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2.
Int J Artif Organs ; 40(7): 358-360, 2017 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-28574114

RESUMO

We describe a young patient who ingested 18 g (240 times the daily therapeutic dose) of venlafaxine in a suicide attempt. She developed severe cardiomyopathy in a takotsubo distribution causing cardiogenic shock and multi-organ dysfunction syndrome (MODS). She was successfully treated with intravenous lipid emulsion (ILE), extracorporeal life support (ECLS) and CytoSorb®. This is remarkable as, to the best of the authors' knowledge, this is the highest amount of venlafaxine intake seen in the literature with a nonfatal outcome.


Assuntos
Oxigenação por Membrana Extracorpórea , Emulsões Gordurosas Intravenosas/uso terapêutico , Hemofiltração/métodos , Inibidores da Recaptação de Serotonina e Norepinefrina/intoxicação , Cardiomiopatia de Takotsubo/terapia , Cloridrato de Venlafaxina/intoxicação , Feminino , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Tentativa de Suicídio , Cardiomiopatia de Takotsubo/etiologia , Adulto Jovem
3.
J Crit Care ; 29(2): 224-9, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24332990

RESUMO

PURPOSE: To evaluate the role of plasma disappearance rate of indocyanine green (PDR-ICG) as an outcome prediction tool in cardiac surgery. PATIENTS AND METHODS: One hundred ninety patients undergoing coronary artery bypass grafting, valve surgery or combined procedures were enrolled. PDR-ICG measurements along with standard lab values were performed preoperative and on postoperative days 1, 2, and on discharge from the intensive care unit. Adverse outcomes were defined as prolonged length of stay in the intensive care unit and/or mortality. Two groups were defined according to length of stay in the intensive care unit (≤ 3 days vs >3 days). RESULTS: PDR-ICG values differed significantly for all time points between the groups. In a multivariate model, in patients over 65 years with a EuroSCORE below 8.5, a preoperative PDR-ICG value below 12.85%/min was the strongest independent predictor for prolonged intensive care unit stay (>3 days). A preoperative PDR-ICG value below 8.2%/min was the strongest independent predictor for mortality in a multivariate analysis including age, cardiac function, and EuroSCORE. CONCLUSIONS: In addition to the established scores, PDR-ICG may provide valuable information for the assessment of perioperative morbidity and mortality in cardiac surgery. Pre- and early postoperative measurements may help to identify patients at risk for developing perioperative complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Corantes/farmacocinética , Verde de Indocianina/farmacocinética , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte de Artéria Coronária/mortalidade , Unidades de Cuidados Coronarianos , Feminino , Valvas Cardíacas/cirurgia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Fatores de Tempo
4.
Thorac Cardiovasc Surg ; 61(1): 47-51, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23307277

RESUMO

INTRODUCTION: Female gender is an established risk factor for worse outcomes after cardiac surgery, and women are more likely to experience postoperative complications. Our aim was to analyze the influence of gender on outcome and postoperative complications after the use of intra-aortic balloon counter-pulsation (IABP) in cardiac surgery patients. METHODS: Fifty-seven consecutive female patients (mean age: 73 ± 9 years) requiring an IABP at our department from January 2007 to January 2010 were retrospectively analyzed and compared with 182 male patients receiving IABP support within the same period. The collected data included patient demographics, preoperative state, operative details, postoperative pharmacological treatment, IABP-associated complications, and inhospital mortality. Preoperative mortality risk was calculated by logistic EuroSCORE. RESULTS: There were no differences regarding the type of operation, preoperative renal or hepatic failure, though the prevalence of peripheral artery occlusive disease was higher in men. Furthermore, female patients receiving an IABP were significantly older (73 ± 9 vs. 67 ± 10 years), had a higher ejection fraction (EF) (45% ± 24% vs. 36% ± 14%), and had a higher EuroSCORE (25% ± 20% vs. 19% ± 17%; p < 0.05). Postoperative catecholamine support was significantly higher in the female patients. Women had a prolonged length of stay (LOS) at the ICU (10.64 ± 9.7 vs. 7.6 ± 7.6 days), higher incidence of renal replacement therapy, and a higher mortality (19 [19.4%] vs. 35 [33.9%]; p < 0.05) after the use of IABP. CONCLUSION: Women have a worse outcome after the use of IABP, including LOS at the ICU, postoperative renal failure, and inhospital mortality, despite higher EF, when compared with men.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Disparidades nos Níveis de Saúde , Cardiopatias/cirurgia , Balão Intra-Aórtico , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Comorbidade , Feminino , Cardiopatias/mortalidade , Mortalidade Hospitalar , Humanos , Balão Intra-Aórtico/efeitos adversos , Balão Intra-Aórtico/mortalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
5.
J Cardiothorac Surg ; 7: 81, 2012 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-22943887

RESUMO

BACKGROUND: Mediastinitis is a severe complication after cardiac surgery. While improvement of prophylaxis and of medical and surgical therapy has reduced its incidence, the treatment of mediastinitis continues to be a challenging problem. Within this study, we report the successful use of daptomycin as supportive therapy in patients developing mediastinitis after open cardiac surgery. METHODS: The records of 21 consecutive patients who developed mediastinitis after cardiac surgery were retrospectively reviewed. After diagnosis, all patients received surgical debridement and antibiotic therapy with daptomycin. All patients were followed up to death or discharge. RESULTS: Clinical improvement after combined surgical and antibiotic therapy with daptomycin was found in 90.5% of the patients. The median time until clinical improvement occurred was 5 [4/6] days. Daptomycin was well-tolerated and no major adverse events during therapy were observed observed. CONCLUSIONS: This study provides new and helpful information regarding the beneficial use of daptomycin as supportive treatment option in patients developing mediastinitis after cardiac surgery.


Assuntos
Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Daptomicina/uso terapêutico , Mediastinite/tratamento farmacológico , Idoso , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
6.
Heart Surg Forum ; 14(3): E200-1, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21676690

RESUMO

The most common causes of myocardial ischemia and myocardial infarction early after coronary artery bypass grafting surgery are early graft occlusion/thrombosis or occlusion/ thrombosis of coronary arteries due to advanced coronary heart disease. We describe a case of postoperative myocardial ischemia due to an uncommon and quickly reversible cause: mechanical compression of a vein graft by a 19F flexible silicone mediastinal drainage tube.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/instrumentação , Drenagem/efeitos adversos , Drenagem/instrumentação , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/prevenção & controle , Idoso , Humanos , Masculino , Isquemia Miocárdica/diagnóstico
7.
Ann Transplant ; 15(4): 30-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21183873

RESUMO

BACKGROUND: Hyperacute xenograft rejection (HXR) is characterized by complement activation and intravascular thrombosis. The pathogenesis of HXR is attributed to antibodies binding to α-Gal-epitopes on the endothelial cells (EC) of the xenograft, activating complement and thrombin-mediated coagulation mechanisms. Our aim was to evaluate the influence of thrombin inhibition upon HXR and tissue integrity in an ex-vivo working heart model. MATERIAL/METHODS: Eighteen isolated porcine hearts were perfused with human whole blood in a working heart model. The blood was treated with heparin (n=9) in group G-I and with heparin and additionally recombinant hirudin (0.012 mg/ml bolus, afterwards 4.5 µg/ml/h continuously) in group G-II (n=9). The experiments were terminated at end of cardiac output. Histological analysis was performed after the experiments. RESULTS: Working heart time of G-II was significantly longer (712.0±37.8 vs. 125.0±31.4 min, p<0.01). Heart weight increase in G-II was lower (0.05±0.01 vs. 0.30±0.06%/min, p<0.01). Stroke work index and specific coronary flow improved significantly in G-II after 120 minutes. Histological analysis revealed increased tissue damage and thrombosis phenomena in G-I. Moreover, immunohistochemistry showed increased C3 and C5b-C9 upon EC of G-I. CONCLUSIONS: Direct thrombin inhibition with Hirudin could be a successful strategy in primate xenotransplantation experiments to prevent tissue damage thus improving the graft survival.


Assuntos
Antitrombinas/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Transplante de Coração/imunologia , Terapia com Hirudina , Doença Aguda , Animais , Modelos Animais de Doenças , Rejeição de Enxerto/sangue , Rejeição de Enxerto/imunologia , Coração/fisiopatologia , Humanos , Miocárdio/imunologia , Miocárdio/patologia , Suínos , Fatores de Tempo , Transplante Heterólogo , Resultado do Tratamento
8.
Heart Surg Forum ; 13(3): E200-1, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20534425

RESUMO

Among coronary artery anomalies, single coronary artery is one of the rarest anomalies. Pulmonary origins of the coronary arteries, coronary artery fistulae, and anomalous aortic origins of the coronary arteries are the most common anomalies requiring surgical intervention. In this case, we describe the performance of bypass grafting after unsuccessful attempts at percutaneous coronary intervention in a 72-year old male patient with single coronary artery arising from the right sinus of Valsalva and with associated diffuse coronary atherosclerosis. Intraoperative angiography was performed to evaluate the revascularization of this anomalous coronary system. The patient remains symptom free 6 months after the operation.


Assuntos
Angiografia Coronária/métodos , Ponte de Artéria Coronária , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/patologia , Cuidados Intraoperatórios , Idoso , Dor no Peito , Angiografia Coronária/instrumentação , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Anomalias dos Vasos Coronários/patologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Dispneia , Humanos , Masculino , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/patologia , Ultrassonografia
9.
Heart Surg Forum ; 13(1): E63-5, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20150045

RESUMO

Congenital anomalies of the pericardium are extremely rare and often difficult to diagnose. We describe a 66-year-old woman presenting with multivessel coronary artery disease and right heart insufficiency complicated by an extremely left-rotated heart due to a congenital absence of left pericardium. A multidetector row computerized tomographic study was performed to evaluate the torsion of the heart as well as the physical relationship between the left internal thoracic artery and the left coronary system. Off-pump coronary surgery was scheduled. Both the operative and postoperative courses were uneventful and the patient was discharged after 11 days.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/congênito , Doença da Artéria Coronariana/cirurgia , Pericárdio/anormalidades , Pericárdio/cirurgia , Disfunção Ventricular Direita/congênito , Disfunção Ventricular Direita/cirurgia , Idoso , Feminino , Humanos , Resultado do Tratamento
10.
J Heart Valve Dis ; 18(4): 418-20, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19852146

RESUMO

Aerococcus urinae is a newly identified Gram-positive coccus that causes serious infections. To date, only 15 cases of A. urinae infective endocarditis have been reported, but with a very high mortality. The case is reported of a patient with A. urinae double valve endocarditis. Following aortic and mitral valve replacement, the patient suffered from refractory cardiogenic shock; extracorporeal membrane oxygenation was used successfully as a rescue mechanical support.


Assuntos
Endocardite/microbiologia , Oxigenação por Membrana Extracorpórea , Infecções por Bactérias Gram-Positivas/complicações , Choque Cardiogênico/terapia , Valva Aórtica/microbiologia , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Choque Cardiogênico/microbiologia , Streptococcaceae
11.
Ther Clin Risk Manag ; 5(4): 409-12, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19753134

RESUMO

Minimizing operative risks for the surgical team in infectious patients is crucial. We report on a patient suffering from Hepatitis C undergoing re-operative aortic valve and ascending aorta replacement for aortic aneurysm and paravalvular leakage due to recurrent endocarditis of a Smeloff-Cutter aortic ball prosthesis. Preoperative multi-slice computed tomography and real-time three-dimensional echocardiography proved helpful in changing operative strategy by detecting a previously unknown aortic aneurysm, assessing its extent, and demonstrating the close proximity of the right coronary artery, right ventricle, and the aortic aneurysm to the sternum. Thus, cardiopulmonary bypass was instituted via the femoral vessels, instead of conventionally. Location, morphology, and extent of the paravalvular defect could also be assessed.

12.
J Heart Lung Transplant ; 28(5): 501-4, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19416780

RESUMO

Primary graft dysfunction after heart transplantation is a severe complication generally related to prolonged ischemia time, size mismatch, or poor quality of the organ. Current therapeutic options include pharmacologic inotropic support with catecholamines or phosphodiesterase inhibitors, and mechanical circulatory support. We report 12 patients who received levosimendan, a new Ca(2+) sensitizer, as adjunctive inotropic support. The patients showed a rapid reduction of the doses of inotropic drugs, and no patient needed mechanical support. Levosimendan may be a useful, adjunctive inotropic drug in the treatment of patients with primary graft dysfunction after heart transplantation.


Assuntos
Cardiotônicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Transplante de Coração/fisiologia , Hidrazonas/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Piridazinas/uso terapêutico , Adulto , Idoso , Quimioterapia Combinada , Ecocardiografia/efeitos dos fármacos , Ecocardiografia Transesofagiana , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Simendana , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/tratamento farmacológico
13.
Interact Cardiovasc Thorac Surg ; 8(2): 247-9, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19008325

RESUMO

A young woman suffering from congenital hypertrophic obstructive cardiomyopathy (HOCM) received a transcoronary ablation of the septal hypertrophy (TASH) and an automated Cardioverter/Defibrillator (AICD) for the relief of progressive symptoms of heart failure. She developed an acute heart failure in the perioperative period and had to be put on veno-arterial extracorporeal membrane oxygenation. Following this the patient developed a nearly complete thrombosis of the left-sided cardiac chambers, despite successful laboratory anticoagulation.


Assuntos
Cardiomiopatia Hipertrófica/terapia , Ablação por Cateter , Desfibriladores Implantáveis , Oxigenação por Membrana Extracorpórea/efeitos adversos , Cardiopatias/etiologia , Insuficiência Cardíaca/terapia , Trombose/etiologia , Anticoagulantes/uso terapêutico , Cardiomiopatia Hipertrófica/complicações , Evolução Fatal , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Humanos , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Interact Cardiovasc Thorac Surg ; 5(5): 637-9, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17670666

RESUMO

BACKGROUND: The DeBakey Surgitool mechanical aortic valve prosthesis was the first mechanical prosthetic valve in which pyrolitic carbon was used. This valve was on the market from 1969 to 1978 and approximately 3300 valves were implanted in this lapse worldwide. REPORT: We present a DeBakey Surgitool mechanical aortic valve prosthesis implanted in 1972, which has been functioning for almost 34 years and still presents a good performance. COMMENT: Spontaneous strut fractures associated with haemodynamic complications and death, even in asymptomatic patients, was the reason to withdraw this prosthetic valve from the market. However, a prophylactic replacement of DeBakey Surgitool valve was not indicated in our patient due to the excellent prosthesis compliance.

16.
Ann Thorac Surg ; 80(6): 2326-32, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16305899

RESUMO

PURPOSE: Inflammation and coagulation disturbances are common consequences of cardiopulmonary bypass (CPB). Recently, miniaturized closed CPB circuits without cardiotomy suction and venous reservoir have been proposed to reduce complication rates. We compared outcomes with conventional (CCPB) and miniaturized cardiopulmonary bypass (MCPB) after coronary artery bypass operations (CABG) with respect to inflammation and coagulation. DESCRIPTION: Thirty patients (23% female; aged 67.9 +/- 9.0 years) were prospectively randomly assigned to undergo isolated CABG with CCPB or MCPB. Conventional CPB had a pump prime of 1, 600 mL. Miniaturized CPB consisted of a centrifugal pump, arterial filter, heparinized tubing, and oxygenator with a priming volume of 800 mL. Shed blood was removed by a cell-saving device and reinfused. Measurements included interleukin (IL)-2 receptor, IL-6, IL-10, tumor necrosis factor receptor 55 and 75, C reactive protein, leukocyte differentiation, d-dimers, fibrinogen, and thrombocytes at six time points. EVALUATION: In both groups no major complication occurred. However, two dangerous air leaks occurred in the closed MCPB circuit, demonstrating the narrow safety margins. Operative handling was also more difficult owing to limitations in venting and fluid management. International normalized ratio (p = 0.03) and antithrombin III (p = 0.04) levels were elevated during CPB in the CCPB group, most likely owing to differences of the intraoperative anticoagulation management. Repeated measures analysis revealed that not a single parameter of inflammation or clinical outcome showed significant differences among groups. CONCLUSIONS: Use of a MCPB affected inflammation and coagulation variables only marginally and did not lead to clinical relevant changes as assessed by blood loss, need for blood products, and intensive care unit and clinical stays. However, safety margins for volume loss, air emboli, and weaning from CPB decrease, because of the closed MCPB circuit.


Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Ponte de Artéria Coronária , Inflamação/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Coagulação Sanguínea/epidemiologia , Feminino , Humanos , Inflamação/epidemiologia , Masculino , Pessoa de Meia-Idade , Miniaturização , Estudos Prospectivos
17.
J Heart Lung Transplant ; 23(5): 632-8, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15135383

RESUMO

A prospective, pilot trial was started to evaluate the effect of a sirolimus-based immunosuppressive regimen on acute and chronic rejection in de novo lung transplant patients. Primary lung transplant (LTx) recipients received a sirolimus- and tacrolimus-based immunosuppressive therapy immediately after transplantation. Both immunosuppressants were administered with trough level adjusted, while steroid administration was minimized. Four patients were enrolled (2 single-lung transplants, 1 double-lung transplant, 1 heart-lung transplant) in the study. Mean ischemia time was 387 +/- 92 minutes. Acute rejection (at least Grade A1 ISHLT) was detected in 1 patient. Incidence of infection was 0.6 infection per 100 patient-days (3 Aspergillus infections). Until hospital discharge mean sirolimus trough level was 6.2 +/- 1.2 ng/ml. Depending upon mean sirolimus trough levels of each patient, severe wound-healing complications were seen in 3 patients, resulting in bronchial airway dehiscence in 2 patients with lethal outcome in 1 patient. As a result of these complications, we revised the study design after inclusion of only 4 patients: Sirolimus administration is now started after completion of bronchial wound-healing. Sirolimus-based immunosuppressive therapy administered immediately after lung transplantation seems to be associated with severe wound-healing complications of the bronchial anastomosis.


Assuntos
Broncopatias/etiologia , Terapia de Imunossupressão/efeitos adversos , Terapia de Imunossupressão/métodos , Imunossupressores/administração & dosagem , Transplante de Pulmão , Sirolimo/administração & dosagem , Corticosteroides/administração & dosagem , Adulto , Rejeição de Enxerto/prevenção & controle , Transplante de Coração-Pulmão , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias , Estudos Prospectivos , Sirolimo/efeitos adversos , Tacrolimo/administração & dosagem , Cicatrização/efeitos dos fármacos
18.
Heart Surg Forum ; 7(6): E535-8, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15769681

RESUMO

BACKGROUND: Success of surgical therapy for atrial fibrillation (AF) mainly depends on creating a complete set of transmural atrial lesions. The established Cox procedures may be simplified by dropping lesions, but not without the risk of impaired results. We aimed to create a complete set of lesions using bipolar irrigated radiofrequency including ablation of the posterior-inferior left atrium (LA) and coronary sinus. Feasibility and safety were investigated. METHODS: Six patients (mean age 63 +/- 14 years) with continuous AF (duration 15 +/- 8 months) underwent elective heart surgery for isolated mitral valve procedures (n = 4), in combination with myocardial revascularization (n = 1) or isolated bypass surgery (n = 1). Ablation of AF was performed using bipolar irrigated radiofrequency to create a modified Cox minimaze pattern. RESULTS: No major intraoperative or postoperative complication occurred. Two patients left the operating room in sinus rhythm and 4 in junctional rhythm with atrioventricular pacing. AF ablation required 20 +/- 5 minutes. CONCLUSIONS: Bipolar irrigated radiofrequency ablation including ablation of the posterior-inferior LA and coronary sinus is feasible and can be performed safety. Long-term studies in large patient cohorts are necessary to show efficiency of this method.


Assuntos
Absorciometria de Fóton/métodos , Seio Carotídeo/cirurgia , Átrios do Coração/cirurgia , Sistema de Condução Cardíaco/cirurgia , Absorciometria de Fóton/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Resultado do Tratamento
19.
Transplantation ; 75(1): 127-32, 2003 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-12544884

RESUMO

OBJECTIVE: In selected patients with severe end-stage combined cardiopulmonary diseases, heart-lung transplantation (HLTx) remains the only therapeutical option for improving survival and quality of life. PATIENTS AND METHODS: Since 1983, 51 HLTx were done at our institution. Mean patient age was 27+/-12 years with a mean donor age of 25+/-11 years. Indications for HLTx were primary pulmonary hypertension (PPH) in 49% of patients, congenital heart disease in 39%, cystic fibrosis in 6%, and repeat-HLTx in 6%. Eleven patients were younger than 14 years. Among these pediatric patients, the indications were PPH in 55% of patients, pulmonary atresia with severe pulmonary artery hypoplasia in 27%, and cystic fibrosis and cardiomyopathy with fixed pulmonary hypertension in 9% of patients each. Two patients had additional liver transplantation because of chronic aggressive virus hepatitis. For organ preservation, Euro-Collins solution (lung perfusion) and cardioplegic solution according to Bretschneider (heart perfusion) were used until 1994. The University of Wisconsin solution replaced Bretschneider's solution in 1994. Since 1996, Perfadex, a low-potassium dextran-based preservation solution, replaced Euro-Collins. All transplantations were done through a median sternotomy until 1994. Thereafter, a transverse thoracotomy was used in patients with suspected adhesions. Until 1995, cyclosporine A, azathioprine, and prednisolone were used for immunosuppression. Since then, tacrolimus replaced cyclosporine A. RESULTS: From 1983 until 1993, perioperative mortality was 35% (6/19). From 1994 on perioperative mortality decreased to 12.5% (4/32). Early mortality was caused by graft failure (n=5), severe bleeding (n=2), multi-organ failure (n=2), and acute rejection (n=1). Cumulative survival rates were 81% after 30 days, 63% after 1 year, and 54% after 5 years, respectively. Since 1994, cumulative survival rates were markedly improved to 87% after 30 days, 81% after 6 months, and 78% after 1 year. There was no death during the first postoperative year among the 11 pediatric patients. Late death was mainly caused by obliterative bronchiolitis (OB; 76%); two patients died because of multi-organ failure or septic complications, respectively, and one patient died within the first postoperative year because of aspergillosis. CONCLUSION: Changes in organ preservation management, surgical techniques, and immunosuppressive therapy significantly improved the short- and mid-term results after HLTx. Long-term results can only be improved in cases of successful prevention and treatment of OB.


Assuntos
Transplante de Coração-Pulmão , Adolescente , Adulto , Bronquiolite Obliterante/etiologia , Criança , Pré-Escolar , Seguimentos , Rejeição de Enxerto , Transplante de Coração-Pulmão/efeitos adversos , Transplante de Coração-Pulmão/mortalidade , Humanos , Pessoa de Meia-Idade
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