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Robert D. Dowling
Naoum Baladi
Marco Zenati
Robert L. Kormos
John M. Armitage
Robert L. Hardesty
Bartley P. Griffith
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Ann Thorac Surg 1990;49:118-122
© 1990 The Society of Thoracic Surgeons

Articles

Disruption of the aortic anastomosis after heart-lung transplantation

Robert D. Dowling, MD, Naoum Baladi, MD, Marco Zenati, MD, J.Stephen Dummer, MD, Robert L. Kormos, MD, John M. Armitage, MD, Samuel A. Yousem, MD, Robert L. Hardesty, MD, Bartley P. Griffith, MD*

Departments of Surgery, Pathology, and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania USA

Accepted for publication September 27, 1989.

* Address reprint requests to Dr Griffith, Department ot Surgery, University of Pittsburgh, 1084 Scaife Hall, Pittsburgh, PA 15261.

Disruption of the aorta at the anastomotic site occurred in 4 of 66 consecutive heart-lung transplant recipients and was associated with a 100% mortality. In 3 of these patients, Candida either was cultured from the suture line or was seen in the wall of the aorta at postmortem examination. In 2 of these 3 patients, cultures of material from the donor trachea taken at the time of explantation grew Candida species. Two patients were seen with sudden massive hemorrhage on postoperative day 26 and postoperative day 28. One patient experienced acute decompensation due to right ventricular outflow tract obstruction on postoperative day 30, and the remaining patient was seen 7 months postoperatively with obstruction of both the left main bronchus and the right pulmonary artery caused by extrinsic compression by an aortic pseudoaneurysm. A high index of suspicion should be maintained when transplanting lungs containing Candida species, as we believe there is substantial evidence of donor transmission of the fungal agents. We now include amphotericin B in our antibiotic prophylactic regimen in an attempt to prevent fungal infection because previous treatment has been uniformly unsuccessful. Furthermore, we wrap both the trachea and the aorta with omentum to lessen the likelihood of mediastinal spread of infection to the aortic suture line.




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