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BACKGROUND: Dialysis patients undergoing transcatheter aortic valve replacement (TAVR) generally have poor prognosis compared with non-dialysis patients. Furthermore, there are few reliable risk models in this clinical setting. Therefore, we aimed to establish a risk model in dialysis patients undergoing TAVR that would be informative for their prognosis and the decision-making process of TAVR. METHODS: A total 118 dialysis patients (full cohort) with severe aortic stenosis underwent TAVR in our institute between 2012 and 2022. The patients of the full cohort were randomly assigned to two groups in a 2:1 ratio to form derivation and validation cohorts. Risk factors contributing to deaths were analyzed from the preoperative variables and a risk model was established from Cox proportional hazard model. RESULTS: There were 69 deaths following TAVR derived from infectious disease (43.5â¯%), cardiovascular-related disease (11.6â¯%), cerebral stroke or hemorrhage (2.9â¯%), cancer (1.4â¯%), unknown origin (18.8â¯%), and others (21.7â¯%) during the observational period (811⯱â¯719â¯days). The cumulative overall survival rates using the Kaplan-Meier method at 1â¯year, 3â¯years, and 5â¯years in the full cohort were 82.8â¯%, 41.9â¯%, and 24.2â¯%, respectively. An optimal risk model composed of five contributors: peripheral vascular disease, serum albumin, left ventricular ejection fractionâ¯<â¯40â¯%, operative age, and hemoglobin level, was established. The estimated C index for the developed models were 0.748 (95â¯% CI: 0.672-0.824) in derivation cohort and 0.705 (95â¯% CI: 0.578-0.832) in validation cohort. The prediction model showed good calibration [intraclass correlation coefficientâ¯=â¯0.937 (95%CI: 0.806-0.981)] between actual and predicted survival. CONCLUSIONS: The risk model was a good indicator to estimate the prognosis in dialysis patients undergoing TAVR.
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Ventricular-assist device therapy for small patients with congenital heart disease is challenging due to its complex anatomy and hemodynamics. We describe a 3-year-old patient with heart failure with truncus arteriosus in the palliative stage. The patient underwent palliative right ventricular outflow tract reconstruction following bilateral pulmonary artery banding. At 6 months of age, the patient developed severe truncal valve regurgitation and left ventricular dysfunction. Emergent truncal valve replacement with a mechanical valve was performed, but left ventricular dysfunction persisted. At 3 years of age, the patient developed acute progression of heart failure triggered by influenza infection. The patient was intubated and transferred to our center to determine the indication for heart transplantation. On the second day after admission, signs of multiorgan failure appeared. Emergent ventricular-assist device implantation for both ventricles was performed with truncal valve closure, ventricular septal defect closure, atrial septal defect closure, and re-right ventricular outflow tract reconstruction. The right ventricular-assist device was successfully removed on the seventh postoperative day. Due to the small pulmonary arteries, severe pulmonary stenosis persisted after ventricular-assist device implantation, but it gradually improved with multiple pulmonary angioplasties. The patient was registered in the Japanese organ transplant network and is awaiting a donor organ in a stable condition.
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BACKGROUND: For patients with nonischemic dilated cardiomyopathy (NIDCM), the indications for and results of mitral surgery remain controversial. We reviewed a strategy of mitral repair and replacement for clinically relevant secondary mitral regurgitation (MR) in patients with NIDCM. METHODS: We retrospectively reviewed 65 patients with advanced NIDCM (LVEF < 40%) who underwent mitral surgery. Of them, 47 (72%) underwent mitral annuloplasty and 18 (28%) replacement for secondary MR. The primary endpoint was postoperative reduction in indexed LV end-systolic volume (LVESVI). RESULTS: At baseline, there was no intergroup difference in LVESVI (123 ± 47 vs. 147 ± 37 ml/m2, P = 0.055), LVEF (27 ± 8% vs. 25 ± 6%, P = 0.41), incidence of severe MR (57% (27/47) vs. 72% (13/18), P = 0.40), or EuroSCORE II score (6.2% vs. 7.6%, P = 0.90). At 6 months, the annuloplasty group reduced LVESVI to a greater degree than the replacement group (P < 0.001), yielding significantly smaller postoperative LVESVI (96 ± 59 vs. 154 ± 61 ml/m2, P < 0.001) and better LVEF (P < 0.001). The rates of moderate/severe recurrent MR were 17% (8/47) and 0%, respectively. Multivariable analysis demonstrated that mitral annuloplasty (OR 6.10, 95% CI 1.14-32.8, P = 0.035) was significantly associated with postoperative LV reverse remodeling. Cumulative survival was not different between the groups (P = 0.26). CONCLUSIONS: In patients with NIDCM, mitral annuloplasty reduced LV volume to a greater degree than did mitral replacement. These findings may assist with surgical options for secondary MR associated with NIDCM.
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Cardiomiopatía Dilatada , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Humanos , Cardiomiopatía Dilatada/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Periodo Posoperatorio , Estudios RetrospectivosRESUMEN
BACKGROUND: Restrictive cardiomyopathy (RCM) is characterized by impaired diastolic function with preserved ventricular contraction. Several pathogenic variants in sarcomere genes, including TNNI3, are reported to cause Ca2+ hypersensitivity in cardiomyocytes in overexpression models; however, the pathophysiology of induced pluripotent stem cell (iPSC)-derived cardiomyocytes specific to a patient with RCM remains unknown. METHODS AND RESULTS: We established an iPSC line from a pediatric patient with RCM and a heterozygous TNNI3 missense variant, c.508C>T (p.Arg170Trp; R170W). We conducted genome editing via CRISPR/Cas9 technology to establish an isogenic correction line harboring wild type TNNI3 as well as a homozygous TNNI3-R170W. iPSCs were then differentiated to cardiomyocytes to compare their cellular physiological, structural, and transcriptomic features. Cardiomyocytes differentiated from heterozygous and homozygous TNNI3-R170W iPSC lines demonstrated impaired diastolic function in cell motion analyses as compared with that in cardiomyocytes derived from isogenic-corrected iPSCs and 3 independent healthy iPSC lines. The intracellular Ca2+ oscillation and immunocytochemistry of troponin I were not significantly affected in RCM-cardiomyocytes with either heterozygous or homozygous TNNI3-R170W. Electron microscopy showed that the myofibril and mitochondrial structures appeared to be unaffected. RNA sequencing revealed that pathways associated with cardiac muscle development and contraction, extracellular matrix-receptor interaction, and transforming growth factor-ß were altered in RCM-iPSC-derived cardiomyocytes. CONCLUSIONS: Patient-specific iPSC-derived cardiomyocytes could effectively represent the diastolic dysfunction of RCM. Myofibril structures including troponin I remained unaffected in the monolayer culture system, although gene expression profiles associated with cardiac muscle functions were altered.
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Cardiomiopatía Restrictiva , Células Madre Pluripotentes Inducidas , Niño , Humanos , Cardiomiopatía Restrictiva/genética , Células Madre Pluripotentes Inducidas/metabolismo , Mutación , Miocitos Cardíacos/metabolismo , Troponina I/genética , Troponina I/metabolismoRESUMEN
We report a case of temporary Berlin Heart EXCOR® explantation in a pediatric patient with idiopathic dilated cardiomyopathy who suffered an uncontrollable inflow cannulation site infection while on bridge-to-transplantation. Despite failure to thrive and catheter-related infections, once free of the device, the patient was cured of infection using systemic antibiotics and surgical debridement. The patient underwent EXCOR® reimplantation after four months, and is awaiting heart transplantation in stable condition. A life-threatening ventricular assist device-related infection may require device explantation under conditions that may not fulfill conventional explantation criteria despite risks. Temporary explantation can be an effective strategy if isolated systolic dysfunction is managed carefully.
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Various surgical techniques have been developed for coarctation of the aorta. However, coarctation repair in neonates with arch hypoplasia remains challenging. We herein report a case in which a premature neonate under 1500â g with coarctation of the aorta and arch hypoplasia underwent an extra-anatomical bypass at 18 days old. A second extra-anatomical bypass was performed at 3 years of age, and a third extra-anatomic bypass for recurrent coarctation was performed in adulthood. By increasing the size of the graft as the patient grows, extra-anatomic bypass can be a useful surgical option for premature neonates with coarctation and arch hypoplasia.
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Aorta Torácica , Coartación Aórtica , Implantación de Prótesis Vascular , Humanos , Coartación Aórtica/cirugía , Coartación Aórtica/diagnóstico por imagen , Coartación Aórtica/complicaciones , Recién Nacido , Aorta Torácica/cirugía , Aorta Torácica/anomalías , Aorta Torácica/diagnóstico por imagen , Resultado del Tratamiento , Implantación de Prótesis Vascular/instrumentación , Masculino , Recien Nacido Prematuro , Aortografía , Recurrencia , Prótesis Vascular , Angiografía por Tomografía Computarizada , Factores de Edad , Edad Gestacional , Preescolar , Adulto , FemeninoRESUMEN
Research on cardiomyopathy models using engineered heart tissue (EHT) created from disease-specific induced pluripotent stem cells (iPSCs) is advancing rapidly. However, the study of restrictive cardiomyopathy (RCM), a rare and intractable cardiomyopathy, remains at the experimental stage because there is currently no established method to replicate the hallmark phenotype of RCM, particularly diastolic dysfunction, in vitro. In this study, we generated iPSCs from a patient with early childhood-onset RCM harboring the TNNI3 R170W mutation (R170W-iPSCs). The properties of R170W-iPSC-derived cardiomyocytes (CMs) and EHTs were evaluated and compared with an isogenic iPSC line in which the mutation was corrected. Our results indicated altered calcium kinetics in R170W-iPSC-CMs, including prolonged tau, and an increased ratio of relaxation force to contractile force in R170W-EHTs. These properties were reversed in the isogenic line, suggesting that our model recapitulates impaired relaxation of RCM, i.e., diastolic dysfunction in clinical practice. Furthermore, overexpression of wild-type TNNI3 in R170W-iPSC-CMs and -EHTs effectively rescued impaired relaxation. These results highlight the potential efficacy of EHT, a modality that can accurately recapitulate diastolic dysfunction in vitro, to elucidate the pathophysiology of RCM, as well as the possible benefits of gene therapies for patients with RCM.
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Cardiomiopatías , Cardiomiopatía Restrictiva , Células Madre Pluripotentes Inducidas , Niño , Preescolar , Humanos , Cardiomiopatía Restrictiva/genética , Cardiomiopatía Restrictiva/terapia , Mutación , Miocitos Cardíacos/fisiologíaRESUMEN
Objective: Whereas transcatheter aortic valve replacement is widely implemented, annular rupture is a devastating complication and could be highly mortal. However, owing to its rare incidence, the optimal treatment algorithm has not been established. Thus, we evaluated the feasibility and effectiveness of a 3-step algorithm to treat annulus rupture. Methods: From 2009 to 2022, 8 patients of 1083 transcatheter aortic valve implantation (0.8%) developed annulus rupture and were treated with the three-step algorithm. The algorithm was composed of a first step (pericardial drainage and protamine neutralization with blood pressure control), second step (manual hemostatic compression via full/partial sternotomy), and a third step (conservative treatment or radical surgical correction). Results: The median age at the procedure was 85 (78-88) years and 7 female patients were included in this study. Two (25%) patients had end-stage renal failure under hemodialysis, and median Society of Thoracic Surgeons score was 8.9% (2.1%-23.2%). The implanted transcatheter heart valves (THVs) were 7 balloon-expandable THVs and 1 self-expandable THV with balloon postdilatation. Under this strategy, 8 (100%) patients underwent pericardial drainage as first step and 5 patients achieved hemostasis. Of these, patient 1 demonstrated bleeding from left sinus of Valsalva and required a Bentall procedure. Although the etiology of this phenomenon was not investigated by contrast-enhanced computed tomography, it might be derived from pseudoaneurysm rupture or delayed annular rupture. In 2 patients, the second step treatment was needed for hemostasis. Third-step treatment was conducted in 1 patient. Postoperatively, 6 patients could be discharged without critical complications whereas 2 patients died during the hospitalization. There were no other complications during the followed-up (584 [7-1614]) days. Conclusions: In accordance with the three-step algorithm, 6 patients, including those with high-risk or inoperative status, survived.
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Objectives: Atrial arrhythmias are a significant cause of late morbidity and mortality in patients after tetralogy of Fallot repair. However, reports on their recurrence following atrial arrhythmia surgery are limited. We aimed to identify the risk factors for atrial arrhythmia recurrence after pulmonary valve replacement (PVR) and arrhythmia surgery. Methods: We reviewed 74 patients with repaired tetralogy of Fallot who underwent PVR for pulmonary insufficiency at our hospital between 2003 and 2021. Twenty-two patients (mean age, 39 years) underwent PVR and atrial arrhythmia surgery. A modified Cox-maze III was performed in 6 patients with chronic atrial fibrillation, and a right-sided maze was performed in 12 with paroxysmal atrial fibrillation, 3 with atrial flutter, and 1 with atrial tachycardia. Atrial arrhythmia recurrence was defined as any documented sustained atrial tachyarrhythmia requiring intervention. The influence of preoperative parameters on recurrence was assessed with the Cox proportional-hazards model. Results: The median follow-up period was 9.2 years (interquartile range, 4.5-12.4). Cardiac death and redo-PVR due to prosthetic valve dysfunction were not observed. Eleven patients had atrial arrhythmia recurrence after discharge. Atrial arrhythmia recurrence-free rates were 68% at 5 years and 51% at 10 years after PVR and arrhythmia surgery. Multivariable analysis revealed that right atrial volume index (hazard ratio, 1.04; 95% confidence interval, 1.01-1.08, P = .009) was a significant risk factor for atrial arrhythmia recurrence after arrhythmia surgery and PVR. Conclusions: Preoperative right atrial volume index was associated with atrial arrhythmia recurrence, which may assist in planning the timing of atrial arrhythmia surgery and PVR.
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BACKGROUND: Aortopulmonary window (APW) is a rare congenital cardiac anomaly characterized by communication between the main pulmonary artery and ascending aorta. There are various surgical techniques, and the short- and long-term results are excellent if the surgical repair is performed early in life. To our knowledge, there have been no reports of pseudoaneurysm after APW repair. Herein, we present a case of a 30-year-old woman with an ascending aortic pseudoaneurysm found at the site of APW repair nine months after the APW repair and bilateral lung transplantation. CASE PRESENTATIONS: A 30-year-old woman presented with APW and Eisenmenger syndrome. The patient underwent APW repair and bilateral lung transplantation. We transected the communication between the aorta and pulmonary artery and closed the aortic side directly with strips of felts. Nine months after the surgery, the patient complained of chest pain. Cardiac computed tomography revealed an ascending aortic pseudoaneurysm at the anastomotic site. Emergent graft replacement of the ascending aorta was performed and the postoperative course was uneventful. CONCLUSIONS: We have presented a case of a pseudoaneurysm at the anastomotic site after APW repair and bilateral lung transplantation. The choice of surgical technique should be based on the patient's background requiring lung transplantation, and in these cases close postoperative follow-up is required.
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Aneurisma Falso , Complejo de Eisenmenger , Trasplante de Pulmón , Procedimientos de Cirugía Plástica , Procedimientos Quirúrgicos Torácicos , Femenino , Humanos , Adulto , Complejo de Eisenmenger/cirugía , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Trasplante de Pulmón/efectos adversosRESUMEN
Anomalous origin of a left coronary artery from the right sinus of Valsalva with a single coronary orifice is a rare congenital anomaly, which has been associated with myocardial ischemia and sudden death. Surgical repair is recommended upon its detection. A 14-year-old boy was diagnosed with anomalous origin of a left coronary artery from the right sinus of valsalva with a single coronary orifice after a syncope attack. The patient underwent relocation of the left coronary orifice. The postoperative course was uneventful, with no ventricular arrhythmia or syncope. The patient did not develop cardiac ischemia or infarction on exercise Tc-99â m myocardial scintigraphy 8 months after the procedure.
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Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Isquemia Miocárdica , Seno Aórtico , Masculino , Humanos , Adolescente , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/cirugía , Seno Aórtico/anomalías , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Corazón , Isquemia Miocárdica/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Síncope/complicaciones , Angiografía Coronaria/métodosRESUMEN
OBJECTIVES: The goal of this study was to identify the clinical significance of the deoxyribonucleic acid (DNA) damage response marker, phosphorylated H2A histone variant X, on the bridge to recovery in low-weight paediatric patients with dilated cardiomyopathy (DCM) after having a Berlin Heart EXCOR implanted. METHODS: Consecutive paediatric patients with DCM who had an EXCOR implanted for DCM at our hospital between 2013 and 2021 were reviewed. Patients were classified into 2 groups according to the degree of DNA damage in the left ventricular cardiomyocytes-the low DNA damage group and the high DNA damage group-using the median value as the threshold. We examined and compared the preoperative factors and histologic findings associated with cardiac functional recovery following the explant procedure in the 2 groups. RESULTS: Competing outcome analysis of 18 patients (median body weight, 6.1 kg) showed that the incidence of an EXCOR explant was 40% at 1 year after the implant procedure. Serial echocardiography revealed significant left ventricular functional recovery in the low DNA damage group 3 months after the implant. The univariable Cox proportional hazards model revealed that the percentage of phosphorylated H2A histone variant X-positive cardiomyocytes was the significant factor associated with cardiac recovery and the EXCOR explant (hazard ratio, 0.16; 95% confidence interval, 0.027-0.51; P = 0.0096). CONCLUSIONS: The degree of DNA damage response to the EXCOR implant may aid in predicting the bridge to recovery with EXCOR among low-weight paediatric patients with DCM.
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Cardiomiopatía Dilatada , Insuficiencia Cardíaca , Trasplante de Corazón , Corazón Auxiliar , Niño , Humanos , Insuficiencia Cardíaca/cirugía , Cardiomiopatía Dilatada/cirugía , Miocitos Cardíacos , Histonas , Corazón Auxiliar/efectos adversos , ADNRESUMEN
In a 14-year-old boy, prolonged right ventricular (RV) dysfunction due to postmyocarditis cardiomyopathy developed, whereas left ventricular function recovered with conservative treatment. On catheterization, the RV end-diastolic volume index was 184 mL/m2, and mean pulmonary artery pressure was 16 mm Hg. Despite one-and-a-half ventricle repair, RV dilation continued to worsen; therefore, 3 years after the operation, RV exclusion and extracardiac total cavopulmonary connection were performed. Postoperatively, left ventricular function was maintained, and no further RV dilation was observed. Univentricular conversion may be an effective procedure for the treatment of acquired severe isolated right-sided heart failure.
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Cardiopatías Congénitas , Insuficiencia Cardíaca , Disfunción Ventricular Derecha , Masculino , Humanos , Adolescente , Ventrículos Cardíacos/cirugía , Función Ventricular Izquierda , Arteria Pulmonar/cirugía , Función Ventricular DerechaRESUMEN
Impella is a device effective for the treatment of cardiogenic shock. However, among small children, its application has limitations due to left ventricle size and vasculature and the turning diameter of the aortic arch. Herein, we report an 11-year-old girl with fulminant myocarditis who was successfully managed with Impella CP implantation via the right subclavian artery using a polyethylene terephthalate chimney graft. Compared with insertion via the femoral artery, this method has several advantages. That is, it can address limitations in aortic arch diameter and facilitate equable fixation of the Impella device in small pediatric patients.
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Corazón Auxiliar , Miocarditis , Femenino , Humanos , Niño , Miocarditis/complicaciones , Miocarditis/cirugía , Resultado del Tratamiento , Choque Cardiogénico/etiología , Choque Cardiogénico/cirugía , ArteriasRESUMEN
A 2-year-old girl underwent the Fontan operation for aortic valve stenosis, mitral valve stenosis, a hypo-plastic left ventricle, and a non-compacted right ventricle. The patient's cardiac function reduced gradually thereafter, mainly due to systemic ventricular dysfunction. A Berlin Heart EXCOR (BHE) ventricular assist device with a 10-mL pump was implanted at 4 years of age. After 465 days, BHE support without major complications, the patient underwent heart transplantation. A safe and long-term BHE support was achieved with proper case selection and repeated examinations.
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Oxigenación por Membrana Extracorpórea , Procedimiento de Fontan , Insuficiencia Cardíaca , Trasplante de Corazón , Corazón Auxiliar , Niño , Preescolar , Femenino , Procedimiento de Fontan/efectos adversos , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/efectos adversos , Corazón Auxiliar/efectos adversos , Humanos , Resultado del TratamientoRESUMEN
Recent advances in genome editing technology are accompanied by increasing public expectations on its potential clinical application, but there are still scientific, ethical, and social considerations that require resolution. In Japan, discussions pertaining to the clinical use of genome editing in human embryos are underway. However, understanding of the public's sentiment and attitude towards this technology is limited which is important to help guide the debate for prioritizing policies and regulatory necessities. Thus, we conducted a cross-sectional study and administered an online questionnaire across three stakeholder groups: the general public, patients and their families, and health care providers. We received responses from a total of 3,511 individuals, and the attitudes were summarized and compared among the stakeholders. Based on the distribution of responses, health care providers tended to be cautious and reluctant about the clinical use of genome editing, while patients and families appeared supportive and positive. The majority of the participants were against the use of genome editing for enhancement purposes. Participants expressed the view that clinical use may be acceptable when genome editing is the fundamental treatment, the risks are negligible, and the safety of the technology is demonstrated in human embryos. Our findings suggest differences in attitudes toward the clinical use of genome editing across stakeholder groups. Taking into account the diversity of the public's awareness and incorporating the opinion of the population is important. Further information dissemination and educational efforts are needed to support the formation of the public's opinion.
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Edición Génica , Opinión Pública , Actitud , Estudios Transversales , Humanos , Japón , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Atrial function in Fontan patients is unknown. Our goal was to report the relationship of atrial function with the cardiac index and atrial function and clinical outcome through longer follow-up periods. METHODS: Twelve patients were followed up for over 20 years after their first Fontan operation. Atrial function, including the expansion index, atrial ejection fraction, passive ejection fraction and active ejection fraction, was examined using cardiac computed tomography. The relationship of atrial function with the cardiac index and failing Fontan patients was analysed. RESULTS: Twelve Fontan patients were included. The median follow-up period after the first Fontan operation was 27 (range, 21-33) years, and the median age of those examined was 33.5 (range, 24-60) years. There were 6 male patients (50%). The cardiac index showed a significant positive correlation with the expansion index (P = 0.02), the atrial ejection fraction (P = 0.035), and the active ejection fraction (P = 0.013). The expansion index (39.2 ± 19.6 vs 64.1 ± 3.9), atrial ejection fraction (26.6 ± 10.9 vs 39.0 ± 1.5%), booster pump (15.6 ± 9.0 vs 31.3 ± 3.5) and cardiac index (2.1 ± 0.3 vs 2.5 ± 0.2 L/min/m2) were significantly lower in patients with a history of arrhythmia than in patients without a history of arrhythmia (P < 0.05). The expansion index (23.5 ± 13.5 vs 59.5 ± 8.7), atrial ejection fraction (18.1 ± 8.6 vs 37.1 ± 3.7) and active ejection fraction (7.3 ± 2.7 vs 27.7 ± 5.2) were significantly lower in failing Fontan patients than in non-failing Fontan patients (P < 0.01). CONCLUSIONS: Patients with atrial arrhythmia and signs of Fontan failure have lower atrial function than those without.
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Procedimiento de Fontan , Cardiopatías Congénitas , Adulto , Arritmias Cardíacas/cirugía , Función Atrial , Procedimiento de Fontan/efectos adversos , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Volumen Sistólico , Función Ventricular Izquierda , Adulto JovenRESUMEN
We report a case of a 28-year-old man with unrepaired congenitally corrected transposition of the great arteries, ventricular septal defect, and pulmonary stenosis who presented with septic shock due to infective endocarditis by Abiotrophia defectiva. The cardiac catheterization had the risk of vegetation scattering. Without invasive hemodynamic assessment, the degree of pulmonary stenosis and left ventricle preparation as a systemic ventricle could not be accurately determined, making surgical planning difficult. We chose a staged approach with pulmonary valve replacement first for source control, followed by a more definitive operation following recovery from endocarditis.
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In this article, we analyzed 114 adult heart transplantation( HTx) cases from 1999 to 2021. Of these cases, 94% of patients underwent left ventricular assist device ( LVAD) implantation before HTx. The mean period of LVAD support was 3.0 ±1.2 years. Thirty-day mortality was 0.8% and the 10-year survival rate was 89% after HTx. Preoperative and postoperative renal function was the prognostic factors. Long LVAD support was not associated with the long-term survival after HTx.
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Insuficiencia Cardíaca , Trasplante de Corazón , Corazón Auxiliar , Adulto , Insuficiencia Cardíaca/cirugía , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , UniversidadesRESUMEN
OBJECTIVES: According to the current guidelines of pulmonary valve replacement (PVR) for pulmonary insufficiency, the age at the time of PVR is becoming younger. However, recent studies have shown that the improvements in mortality have leveled off, making it important to suppress the cumulative lifetime risk of morbidity. In this study we aimed to identify the risk factors for morbidity late after PVR. METHODS: Sixty-three patients who underwent PVR for pulmonary insufficiency after intracardiac repair of tetralogy of Fallot or pulmonary atresia with ventricular septal defect at our hospital from 2003 to 2019 were included in this study. Morbidity of PVR included arrhythmia requiring treatment and hospitalization for heart failure. The influence of hemodynamic parameters before PVR was analyzed using the Cox proportional hazards model. RESULTS: The median postoperative follow-up period was 6.5 years. Cardiac death and redo PVR because of prosthetic valve dysfunction were not observed. Twenty-two patients suffered cardiovascular adverse events, including 16 supraventricular tachycardia, 3 sick sinus syndrome/atrioventricular block, 2 sustained ventricular tachycardia, and 1 heart failure hospitalization as first events. In the multivariable analysis, pulmonary end diastolic forward flow (hazard ratio [HR], 7.8; 95% CI, 2.6-23; P < .001), right atrial volume index (HR, 1.02; 95% CI, 1.01-1.04; P = .005), and right atrial pressure (HR, 1.2; 95% CI, 1.01-1.45; P = .042) were significant risk factors for adverse events late after PVR. CONCLUSIONS: End diastolic forward flow, large right atrial volume index, and high right atrial pressure before PVR, which are considered markers of diastolic dysfunction, were significant risk factors for cardiovascular adverse events after PVR.