a-high-fidelity-porcine-model-orthotopic-heart-transplantation

A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death

The number of advanced heart failure patients who can receive a heart transplant is limited by a shortage of suitable organ donors. In efforts to expand ...

Duke University Medical Center

Commentary: The silver lining of coronary artery bypass grafting in the era of coronavirus disease 2019.

Integrated cardiothoracic surgery: Navigating interviews and the match.

We developed a technique for the Norwood operation utilizing continuous perfusion of the head, heart, and lower body at mild hypothermia named Sustained Total All-Region (STAR) perfusion. We hypothesized that STAR perfusion would be associated with shorter operative times, decreased coagulopathy, and expedited post-operative recovery compared to standard perfusion techniques. Between 2012 and 2020, 80 infants underwent primary Norwood reconstruction at our institution. Outcomes for patients who received successful STAR perfusion (STAR, n = 37) were compared to those who received standard Norwood reconstruction utilizing regional cerebral perfusion only (SNR, n = 33), as well as to Norwood patients reported in the PC national database during the same timeframe (n = 1238). STAR perfusion was performed with cannulation of the innominate artery, descending aorta, and aortic root at 32-34°C. STAR patients had shorter median CPB time compared to SNR (171 vs 245 minutes, P < 0.0001), shorter operative time (331 vs 502 minutes, P < 0.0001), and decreased intraoperative pRBC transfusion (100 vs 270 mL, P < 0.0001). STAR patients had decreased vasoactive-inotropic score on ICU admission (6 vs 10.8, P = 0.0007) and decreased time to chest closure (2 vs 4.5 days, P = 0.0004). STAR patients had lower peak lactate (8.1 vs 9.9 mmol/L, P = 0.03) and more rapid lactate normalization (18.3 vs 27.0 hours, P = 0.003). In-hospital mortality in STAR patients was 2.7% vs 15.1% with SNR (P = 0.06) and 10.3% in the PC aggregate (P = 0.14). STAR perfusion is a novel approach to Norwood reconstruction associated with excellent survival, decreased transfusions, shorter operative time, and improved convalescence in the early post-operative period.

Sustained Total All-Region Perfusion During the Norwood Operation and Postoperative Recovery.

The optimal timing of surgical repair for infants with complete atrioventricular canal defect remains controversial, as there are risks to both early and late repair. We address this debate by investigating the association of various risk factors, including age and weight at surgery, markers of failure to thrive, and pulmonary vascular disease, with postoperative length of stay following complete atrioventricular canal repair.

Predictors of increased postoperative length of stay after complete atrioventricular canal repair.

Heart transplantation following donation after circulatory death (DCD HT) has short-term survival outcomes comparable to donation after brain death and has led to a significant increase in transplantation volume. The U.S. experience with the normothermic regional perfusion (NRP) DCD HT procurement method has not been evaluated.

Article	Year
Commentary: The silver lining of coronary artery bypass grafting in the era of coronavirus disease 2019. JTCVS open\| PubMed ID: 33907740	2021
Integrated cardiothoracic surgery: Navigating interviews and the match. The Journal of thoracic and cardiovascular surgery\| PubMed ID: 32199661	2021
Sustained Total All-Region Perfusion During the Norwood Operation and Postoperative Recovery. Seminars in thoracic and cardiovascular surgery\| PubMed ID: 35176496	2023
Predictors of increased postoperative length of stay after complete atrioventricular canal repair. Cardiology in the young\| PubMed ID: 36168722	2023
Early U.S. Heart Transplant Experience With Normothermic Regional Perfusion Following Donation After Circulatory Death. JACC. Heart failure\| PubMed ID: 39093259	2024

Abigail R. Benkert

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