RESUMO
AIMS: The prevalence of heart failure in New Zealand is increasing. A small number of select patients with predicted poor short-term survival are candidates for advanced heart failure therapies such as transplantation and durable mechanical circulatory support (MCS). The aim of our study was to introduce left ventricular assist devices (LVADs) to the wider clinicians and highlight their role in managing patients with advanced heart failure in New Zealand. METHOD: A retrospective audit of all ventricular assist device (VAD) recipients from January 2005 to December 2022 was conducted. Data were collated using electronic medical and paper records. The primary outcome was survival to transplantation or successful explant of VAD. RESULTS: Thirty-nine patients received VADs; 32 were male and seven female. Mean age was 45 years (range 10-64 years). Most recipients were NZ European (25), six were Maori, four were Pacific peoples and four were of other ethnicities. The majority of LVADs were implanted for those with dilated cardiomyopathy (67%). At the time of data collection, 24 (62%) had survived to heart transplantation, seven (18%) died while on VAD support, five from right ventricular failure and two from strokes, one patient had their VAD explanted due to recovery and seven (18%) VAD recipients continue on support awaiting transplant. CONCLUSION: This audit has provided an opportunity to inform New Zealand clinicians of our durable MCS programme and the expanding role of VAD support in patients with advanced heart failure. The programme will need to continue to audit and report its practice in order to provide equitable allocation of this very limited resource to a growing population in need.
Assuntos
Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Humanos , Masculino , Feminino , Nova Zelândia , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/mortalidade , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Adolescente , Adulto Jovem , CriançaRESUMO
BACKGROUND: Cold static storage preservation of donor hearts for periods longer than 4 hours increases the risk of primary graft dysfunction (PGD). The aim of the study was to determine if hypothermic oxygenated perfusion (HOPE) could safely prolong the preservation time of donor hearts. METHODS: We conducted a nonrandomized, single arm, multicenter investigation of the effect of HOPE using the XVIVO Heart Preservation System on donor hearts with a projected preservation time of 6 to 8 hours on 30-day recipient survival and allograft function post-transplant. Each center completed 1 or 2 short preservation time followed by long preservation time cases. PGD was classified as occurring in the first 24 hours after transplantation or secondary graft dysfunction (SGD) occurring at any time with a clearly defined cause. Trial survival was compared with a comparator group based on data from the International Society of Heart and Lung Transplantation (ISHLT) Registry. RESULTS: We performed heart transplants using 7 short and 29 long preservation time donor hearts placed on the HOPE system. The mean preservation time for the long preservation time cases was 414 minutes, the longest being 8 hours and 47 minutes. There was 100% survival at 30 days. One long preservation time recipient developed PGD, and 1 developed SGD. One short preservation time patient developed SGD. Thirty day survival was superior to the ISHLT comparator group despite substantially longer preservation times in the trial patients. CONCLUSIONS: HOPE provides effective preservation out to preservation times of nearly 9 hours allowing retrieval from remote geographic locations.
Assuntos
Transplante de Coração , Doadores de Tecidos , Humanos , Austrália/epidemiologia , Sobrevivência de Enxerto , Nova Zelândia , Preservação de Órgãos/métodos , Perfusão/métodosAssuntos
Endocardite Bacteriana , Infecções por Bactérias Gram-Positivas , Transplante de Coração , Próteses Valvulares Cardíacas , Infecções Relacionadas à Prótese , Endocardite Bacteriana/cirurgia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/cirurgia , Transplante de Coração/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Valvas Cardíacas , Humanos , Propionibacterium acnes , Infecções Relacionadas à Prótese/diagnósticoRESUMO
Suck down events in an extracorporeal membrane oxygenation (ECMO) circuit, due to vein wall being suctioned onto the cannula inflow ports, lead to low circuit flows. These low flow states can be reversed with fluid administration. We present a patient with a prominent eustachian valve (EV) which was encountered while managing the patient on ECMO post lung transplantation for pleuroparenchymal fibroelastosis. We hypothesize that presence of a prominent EV can induce suck down events and needs to be recognized in the differential diagnosis of this problem. This case adds to the literature to increase the awareness of this rare but significant problem.
Assuntos
Anormalidades Cardiovasculares , Oxigenação por Membrana Extracorpórea , Cardiopatias , Transplante de Pulmão , Cânula , HumanosRESUMO
The use of aortic homograft in infective pathology is well described. Its use in the repair of post-transplant airway complications has been seldom reported. Herein, we report our experience with the successful use of aortic homograft in the management of post-transplant large airway complications in two patients.
Assuntos
Aorta/transplante , Brônquios/cirurgia , Pneumopatias/cirurgia , Transplante de Pulmão/efeitos adversos , Deiscência da Ferida Operatória/cirurgia , Adulto , Brônquios/patologia , Humanos , Pneumopatias/etiologia , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Reoperação , Terapia de Salvação , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/etiologia , Transplante HomólogoRESUMO
Surgical repair of right-sided bronchial dehiscence post lung transplant is challenging. We report a hybrid reconstruction of the bronchus using an aortic homograft patch with stenting as a novel technique of management of ischemic airway injury following lung transplantation.
Assuntos
Aloenxertos , Aorta/transplante , Brônquios/cirurgia , Broncomalácia/cirurgia , Transplante de Pulmão/efeitos adversos , Necrose/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Stents , Brônquios/patologia , Constrição Patológica/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We describe the intraoperative surgical management of tracheal bronchus encountered in a lung transplant recipient.
Assuntos
Brônquios/anormalidades , Brônquios/cirurgia , Displasia Broncopulmonar/cirurgia , Transplante de Pulmão , Traqueia/anormalidades , Traqueia/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Brônquios/diagnóstico por imagem , Displasia Broncopulmonar/diagnóstico por imagem , Broncoscopia , Humanos , Masculino , Procedimentos de Cirurgia Plástica/métodos , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagemRESUMO
Nonbacterial thrombotic endocarditis (NBTE) of bioprosthetic valves is extremely rare. We report a 67-year-old lady with early bioprosthetic "failure" that at reoperation was proven to be NBTE. The choice of a prosthesis in this condition may have implications for patients' late clinical course.
Assuntos
Bioprótese/efeitos adversos , Endocardite não Infecciosa/etiologia , Endocardite não Infecciosa/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese , Idoso , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Calcinose/cirurgia , Ecocardiografia Transesofagiana , Endocardite não Infecciosa/diagnóstico por imagem , Endocardite não Infecciosa/patologia , Feminino , Humanos , Reoperação , ReimplanteAssuntos
Aneurisma Aórtico , Valva Aórtica , Próteses Valvulares Cardíacas , Seio Aórtico , Tomografia Computadorizada por Raios X , Idoso , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Humanos , Masculino , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgiaRESUMO
Staphylococcus lugdunensis is an infrequent cause of native valve endocarditis. A case of triple-valve involvement of Staphylococcus lugdunensis with intracardiac fistula formation in a 47-year-old woman was managed successfully with surgery. The importance of early diagnosis and prompt referral for surgical treatment is highlighted.
Assuntos
Valva Aórtica/microbiologia , Endocardite Bacteriana/microbiologia , Valva Mitral/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/isolamento & purificação , Valva Tricúspide/microbiologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estimulação Cardíaca Artificial , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Feminino , Fístula/microbiologia , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Valor Preditivo dos Testes , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/cirurgia , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgiaRESUMO
BACKGROUND: To evaluate our surgical results for Acute Ischaemic Ventricular Septal Defect and suggest practice guidelines. METHODS: Retrospective review of data from patient records between 1992 and 2006 for presentation, surgical approaches, morbidity and mortality, statistically analysed to derive guidelines for management. RESULTS: We had 36 patients with a mean age of 70.44(+/-6.34) years. Fourteen patients had inferior defects. Twenty-eight patients were in shock (22 on pre-operative IABP). Severe LV and RV dysfunction were present in 18 and 20 patients respectively. At surgery, 17 had infarct resection with patching while 18 had repair with infarct exclusion. Concomitant CABG was performed in 15. One patient was re-operated on for mitral valve replacement and one for recurrent VSD. Recurrent VSD was common (11 patients). Two of these patients underwent percutaneous device closure of whom one died. Prolonged ICU and hospital stay was normal. Early mortality was 52.78% (inferior defects-85.71% and anterior defects-31.82%). Inferior VSD (OR 7.7) and pre-operative shock (OR 6.7), predicted mortality. The subgroup of inferior VSD with shock had mortality equating that with medical management published in literature. CONCLUSIONS: Acute Ischaemic VSD is a grim surgical disease marked by residual shunts and high mortality. Patients with inferior defects with shock should be offered surgery only under exceptional circumstances.
Assuntos
Comunicação Interventricular/cirurgia , Infarto do Miocárdio/complicações , Isquemia Miocárdica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária , Feminino , Comunicação Interventricular/complicações , Comunicação Interventricular/etiologia , Comunicação Interventricular/mortalidade , Humanos , Balão Intra-Aórtico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/mortalidade , Nova Zelândia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Disfunção Ventricular Esquerda , Disfunção Ventricular DireitaRESUMO
BACKGROUND: Although there are many methods for postoperative pain management, implementation may be limited in some settings due to practical or financial constraints. Simple, inexpensive and easily implemented analgesic methods may improve access to effective pain relief. METHODS: Fifty patients undergoing truncal vagotomy and gastrojejunostomy for pyloric stenosis secondary to chronic duodenal ulceration were studied in this prospective randomized trial. Subjects were assigned to receive either wound perfusion with 8 mL of 0.25% bupivacaine every 5 hours through a catheter placed subcutaneously or intravenous pethidine 0.2 mg/kg on demand for postoperative pain relief. Postoperative pain scores at rest were measured by visual analog scale and the opioid requirement at 0-12 hours, at 12-24 hours and at 24-36 hours were compared. Changes in respiratory parameters were also compared between the two groups. RESULTS: Pain scores at 0-12 hours were significantly lower in the wound perfusion group compared with the intravenous pethidine group (5.7 +/- 1.3 vs. 4.3 +/- 1.2, mean +/- SD; P < 0.001). The number of doses of analgesic required in the wound perfusion group was significantly lower compared with the controls during the 36 hours of study (3.5 +/- 1.3 vs. 1.4 +/- 1.0, P < 0.001). There were no differences in respiratory parameters, vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate between the two groups. The FEV1:FVC ratio, however, was significantly higher in the intravenous pethidine group. There were no wound complications due to catheter placement or systemic toxicity due to the anesthetic. CONCLUSION: Intermittent wound perfusion with 0.25% bupivacaine is a safe and efficient method to reduce pain scores and opioid requirement in the early postoperative period. Wound perfusion, however, had no beneficial effect on the postoperative respiratory function.
Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Derivação Gástrica/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Ferimentos e Lesões/tratamento farmacológico , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Injeções Intravenosas , Masculino , Meperidina/administração & dosagem , Pessoa de Meia-Idade , Medição da Dor , Estenose Pilórica/cirurgia , Vagotomia/efeitos adversosRESUMO
Acute ischaemic ventricular septal defect (VSD) is a severe complication of acute myocardial infarction. We present the unusual case of a 66-year-old man with a haemodynamically stable acute posterior basal ischemic VSD, who was managed successfully with hybrid primary coronary artery bypass grafting followed by delayed percutaneous VSD closure, with an excellent intermediate-term outcome. We feel this management strategy should be considered in selected patients with acute posterior VSDs and stable clinical status.
Assuntos
Ponte de Artéria Coronária , Comunicação Interventricular/cirurgia , Idoso , Angioplastia Coronária com Balão , Angiografia Coronária , Comunicação Interventricular/etiologia , Comunicação Interventricular/fisiopatologia , Humanos , Masculino , Infarto do Miocárdio/complicaçõesRESUMO
BACKGROUND: Traumatic injury to the aorta and great vessels is a surgical emergency with survivors who reach hospital typically having suffered multiple injuries. There are several diagnostic and treatment options available, with new modalities emerging to challenge the gold standards. A review of recent trends in management of these injuries in Auckland, New Zealand was carried out and patient outcomes assessed. METHODS: The charts of patients admitted to Auckland and Green Lane Hospital's cardiothoracic intensive care unit, with a diagnosis of injury to the thoracic aorta or great vessels since 1995 were retrospectively reviewed. Imaging techniques, injury types and treatment methods were analysed along with survival and neurological morbidity. RESULTS: In the study period our unit operated on 29 cases of traumatic rupture of the thoracic aorta or great vessels. Digital subtraction angiography and more recently, multidetector computed tomography scanning have been used to diagnose the injury. Twenty-seven injuries were to the aorta and two to the innominate artery. The 30-day survival rate of those reaching the operating theatre was 90%. There was one case of postoperative hemiparesis and five cases of recurrent laryngeal nerve injury, but none of spinal cord ischaemic injury. Endoluminal stent grafting was carried out for one patient, without complication. CONCLUSIONS: Good survival rates exist for those who reach surgery for traumatic rupture of the aorta or great vessels. Multidetector computed tomography scanning is an alternative to digital subtraction angiography, potentially reducing treatment delay. In addition endoluminal grafting as opposed to open repair has been reported as a safe technique. The injury remains a surgical emergency requiring urgent diagnosis and transfer to an equipped cardiothoracic unit for definitive treatment.