Heart Transplant from a Donor with Malignant Hyperthermia
Presented During: Welcome Reception and Poster Competition | Sponsored by: TransMedics
Northwell Health
Port Washington, NY
United States - Contact Me
Caleb is an Integrated Cardiothoracic Surgical Resident at Northwell Health. He graduated from Michigan State University summa cum laude and then was a member of Alpha Omega Alpha at Wayne State University School of Medicine. He is currently an Adjunct Assisstant Professor at Hofstra/Northwell School of Nursing and Physician Assistant Studies. He is interested in adult cardiac surgery including minimally invasive cardiac surgery and structural heart.
Friday, September 20, 2024: 5:00 PM - 6:30 PM
Omni King Edward Hotel
Description
Heart Transplant from a Donor with Malignant Hyperthermia
Caleb Sokolowski M.D., Joshua Newman M.D., Zachary N. Kon M.D., Christina E. Saikus M.D. Ph.D.
Northwell Health/Zucker School of Medicine at Hofstra/Northwell
Objective: A male in his late 60's was listed for heart transplantation due to stage D non-ischemic cardiomyopathy requiring inotropic support. The patient's large size, blood group, and status made identifying a suitable donor challenging and the patient experienced prolonged waiting time during which he required hospitalization due to bacteremia and arrhythmia episodes. A suitable donor was identified but carried a history of malignant hyperthermia (MH). After thorough discussion with the patient, the organ was accepted.
Methods: Due to the donor's history of malignant hyperthermia, the donor recovery case was performed with MH precautions and the recipient case was completed using the guidelines for perioperative care of patients with malignant hyperthermia. The anesthetic workstation and machine were prepared to avoid exposure to residual volatile anesthetics. Anesthesia was commenced with the avoidance of all potential triggers (e.g. Desflurane, Sevoflurane, Isoflurane, Halothane, Methoxyflurane, and Succinylcholine). Total intravenous anesthesia (TIVA) was used with rocuronium for paralysis and a combination of propofol, dexmedetomidine, and sufentanil for sedation and analgesia. No volatile anesthetics were used in the cardiopulmonary bypass circuit.
Results: A cardiac donor with a history of MH poses potential ethical, clinical, and practical considerations to the heart failure team. It is plausible that the recipient may not be affected due to ryanodine receptors predominant concentration on skeletal muscle; however, a paucity of data renders it unknown what implications introducing a MH positive heart has on a transplant recipient. In this case, total intravenous anesthesia was used, and the recipient experienced no signs or symptoms of malignant hyperthermia. The patient had an uneventful postoperative course and was discharged home in stable condition.
Conclusion: We present a patient with limited compatible organ offers who underwent successful orthotopic heart transplant with a heart from a donor with a history of MH. With the appropriate donor and recipient considerations, this donor diagnosis may not preclude heart donation.
Authors
Caleb Sokolowski (1), Joshua Newman (2), Zachary Kon (3), Christina Saikus (4)
Institutions
(1) Northwell Health/Long Island Jewish Medical Center, Port Washington, NY, (2) North Shore University hospital, United States, (3) N/A, New York, NY, (4) N/A, Great Neck, NY
Caleb Sokolowski M.D., Joshua Newman M.D., Zachary N. Kon M.D., Christina E. Saikus M.D. Ph.D.
Northwell Health/Zucker School of Medicine at Hofstra/Northwell
Objective: A male in his late 60's was listed for heart transplantation due to stage D non-ischemic cardiomyopathy requiring inotropic support. The patient's large size, blood group, and status made identifying a suitable donor challenging and the patient experienced prolonged waiting time during which he required hospitalization due to bacteremia and arrhythmia episodes. A suitable donor was identified but carried a history of malignant hyperthermia (MH). After thorough discussion with the patient, the organ was accepted.
Methods: Due to the donor's history of malignant hyperthermia, the donor recovery case was performed with MH precautions and the recipient case was completed using the guidelines for perioperative care of patients with malignant hyperthermia. The anesthetic workstation and machine were prepared to avoid exposure to residual volatile anesthetics. Anesthesia was commenced with the avoidance of all potential triggers (e.g. Desflurane, Sevoflurane, Isoflurane, Halothane, Methoxyflurane, and Succinylcholine). Total intravenous anesthesia (TIVA) was used with rocuronium for paralysis and a combination of propofol, dexmedetomidine, and sufentanil for sedation and analgesia. No volatile anesthetics were used in the cardiopulmonary bypass circuit.
Results: A cardiac donor with a history of MH poses potential ethical, clinical, and practical considerations to the heart failure team. It is plausible that the recipient may not be affected due to ryanodine receptors predominant concentration on skeletal muscle; however, a paucity of data renders it unknown what implications introducing a MH positive heart has on a transplant recipient. In this case, total intravenous anesthesia was used, and the recipient experienced no signs or symptoms of malignant hyperthermia. The patient had an uneventful postoperative course and was discharged home in stable condition.
Conclusion: We present a patient with limited compatible organ offers who underwent successful orthotopic heart transplant with a heart from a donor with a history of MH. With the appropriate donor and recipient considerations, this donor diagnosis may not preclude heart donation.
Authors
Caleb Sokolowski (1), Joshua Newman (2), Zachary Kon (3), Christina Saikus (4)
Institutions
(1) Northwell Health/Long Island Jewish Medical Center, Port Washington, NY, (2) North Shore University hospital, United States, (3) N/A, New York, NY, (4) N/A, Great Neck, NY