RESUMEN
Acute kidney injury (AKI) and primary graft dysfunction (PGD) are serious complications after heart transplantation (HT). The relationship between AKI and PGD is poorly understood. We sought to examine the incidence of AKI and identify risk factors associated with AKI. We hypothesized that PGD is one of the risk factors independently associated with post-HT AKI. We gathered data for all adult patients who underwent HT between 2009 and 2014. AKI was defined by the KDIGO criteria. PGD was categorized using ISHLT criteria. We assessed univariable and multivariable logistic regression to identify risk factors independently associated with post-HT AKI. Out of 316 patients, postoperative AKI occurred in 273 (86%) patients: 188 (68%) stage I, 44 (16%) stage II, and 41 (15%) stage III. Stage II/III AKI was associated with increased risk of mortality at 1 year. There was significant association between severe PGD and stage II/III AKI (P = 0.001, OR 3.63, 95% CI: 1.69-7.94). Other clinical factors significantly associated with stage II/III AKI included longer donor brain death duration and lower recipient baseline creatinine. We found that stage II/III AKI is common and independently associated with severe PGD. Another potentially modifiable risk factor is donor brain death duration.
Asunto(s)
Lesión Renal Aguda , Trasplante de Corazón , Disfunción Primaria del Injerto , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Adulto , Estudios de Cohortes , Trasplante de Corazón/efectos adversos , Humanos , Incidencia , Disfunción Primaria del Injerto/epidemiología , Disfunción Primaria del Injerto/etiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE OF REVIEW: Central pulse pressure (PP), a marker of vascular stiffness, is a novel indicator of risk for perioperative morbidity including ischemic stroke. Appreciation for the mechanism by which vascular stiffness leads to organ dysfunction along with understanding its clinical detection may lead to improved patient management. RECENT FINDINGS: Vascular stiffness is associated with increased mortality and neurologic, cardiac, and renal injury in nonsurgical and surgical patients. Left ventricular hypertrophy and diastolic dysfunction along with microcirculatory changes in the low vascular resistance, high blood flow, cerebral and renal vasculature are seen in patients with vascular stiffness. Pulse wave velocity and the augmentation index have higher sensitivity for detecting of vascular stiffness than peripheral PP as the hemodynamic consequences of vascular stiffness are secondary to alterations in the central vasculature. Vascular stiffness alters cerebral autoregulation, resulting in a high likelihood of having a lower limit of autoregulation more than 65âmmHg during surgery. Vascular stiffness may predispose to cerebral hypoperfusion, increasing vulnerability to ischemic stroke, postoperative delirium, and acute kidney injury. SUMMARY: Vascular stiffness leads to alterations in cerebral, cardiac, and renal hemodynamics increasing the risk of perioperative ischemic stroke and neurologic, cardiac, and renal dysfunction.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Periodo Perioperatorio , Accidente Cerebrovascular/prevención & control , Rigidez Vascular/fisiología , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/prevención & control , Presión Sanguínea , Delirio del Despertar/fisiopatología , Delirio del Despertar/prevención & control , Humanos , Monitoreo Fisiológico/métodos , Análisis de la Onda del Pulso/métodos , Accidente Cerebrovascular/fisiopatologíaRESUMEN
Changes in heart transplantation (HT) donor and recipient demographics may influence the incidence of primary graft dysfunction (PGD). We conducted a retrospective study to evaluate PGD incidence, trends, and associated risk factors by analyzing consecutive adult patients who underwent HT between January 2009 and December 2014 at our institution. Patients were categorized as having PGD using the International Society for Heart & Lung Transplantation (ISHLT)-defined criteria. Variables, including clinical and demographic characteristics of donors and recipients, were selected to assess their independent association with PGD. A time-trend analysis was performed over the study period. Three-hundred seventeen patients met inclusion criteria. Left ventricular PGD, right ventricular PGD, or both, were observed in 99 patients (31%). Risk factors independently associated with PGD included ischemic time, recipient African American race, and recipient amiodarone treatment. Over the study period, there was no change in the PGD incidence; however, there was an increase in the recipient pretransplantation use of amiodarone. The rate of 30-day mortality was significantly elevated in those with PGD versus those without PGD (6.06% vs 0.92%, P = .01). Despite recent advancements, incidence of PGD remains high. Understanding associated risk factors may allow for implementation of targeted therapeutic interventions.
Asunto(s)
Trasplante de Corazón , Disfunción Primaria del Injerto , Adulto , Amiodarona/uso terapéutico , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoAsunto(s)
Cateterismo Cardíaco/métodos , Oxigenación por Membrana Extracorpórea/métodos , Trasplante de Pulmón/métodos , Disfunción Ventricular Derecha/terapia , Cateterismo Cardíaco/instrumentación , Femenino , Humanos , Persona de Mediana Edad , Insuficiencia Respiratoria/diagnóstico por imagen , Insuficiencia Respiratoria/terapia , Disfunción Ventricular Derecha/diagnóstico por imagenRESUMEN
â¢A Gerbode VSD is a communication between the left ventricle and right atrium.â¢Etiologies include trauma, infective endocarditis, and iatrogenic causes.â¢Echocardiographic evaluation for this defect requires a careful interrogation.
RESUMEN
Impalement injuries are a unique form of penetrating trauma and are typically associated with a fall onto the object (Steele, 2006). We present the case of a 45-year-old man who reportedly slipped in his bathtub and fell onto a broomstick. Radiographic examination revealed a slender mass extending from his rectum to the right side of his neck. A review of English literature suggests that this is the second reported case in the last 100 years describing the successful management of an impalement injury traversing the pelvic, abdominal, and thoracic cavities. The management of this case is described.