Axillary Intra-aortic Balloon Pump, Biventricular Assist Device Implantation And Orthotopic Heart Transplantation With Sickle Cell Trait
Zakariya Mouyer1, Marcus Taylor2, Nnamdi Nwaejike2.
1Imperial College London, London, United Kingdom, 2Manchester Foundation Trust, Manchester, United Kingdom.
BACKGROUND: Sickle cell disease is an autosomal recessive disorder, where the HbS protein replaces the normal HbA protein. Patients with sickle cell dysfunction are high risk for cardiac surgery, as the factors which precipitate crises are encountered during cardiopulmonary bypass (CPB), including hypothermia, stress, inflammation and acidosis.
CASE REPORT: Routine work-up for cardiac transplantation found a 38 year old man to be a carrier for HbS sickle cell trait, with an HbS concentration of 34.4%. Due to uncertainty of candidacy and deterioration, axillary-IABP supported his bridge-to-decision. An IABP was inserted under fluoroscopic guidance via the right axillary artery using Seldinger technique. He continued to deteriorate requiring implantation of a BiVAD. He developed cardiac tamponade 23 days after BiVAD implantation demanding surgical evacuation. As there was no evidence of myocardial recovery, he was placed on the super-urgent heart transplant (HTX) list. After 45 days of BiVAD support, he underwent orthotopic-HTX. The donor heart was from a 31-year-old male transported on cold storage. The patient remained normothermic throughout and diastolic arrest was achieved with cold-blood cardioplegia delivered via the aortic root. Upon completion of anastomoses, bleeding from the posterior aortic wall occurred, requiring further aortic cross-clamping, cold-blood cardioplegia and administration of multiple blood products. Subsequently, the right ventricle distended and the septum became dyskinetic. VA-ECMO was initiated uneventfully and weaned on the 5th-postoperative day, he was discharged from the CTCCU six days later and returned home 28 days after. He maintained recovery and is well 34 months after discharge.
CONCLUSIONS:The reported series of patients undergoing cardiac surgery with concomitant SCD are not common, hence universal agreement on the preferred protective strategy is lacking. There are currently three published cases of adults with SCT undergoing HTX. This case demonstrates, with appropriate assessment and careful intra-operative management, successful outcomes can be achieved without sickle cell crises.
Back to 2022 Display Posters