Primer puente a trasplante cardiaco exitoso en Chile usando el dispositivo Heart Mate II / First successful bridge to cardiac transplantation in Chile using the Heart Mate II device. Report of one case

Implantable ventricular assist devices are an effective treatment option for end-stage heart failure patients as a bridge to cardiac transplantation, to improve the clinical condition and organ function allowing discharge from the hospital to await for transplantation. The second alternative is to use the device as destination therapy for patients with contraindications for cardiac transplantation, in whom it is maintained indefinitely. We report a 43-year-old patient, with a dilated cardiomyopathy, severe left ventricular dysfunction and advanced heart failure. A ventricular assist device Heart Mate II©, as a bridge to transplantation, was implanted to the patient in the United States. It was explanted for the first time in Chile at the National Thorax Institute. Heart transplantation was performed using the bicaval technique. Induction of immunosuppression was done with basiliximab. Generic immunosuppression was carried out with cyclosporine, mycophenolate mofetil and prednisone. Postoperatively the patient evolved with right femoral vein thrombosis in the femoral cannulation site, phlegmasia alba dolens, rhabdomyolysis, oliguric acute renal failure, which required renal replacement therapy, severe shock, with high requirements of vasoactive drugs and need for mechanical ventilation. He required a reoperation for hemothorax and had an Enterobacter pneumonia. After a period of serious illness, he began a gradual recovery and was discharged from the hospital after 58 days. After two years, he remains in functional class I, with a normal graft function.

Adult cardiac transplantation: A review of perioperative management (Part - II).

Heart transplant is the definitive therapy for end-stage heart failure. This two part review article focussed first on the perioperative management of patients for heart transplantation. This part II will be a comprehensive review of the current status of mechanical assist device therapy for surgical management of the patient with refractory end-stage heart failure.

Avaliação do nível da pressão positiva expiratória como recurso fisioterapêutico no pós-operatório de transplante cardíaco / Evaluation of the level of expiratory positive pressure as physiotherapeutical

Introdução: O transplante cardíaco (TC) é considerado última alternativa para pacientes com grande comprometimento por insuficiência cardíaca (IC) com classes funcionais III e IV. Pacientes submetidos a TC apresentam alterações nas respostas das variáveis cardiovasculares e ocorre elevação da sobrevida com qualidade de vida retornando à classe funcional I. A fisioterapia respiratória deverá ser realizada tão logo o paciente se apresente hemodinamicamente estável, a fim de evitar complicações pulmonares. Objetivo: Relatar um método utilizado para eleger valor adequado de PEEP (Positive End-Expiratory Pressure) em um caso de pós-operatório de TC. Materiais e Metodologia: Para escolha do nível de valor pressórico ideal, foram observadas as respostas hemodinâmicas e respiratórias em três níveis de valores pressóricos diferentes: 5 cmH2O, 10 cmH2O e 15 cmH2O, com duração de 2 a 3 minutos, tendo intervalo de 10 minutos entre elas. Conclusão: Deste modo observou-se que os valores pressóricos 5 cmH2O e 10 cmH2O apresentaram resposta positiva; enquanto que 15 cmH2O provocaram alterações hemodinâmicas e respiratórias como: redução da pressão arterial, aumento da pressão da artéria pulmonar e diminuição da saturação de oxigênio e aumento da freqüência respiratória.

Introduction: The Heart Transplant (HT) is considered the last alternative for patients with serious impairments due to Heart Failure (HF) with functional classes III and IV. The patients submitted to HT have modifications in the responses of cardiovascular variables and survival elevation, resulting in improvement of life quality and return of functional class I. The respiratory physiotherapy should be performed as soon as the patient is hemodynamically stable, in order to avoid lung complications . Objective: To report a method to find an adequate level of PEEP (Positive End-Expiratory Pressure) pressure value in a case of a postoperative HT. Materials and Methods: To select the ideal pressure value level, the hemodynamics and respiratory responses were observed in 3 different pressure value levels: 5 cmH2O, 10 cmH2O and 15 cmH2O, during 2 to 3 minutes with an interval of 10 minutes between them. Conclusions: Therefore, it was observed that the 5 cmH2O and 10 cmH2O pressure values have produced positive responses. However, the 15 cmH2O produced respiratory and hemodynamic alterations such as: decrease of blood pressure, increase of pulmonary artery pressure, decrease of O2 blood concentration and increase of respiratory rate.