RESUMEN
Background: The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation. Aim: To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation. Material and Methods: Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied. Results: During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043). Conclusions: ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.
Asunto(s)
Humanos , Trasplante de Pulmón , Perfusión , Donantes de Tejidos , Circulación Extracorporea , América Latina , Pulmón/cirugíaRESUMEN
Resumen El implante coclear (IC) es el tratamiento estándar para las sorderas profundas en niños y adultos. En adultos mayores esta indicación ha pasado a ser cada día más común. Se describe un abordaje para implantes cocleares en adultos mayores usando como hilo conductor el caso clínico de una mujer de 98 años y 9 meses con hipoacusia neurosensorial severa que ya no se beneficiaba de sus audífonos. Las evaluaciones fueron conducidas por las áreas de otología, cardiología, neurología y anestesiología. Con las aprobaciones de las áreas médicas, la cirugía de implante coclear en el oído izquierdo fue realizada con anestesia local y sedación. No hubo complicaciones intra ni postoperatorias. La rápida recuperación permitió el alta al segundo día posoperatorio. El implante fue activado al mes de operada con todos los electrodos estando activos. Se lograron umbrales para tonos puros de 25 dB HL en campo libre y discriminación en silencio con IC en oído izquierdo y audífono en oído derecho para frases del 76% y para palabras familiares del 100%. El implante coclear fue una alternativa adecuada para esta paciente, posiblemente la implantada de mayor edad en el mundo, y debe ser considerado una alternativa razonable para el adulto mayor con sordera profunda. La decisión quirúrgica debe estar enfocada en las condiciones generales de salud más que en la edad cronológica.
Abstract Cochlear implant (IC) is the standard treatment for profound deafness in children and adults. In the elderly this indication is becoming more common every day. An approach to cochlear implants in the elderly is described, using as a common thread the case of a 98 years and 9 months old woman with severe bilateral gradually progressive sensorineural hearing loss who did not benefit from her hearing aids. She underwent comprehensive multispecialty medical evaluation including otolaryngology, neurology, cardiology and anesthesiology. She underwent cochlear implantation under local anesthesia and sedation. No intra or postoperative complications occurred. Recovery was quick and she was discharged on the second postoperative day. The device was activated at 1-month post-surgery and all electrodes were active. Free field thresholds for pure tones were 25 dB HL and discrimination in silence with IC in left ear and hearing aid in right ear for sentences were 76% and for familiar words 100%. Cochlear implantation resulted in an adequate alternative for this elderly patient, possibly the oldest implanted individual in the world. Cochlear implantation should be considered a reasonable alternative for elderly patients with profound hearing loss. The surgical decision should focus more on the general health conditions than on the chronological age.