Transplantation has become the gold-standard treatment for endstage heart and lung failure. A well-executed procurement process is the cornerstone of a successful transplant program and patient outcome after transplantation. The aim of this review was to describe a standardized protocol and guidelines for optimal thoracic organ procurement. Here, we describe all aspects of optimal thoracic organ procurement including the intraoperative conduct of the teams, operative steps, graft preservation, transportation, and pitfalls. We believe that a standardized protocol helps in streamlining and minimizing errors, provides optimal training for junior members of the team, and predetermines graft function postimplantation.

No abstract

Objective With progressive aging of population in developing nations, cardiac surgeons increasingly face elderly patients. These patients are usually symptomatic, yet at high risk for intervention. This study aims to review our experience in elderly Indian patients. Methods We reviewed the records of 128 elderly patients (mean age 74.6 years; range 70-84) operated at our institution from 2005 to 2009. Postoperatively, patients were followed-up in the out-patient-department. Results Surgery was performed on 10 as an emergency and 41 on an urgent (on the day of referral or the following day) basis. Mean left ventricular ejection fraction was 44%± 9.5. Early mortality (during current admission or within 30 days of discharge from the hospital) was 12 (9.3%). Mean New York Heart Association functional class was improved from 3.0±0.8 preoperatively to 1.5±0.7 postoperatively. Median Intensive Care Unit and in-hospital stay was 4 days (range 1-17) and 12 days (range 4-37), respectively. Postoperative complications included pneumonia (6.3%), stroke (5.5%), reoperation for bleeding (4.6%) and intra-aortic balloon pump requirement (4.6%). Emergency surgery was significantly associated (P<0.05) with an increased risk of early mortality-operative procedure and cardiopulmonary bypass time were not. Conclusion We conclude that cardiac surgery can be performed in elderly population with an acceptable early mortality. Postoperatively, patients attain an improved quality of life. Operative procedures and cardiopulmonary bypass times are not risk factors for increased mortality. Emergency surgery in this group of patients is less rewarding.

Primary cardiac lymphoma (PCL) is an extremely rare diagnosis. We present a case of a 38-year-old immunocompetent female who presented with dyspnea on exertion and chest pain and the echocardiography revealed a mass in the left atrium (LA) causing moderate mitral regurgitation and mimicking a left atrial myxoma. The patient was managed with excision of the mass and mitral valve replacement followed by chemotherapy. The histopathology revealed B-cell non-Hodgkin lymphoma (NHL) with tumor cells showing immunoreactivity with CD20 and negative for CD45RO.

Lead perforation is a rare complication of implantable cardiac devices. Late lead perforation is defined as the one occurring after 30 days of implantation. Majority of these cases of lead perforation occurs within 1 year of implantation. We report a case of lead perforation which was managed by percutaneous transvenous removal in the operating room with a cardiac surgery team kept on standby and present a detailed review of existing literature on this rare but interesting problem.