Surgical director heart transplant and mechanical assist device program

1. Christopher T. Salerno, MD, FACS
Surgical Director Heart Transplant and
Mechanical Assist Device Program
St. Vincent Heart Center of Indiana
March 14, 2015

2. History
o 55 y/o female – 3 heart failure admissions last 4 months
o PMH:
o Rheumatic valve disease v. collagen vascular abormality
o AVR (tilting disc) / MVR (pericardial) 1980
o Redo MVR (Starr-Edwards) 1987
o CAD: MIx2, PTCA
o Chronic Afib
o ICD
o Blood Type A
o Class I PRA 77%, Class II PRA 93%
o Previous tracheostomy, renal failure
o Current Status:
o Admit with recurrent heart failure
o RHC: CI = 1.6, RAP = 19, PAP =58/33, PCWP = 27
o Hct = 30.5, plt – 170, Cr =0.82
o Echo EF<10% , moderate TR
2

3. What are the Options?
• Medical Therapy
• Ablation
• Transplant
• TAH
• VAD
• Management of mechanical
valves
• Hospice
3

4. Clincal Course
• Optimization
• RHC: RAP 8, RVP 35/15, PCWP 25
• Redo Sternotomy
• Redo AVR: pericardial
• HMII
4

5. Post op Course
5
• Prolonged Vent
• Trach/Peg POD 13
• Discharge POD 26 to LTAC
• INR goal 2.5-3.5
• LDH WNL
• Stable 8 months post-op

6. 6