Valvular surgery in donor hearts before orthotopic heart transplantation.

Autor: Fiore A; Department of Cardiac and Thoracic Surgery, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France. Electronic address: fioreant7@gmail.com., Grande AM; Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy., Gatti G; Cardio-Thoracic and Vascular Department, Trieste University Hospital, 34149 Trieste, Italy., Youssari A; Department of Cardiac and Thoracic Surgery, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France., Piscitelli M; Department of Cardiac and Thoracic Surgery, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France., Bergoend E; Department of Cardiac and Thoracic Surgery, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France., Mongardon N; Department of Anaesthesiology and Surgical Critical Care Medicine, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France., Ternacle J; Department of Cardiology, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France., Couetil JP; Department of Cardiac and Thoracic Surgery, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France.
Jazyk: angličtina
Zdroj: Archives of cardiovascular diseases [Arch Cardiovasc Dis] 2020 Nov; Vol. 113 (11), pp. 674-678. Date of Electronic Publication: 2020 Aug 28.
DOI: 10.1016/j.acvd.2020.05.010
Abstrakt: Background: Donor heart shortage has extended the waiting time and increased the mortality of patients on the transplant waiting list. Widening old standard donor criteria has successfully increased the number of heart transplantations, but for many years, a valve disease in a donor heart has been considered a primary contraindication for organ donation.
Aims: To analyse the results of aortic and mitral valvular surgery in marginal donor hearts with valvulopathy before orthotopic heart transplantation.
Methods: Between January 2012 and November 2015, we performed 53 heart transplantations in our department. In four donors, echocardiography performed at the time of organ procurement showed a valvular disease: three had moderate-to-severe mitral regurgitation; and one had moderately severe aortic valve stenosis.
Results: The mean bench mitral repair and aortic replacement time, aortic cross-clamp time and total ischaemic time were: 18 (range 7-25) minutes, 78.7 (range 57-98) minutes and 184 (range 89-255) minutes, respectively. Intraoperative transoesophageal echocardiography showed good mitral repair or aortic prosthetic valve function, and good right and left ventricular function. One patient died of infectious pneumonia after 1 month. The mean duration of follow-up for the patients discharged home was 75±13 months, and all have returned to an active unrestricted lifestyle.
Conclusions: Our limited series demonstrates that conventional valvular procedures performed on otherwise healthy donor hearts with mitral and aortic valve pathology can efficaciously expand the donor pool for orthotopic cardiac transplantation and decrease the mortality rate on the waiting list.
(Copyright © 2020 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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