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Transplant & Mechanical Support
LEGMO: Extremity Salvage Using Extracorporeal Membrane Oxygenation
Mycotic aneurysm management balances the urgency of excising infected vasculature with the need to revascularize in or near an infected field. We present a case of a 47-year-old man with Pseudomonas sepsis, a failed kidney transplant, and a ruptured, previously stented right external iliac pseudoaneurysm. After excision of the infected pseudoaneurysm and stents, lower extremity revascularization was delayed through the innovative use of isolated limb perfusion using extracorporeal membrane oxygenation followed by staged extra-anatomic femoral-femoral bypass.Sarcopenia Predicts Outcomes After Lung Transplantation in Older Lung Transplant Candidates
As lung transplantation (LT) expands to older recipients, objective approaches to evaluate the aging are needed to optimize posttransplantation outcomes. Frailty assessment and sarcopenia have shown promise as tools for predicting clinical outcomes.ECMO During COVID-19: A Society of Thoracic Surgeons/Extracorporeal Life Support Organization Survey
The Society of Thoracic Surgeons Workforce on Critical Care and the Extracorporeal Life Support Organization sought to identify how the coronavirus disease 2019 (COVID-19) pandemic has changed the practice of venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) programs across North America.Open Ablation of the Left Ventricle During Implantation of a Left Ventricular Assist Device
This report describes the successful treatment of persistent ventricular tachycardia in a 66-year-old patient with ischemic cardiomyopathy during left ventricular assist device (LVAD) implantation. Recurrent episodes of ventricular tachycardia led to cardiac decompensation necessitating LVAD implantation. After opening the left ventricle, an AtriCure Isolator Synergy OLL2 radiofrequency clamp was used to perform 4 sets of transmural lesions. Transmurality was observed in all lesions. A HeartMate 3 (Abbott) LVAD was implanted in standard fashion.Successful Lung Transplantation From a Donor With Previous Severe COVID-19 Pneumonia
Lungs from donors with previous COVID-19 could become a precious resource if proved safe. So far, only 3 successful lung transplantations from donors with previous mild COVID-19 have been reported. We describe a successful bilateral sequential lung transplantation from a donor who, 10 months before, had developed severe COVID-19 acute respiratory distress syndrome. No donor-derived viral transmission occurred, and 12 months after transplantation, the recipient’s lung function is normal. In the presence of normal results of bronchoalveolar lavage and adequate functional and morphologic parameters, even a history of severe COVID-19 acute respiratory distress syndrome might not be considered a contraindication to lung donation.HeartMate 3 Implantation Through Left Atrial e-PTFE Conduit for Restrictive Cardiomyopathy
Restrictive or hypertrophic cardiomyopathy presents a challenge to left ventricular assist device placement because of the small left ventricle cavity. Cases have described inflow cannulation of the HeartWare HVAD by expanded polytetrafluoroethylene conduit through the atrial septum to the left atrium. We applied this technique to an adult man with restrictive cardiomyopathy and pulmonary hypertension using the HeartMate 3, which successfully supported the patient and led to significant reduction in pulmonary artery pressure.Outcomes of Full and Partial Cardiac Autotransplantation for Complex Left-Sided Heart Tumors
Complex or malignant left-sided heart tumors present a challenge for resection and reconstruction. Cardiac autotransplantation was developed to address this but is a complex technique. Partial autotransplantation was developed to simplify the procedure. This study evaluates the outcomes of partial cardiac autotransplantation compared with those of full cardiac autotransplantation.The First Autoregulated Total Artificial Heart Implant in the United States
The Aeson total artificial heart provides right- and left-sided heart replacement for biventricular failure with notable improvements from prior generations. These include enhanced hemocompatibility and autoregulation enabling increased output in response to higher filling pressures. We report the first clinical implantation in the United States as part of an early feasibility study. The patient was successfully bridged to transplant after 5 months of support on the device and has made a full recovery.
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