Disruption of the aortic anastomosis after heart-lung transplantation

Robert Dowling, Naoum Baladi, Marco Zenati, J. Stephen Dummer, Robert L. Kormos, John M. Armitage, Samuel A. Yousem, Robert L. Hardesty, Bartley P. Griffith

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Disruption of the aorta at the anastomotic site occurred in 4 of 66 consecutive heart-lung transplant recipients and was associated with a 100% mortality. In 3 of these patients, Candida either was cultured from the suture line or was seen in the wall of the aorta at postmortem examination. In 2 of these 3 patients, cultures of material from the donor trachea taken at the time of explantation grew Candida species. Two patients were seen with sudden massive hemorrhage on postoperative day 26 and postoperative day 28. One patient experienced acute decompensation due to right ventricular outflow tract obstruction on postoperative day 30, and the remaining patient was seen 7 months postoperatively with obstruction of both the left main bronchus and the right pulmonary artery caused by extrinsic compression by an aortic pseudoaneurysm. A high index of suspicion should be maintained when transplanting lungs containing Candida species, as we believe there is substantial evidence of donor transmission of the fungal agents. We now include amphotericin B in our antibiotic prophylactic regimen in an attempt to prevent fungal infection because previous treatment has been uniformly unsuccessful. Furthermore, we wrap both the trachea and the aorta with omentum to lessen the likelihood of mediastinal spread of infection to the aortic suture line.

Original languageEnglish (US)
Pages (from-to)118-122
Number of pages5
JournalThe Annals of Thoracic Surgery
Volume49
Issue number1
DOIs
StatePublished - Jan 1 1990

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Heart-Lung Transplantation
Candida
Aorta
Trachea
Sutures
Tissue Donors
Ventricular Outflow Obstruction
Postoperative Hemorrhage
Lung
Omentum
Mycoses
False Aneurysm
Amphotericin B
Bronchi
Pulmonary Artery
Autopsy
Anti-Bacterial Agents
Mortality
Infection

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Dowling, R., Baladi, N., Zenati, M., Dummer, J. S., Kormos, R. L., Armitage, J. M., ... Griffith, B. P. (1990). Disruption of the aortic anastomosis after heart-lung transplantation. The Annals of Thoracic Surgery, 49(1), 118-122. https://doi.org/10.1016/0003-4975(90)90368-G
Dowling, Robert ; Baladi, Naoum ; Zenati, Marco ; Dummer, J. Stephen ; Kormos, Robert L. ; Armitage, John M. ; Yousem, Samuel A. ; Hardesty, Robert L. ; Griffith, Bartley P. / Disruption of the aortic anastomosis after heart-lung transplantation. In: The Annals of Thoracic Surgery. 1990 ; Vol. 49, No. 1. pp. 118-122.
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abstract = "Disruption of the aorta at the anastomotic site occurred in 4 of 66 consecutive heart-lung transplant recipients and was associated with a 100{\%} mortality. In 3 of these patients, Candida either was cultured from the suture line or was seen in the wall of the aorta at postmortem examination. In 2 of these 3 patients, cultures of material from the donor trachea taken at the time of explantation grew Candida species. Two patients were seen with sudden massive hemorrhage on postoperative day 26 and postoperative day 28. One patient experienced acute decompensation due to right ventricular outflow tract obstruction on postoperative day 30, and the remaining patient was seen 7 months postoperatively with obstruction of both the left main bronchus and the right pulmonary artery caused by extrinsic compression by an aortic pseudoaneurysm. A high index of suspicion should be maintained when transplanting lungs containing Candida species, as we believe there is substantial evidence of donor transmission of the fungal agents. We now include amphotericin B in our antibiotic prophylactic regimen in an attempt to prevent fungal infection because previous treatment has been uniformly unsuccessful. Furthermore, we wrap both the trachea and the aorta with omentum to lessen the likelihood of mediastinal spread of infection to the aortic suture line.",
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Dowling, R, Baladi, N, Zenati, M, Dummer, JS, Kormos, RL, Armitage, JM, Yousem, SA, Hardesty, RL & Griffith, BP 1990, 'Disruption of the aortic anastomosis after heart-lung transplantation', The Annals of Thoracic Surgery, vol. 49, no. 1, pp. 118-122. https://doi.org/10.1016/0003-4975(90)90368-G

Disruption of the aortic anastomosis after heart-lung transplantation. / Dowling, Robert; Baladi, Naoum; Zenati, Marco; Dummer, J. Stephen; Kormos, Robert L.; Armitage, John M.; Yousem, Samuel A.; Hardesty, Robert L.; Griffith, Bartley P.

In: The Annals of Thoracic Surgery, Vol. 49, No. 1, 01.01.1990, p. 118-122.

Research output: Contribution to journalArticle

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AU - Baladi, Naoum

AU - Zenati, Marco

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AU - Kormos, Robert L.

AU - Armitage, John M.

AU - Yousem, Samuel A.

AU - Hardesty, Robert L.

AU - Griffith, Bartley P.

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N2 - Disruption of the aorta at the anastomotic site occurred in 4 of 66 consecutive heart-lung transplant recipients and was associated with a 100% mortality. In 3 of these patients, Candida either was cultured from the suture line or was seen in the wall of the aorta at postmortem examination. In 2 of these 3 patients, cultures of material from the donor trachea taken at the time of explantation grew Candida species. Two patients were seen with sudden massive hemorrhage on postoperative day 26 and postoperative day 28. One patient experienced acute decompensation due to right ventricular outflow tract obstruction on postoperative day 30, and the remaining patient was seen 7 months postoperatively with obstruction of both the left main bronchus and the right pulmonary artery caused by extrinsic compression by an aortic pseudoaneurysm. A high index of suspicion should be maintained when transplanting lungs containing Candida species, as we believe there is substantial evidence of donor transmission of the fungal agents. We now include amphotericin B in our antibiotic prophylactic regimen in an attempt to prevent fungal infection because previous treatment has been uniformly unsuccessful. Furthermore, we wrap both the trachea and the aorta with omentum to lessen the likelihood of mediastinal spread of infection to the aortic suture line.

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