Search

The outcomes of heart-lung transplant (HLT) are worse than those of heart transplant (HT) and lung transplant alone; this and the availability of mechanical assistance have meant that the indications for HLT have been changing. This study aims to analyze the evolution of indications for HLT in a country of 47 million inhabitants.We performed a retrospective observational study of all HLTs performed in Spain (performed in 2 centers) from 1990 to 2020. The total number of patients included was 1751 (HT 1673 and HLT 78). After clinical adjustment, overall survival was compared between the 2 groups. Seven etiological subgroups were considered within the HLT group: (1) cardiomyopathy with pulmonary hypertension (CM + PH);, (2) Eisenmenger syndrome, (3) congenital heart disease without Eisenmenger syndrome, (4) idiopathic pulmonary arterial hypertension (IPAH), (5) cystic fibrosis, (6) chronic obstructive pulmonary disease (COPD) and/or emphysema), and (7) diffuse interstitial lung disease.There were a large number of differences between patients with HLT vs HT. HLT had a 2.69-fold increased probability of death in the first year compared with HT. The indications for HLT have changed over the years. In the recent period the indications are mainly congenital heart disease and Eisenmenger syndrome, with some cases of CM + PH. Other indications for HLT have virtually disappeared, mainly lung diseases (IPAH, COPD, cystic fibrosis). Median survival was low in CM + PH (18 days), diffuse interstitial lung disease (29 days), and ischemic heart disease (114 days); intermediate in Eisenmenger syndrome (600 days); and longer in IPAH, COPD and/or emphysema, and cystic fibrosis.HLT is a procedure with high mortality. This and mechanical assists mean that the indications have changed over the years. Etiological analysis is of utmost interest to take advantage of organs and improve survival.

Resumen: La patología de la aorta supone un reto para la medicina. Tanto a nivel diagnóstico, como terapéutico, el volumen de variables implicado ha hecho que dicha patología sea abordada por una ingente cantidad de especialistas. El manejo quirúrgico de dichas patologías implica un esfuerzo extraordinario por parte de muchos profesionales, dada la complejidad técnica y tecnológica empleada. A lo largo de estos años, dichos esfuerzos están dando sus frutos en forma de mejoras de resultados, gracias a un abordaje sistemático y protocolizado en el seno de un grupo de expertos (Comités de aorta o «Aortic team») en el que se han de implicar cardiólogos, cirujanos cardiacos, cirujanos vasculares, anestesiólogos y radiólogos, principalmente.En este documento, consensuado entre los grupos de trabajo de aorta de las sociedades españolas de Anestesiología y Cirugía Torácica-Cardiovascular se busca difundir los modos de trabajo más consensuados entre los centros de mayor actividad del país por parte de ambas especialidades, en lo que al tratamiento quirúrgico se refiere de la patología crónica de aorta descendente.Somos conscientes de la evolución constante de la terapéutica, lo cual sin duda puede hacer cuestionables algunas opiniones aquí expresadas y que sin duda irán modificándose en futuras ediciones.Este documento aspira a ser una herramienta de trabajo para los diferentes profesionales implicados en el tratamiento de la patología aórtica. Abstract: The pathology of the aorta is a challenge for medicine. Diagnostic and therapeutics move a huge volume of variables. This has let this pathology to be addressed by a big number of specialists. The surgical management of these pathologies implies an extraordinary effort on the part of many professionals, given the technical and technological complexity employed. Throughout these years, these efforts are paying off in the form of improved results, thanks to a systematic and protocolized approach within a group of experts (Aortic Committees or “Aortic team”) in which they have to involve cardiologists, cardiac surgeons, vascular surgeons, anesthesiologists and radiologists, mainly.In this document, agreed between the Aorta working groups of the Spanish societies of Anesthesiology and Thoracic-Cardiovascular Surgery, it is sought to disseminate the most agreed working modes among the centers of greatest activity in the country by both specialties, as far as surgical treatment is concerned in descending chronical aortic pathology.We are aware of the constant evolution of therapeutics, which can undoubtedly make some of the opinions expressed here questionable and that will undoubtedly be modified in future editions.This document aims to be a working tool for the different professionals involved in the treatment of aorticpathology.

RESUMO Objetivo: Determinar os niveis plasmaticos e o comportamento farmacocinetico da micafungina em pacientes tratados com oxigenacao por membrana extracorporea. Metodos: As amostras foram colhidas por meio de pontos de acesso antes e depois da membrana, em dois hospitais espanhois de nivel terciario. Os momentos para o calculo das curvas farmacocineticas foram antes da administracao do farmaco, e 1, 3, 5, 8, 18 e 24 horas apos o inicio da infusao nos dias 1 e 4 de tratamento. Calcularam-se a area sob a curva, a depuracao do farmaco, o volume de distribuicao e a meia-vida plasmatica por meio de analise farmacocinetica nao compartimental. Resultados: Os valores farmacocineticos analisados no primeiro e quarto dias de tratamento nao mostram qualquer diferenca de concentracao entre amostras colhidas antes da membrana e apos a membrana, e o comportamento farmacocinetico foi similar na vigencia de diferentes falencias de orgaos. A area sob a curva antes da membrana no dia 1 foi de 62,1 (IC95% 52,8 - 73,4) e a area sob a curva apos a membrana nesse mesmo dia foi de 63,4 (IC95% 52,4 - 76,7), com p = 0,625. A area sob a curva antes da membrana no dia 4 foi de 102,4 (IC95% 84,7 - 142,8), enquanto a area sob a curva apos a membrana nesse mesmo dia foi de 100,9 (IC95% 78,2 - 138,8), com p = 0,843. Conclusao: Os parâmetros farmacocineticos da micafungina nao foram alterados significantemente.

The objective of the present work is to describe the experience with intravenous (IV) sildenafil in heart transplant (HT) patients with reactive pulmonary hypertension (PH) who developed right ventricular dysfunction (RVD) in the immediate postoperative period. The first 5 patients who received IV sildenafil followinga HT are presented. The HTs took place between March 2011 and September 2012 in patients aged 37 to 64 years; all patients were male. Prior to the HT, mean pulmonary artery pressure (mPAP) was 32-56 mmHg. In all cases, the hemodynamic study demonstrated PH reactivity (positive vasodilator test with nitric oxide). All 5 patients developed RVD with hemodynamic instability immediately after the HT, despite the administration of nitric oxide from the time of intubation prior to the implant, optimal medical treatment in all cases, and a ventricular assist in 2 cases. In all patients, IV sildenafil was initiated at 10 mg/8 h for 48 h and was subsequently increased to 20 mg/8 h. in its oral formulation until discharge from the hospital. The change in pulmonary pressure was assessed using a Swan-Ganz catheter. Ventricular function was assessed using echocardiography. Length of stay in the Resuscitation Unit and mid-term survival were also assessed. Average time of extracorporeal circulation was 200 ± 110 min and organ ischemic time was 210 ± 95 min. All of the patients demonstrated pulmonary and systemic hemodynamic improvement, as well as recovery of right ventricular function after completing the treatment with IV sildenafil. The stay in the Resuscitation Unit lasted 3-25 days. All the patients were discharged from hospital with no mortality to date. Intravenous sildenafil improves right ventricle hemodynamics associated with pulmonary hypertension post-HT. Prophylactic prevention with this drug could be indicated for patients with reactive PH who are about to receive a transplant.

Fundamento y objetivo Describir la incidencia de complicaciones perioperatorias de los pacientes trasplantados de pulmon por enfisema pulmonar y estudiar los factores de riesgo asociados a la morbimortalidad en el postoperatorio inmediato. Pacientes y metodo Estudio retrospectivo que incluye a 69 pacientes trasplantados de pulmon por enfisema pulmonar durante los anos 1994-2002. Se realizo un analisis univariante para identificar las variables asociadas con la incidencia de la mortalidad en la Unidad de Reanimacion o con el aumento de complicaciones postoperatorias. Las variables que presentaron significacion estadistica se sometieron a analisis multivariante mediante el modelo de regresion logistica. Resultados Se incluyo a 65 pacientes. Diecisiete recibieron un trasplante unipulmonar (TUP) y 48 un transplante bilateral secuencial (TBP). Las complicaciones intraoperatorias fueron mas habituales en el grupo del trasplante bipulmonar (35,3% en el TBP frente a 72,9% en el TUP, p Conclusiones Los pacientes con TUP tienen menor numero de complicaciones en el perioperatorio, lo que condiciona una mayor supervivencia durante la estancia en reanimacion. La ventilacion mecanica durante mas de 48 h y la hemorragia posquirurgica fueron las variables que mejor predijeron la mortalidad en el postoperatorio inmediato.

Our goal was to analyze the incidence of perioperative complications in patients with pulmonary emphysema who underwent lung transplantation and to identify variables associated with the incidence of morbidity and mortality during the immediate postoperative period.We undertook a retrospective study of 65 pulmonary emphysema patients who received lung transplants from 1994 through 2002 with the aim of determining the most common intra- and early postoperative complications in the ICU. An univariate analysis was carried out in order to identify variables associated with the incidence of mortality and postoperative complications. Those variables showing statistical significance underwent a multivariate analysis, by means of a pattern of logistic regression, in order to calculate the odds ratio and confidence interval.Seventeen patients received single-lung transplants (SLT) and 48 patients received sequential double-lung transplants (DLT). Intraoperative complications appeared more frequently in the DLT group. Most frequent complications during surgery were reperfusion syndrome (44.6%) and pulmonary hypertension (16.9%). The intraoperative survival was 100%. Fifty-five patients had some type of postoperative complication. Commonest postoperative complications were infection (56.9%) and primary graft failure (36.6%). In the early postoperative period the mortality rate was 16.9%. Main cause of death in the ICU was sepsis (54.5%). A time of mechanical ventilation48 hours and postoperative hemorrhage were the variables with a higher predictive value for mortality in the early postoperative period.Patients with SLT had a lower rate of perioperative complications and a higher survival during their stay in the ICU. Time of mechanical ventilation48 hours and postoperative hemorrhage were the variables that best predicted death in the early postoperative period following lung transplantation. Despite our experience, however, perioperative mortality in lung transplantation remains high up to this day.

Background and purpose: Right ventricular dysfunction (RVD) has been described as an independent factor for morbidity and/ or mortality in various nosological entities. However, there are no data on its true