ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fernández, A. L.
Right arrow Articles by Martínez, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fernández, A. L.
Right arrow Articles by Martínez, A.
Related Collections
Right arrow Mechanical Circulatory Assistance

Ann Thorac Surg 2001;71:1753-1754
© 2001 The Society of Thoracic Surgeons

Correspondence

Successful recovery of allograft failure with biventricular support

Angel L. Fernández, MDa, Amparo Martínez, MDb

a Department of Cardiac Surgery, Hospital Clínico Universitario de Santiago, Ave Choupana, s/n, 15706 Santiago de Compostela, Spain
b Department of Cardiology, Hospital Clínico Universitario de Santiago, Ave Choupana, s/n, 15706 Santiago de Compostela, Spain

e-mail: alfg{at}vll.servicom.es

To the Editor

We read with interest the article by Albes and colleagues [1]. This excellent article points out that mechanical ventricular assistance is recommended as a therapeutic option for primary cardiac allograft failure, although only a limited number of successful cases have been reported.

We previously reported a case of a patient with a primary graft failure, who recovered with pneumatic biventricular assistance [2]. Our patient was a 41-year-old man who underwent orthotopic heart transplantation. Intraoperative acute allograft failure occurred and required immediate placement of a pneumatic biventricular assist device (Thoratec Laboratories, Berkeley, CA). The mechanical support continued for 49 days until graft recovery resulted in successful weaning.

Primary graft failure after heart transplantation, although uncommon, is associated with high mortality. Increasing experience of heart transplant teams with high recipient pulmonary vascular resistance and use of suboptimal donor hearts may increase intraoperative acute graft failure.

Several questions remain in the management of primary graft failure with biventricular mechanical circulatory support.

First, it is impossible to distinguish between grafts that can be recovered after circulatory assistance and irreversibly damaged hearts.

Second, in patients with right ventricular failure secondary to pulmonary hypertension it may be sufficient to place a right ventricular assistance device. However, use of biventricular support in all cases allows optimal decompression of cardiac cavities and avoids paradoxical movement of the interventricular septum.

Third, the duration ventricular assistance is highly variable and ranges from several hours to many weeks. In our patient weaning was performed on the 49th postoperative day.

Fourth, the patient we reported and that of Albes and associates returned to the operating room after ventricular assist device implantation because of mediastinal bleeding. In addition, convalescence after device explantation was complicated by infection. These experiences show that bleeding and infection remain the most serious complications of ventricular support for intraoperative primary graft failure.

References

  1. Albes J.M., Eckstein F.S., Heinemann M.K., Ziemer G. Successful weaning of a transplanted heart from biventricular assist device. Ann Thorac Surg 2000;70:277-278.[Abstract/Free Full Text]
  2. Fernández A.L., Herreros J.M., Llorens R., Martínez A., Panizo A., Manito N. Primary graft failure after heart transplantation. Successful recovery with pneumatic biventricular assistance. Int J Artif Organs 1996;19:307-310.[Medline]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fernández, A. L.
Right arrow Articles by Martínez, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fernández, A. L.
Right arrow Articles by Martínez, A.
Related Collections
Right arrow Mechanical Circulatory Assistance

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS