Reduction in Bleeding after Heart-Lung Transplantation: Discussion (1)
Heart-lung transplantation is nearing the end of its first decade of clinical application. Because the number of satisfactory heart-lung grafts is limited, only a few centers in North America have acquired a significant experience and hence technical facility with the procedure. Intraoperative hemorrhage and postoperative hemorrhage from pleural adhesions and the posterior mediastinum have been problematic in the early experience with HLT,2’’’’ and with infection have been a major cause of morbidity and mortality postoperatively. buy cheap antibiotics
Several reports emphasize the importance of proper recipient selection in improving the results of HLT. In the early Pittsburgh experience, no patient with a previous sternotomy survived, and those who had undergone previous thoracotomy had development of postoperative hemorrhage from pleural and mediastinal adhesions. In the Stanford experience, as well, the highest risk of operative mortality occurred in patients with a previous thoracic operation, pleural adhesions, or impaired hepatic function.2 These factors were strongly correlated with increased perioperative hemorrhage and poor postoperative allograft function due to multiple transfusions. Like the Stanford group, we no longer consider a previous thoracotomy to be a contraindication for HLT, but we review these patients carefully on a case-by-case basis.