Abstract
We present findings in a 68-year-old man listed for heart transplantation (T status, which is similar to US status 1B) who suffered from long-term heart failure due to dilative cardiomyopathy. After recurrent cardiac decompensation, he was supported with a left ventricular assist device (Synergy, CircuLite, Saddle Brook, NJ).1 After 17 weeks of support, the pump had to be deactivated because of recurrent system failure and thromboembolic events. As a consequence, he was registered as a high-urgency patient and had to wait for another 16 weeks before an organ became available. Orthotopic heart transplantation using the bicaval technique combined with explantation of the left ventricular assist device was uneventful.2,3 Intraoperatively, 3 additional procedures had to be performed: (1) A patch repair of the upper right pulmonary vein was performed after explantation of the left atrial cannula of the left ventricular assist device; (2) a significant discrepancy in the diameters of the native and the transplanted ascending aorta (34 versus 24 mm) made a tapered diameter reduction in the aortic anastomosis necessary; and (3) the donor pulmonary trunk was directly connected to the branching point of the left and right pulmonary arteries. Immediately after heart transplantation and while still in the operating room, the patient was examined by transesophageal echocardiography and pulmonary artery catheterization (Swan-Ganz catheter, Edwards Lifesciences Corp, Irvine, CA). The catheter measurement revealed an elevated systolic pressure gradient in the pulmonary artery of 10 mm Hg, indicative of a pulmonary stenosis; however, this was not supported by transesophageal echocardiography or other hemodynamic data (central venous pressure, pressure in the right ventricle, and cardiac output). After a smooth intraoperative course, the patient made an uncomplicated recovery and was discharged from the hospital within 30 days after heart transplantation. All predischarge examinations, including transthoracic echocardiography, chest radiographs, laboratory …
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