Browsing by Author "Silvestry, Scott"

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    Adult cardiac transplantation utilizing donors after circulatory death
    (AME, 2024) Rajah, Tanisha; Blitzer, David; Silvestry, Scott; Copeland, Hannah; Surgery, School of Medicine
    Donation after circulatory death (DCD) presents both opportunities and challenges in the realm of heart transplantation. Its emergence holds promise for narrowing the gap between patients in need of organs and the available donor pool. The rapid emergence of DCD use has allowed heart transplant volume to increase worldwide. Long-term outcomes and best practices remain to be defined and are important considerations in the wider use of these techniques in a broad selection of patients to understand best use and practice moving forward. Expanding DCD donation entails substantial resource allocation, coordination efforts, and training initiatives. Moving forward, standardization is imperative, particularly in aspects such as "stand-off" time, warm ischemic time (WIT), and perfusate composition.
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    Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study
    (Frontiers Media, 2022-06-09) Gökler, Johannes; Aliabadi-Zuckermann, Arezu Z.; Kaider, Alexandra; Ambardekar, Amrut V.; Antretter, Herwig; Artemiou, Panagiotis; Bertolotti, Alejandro M.; Boeken, Udo; Brossa, Vicens; Copeland, Hannah; Crespo-Leiro, Maria Generosa; Eixerés-Esteve, Andrea; Epailly, Eric; Farag, Mina; Hulman, Michal; Khush, Kiran K.; Masetti, Marco; Patel, Jignesh; Ross, Heather J.; Rudež, Igor; Silvestry, Scott; Martin Suarez, Sofia; Vest, Amanda; Zuckermann, Andreas O.; Surgery, School of Medicine
    Background: Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports. Methods: We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate. Results: Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 11), with a total of 110 patients. A median of 3 (IQR 2-8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 2). The median age at CASH was 57.7 (47.8-63.1) years, with a median time from transplant to CASH of 4.4 (1-9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% (n = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8-14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively. Conclusion: Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure.