ABSTRACT
ABSTRACT Introduction: Combined solid organ transplantation is infrequently performed in Brazil. The objective of this article is to present our initial experience with combined heart and kidney transplantation. Methods: From January 2007 to December 2019, four patients were submitted to combined heart and kidney transplantation. Their mean age was 55.7±4.4 years, and three (75%) patients were males. All patients had Chagas cardiomyopathy, two were hospitalized and inotrope dependent, and all patients were on preoperative dialysis (median of 12 months prior to transplant). Results: All patients survived and were in New York Heart Association functional class I at the latest follow-up (mean 34.7±17.5 months). Mean retarded kidney graft function was 22.9±9.7 days. One patient lost the kidney graft two years after the transplant due to Polyomavirus infection. Conclusion: Our initial experience of combined heart and kidney transplantation was favorable in selected patients with advanced heart failure and end-stage kidney disease. It requires involvement of a dedicated multispecialty team throughout all the diagnostics and treatment steps.
ABSTRACT
RESUMO Reportamos o caso de paciente do sexo feminino, 58 anos, sem doença cardíaca conhecida, submetida a transplante hepático sem intercorrências. No segundo dia do pós-operatório desenvolveu choque cardiogênico secundário à miocardiopatia induzida pelo estresse (síndrome de Takotsubo-like). A paciente foi manejada com sucesso com oxigenação por membrana extracorpórea venoarterial periférica, por 6 dias, com recuperação completa da função cardíaca, bem como do enxerto hepático. Síndrome coronariana e miocardite aguda foram excluídas como causas do choque. O uso de oxigenação por membrana extracorpórea neste cenário é possível e seguro, considerando protocolos e tratamento especializado neste tipo de suporte.
ABSTRACT We report the case of a female patient, 58 years of age, without known heart disease, who underwent liver transplantation without complications. On the second postoperative day, the patient developed cardiogenic shock secondary to stress-induced cardiomyopathy (Takotsubo-like syndrome). The patient was successfully managed with veno-arterial peripheral extracorporeal membrane oxygenation for 6 days, with complete recovery of cardiac function and of the hepatic graft. Coronary syndrome and acute myocarditis were excluded as the causes of the shock. The use of extracorporeal membrane oxygenation in this scenario is possible and safe, considering its specialized protocols and treatment.
Subject(s)
Humans , Female , Shock, Cardiogenic/therapy , Extracorporeal Membrane Oxygenation/methods , Liver Transplantation/methods , Takotsubo Cardiomyopathy/therapy , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Shock, Cardiogenic/etiology , Treatment Outcome , Takotsubo Cardiomyopathy/etiology , Middle AgedABSTRACT
Background:Primary graft dysfunction is the main cause of early mortality after heart transplantation. Mechanical circulatory support has been used to treat this syndrome.Objective:Describe the experience with extracorporeal membrane oxygenation to treat post-transplant primary cardiac graft dysfunction.Methods:Between January 2007 and December 2013, a total of 71 orthotopic heart transplantations were performed in patients with advanced heart failure. Eleven (15.5%) of these patients who presented primary graft dysfunction constituted the population of this study. Primary graft dysfunction manifested in our population as failure to wean from cardiopulmonary bypass in six (54.5%) patients, severe hemodynamic instability in the immediate postoperative period with severe cardiac dysfunction in three (27.3%), and cardiac arrest (18.2%). The average ischemia time was 151 ± 82 minutes. Once the diagnosis of primary graft dysfunction was established, we installed a mechanical circulatory support to stabilize the severe hemodynamic condition of the patients and followed their progression longitudinally.Results:The average duration of extracorporeal membrane oxygenation support was 76 ± 47.4 hours (range 32 to 144 hours). Weaning with cardiac recovery was successful in nine (81.8%) patients. However, two patients who presented cardiac recovery did not survive to hospital discharge.Conclusion:Mechanical circulatory support with central extracorporeal membrane oxygenation promoted cardiac recovery within a few days in most patients.
Fundamento:A disfunção primária de enxerto é a principal causa de mortalidade precoce após o transplante cardíaco. O uso de assistência circulatória mecânica tem sido empregado no tratamento dessa síndrome.Objetivo:Descrever a experiência com o uso de oxigenação por membrana extracorpórea para tratamento de disfunção primária de enxerto pós-transplante cardíaco.Métodos:Entre janeiro de 2007 e dezembro de 2013, foram realizados 71 transplantes cardíacos ortotópicos em pacientes com insuficiência cardíaca avançada. Destes, 11 (15,5%) pacientes apresentaram disfunção primária de enxerto, os quais constituíram a população deste estudo. As manifestações da disfunção primária de enxerto na nossa população foram falência no desmame da circulação extracorpórea em seis (54,5%) pacientes, instabilidade hemodinâmica grave no pós-operatório imediato com disfunção cardíaca acentuada em três (27,3%) e pós-parada cardíaca em dois (18,2%). O tempo de isquemia médio foi 151 ± 82 minutos. Assim que o diagnóstico de disfunção primária de enxerto foi estabelecido, procedeu-se à instalação de suporte circulatório mecânico para estabilização de quadro hemodinâmico grave, e a evolução dos pacientes foi estudada temporalmente.Resultados:A duração média de assistência em oxigenação por membrana extracorpórea foi 76 ± 47,4 horas (variação de 32 a 144 horas). O desmame com recuperação cardíaca obteve sucesso em nove (81,8%) pacientes. No entanto, dois pacientes, que tiveram recuperação cardíaca, não sobreviveram à alta hospitalar.Conclusão:O uso de assistência circulatória mecânica por meio de oxigenação por membrana extracorpórea central promoveu recuperação cardíaca em poucos dias na maioria dos pacientes.