Makey, Ian A.

Abstract Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm. It usually originates from the parietal pleura. SFT originating from the esophagus is exceedingly rare and even more so as a malignancy. We report a 57-year-old patient with a malignant 18 cm SFT of the esophagus that was treated with esophagectomy through a left thoracoabdominal incision. We discuss his surgical and oncologic management.

Abstract Declining a donor when there is a reasonable possibility that the abnormality on chest imaging could be benign carries the risk of losing out on potentially usable lungs in an already parched landscape of donor organ availability. Cautiously aggressive attitudes to acceptance of borderline donors can help bridge the significant discrepancy that exists between the demand and availability of donor organs. Herein, we present a case highlighting successful bilateral lung transplantation from a relatively imperfect donor.

AbstractBackgroundSevere primary graft dysfunction (PGD) is the leading cause of early death after heart transplant.AimTo examine the outcomes of heart transplant recipients who received venoarterial extracorporeal membrane oxygenation (VA‐ECMO) for severe PGD.MethodsWe reviewed electronic health records of adult patients who underwent heart transplant from November 2005 through June 2015. We defined severe PGD according to International Society for Heart and Lung Transplantation consensus statements.ResultsOf 1030 heart transplant patients, 31 (3%) had severe PGD and required VA‐ECMO. The mean (range) age was 59 (43‐69) years. Fifteen patients (48%) underwent prior sternotomy and 10 (32%) received a left ventricular assist device as a bridge to transplant. Severe PGD manifested as failure to wean from cardiopulmonary bypass in 20 patients (65%) and as severe hemodynamic instability in the immediate postoperative period in 10 (32%), including cardiac arrest in 3 (10%). Twenty‐five patients (81%) were successfully weaned from VA‐ECMO, and 19 (61%) were discharged; the other 12 (39%) died.ConclusionsAlthough VA‐ECMO is a common method for providing mechanical circulatory support to patients with PGD, multicenter studies are needed to assess factors associated with successful outcomes and improved survival of these patients.

A 60-year-old male patient presented to an outside hospital with severe cardiogenic shock. A triple bridge of mechanical circulatory support was utilized to transition him to heart transplantation listing. Initially, coronary artery disease was percutaneously treated and Impella 2.5 was used as mechanical circulatory support for 5 days followed by the second Impella 2.5 for 4 days. Veno-arterial extracorporeal membrane oxygenation support was deployed for 16 days. This was exchanged for HeartWare ventricular assist device support as the third stage of mechanical circulatory support to heart transplantation listing. The patient experienced acute renal failure which was managed by continuous renal replacement therapy then intermittent hemodialysis with eventual complete recovery of the renal function. He was discharged home 56 days after HeartWare ventricular assist device implantation with stable hemodynamic, intact neurologic status and fully recovered renal function. Currently, the patient is listed for heart transplantation.

A true left middle lobe (lingular lobe) is very rare, but accessory fissures can be unexpectedly found at transplant. Pre-transplant knowledge of accessory lobes and accessory fissures aids in preparation, transplantation, postoperative assessment, and long-term care planning; however, fissures and accessory lobes can be overlooked by radiologists during routine evaluation of images. Here, we describe the first left lung with three anatomical lobes that was successfully transplanted into a 63-year-old patient with idiopathic pulmonary fibrosis. This anatomical variation did not change our surgical plan or technique, but surgeons should be aware of this possibility, especially when planning postoperative care.

Cardiac tamponade is a common complication after cardiac surgery and is usually caused by bleeding or thrombus in the early postoperative period. Postoperative serous tamponade is more rare and usually of gradual onset. We report an unusual and life-threatening case of serous tamponade occurring on postoperative day 1 following a third-time paraesophageal hernia repair.

AbstractBackgroundA relative contraindication for lung transplant (LT) is coronary disease burden sufficient to cause risk of myocardial infarction after LT. We analyzed cause of death and outcomes of our LT patients with coronary artery disease (CAD).MethodsInpatient records from March 1, 2004, to January 31, 2015, were retrospectively examined and data of 306 LTs extracted. Twenty‐five patients without coronary angiography (CA) and 7 with redo LTs were excluded. The other 274 patients were divided into 2 groups: CAD (n = 116) and no CAD (n = 158). Patients with prior revascularization or coronary stenosis >10% were placed into the CAD group.ResultsThe CAD group was older and had more male patients, greater history of smoking and hypertension, and greater proportion of patients with interstitial lung disease than the no‐CAD group. CAD patients were more likely to receive a single‐lung transplant. Death of cardiac causes occurred for 2 patients (1.7%) in the CAD group and for 1 patient (0.6%) in the no‐CAD group (P = 0.39).ConclusionsThis analysis shows that compared with patients who have no CAD, patients with CAD have different demographic characteristics and receive more single‐lung transplants. Incidence of death of cardiac causes is rare.