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Gender-affirming surgery in end-stage congenital cardiac disease: a case report

dc.contributor.authorXia, Sunny
dc.contributor.authorNadine, Makki
dc.contributor.authorPearce, Bridget
dc.coverage.spatialAnaheim, California
dc.date.accessioned2024-02-13T19:26:11Z
dc.date.available2024-02-13T19:26:11Z
dc.identifier.urihttps://hdl.handle.net/2027.42/192316
dc.description.abstractGender reassignment surgery and complex congenital cardiac disease Sunny Xia, Nadine Makki MD, Bridget Pearce MD Introduction: Gender dysphoria carries attempted suicide rates of 30% and gender-affirming surgery can be lifesaving.1 We present a patient with end-stage complex congenital heart disease (CHD) for gender reassignment surgery. Upon completion of this poster session, the learner will be able to: 1. Discuss the risks and benefits of transgender surgery for patients with complex cardiac disease. 2. Summarize the ethical and anesthetic considerations for this unique patient. Body: A 22-year-old, ASA 4 biologic female identifying as male with congenitally corrected transposition of the great arteries and heart block, s/p double switch operation and biventricular pacemaker presented for gender-affirming surgery. First year of life he had surgical intervention to enable systemic morphologic left ventricle (LV). He experienced gender dysphoria, and at age 18 began transgender hormone therapy and had chest masculinization. At age 20, due to end of pacemaker life he was converted to dual-chamber transvenous pacemaker that unfortunately resulted in dyssynchrony cardiomyopathy. Urgent pacemaker revision to biventricular resynchronization yielded symptomatic improvement but LV function remained severely depressed. He was scheduled for total hysterectomy to continue female to male gender (FTM) confirmation and desire to avoid pregnancy. However, his end-stage cardiac status was felt prohibitive for gender-affirming surgery and instead, he was offered surgical sterility with laparoscopic bilateral salpingectomy. Perioperative planning for the procedure involved gynecology, adult congenital heart cardiology, electrophysiology (EP) and anesthesiology. Plans included senior surgeon performing the procedure, pediatric cardiac anesthesia, invasive arterial monitoring, adequate venous access, avoidance of negative inotropes, vasoactive support if needed, and a cardiac ICU bed for postop care. An EP physician was immediately available to assist with unstable ectopy. The pacemaker was not reprogrammed but a magnet and cutaneous defibrillator would be available in the OR if electrical interference resulted in hemodynamic instability. Vasoactive medications and emergency drugs were available. Induction was with etomidate, rocuronium, fentanyl and midazolam. Anesthetic and hemodynamic goals were met with sevoflurane and ketamine. Vasoactive support was not needed and there was no hemodynamically significant ectopy. The patient tolerated the procedure well and his plan is to proceed with FTM gender-affirming surgery in the future. Conclusions: This case highlights perioperative considerations for transgender surgery with complex adult congenital heart disease. Almost one-third of patients with untreated gender dysphoria attempt suicide and gender-affirming surgery may save lives. Our case shows that end-stage complex CHD is not exclusionary for these types of procedures, but careful multidisciplinary planning is paramount to provide optimal care for these patients. Reference: 1. Peterson CM, et al. Suicidality: Self‐harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Suic Life Threat Behav. 2017, 47:475-482
dc.titleGender-affirming surgery in end-stage congenital cardiac disease: a case report
dc.typeConference Paper
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/192316/2/GenderReassigmentAbstract2.13.24_WithReferences Edited SM (002) (002).docx
dc.identifier.doihttps://dx.doi.org/10.7302/22225
dc.date.updated2024-02-13T19:26:11Z
dc.identifier.orcid0000-0003-2214-1798
dc.identifier.name-orcidXia, Sunny
dc.identifier.name-orcidNadine, Makki
dc.identifier.name-orcidPearce, Bridget; 0000-0003-2214-1798
dc.working.doi10.7302/22225en
dc.owningcollnameAnesthesiology, Department of


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