ISSN: 1859 - 2872
Anesthetic management in heart transplantation for a patient with a pre-existing left ventricular assist device: A case report
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Background: Heart transplantation in patients with a pre-existing left ventricular assist device (LVAD) poses significant anesthetic and surgical challenges, especially in centers with limited prior experience. We report the first successful case in Vietnam of anesthetic management for heart transplantation in a patient supported by a LVAD. Case Presentation: A 39-year-old woman with end-stage dilated cardiomyopathy had undergone HeartMate LVAD implantation in 2019. She was admitted multiple times for LVAD-related infections and subsequently listed for heart transplantation. Intervention & Outcome: Anesthesia included fentanyl, ketamine, low-dose propofol, and rocuronium, with advanced monitoring with FloTrac and trans-esophageal echocardiograph (TEE). Prophylactic femoral cannulation was performed prior to sternotomy to mitigate serious complications. Surgery lasted 420 minutes with 321 minutes of cardiopulmonary bypass. Transfusion requirements: 2000 mL of red blood cells, 1500mL of plasma, 400mL of cryoprecipitate, and 3 units of platelets. Inotropes and inhaled nitric oxide were used to support right ventricular function. Postoperatively, the cardiac index improved from 1.4 to 2.8L/min/m², ejection fraction was 51%, and the patient was extubated on postoperative day one without anesthetic complications.
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Các tài liệu tham khảo
2. Askar FZ, Kocabas S, Yagdi T, Engin C, Ozbaran M (2013) Anesthesia for cardiac transplantation: experience from a single center. Transplant Proc 45: 1001-1004.
3. Edwards S, Allen S, Sidebotham D (2021) Anaesthesia for heart transplantation. BJA Educ 21(8): 284-291.
4. Velleca A et al (2023) The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant 42(5): 1-141.
5. Peled Y et al (2024) The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates. J Heart Lung Transplant.
6. Still S et al (2018) Reoperative sternotomy is associated with primary graft dysfunction after heart transplantation. Interact Cardiovasc Thorac Surg 27(3): 343-351.
7. Axtell AL et al (2019) Reoperative sternotomy is associated with increased early postoperative mortality after cardiac transplantation. Ann Thorac Surg 108(2): 458-465.
8. Sert DE et al (2020) Early and long-term results of heart transplantation with reoperative sternotomy. Cardiovasc J Afr 31(1): 1-7.
9. Gaffey AC et al (2015) Prior sternotomy and ventricular assist device as a bridge: Impact on outcomes after orthotopic heart transplantation. Ann Thorac Surg 100(2): 542-549.
10. Mariani C et al (2022) Impact of prior sternotomy on survival and allograft function after heart transplantation. Artif Organs 46(5): 894-903.
11. Tarzia V, Ponzoni M, Azzolina D et al (2024) Heart transplantation from donation after circulatory death: a meta-analysis of national registries. Ann Cardiothorac Surg 13(6): 464-473.
12. Anubodh SV, Ersilia MD, Jennifer A et al (2022) Trends and Outcomes of Left Ventricular Assist Device Therapy: JACC Focus Seminar. J Am Coll Cardiol 79(11): 1092-1107.
13. Frazier O, Rose E, Macmanus Q et al (1992) Multicenter clinical evaluation of the HeartMate 1000 IP Left Ventricular Assist Device. Ann Thorac Surg 53:1080-1090.
14. Yu Matsumoto , Sho C Shibata , Akihiko Maeda et al (2015) Early postoperative management of heart transplant recipients with current ventricular assist device support in Japan: Experience from a single center. J Anesth 29(6): 868-873.
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