An Alternative Technique for Orthotopic Cardiac Transplantation, with Preservation of the Normal Anatomy of the Right Atrium

Fatores associados à sobrevida em pacientes submetidos a transplante cardíaco utilizando microcardioplegia sanguínea retrógrada Associated factors with survivals in patients undergoing orthotopic heart transplant using retrograde blood microcardioplegia Abstract Background: Several techniques and cardioplegic solutions have been used for heart preservation during transplant procedures. Unfortunately, there is a lack of ideal method for myocardial preservation in the clinical practice. The use of retrograde cardioplegia provides continuous infusion of cardioplegic solution during the graft implantation. This strategy may provide better initial recovery of the graft. The objective of this study is to describe the experience of a single center where all patients received the same solution for organ preservation and were subjected to continuous retrograde blood microcardioplegia during implantation of the graft and to evaluate factors associated to early and late mortality with this technique.Methods: This is a retrospective, observational and descriptive study of a single center.Results: During the study period were performed 35 heart transplants. Fifteen (42.9%) patients were in cardiogenic shock. The probability of survival was 74.8±7.8%, 60.4±11.3% and 15.1±13.4% at 1 year, 5 years and 10 years of follow-up, respectively. The median survival time was 96.6 months.Conclusion: The use of myocardial protection with retrograde cardioplegic solution may reduce the risks associated morbidity due to cold ischemia time during the heart transplant, and we suggest that this benefit may be even greater in cases of cold ischemia time longer ensuring protection to the myocardium.Descriptors: Heart transplantation. Transplantation. Heart arrest, induced. Myocardium. Follow-up studies. ResumoIntrodução: Uma grande variedade de técnicas e soluções é utilizada na preservação do coração durante o transplante, o que demonstra a falta de método ideal na prática clínica. A 348Lavagnoli CFR, et al. -Associated factors with survivals in patients undergoing orthotopic heart transplant using retrograde blood microcardioplegia Bras Cir Cardiovasc 2012;27(3):347-54 INTRODUCTION A variety of techniques and solutions are used in the preservation of the heart during transplantation, demonstrating the lack of ideal method in clinical practice [1]. RevIn the present day, where the number of donors is not enough, in addition to the increase of high-risk recipients on the waiting list, every effort should be made towards better organ preservation. A better organ preservation leads to lower graft dysfunction and promotes better late outcomes after transplantation [2,3].The use of retrograde blood cardioplegia has been described in several studies in the literature. There is no consensus whether this strategy promotes adequate myocardial protection [4]. Its use for the administration of blood cardioplegia during implantation is frequently reported in the literature. This strategy of cardioplegia administration allows for continuous perfusion o...

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“…All patients underwent the same bicaval implantation technique, as described by Lower & Shumway modified Yacoub & Banner [9][10][11].…”

Section: Surgical Technique Of Implantation and Intraoperative Monitomentioning

confidence: 99%

Associated factors with survivals in patients undergoing orthotopic heart transplant using retrograde blood microcardioplegia

Lavagnoli

Severino

Vilarinho

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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“…The failure to include a sufficient length of the infracardiac IVC can lead to injury of the closely opposed right coronary artery or coronary sinus. 7 Conversely, a short cuff of the suprahepatic IVC can increase the risk of venous outflow Christopher J. Sonnenday is supported by the American Association for the Study of Liver Diseases through the Career Development Award in Liver Transplantation.…”

Section: To the Editorsmentioning

confidence: 99%

There is plenty for everyone: Transection of the infracardiac inferior vena cava during organ recovery

et al. 2012

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“…Biatrial orthotopic heart transplantation was compared to bicaval transplantation, in which the left atrial anastomosis is performed in a similar fashion to that in Lower and Shumway's technique, however with the anastomosis of both venae cavae made separately, thus preserving the right atrial anatomy 5,8 . Likewise, biatrial transplantation was compared to total transplantation, in which the bicaval technique is used associated with complete removal of the recipient's left atrium, except for the pulmonary vein inlet region, to the right and to the left; in this site the donor's left atrium is anastomosed 9 .…”

Section: Interventionmentioning

confidence: 99%

“…standard, two other techniques -the total and bicaval transplantation, were developed with the aim of ensuring better anatomical and physiological graft adaptation and better postoperative outcomes [5][6][7][8][9] . In fact, there are evidences in the literature that better results are obtained with the two techniques described more recently [10][11][12][13][14][15][16][17][18][19][20][21] .…”

mentioning

confidence: 99%

O transplante cardíaco biatrial deve ainda ser realizado? Metanálise

Locali¹,

Matsuoka²,

Cherbo³

et al. 2010

Arq. Bras. Cardiol.

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.standard, two other techniques -the total and bicaval transplantation, were developed with the aim of ensuring better anatomical and physiological graft adaptation and better postoperative outcomes [5][6][7][8][9] . In fact, there are evidences in the literature that better results are obtained with the two techniques described more recently [10][11][12][13][14][15][16][17][18][19][20][21] . However, these evidences are weak when considered alone, and thus do not ensure an adequate level of evidence, especially because most of them are from retrospective studies with small case series 11,14,[22][23][24][25] .For this reason, in 2007, Schnoor et al 10 conducted a metaanalysis with the purpose of increasing the statistical power of the evidences that the new techniques are better than the biatrial transplantation 10 . However, these authors excluded retrospective studies from the main assessments; they included the two more recent techniques in a single group and made a limited review of the literature. As such, relevant data may have not been included in the meta-analysis, thus making the evidence incomplete. For this reason, the objective of this study was to determine whether the techniques of total and bicaval heart transplantation are better than the biatrial technique, thus adding to Schnoor et al 10 results. Method Inclusion and exclusion criteria Study selectionProspective controlled studies were included, whether randomized or not. Description of the randomization techiques, masking and patient follow-up, as described in the respective methodology of the studies, were not considered as criteria for inclusion. Retrospective studies including control groups were also included.Studies whose designs did not meet these requirements, like case series and uncontrolled retrospective studies, narrative reviews and systematic reviews of the literature, case reports, letters, brief communications, and experimental animal studies were excluded. Additionally, studies whose results were incomplete, that is, those not reporting information on mean and standard deviation for continuous numeric variables and proportion of events occurred for nominal categorical variables, were also excluded. PatientsNo restrictions were made as to patient gender, age, and ethnicity, or as to the baseline heart diseases that led SummaryThe outcomes of total and bicaval heart transplantation techniques are better than those of the biatrial technique; however, the latter is still considered the gold-standard. The objective of this study was to determine whether the total and bicaval heart transplantation techniques are, in fact, better than the biatrial technique. A systematic review with meta-analysis was carried out. Studies were retrieved from Pubmed™, Lilacs™, Web of Science™, Scirus™, Scopus™, Google Scholar™, and Scielo™ databases, identified by sensitive strategy. Randomized, prospective, and retrospective controlled studies were selected for inclusion. Intra and postoperative parameters were assessed. A total of 11,602 studies were ...

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An Alternative Technique for Orthotopic Cardiac Transplantation, with Preservation of the Normal Anatomy of the Right Atrium

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Associated factors with survivals in patients undergoing orthotopic heart transplant using retrograde blood microcardioplegia

Associated factors with survivals in patients undergoing orthotopic heart transplant using retrograde blood microcardioplegia

There is plenty for everyone: Transection of the infracardiac inferior vena cava during organ recovery

O transplante cardíaco biatrial deve ainda ser realizado? Metanálise

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