This study reports the longest median survival to date (96 days) of pig hearts transplanted heterotopically into baboons. Duplication of these results in the orthotopic life-supporting position could bring cardiac xenotransplantation to the threshold of clinical application.
The median survival of 76 days in this group of heterotopic porcine-to-baboon cardiac xenografts represents a major advance over the median 27-day survival reported in the literature. Cellular rejection may not constitute a direct major barrier to xenotransplantation. A median survival of 90 days may be achievable with better control of BCMV infection. If further studies in the orthotopic position replicate these outcomes, criteria considered appropriate for clinical application of cardiac xenotransplantation would be approached.
This study summarizes one of the lowest overall fistula rates reported in the literature. In a tertiary-care academic setting, plastic surgery residents can actively contribute to palatoplasty with a very low fistula rate. Technical keys to achieving low fistula rate include skeletonization of the vascular pedicle for medialization of the mucoperiosteal flaps, aggressive posterior repositioning of the levator muscle, and meticulous two-layer mattress-suture closure. We recommend Furlow repair for narrower clefts (less than 8 mm wide at the posterior border of the hard palate) and the Bardach two-flap palatoplasty for wider clefts.
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