Kim, Ho Jin
(Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
,
Jung, Sung-Ho
(Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
,
Kim, Jae Joong
(Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
,
Kim, Joon Bum
(Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
,
Choo, Suk Jung
(Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
,
Yun, Tae-Jin
(Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
,
Chung, Cheol Hyun
(Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
,
Lee, Jae Won
(Division of Cardiology, Department)
Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical...
Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.
Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
문제 정의
This study represents the experience with early postoperative complications of adult heart transplantation accumulated at the Asan Medical Center over a 13-year period, during which significant advancement in organ procurement and operative techniques, refinement in perioperative care, and changes in immunosuppressive protocols were achieved. As previously reported, the long-term results of our institution were comparable to those reported by the ISHLT [5].
제안 방법
Therefore, the results might be affected by unmeasured confounders. Second, this study incorporates the surgical outcomes of a thirteen-year period, performed by various surgeons. In spite of the use of the same technique, the difference in surgical outcomes among operating surgeons was not adequately reflected.
Data were extracted from the prospectively registered database of Asan Medical Center, and supplemental information was obtained by reviewing the relevant medical records. The collected variables were basic demographic characteristics, preoperative diagnosis and laboratory data, preoperative need for inotropic support, preoperative intensive care unit (ICU) stay, preoperative mechanical circulatory support (MCS), total length of ICU and hospital stay, and postoperative complications. Postoperative complications included early graft failure, cerebrovascular accident (CVA), bleeding requiring re-exploration, renal failure requiring renal replacement therapy, low cardiac output syndrome requiring MCS, pericardial effusion, and inguinal lymphocele.
Therefore, we reviewed the early postoperative complications and mortality in adult recipients who underwent heart transplantations at the Asan Medical Center, using the bicaval technique. We are presenting our experience with early postoperative complications and their management, and the analysis of early mortality.
대상 데이터
Among them, patients undergoing multi-organ transplantations were excluded: four patients with heart–lung transplantations and four patients with heart–kidney transplantations. Finally, 239 patients were enrolled in this study, comprising the current study population. Data were extracted from the prospectively registered database of Asan Medical Center, and supplemental information was obtained by reviewing the relevant medical records.
데이터처리
Differences in baseline characteristics between the patient groups, categorized on the basis of the presence of complications, were compared using the Student t-test or Mann–Whitney U-test for continuous variables and the chi-square test or Fisher’s exact test for categorical variables, as appropriate.
이론/모형
The survival rates were calculated using the Kaplan–Meier method.
성능/효과
In conclusion, heart transplantation is a life-saving procedure for patients with end-stage heart failure with good early outcomes and relatively low catastrophic complications. Most of the early postoperative complications could be adequately managed with surgical or medical treatment and did not result in an extended hospital stay.
The most common cause of death was sepsis, which occurred in two patients. Throughout the study, there were 26 late deaths (10.8%), and the 1-year, 5-year, and 10-year survival rates were 95.1%, 89.1%, and 76.3%, respectively.
후속연구
Most of the early postoperative complications could be adequately managed with surgical or medical treatment and did not result in an extended hospital stay. We hope that this study can be used as a reference and can provide guidance for postoperative management after heart transplantation.
참고문헌 (19)
1 Song MG Seo DM Lee JW Cardiac transplantation: 1 case report Korean J Thorac Cardiovasc Surg 1993 26 224 227
2 Park CB Song H Song MG Early results of heart transplantation: a review of 20 patients Korean J Thorac Cardiovasc Surg 1997 30 164 171
3 Park KY Park CH Kim WS Heart transplantation: the Sejong General Hospital experience Korean J Thorac Cardiovasc Surg 1996 29 606 613
4 Jung SH Kim JJ Choo SJ Yun TJ Chung CH Lee JW Long-term mortality in adult orthotopic heart transplant recipients J Korean Med Sci 2011 26 599 603 21532848
5 Stehlik J Edwards LB Kucheryavaya AY The Registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report--2012 J Heart Lung Transplant 2012 31 1052 1064 22975095
6 Davies RR Russo MJ Morgan JA Sorabella RA Naka Y Chen JM Standard versus bicaval techniques for orthotopic heart transplantation: an analysis of the United Network for Organ Sharing database J Thorac Cardiovasc Surg 2010 140 700 708 708.e1 708.e2 20584533
7 Schnoor M Schafer T Luhmann D Sievers HH Bicaval versus standard technique in orthotopic heart transplantation: a systematic review and meta-analysis J Thorac Cardiovasc Surg 2007 134 1322 1331 17976469
8 Luckraz H Goddard M Charman SC Wallwork J Parameshwar J Large SR Early mortality after cardiac transplantation: should we do better? J Heart Lung Transplant 2005 24 401 405 15797739
9 Bocchi EA Fiorelli A First Guideline Group for Heart Transplantation of the Brazilian Society of Cardiology The Brazilian experience with heart transplantation: a multicenter report J Heart Lung Transplant 2001 20 637 645 11404169
10 Dellgren G Geiran O Lemstrom K Three decades of heart transplantation in Scandinavia: long-term follow-up Eur J Heart Fail 2013 15 308 315 23109651
11 Favaloro R Peradejordi M Bertolotti A Results of heart transplantation: 16 years' experience in a center in Argentina Transplant Proc 2010 42 321 323 20172341
12 Chokshi A Cheema FH Schaefle KJ Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction J Heart Lung Transplant 2012 31 591 600 22458996
13 Carrier M Perrault LP Pellerin M Sternal wound infection after heart transplantation: incidence and results with aggressive surgical treatment Ann Thorac Surg 2001 72 719 723 11565647
15 Gude E Andreassen AK Arora S Acute renal failure early after heart transplantation: risk factors and clinical consequences Clin Transplant 2010 24 E207 E213 20184627
17 Sénéchal M LePrince P Tezenas du Montcel S Bacterial mediastinitis after heart transplantation: clinical presentation, risk factors and treatment J Heart Lung Transplant 2004 23 165 170 14761763
18 Kavarana MN Sinha P Naka Y Oz MC Edwards NM Mechanical support for the failing cardiac allograft: a single-center experience J Heart Lung Transplant 2003 22 542 547 12742416
19 Park SJ Kim JB Jung SH Choo SJ Chung CH Lee JW Outcomes of extracorporeal life support for low cardiac output syndrome after major cardiac surgery J Thorac Cardiovasc Surg 2012 12 5 [Epub]. http://dx.doi.org/10.1016/j.jtcvs.2012.11.006
※ AI-Helper는 부적절한 답변을 할 수 있습니다.