The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2024
Reoperative Aortic Root Replacement Following Previous Cardiac Surgery or Type A Aortic Dissection Repair.
Reoperative aortic root replacement (ARR) is a technically challenging procedure. This study assesses the influence of reoperation on outcomes following ARR, particularly after prior acute type A aortic dissection (ATAAD) repair. ⋯ Patients undergoing reoperative ARR have more comorbidities and extensive aortic disease compared to those undergoing primary surgery. They face a 3.5-fold increased risk of major adverse events but no difference in operative mortality compared to primary ARR.
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J. Thorac. Cardiovasc. Surg. · Aug 2024
Heart-Liver Transplantation Utilizing the En Bloc Technique: A Single-Center Experience Over Two Decades.
Combined heart-liver transplantation (CHLT) is a definitive therapy reserved for patients with concomitant heart failure and advanced liver disease. A limited number of centers perform CHLT, and even fewer use the en bloc implantation technique. This study 1) reviews clinical outcomes and immunoprotective effects following CHLT, and 2) describes our institution's experience of over two decades using the en bloc technique. ⋯ CHLT is a definitive therapy reserved for patients with multi-organ dysfunction. At our institution, the en bloc technique is the preferred operative approach, as it minimizes cardiac insult, requires fewer anastomoses, minimizes cold ischemia time, and allows for rapid correction of coagulopathy. Overall survival for this cohort is excellent. Episodes of acute rejection were rarely observed, providing further support that the liver may serve an immunoprotective role in multi-organ transplantation.