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Objective:To explore the treatments and outcomes of heart and kidney transplantation(HKTx)and summarize its management experiences.Methods:From October 2016 to October 2020, clinical data, treatment strategies and prognosis of 11 patients received HKTx were analyzed retrospectively.In 11HKTx cases, the ratio of male-to-female was 10∶1, the age(50.6±12.9)years and the preoperative body mass index(26.72±3.29)kg/m 2.The preoperative cardiac function was class Ⅳ and the preoperative left ventricular ejection fraction(29.40±4.48)%.All patients were in uremic state pre-operation and underwent regular dialysis.The mean duration of dialysis was 2.5(0.5-7.0)years, preoperative creatinine 753.5(434-1144)μmol/L and preoperative predictive glomerular filtration rate 5.59(3.93-17.23)ml/(min preop 2). Non-staged transplant was performed and donor heart and kidney were from the same donor.The median time of cold cardiac ischemia 2.75(2.5, 4.0)hours, the median time of cold renal ischemia 9(8.5, 15.0)hours and the median time from the end of heart transplantation to the beginning of kidney transplantation 2(1.0, 3.5)hours.The immunosuppressive regimen was a combination of tacrolimus, mycophenolate mofetil and methylprednisolone. Results:Normal cardiac function and renal function normalized in 9 cases.At Month 6 post-operation, the postoperative left ventricular ejection fraction was(57.55±2.51)%, creatinine 107.7(85-132)μmol/L and urine volume in 24h 1988(1800-2200)ml.The long-term survival time was 6-62 months.No such complications as infection or rejection occurred in 9 patients.The cardiac function was class Ⅰ at Month 6 post-operation.One patient died from pulmonary mucor infection at Month 4 post-operation.Another death was due to gastrointestinal fungal infection at Month 1 after HKTx.Conclusions:HKTx is an effective treatment for end-stage heart disease with renal failure.
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Objective To summarize the outcomes and clinical experience of combined heart and kidney transplantation.Methods The clinical data of one case of combined heart and kidney transplantation were retrospectively analyzed.The kidney transplant was completed immediately after the heart transplant.The immunosuppressive therapy strategies included tacrolimus,corticosteroids and mycophenolate mofetil.Results For heart transplantation,heart cold ischemia time was 200 min,aorta blocking time was 136 min,and extracorporeal circulation time was 201 min.The kidney was transplanted to the right iliac fossa after heart transplantation.The endotracheal tube was removed 15 h after surgery.The patient was transferred to the general ward on the 8th day after surgery.The patient was discharged from the hospital at 27th day after surgery,the renal function was normal and no activity was restricted.Conclusion Reasonable perioperative management and selection of surgical methods are the keys to the success of combined heart and kidney transplantation.
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The incidence of dextrocardia is lower. The dextrocardia is often associated with congenital anatomical abnormalities. The patient with normal cardiac structure of dextrocardia and severe coronary heart disease that needs coronary artery bypasss is rarer. This article summarizes the perioperative management and surgical experience of dextrocardia with bypass surgery via a clinical case.
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Objective To summarize the experience of surgical treatment in patients with uremia and severe coronary artery disease, and reduce the perioperative risk thereof. Methods Sixteen chronic renal failure patients who were received haemodialysis and underwent coronary artery bypass grafting (CABG) during the period of February 2009 to December 2016 in Tianjin First Central Hospital were assessed in this retrospective study. Of the 16 patients, 8 patients and 6 patients were treated with off pump and on pump CABG respectively, one patient was treated with CABG and resection of ventricular aneurysm, and one patient was treated with CABG and tricuspid valve replacements. The renal function changes in preoperative and postoperative periods, 2-day and 1-week after surgery were observed. Echocardiography was used to evaluate cardiac function. The improvement of angina was recorded. Results Fourteen patients were successfully withdrawn from ventilator therapy within 24 h after surgery. The tracheal intubation was removed 65-hour after surgery in one patient. One patient died of multiple organ failure on the seventh day after surgery. The average length of ICU staying and in-hospital stay were (125.5 ± 21.6) h and (28.6 ± 7.4) days respectively. The serum creatinine (sCr) and blood urea nitrogen (BUN) were higher in two days after surgery than those before the operation (P 0.40, and no angina occurred. Conclusion CABG is relatively safe for patients with end-stage renal disease and severe coronary artery disease. CABG can significantly eliminate angina symptoms with satisfactory clinical effect.
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Objective To investigate the risk factors of postoperative atrial fibrillation (POAF) in patients with on-pump coronary artery bypass grafting (ONCAB). Methods The clinical data of 200 patients with ONCAB were retrospectively analyzed. The patients were divided into POAF group (n=52) and non POAF group (n=148) according to the occurrence of POAF after operation. The perioperative data including age and gender of all patients were collected and analyzed. The index of opinion of statistical results was classified by two categories Logistic regression analysis, and the related risk factors of POAF were analyzed. The receiver operating characteristic (ROC) curves of the age, red blood cell (RBC), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) were analyzed in two groups. Results The incidence rate of POAF was 26%, mostly occurred in the postoperative period from 1 d to 3 d. Compared with non POAF group, the age, the proportion of patients with age≥62.5 years or older, the proportion of patients with LAD≥35 mm, left ventricular end-diastolic diameter and perioperative transfusion of RBC were increased in POAF group, and data of mechanical ventilation time, ICU stay time and hospitalization time were prolonged, but the LVEF level decrease ( P<0.05). Among them, the elderly (≥62.5 years), increased LAD (≥35 mm), the higher perioperative transmission amount of RBC were the independent risk factors of POAF after ONCAB, and the higher LVEF was a protective factor for ONCAB. The optimal thresholds for age, RBC, LAD and LVEF were 62.5 years, 1U, 35.5 mm, and 0.34. Conclusion The occurrence of POAF after ONCAB is related with age (≥62.5 years old),LAD≥35 mm and perioperative transfusion of RBC, which can be used as clinically to predict the occurrence of POAF.
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Objective To summarize the treatment experiences in patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods The clinical data of 9 patients with acute renal injury after orthotopic heart transplantation in our hospital from January 2009 to July 2016 were retrospectively analyzed. Three patients were required the high-dose diuretics (furosemide, >80 mg/d) and six patients were received continuous renal replacement therapy (CRRT). The levels of serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) were compared before and after heart transplantation and after the treatment of AKI. The quality of life was observed in patients in perioperative period. Results After the treatment of diuretics or CRRT, patients showed renal function recovery with significant decreased Cr levels and increased eGFR compared with the postoperation. The patients with diuretic therapy revealed a better eGFR recovery than those with CRRT. Conclusion CSA-AKI should be based on the severity of disease, and comprehensive treatment should be taken to reduce renal damage.
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Objective To study the application of coronary endarterectomy (CE) in coronary artery bypass graft (CABG), and to evaluate the effect of CE plus CABG on patients with chronic total occlusion (CTO) combined with diffuse distal atherosclerosis. Methods Thirty one patients, who underwent coronary endarterectomy in our institution between Oc-tober 2009 and October 2012, were reviewed retrospectively and compared the control group with 31 patients of their age, sex, LV function, and angina class. Results Among the 31 patients, 27 patients underwent one, 4 patient underwent two coronary arteries endarterectomized. Of all these 35 total endarterectomies, 13 (37%) were at left anterior descending artery, 3(9%) were at branches of the circumflex artery, and 19 (54%) involved the right coronary artery. There was no statistical dif-ference between two groups in clinical parameters including aorta cross time, cardiopulmonary bypass time, graft runoff, pul-sation index and mechanism ventilate time (P>0.05). There was no perioperative myocardial infarctions in CE group nor in control group. All patients were followed up and no recurrent angina were present in CE group. In CE group, one patient died of fungal pneumonia and heart failure half a year after operation. Conclusion In current cardiac surgical practice, coronary endarterectomy is an indispensable adjunct to CABG. The operative mortality and major morbidity were comparable or simi-lar to coronary artery bypass grafting, but its short-term and medium-term results were more favorable than to CABG.