Impact of Cardiopulmonary Resuscitation on Cardiac Transplantation outcome

Introduction: Donor heart shortage limits heart transplantations programs while the number of patients waiting for cardiac transplant continues to increase. Optimizing the use of all available donor hearts is a vital key to reduce waiting list mortality. Among different extended criteria, prolong cardiopulmonary resuscitation (CPR), i.e. more than 20 min, has been considered under doubt to be a selection criterion in donor selection. The aim of this study was to compare the outcomes of heart transplantation from cardiopulmonary-resuscitated donors to those who received hearts from donors who did not require cardiopulmonary resuscitation.Methods: This study was a retrospective analysis of adult heart transplantation program in Masih Daneshvari Hospital in Tehran, Iran from 2010 to 2019. Donors and recipients’ demographics, cause of end-stage heart disease and brain death, duration of hospitalization for both donors and recipients and also the duration of cardiopulmonary resuscitation and other factors related to it were investigated. Qualitative variables were compared using Chi-square test. Quantitative variables were compared using T-test. Patient and graft survival rates were calculated using the actuarial method and compared using Wilcoxon's test.Results: Among 92 recipients, 39 were transplanted with cardiac grafts from CPR-suffering donors. There were no significant differences regarding sex, age, donor and recipient hospitalization periods, early rejection and 1-year-survival rate considering CPR and non-CPR grafts. However, we detected a strong negative correlation between the duration of CPR and 3-year-survival rate (P = 0.02 and R-value = -0.62) and also its association with post-transplant arrhythmias (P = 0.04).Conclusion: There is a negative possible influence of long-lasting CPRs (especially more than 20 minutes) in midterm survival and post-transplant complications

Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum

A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result

Post-Intubation Tracheoesophageal Fistula; A Nine-Year Experience

Introduction: Tracheoesophageal fistula (TEF) is a rare condition, which could be life-threatening if diagnosed late or mismanaged. Post-intubation TEF is the most common form of acquired, non-malignant TEF and is usually associated with tracheal stenosis, which makes the treatment more challenging. Here, we present our experience of managing 21 patients with post-intubation TEF.   Materials & Methods: Twenty one patients including seven women and fourteen men with mean age of 38.05 years, who had post-intubation TEF were managed in our center (Massih Daneshvari Hospital, Tehran, Iran) during 2004-2013. None of the patients were operated before weaning from mechanical ventilation. Single division and closure of the fistula was performed in one patient who did not have accompanying tracheal stenosis. One-stage surgical repair including tracheal resection, anastomosis, primary closure of the esophageal defect, and muscle flap Interposition was the main treatment method in all other cases. Patients were followed up for at least two years. Results: Excellent and good results achieved in 85.7% of our patients. Major complications including permanent vocal cord paralysis and recurrence of tracheal stenosis necessitating T-tube insertion occurred in two patients (9.5%). Severe cachexia and sepsis secondary to sputum retention resulted in one mortality (4.8%). Conclusion: Surgery might provide the best treatment results along with low mortality and morbidity rates in post-intubation TEFs if performed within the proper time

Indications and results of sternal allograft transplantation: learning from a worldwide experience

BACKGROUND: Reconstruction of the anterior chest wall defect after sternectomy is a challenge for cardiothoracic surgeons. In 2010 the Padua group published the first case of cadaveric sternum transplantation after sternectomy. This multi-center study reports the clinical indications, early and long-term results of sternal chondral allograft transplantation.METHODS: This is a retrospective multicentre-study from seven Academic-Centres. Demographic data, surgical indications, technical details, early postoperative results were collected. The complications, long-term stability and tolerance of the allografts were also analysed.RESULTS: Between January 2008 and December 2019 58-patients underwent sternectomy followed by reconstruction using cadaveric-cryopreserved sterno-chondral allografts. Thirty-two patients were males, with a median age of 63.5 years(IQR50-72). Indications for sternectomy were secondary sternal tumors(n=13), primary sternal tumors(n=15) and non-neoplastic disease(30). Thirty patients underwent total sternectomy, 16 lower-body sternectomy and 12 upper-body-manubrium resection. The 30-days mortality was 5%. The overall morbidity was 31%. Six early reoperations were necessary because of bleeding(n=1), titanium-plates dislocation(n=1) and re-suture of the skin in the lower part of the incision(n=4). Overall, the 5-year survival was 74%. The surviving patient's reconstructions are stable and free from mechanical or infective complications.CONCLUSIONS: The main indications for sternal allograft implantation were complex post sternotomy dehiscence followed by primary or secondary tumor involvement of the sternum. The collected results demonstrate that sterno-chondral allograft transplantation is a safe and effective method in reconstructing the anterior chest wall after sternectomy. Further studies to demonstrate the integration of the bone grafts into the patient's sternal wall will be made