| Autor: |
Preda S; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.; Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania., Câlmâc L; Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania., Nica C; Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania., Cacoveanu M; Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania., Țigănașu R; Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania., Badea A; Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania., Zăman A; Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania., Ciomag Ianula R; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.; Department of Cardiology, 'Bagdasar Arseni' Clinical Emergency Hospital, 041915 Bucharest, Romania., Nistor C; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.; Department of Thoracic Surgery, Central Military Emergency University Hospital, 013058 Bucharest, Romania., Gașpar BS; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.; Department of Cardiology, 'Bagdasar Arseni' Clinical Emergency Hospital, 041915 Bucharest, Romania., Iliuță L; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.; Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania., Dorobanțu L; Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania.; Department of Cardiovascular Surgery, Monza Metropolitan Hospital, 040204 Bucharest, Romania., Iliescu VA; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.; Department of Cardiovascular Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania., Moldovan H; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.; Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania.; Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania. |
| Abstrakt: |
The global demand for cardiac transplants continues to rise, even with advancements in assistive devices. Currently, the estimated annual mortality rate stands at 3-5%, and patients often face a waiting time of approximately four years on transplant waiting lists. Consequently, many transplant centers have started to consider heart transplants from donors who may be deemed "less than ideal" or marginal. However, the decision to accept such donors must be highly individualized, taking into consideration the risks associated with remaining on the waiting list versus those posed by the transplantation procedure itself. A potential solution lies in the creation of two distinct recipient lists, matched with donor criteria, allowing marginal donors to provide the lifeline that selected patients require. This paper follows a two-step approach. Firstly, it offers an overview of the current state of affairs regarding the topic of transcatheter aortic valve implantation (TAVI) in orthotopic heart transplant (OHT) patients. Secondly, it presents firsthand experience from our clinical center with a comprehensive case presentation of a patient in this unique medical context. The clinical case refers to a 62-year-old male patient, a smoker with a history of hypertension, dyslipidemia, and a prior OHT a decade earlier, who presented with fatigue during minimal physical exertion. The Heart Team carefully reviewed the case, considering the patient's immunosuppressed status and the heightened risk associated with a repeat intervention. In this instance, transcatheter aortic valve implantation (TAVI) was deemed the appropriate treatment. The TAVI procedure yielded successful results, leading to improved clinical status and enhanced cardiac function. The inclusion of marginal donors has introduced novel challenges related to the utilization of previously diseased marginal organs. TAVI has already demonstrated its efficacy and versatility in treating high-risk patients, including heart transplant recipients. Consequently, it emerges as a vital tool in addressing the unique challenges posed by the inclusion of marginal donors. |
