High-risk pulmonary surgery in potential heart transplant candidates [Chirurgia polmonare ad alto rischio in potenziali candidati a trapianto cardiaco]

Severe ventricular dysfunction and concomitant infection are considered absolute cotraindications for major thoracic operations and immunosuppressive therapy, respectively. However, cardiac transplantation represents the first- choice treatment in advanced heart failure. We report the case of a patient with dilated cardiomyopathy and severe left ventricular dysfunction (ejection fraction = 25%), initially not considered as a potential heart transplant candidate due to the presence of a lung abscess. The patient subsequently underwent atypical pulmonary resection with intraoperative and perioperative intraaortic balloon counterpulsation for circulatory support and was then listed for cardiac transplant. Pitfalls and intra/postoperative strategy, all of which are potentially important aspects in minimizing operative risk, are discussed.