1. Effective perioperative bilirubin plasma-adsorption in
a Total Artificial Heart recipient: report of the first clinical application
Objective
Total artificial heart (TAH) replaces the heart with 2 pneumatic pumps and 4 tilting disk mechanical valves.
It was hypothesized that patients receiving TAH support have persistent hemolysis that resolves after heart transplantation (HT).
In the acute postoperative phase bilirubin overload related to hemolysis may be detrimental in patients with multi-organ insufficiency.
Clinical case
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Out of 3 implant of TAH in a single center experience 2 patients had significant hemolysis during the postoperative course.
In a 68 years old man with preoperative stage III renal insufficiency, early hepatic dysfunction and severe pulmonary hypertension, we registered 3 days after TAH implantation a severe increase in bilirubin level suspected for sepsis, biliary obstruction or ongoing liver dysfunction.
Blood samples examinations disclosed significant hemolysis and systemic inflammation with positive blood cultures.
Antibiotic therapy was promptly started and after 2 days of progressive increase of bilirubin(>20mg/dl) compassionate plasma absorption was instituted.
We performed five plasma absorption treatments, lowering bilirubin levels after each session. Absorption therapy was stopped on the 11st post-operative day with a bilirubin level of 12,1mg/dl.
Renal and hepatic functional parameters rapidly returned to normal ranges and after 58 days the patient was discharged in rehabilitation regimen.
The patient is now on waiting list for HT, bilirubin level is 1,6mg/dl with a slightly low haptoglobin and an increased LDH level.
Conclusions
Peri-operative hyperbilirubinemia may be detrimental after TAH implantation, temporary plasma absorption treatment may preserve organs from its toxic effects.
Buonocore M.,1 Amarelli C.,2 Marra C.,2 Romano G.,2 Maiello C.,2 Angelone M.,3 De Pietro A.,3 Galdieri N.3
1Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy; 2Cardiovascular Surgery and Transplants, Monaldi Hospital‐Azienda Ospedaliera dei Colli, Naples, Italy; 3 Intensive Care Unit in Cardiac Surgery, Monaldi Hospital‐Azienda Ospedaliera dei Colli, Naples, Italy.