A modified heterotopic heart transplant technique to bridge patients with “fixed” pulmonary hypertension: A case report

Advanced heart failure (AHF) management includes heart transplantation (HT), ventricular assist devices, and palliative care. 1 Crespo-Leiro MG Metra M Lund LH et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018; 20 (Epub 2018 Jul 17. PMID: 29806100): 1505-1535https://doi.org/10.1002/ejhf.1236 Crossref PubMed Scopus (362) Google Scholar ,2 Marcondes-Braga FG Moura LAZ Issa VS et al. Emerging topics update of the Brazilian Heart Failure Guideline - 2021. Arq Bras Cardiol. 2021; 116: 1174-1212https://doi.org/10.36660/abc.20210367 Crossref PubMed Scopus (10) Google Scholar Heart transplantation is the gold standard therapy for most of these patients. However, some specific situations preclude a patient with AHF from successfully undergoing orthotopic HT. Pulmonary hypertension (PH) is one of these conditions due to the higher incidence of right ventricle (RV) failure after HT in patients with “fixed” PH. Left ventricular assist device (LVAD) implantation is the current approach for these patients worldwide. 3 Mehra MR Canter CE Hannan MM et al. International Society for Heart Lung Transplantation (ISHLT) Infectious Diseases, Pediatric and Heart Failure and Transplantation Councils. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016; 35 (PMID: 26776864): 1-23https://doi.org/10.1016/j.healun.2015.10.023 Abstract Full Text Full Text PDF PubMed Scopus (776) Google Scholar ,4 Bacal F Marcondes-Braga FG Rohde LEP et al. 3a Diretriz Brasileira de Transplante Cardíaco. Arq Bras Cardiol. 2018; 111 (PortugueseErratum in: Arq Bras Cardiol. 2019; 112:116): 230-289https://doi.org/10.5935/abc.20180153 Crossref PubMed Scopus (24) Google Scholar Nevertheless, the high cost of the devices could limit their use. Heterotopic HT (HHT) is an alternative for treating patients with PH with limited results. 5 Copeland J Copeland H. Heterotopic heart transplantation: the technique for left ventricular assistance. Operative Tech Thorac Cardiovasc Surg. 2017; 21: 269-280 Abstract Full Text Full Text PDF Scopus (6) Google Scholar Copeland et al 6 Copeland H Kalra N Gustafson M Coehlo-Anderson R Friedman M Copeland JG. A case of heterotopic heart transplant as a “biologic left ventricular assist” in restrictive cardiomyopathy. World J Pediatr Congenit Heart Surg. 2011; 2 (PMID: 23804478): 637-640https://doi.org/10.1177/2150135111411588 Crossref PubMed Scopus (9) Google Scholar described a new technique for HHT: a biological left ventricular assist transplant (bio-LVA). Recently, we have reported a new 2-stage approach to assist the left ventricle (LV) by introducing a modification to Copeland's HHT technique. 7 Gaiotto FA Barbosa ACA Filho Tenório DF Steffen SP Jatene FB Heterotopic heart transplantation as a left ventricular biological assistance: a new two-stage method proposal. Braz J Cardiovasc Surg. 2020; 35 (PMID: 33306325; PMCID: PMC7731838): 986-989https://doi.org/10.21470/1678-9741-2020-0506 Crossref PubMed Scopus (4) Google Scholar The aim of this report is to describe the first case of modified bio-LVA in a patient with AHF and PH. The study was approved by the local Ethics Committee (CAAE: 20026018.6.0000.0068).