion to veno-veno-arterial (VVA) ECMO.

Delayed Chest Closure With Skin Approximation After Lung Transplant in Oversized Graft.

Closure of the chest after lung transplant in cases of oversized grafts is often difficult. Lung volume reduction and delayed closure of the chest with Bogota bag are the only options available in such situations. Here, we propose to keep the sternum and intercostal spaces open and approximate skin over it.

Influence of history of cannabis smoking in selected donors on the outcomes of lung transplantation.

Objectives: Cannabis is the most commonly abused illicit drug and the smokers are at the risk of lung infections, bullous emphysema and lung cancer. However, no evidence about the outcomes of lung transplantation (LTx) utilizing the lungs from such donors is available in the literature.

Methods: We retrospectively analysed lung 'organ offers' and LTx at our centre between January 2007 and November 2013.

Full-Support LVAD Implantation in a C-Pulse Heart Assist System Recipient with Deteriorating Chronic Heart Failure: Is It Feasible and Safe?

Heart failure is a progressive disease with limited treatment options. The C-Pulse Heart Assist System (Eden Prairie, MN) is an extravascular, diastolic counterpulsation circulatory support device for patients with refractory NHYA Class III/ambulatory class IV heart failure. It comprises a balloon-cuff which is implanted around the ascending aorta that is synchronised to inflate during ventricular diastole.

Zonal organ allocation system and its impact on long-term outcomes after lung transplantation: a propensity score matched analysis†.

Objective: Zonal organ allocation system comprises organ procurement by teams within a specific geographical area of each retrieval team. Therefore, in a substantial number of cases organs are retrieved by 'foreign' teams and are sent for transplantation to the implanting centre. The aim of this study was to assess the impact of zonal organ allocation system on early- and long-term outcomes after lung transplantation (LTx).

Salvage myocardial revascularisation in spontaneous left main coronary artery dissection with cardiogenic shock - the role of mechanical circulatory support.

Spontaneous left main coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death, constituting less than 1% of all epicardial coronary artery dissections. It is often fatal and is mostly recognized at post-mortem examination in young victims of sudden death. More than 70% of the reported cases occurred in women, particularly during pregnancy and the peripartum period and those on oral contraceptives.

Moving Back to the Future: Use of Organ Care System Lung for Lobectomy Before Lobar Lung Transplantation.

BACKGROUND Lung transplantation remains the gold standard treatment for patients with end-stage lung disease. Lobar lung transplantation allows for transplantation of size-mismatch donor lungs in small recipients; however, donor lung volume reduction represents a challenging surgical technique. In this paper we present our initial experience with bilateral lobectomy in donor lungs before lobar lung transplantation using normothermic perfusion on the Organ Care System (OCS) Lung.

Utilization of the organ care system for bilateral lung transplantation: preliminary results of a comparative study.

Objectives: Lung transplantation (LTx) remains the gold standard for patients with end-stage lung disease. However, due to donor organ shortage and brain stem death-related lung injury, only a small proportion of lungs are used increasing the mortality rate on the waiting list. A portable normothermic continuous ex vivo perfusion using the organ care system (OCS) represents one of the tools to increase the pool of donor organs and to improve the function of marginal lungs.

Extended Recipient Criteria in Lung Transplantation: Impact of Pleural Abnormalities on Primary Graft Dysfunction.

Background: Because of improved surgical expertise and intraoperative management, pleural disease (PD+) represents a relatively minor contraindication to lung transplantation (LTx). The presence of pleural abnormalities from previous procedures or pleural involvement from fungal or bacterial disease is not considered a limiting factor for LTx. However there are no studies available to assess the impact of pleural diseases on short- and midterm outcomes after LTx.

Effect of donor cardiac arrest and arrest duration on outcomes of lung transplantation.

Background: Limited data are available about lung transplantation (LTx) from donors suffering cardiac arrest (CA) prior to actual donation.

Methods: A retrospective analysis of LTx performed between January 2007 and September 2012 was done with the focus on CA in donors. The recipients were grouped depending on the history of donor CA and CA duration (downtime) as: No cardiac arrest ("NoCA"), CA downtime less than 20 min ("CA < 20"), and CA downtime equal to or more than 20 min ("CA > 20").

Oxygenator in short-term LVAD circuit: a rescue in post-LVAD pulmonary complications.

Pulmonary complications after left ventricular assist device (LVAD) implantation, though infrequent, can be potentially catastrophic. A 62-year-old female with cardiogenic shock, supported on short-term LVAD, developed pulmonary oedema. An oxygenator was introduced into the LVAD circuit, which improved the gas exchange and, eventually, after weaning off the oxygenator, the patient received long-term LVAD.

The role of cardiopulmonary bypass in lung transplantation.

Background: The risk-benefit for utilizing cardio-pulmonary bypass (CPB) in lung transplantation (LTx) remains debatable. This study compares outcomes after LTx utilizing different CPB strategies - elective CPB vs. off-pump vs.