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1.
Medicine (Baltimore) ; 99(9): e19393, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118791

RESUMEN

BACKGROUND: Due to advances in technology and medical devices, intra-thoracic left ventricular assisted devices such as the fully magnetically levitated centrifugal-flow pump may now prolong the life of patients with advanced heart failure. However, several concerns have been raised about pump thrombosis and durability of the device. We aimed to systematically compare the two year outcomes of magnetic levitated centrifugal continuous flow circulatory pump versus the axial continuous flow pump for advanced heart failure. METHODS: Following the PRISMA guideline, online databases were searched for relevant trials based on centrifugal continuous flow circulatory pump and axial continuous flow pump in patients with advanced heart failure. The adverse clinical outcomes reported at 2 years follow-up were considered as the endpoints. This analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) and 95% confidence intervals (CI) were generated. RESULTS: A total number of 1011 patients with advanced heart failure was included. At 2 years, pump thrombosis was not significantly different between the two groups, with OR: 0.43, 95% CI: 0.06-3.29; P = .42. However, pump replacement was significantly higher with the axial continuous-flow pump with OR: 0.36, 95% CI: 0.15-0.84; P = .02. Stroke, sepsis and bleeding events were not significantly different. In addition, outcomes such as right heart failure, cardiac arrhythmia, the need for right ventricular assisted device, respiratory failure, renal failure and hepatic dysfunction were also not significantly different. CONCLUSIONS: At a follow-up time period of 2 years, pump replacement was significantly higher with the axial continuous-flow pump in comparison to the magnetic levitated centrifugal continuous flow circulatory pump. However, no significant difference was observed with the other adverse outcomes.


Asunto(s)
Diseño de Equipo/normas , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/normas , Resultado del Tratamiento , Insuficiencia Cardíaca/fisiopatología , Corazón Auxiliar/tendencias , Humanos , Oportunidad Relativa , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos
2.
Am Heart J ; 222: 30-37, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32007823

RESUMEN

BACKGROUND: The safety and efficacy of angiotensin converting enzyme inhibition (ACEI) after heart transplantation (HT) is unknown. This study examined long-term clinical outcomes after ACEI in HT recipients. METHODS: The ACEI after HT study was a prospective, randomized trial that tested the efficacy of ACEI with ramipril after HT. In this study, long-term clinical outcomes were assessed in 91 patients randomized to either ramipril or placebo (median, 5.8 years). The primary endpoint was a composite of death, retransplantation, hospitalization for rejection or heart failure, and coronary revascularization. RESULTS: The primary endpoint occurred in 10 of 45 patients (22.2%) in the ramipril group and in 14 of 46 patients (30.4%) in the placebo group (Hazard ratio (HR), 0.68; 95% CI, 0.29-1.51; P = .34). When the analysis was restricted to comparing patients who remained on a renin-angiotensin system inhibitor beyond 1 year with those who did not, there was a trend to improved outcomes (HR, 0.54; 95% CI, 0.22-1.28, P = .16). There was no significant difference in creatinine, blood urea nitrogen, and potassium at 3 years after randomization. The cumulative incidence of the primary endpoint was significantly higher in patients in whom the index of microcirculatory resistance increased from baseline to 1 year compared with those in whom it did not (39.1 vs 17.4%, HR: 3.36; 95% CI, 1.07-12.7; P = .037). CONCLUSION: The use of ramipril after HT safely lowers blood pressure and is associated with favorable long-term clinical outcomes. Clinical Trial Registration-URL: https://www.clinicaltrials.gov. Unique identifier: NCT01078363.


Asunto(s)
Rechazo de Injerto/prevención & control , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/efectos adversos , Ramipril/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Femenino , Estudios de Seguimiento , Rechazo de Injerto/fisiopatología , Humanos , Masculino , Microcirculación/efectos de los fármacos , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento
4.
J Surg Res ; 246: 207-212, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31605947

RESUMEN

BACKGROUND: The use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. MATERIALS AND METHODS: The United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. RESULTS: A total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53%) and high rates of device-related complications (42.7% experienced at least one device-related complication). Kaplan-Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). CONCLUSIONS: Recipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.


Asunto(s)
Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/efectos adversos , Corazón Auxiliar/efectos adversos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Diálisis Renal/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Listas de Espera/mortalidad
5.
Urology ; 136: 46-50, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31786304

RESUMEN

OBJECTIVE: To evaluate the outcomes of men diagnosed with prostate cancer (CaP) following implanted treatments for advanced heart failure. Given the increasingly favorable 10-year life expectancy, MedStar Washington Hospital Center screens heart transplant (HT) candidates for CaP and other malignancies prior to intervention. METHODS: Men aged 18-90 with available pretransplant Prostate Specific Antigen (PSA) who underwent left ventricular assist device (LVAD) and/or HT at MedStar Washington Hospital Center from 2007 to 2018 were identified. Serum PSA, CaP diagnosis, and treatment were captured and analyzed. Survival was analyzed using Kaplan-Meier curves. RESULTS: Data were available for 34 patients. Median age was 53 [IQR = 51-58]. Median follow-up was 77 months (95% CI = 40-87 months). Six men had postimplant elevated PSA (5.3; SD = 8.5) and 4 were diagnosed with CaP. Median age of CaP diagnosis was 59 [IQR = 58.5-62). As of 2018, 31 of the 34 patients were living, and none died from CaP. Five-year survival was 96% in those without CaP and 100% in those with CaP (Figure 2). CONCLUSION: Our cohort represents the largest known cohort with heart failure treated by LVAD and/or HT and CaP. Our median age of 59 at CaP diagnosis is considerably younger than the national median of 66.1 Of the 4 individuals diagnosed with CaP, 3 had high-grade disease. Given the favorable long-term survival of these patients post-LVAD and/or HT, age-appropriate treatment for CaP should be continued postimplantation.


Asunto(s)
Detección Precoz del Cáncer , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón , Corazón Auxiliar , Neoplasias de la Próstata/complicaciones , Neoplasias de la Próstata/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
7.
Am J Cardiol ; 125(2): 264-269, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-31847958

RESUMEN

Described herein are 3 adults in whom histologic study of the left ventricular myocardium excised ("LV core") to insert a left ventricular assist device (LVAD) disclosed severe acute myocarditis and the inflammatory cells included numerous eosinophils (eosinophilic myocarditis). Examination of the clinical records disclosed elevated absolute eosinophil counts at the time of insertion of the LVAD and the counts rapidly (<30 days) returned to normal after the operation. Because of the numerous medications that each patient was taking at the time of LVAD insertion, identification of a specific initiating medication as its cause was not possible. Of the 3 patients, 2 had idiopathic-dilated cardiomyopathy and 1 had ischemic cardiomyopathy and each had had heart failure for years. The eosinophilic myocarditis in these 3 patients appears to have been transient and superimposed on the earlier cardiomyopathy.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Eosinofilia/diagnóstico , Insuficiencia Cardíaca/cirugía , Ventrículos Cardíacos/patología , Corazón Auxiliar , Miocarditis/diagnóstico , Miocardio/patología , Anciano , Biopsia , Electrocardiografía , Eosinofilia/complicaciones , Eosinofilia/cirugía , Eosinófilos/patología , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Miocarditis/complicaciones , Miocarditis/cirugía , Índice de Severidad de la Enfermedad
8.
Medicine (Baltimore) ; 98(49): e18080, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804316

RESUMEN

BACKGROUND: Tpeak-Tend interval (TpTe), a measurement of transmural dispersion of repolarization (TDR), has been shown to predict ventricular tachyarrhythmia in cardiac resynchronization therapy with defibrillator (CRT-D) patients. However, the ability of TpTe to predict ventricular tachyarrhythmia and mortality for heart failure patients with a cardioverter-defibrillator (ICD) is not clear. The purpose of this study was to assess the predictive ability of TpTe in heart failure patients with ICD. METHODS AND RESULTS: We enrolled 318 heart failure patients treated after ICD. Patients were divided into 3 groups according to their post-implantation TpTe values and were evaluated every 6 months. The primary endpoint was appropriate ICD therapy. The secondary endpoint was all-cause mortality. During long-term follow-up, the TpTe > 110 ms group (n = 111) experienced more VT/VF episodes (45%) and all-cause mortality (25.2%) than the TpTe 90-110 ms group (n = 109) (26.4%, 14.5%) and TpTe < 90 ms group (n = 98) (11.3%, 11.3%) (overall P < .05, respectively). In Cox regression, longer post-implantation TpTe was associated with an increased number of VT/VF episodes [HR: 1.017; 95% CI: 1.008-1.026; P < .001], all-cause mortality [HR: 1.015; 95% CI: 1.004-1.027; P = .010] and the combined endpoint [HR: 1.018; 95%CI: 1.010-1.026; P < .001]. CONCLUSIONS: Post-implantation TpTe was an independent predictor of both ventricular arrhythmias and all-cause mortality in heart failure patients with an implanted ICD.


Asunto(s)
Terapia de Resincronización Cardíaca/métodos , Electrocardiografía , Insuficiencia Cardíaca/mortalidad , Taquicardia Ventricular/terapia , Adulto , Anciano , Desfibriladores Implantables , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Taquicardia Ventricular/etiología
9.
Zhonghua Wai Ke Za Zhi ; 57(12): 893-897, 2019 Dec 01.
Artículo en Chino | MEDLINE | ID: mdl-31826591

RESUMEN

Tricuspid insufficiency late after left-sided heart valve surgery is not uncommon. These patients usually suffer from severe right heart insufficiency and poor general condition due to untimely surgical intervention, and are often complicated with hepatic and renal insufficiency and hemopoietic dysfunction. The choice of strategy for reoperation and perioperative management are still the major challenges for contemporary cardiac surgeons. This article introduces the clinical characteristics and operation timing of patients with severe tricuspid insufficiency after previous left-sided heart valve surgery, and focuses on the selection of operation approach and operation methods.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/cirugía , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Reoperación , Insuficiencia de la Válvula Tricúspide/etiología
10.
Monaldi Arch Chest Dis ; 89(3)2019 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-31850695

RESUMEN

A 39-year-old woman underwent heart transplantation (HTx) for advanced heart failure. The donor was a 36-year-old young woman without past medical history. The first day after HTx, T-waves changes were noted. Echocardiography revealed akinesia/dyskinesia of all basal segments of the two ventricles. Coronary catheterization plus biopsy were done 7 days later showing no coronary obstruction, no rejection and complete recovery of wall motion abnormalities on echocardiogram, suggesting biventricular inverted takotsubo syndrome (TTS). This is a case of TTS during the first day after HTx, with completely denervated heart but because of the inotropic drug support it still represents a target for catecholamine-induced cardiac dysfunction.


Asunto(s)
Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/efectos adversos , Cardiomiopatía de Takotsubo/etiología , Médula Suprarrenal/metabolismo , Adulto , Cardiotónicos/uso terapéutico , Catecolaminas/sangre , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Estrés Fisiológico , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/fisiopatología
11.
Nat Commun ; 10(1): 5830, 2019 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-31862877

RESUMEN

Heart failure (HF) is a major public health problem characterized by inability of the heart to maintain sufficient output of blood. The systematic characterization of circulating proteins across different stages of HF may provide pathophysiological insights and identify therapeutic targets. Here we report application of aptamer-based proteomics to identify proteins associated with prospective HF incidence in a population-based cohort, implicating modulation of immunological, complement, coagulation, natriuretic and matrix remodeling pathways up to two decades prior to overt disease onset. We observe further divergence of these proteins from the general population in advanced HF, and regression after heart transplantation. By leveraging coronary sinus samples and transcriptomic tools, we describe likely cardiac and specific cellular origins for several of the proteins, including Nt-proBNP, thrombospondin-2, interleukin-18 receptor, gelsolin, and activated C5. Our findings provide a broad perspective on both cardiac and systemic factors associated with HF development.


Asunto(s)
Insuficiencia Cardíaca/sangre , Trasplante de Corazón , Proteoma/análisis , Adulto , Anciano , Aptámeros de Péptidos/metabolismo , Biomarcadores/sangre , Biomarcadores/metabolismo , Seno Coronario/metabolismo , Seno Coronario/patología , Femenino , Perfilación de la Expresión Génica , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/cirugía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteoma/metabolismo , Proteómica/métodos , Factores de Riesgo
12.
J Cardiothorac Surg ; 14(1): 219, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31852537

RESUMEN

BACKGROUND: Left ventricular assist devices (LVAD) have become a common treatment option in advanced heart failure. Lack of aortic valve opening during left ventricular unloading is a common complication and associated with a worse outcome. Maintaining a minimum pulse pressure is an important goal during the early postoperative period after LVAD implantation since it is commonly seen as secure sign of aortic valve opening. AIMS/OBJECTIVE: We report a case of an LVAD-supported patient with early permanent closure of the aortic valve despite a pulse pressure > 15 mmHg at all times following LVAD implantation. We demonstrate how careful assessment of the invasive arterial blood pressure curve can indicate aortic valve closure irrespective of pulsatile blood flow. METHOD: A 69-year old male patient with terminal ischemic cardiomyopathy was referred for long-term mechanical circulatory support. Due to mild aortic regurgitation both an aortic bioprosthesis and a continuous-flow left ventricular assist device were implanted. Postoperative echocardiography documented a patent aortic bioprosthesis and an acceptable residual systolic left ventricular contractility. During invasive arterial blood pressure monitoring repetitive transient slight blood pressure decreases followed by slight blood pressure increases coincided with programmed LVAD flushing cycles. Permanent pulsatile flow with a pulse pressure of ≥15 mmHg conveyed systolic opening of the aortic valve. Echocardiography, however, proved early permanent aortic valve closure. In retrospect, transformation of the automated LVAD flushing cycles into visible changes of the arterial blood pressure curve during invasive blood pressure monitoring is indicative of ejection of the complete cardiac output through LVAD itself, and therefore an early clinical sign of aortic valve closure. DISCUSSION/CONCLUSION: We present this interesting didactic case to highlight caveats during the early postoperative period after LVAD implantation. Moreover, this case demonstrates that careful and differentiated observation of the arterial blood pressure waveform provides crucial information in this unique and growing patient population of continuous-flow LVAD support.


Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/efectos adversos , Anciano , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/fisiopatología , Presión Sanguínea/fisiología , Diagnóstico Diferencial , Ecocardiografía , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Flujo Pulsátil , Sístole
13.
J Cardiothorac Surg ; 14(1): 200, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752946

RESUMEN

BACKGROUND: Vasoplegia is a severe complication which may occur after cardiac surgery, particularly in patients with heart failure. It is a result of activation of vasodilator pathways, inactivation of vasoconstrictor pathways and the resistance to vasopressors. However, the precise etiology remains unclear. The aim of the Vasoresponsiveness in patients with heart failure (VASOR) study is to objectify and characterize the altered vasoresponsiveness in patients with heart failure, before, during and after heart failure surgery and to identify the etiological factors involved. METHODS: This is a prospective, observational study conducted at Leiden University Medical Center. Patients with and patients without heart failure undergoing cardiac surgery on cardiopulmonary bypass are enrolled. The study is divided in two inclusion phases. During phase 1, 18 patients with and 18 patients without heart failure are enrolled. The vascular reactivity in response to a vasoconstrictor (phenylephrine) and a vasodilator (nitroglycerin) is assessed in vivo on different timepoints. The response to phenylephrine is assessed on t1 (before induction), t2 (before induction, after start of cardiotropic drugs and/or vasopressors), t3 (after induction), t4 (15 min after cessation of cardiopulmonary bypass) and t5 (1 day post-operatively). The response to nitroglycerin is assessed on t1 and t5. Furthermore, a sample of pre-pericardial fat tissue, containing resistance arteries, is collected intraoperatively. The ex vivo vascular reactivity is assessed by constructing concentrations response curves to various vasoactive substances using isolated resistance arteries. Next, expression of signaling proteins and receptors is assessed using immunohistochemistry and mRNA analysis. Furthermore, the groups are compared with respect to levels of organic compounds that can influence the cardiovascular system (e.g. copeptin, (nor)epinephrine, ANP, BNP, NTproBNP, angiotensin II, cortisol, aldosterone, renin and VMA levels). During inclusion phase 2, only the ex vivo vascular reactivity test is performed in patients with (N = 12) and without heart failure (N = 12). DISCUSSION: Understanding the difference in vascular responsiveness between patients with and without heart failure in detail, might yield therapeutic options or development of preventive strategies for vasoplegia, leading to safer surgical interventions and improvement in outcome. TRIAL REGISTRATION: The Netherlands Trial Register (NTR), NTR5647. Registered 26 January 2016.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Insuficiencia Cardíaca/cirugía , Complicaciones Posoperatorias/etiología , Vasodilatación/fisiología , Vasoplejía/etiología , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Estudios Prospectivos , Vasoplejía/fisiopatología , Vasoplejía/prevención & control
15.
Tex Heart Inst J ; 46(3): 179-182, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31708699

RESUMEN

Driveline infection has been a persistent problem with mechanical cardiac assist devices. The reported incidence of infection has been low in patients who receive a Jarvik 2000 continuous-flow left ventricular assist device when a skull-pedestal driveline exit site is used. We evaluated whether this is also true when a subcostal driveline exit site is used. We reviewed baseline demographic variables, postimplantation vital signs, laboratory values, and culture results in patients who underwent Jarvik 2000 implantation at our center from April 2000 through October 2009, including follow-up through June 2014. All patients had a subcostal driveline exit site. We defined device-related infection as a positive blood or wound culture associated with a medical or surgical device intervention. Event and time-to-event rates were calculated. Eighty-one patients received 89 Jarvik 2000 devices, all as bridges to transplantation. The median support duration was 69 days (interquartile range, 27-153 d; range, 2-2,249 d). Five superficial driveline infections and one incision-site infection occurred (0.002 events per patient-year of support). The median time from pump implantation to onset of driveline infection was 30 days; the incision-related infection occurred at 44 days. The Jarvik 2000 has a low incidence of infection when implanted with use of a subcostal driveline exit site. The incidence of pump infections is particularly low. Using a subcostal driveline exit site may be as effective in preventing infections as using a skull-pedestal driveline exit site. We detail our findings in this report.


Asunto(s)
Insuficiencia Cardíaca/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Corazón Auxiliar/efectos adversos , Infecciones Relacionadas con Prótesis/epidemiología , Adolescente , Adulto , Anciano , Ecocardiografía , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/diagnóstico , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología , Adulto Joven
16.
Rev Esp Cardiol (Engl Ed) ; 72(11): 954-962, 2019 Nov.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31611149

RESUMEN

INTRODUCTION AND OBJECTIVES: The present report updates the clinical characteristics and outcomes of heart transplant in Spain to 2018. METHODS: Prospective registry of all the heart transplants performed between 1984 and 2018 in Spain. Specifically, temporal trends in clinical characteristics and outcomes are described for the period from 2009 to 2017. RESULTS: In 2018, 321 transplants were performed (8494 since 1984; 2719 between 2009 and 2018). Compared with the previous year, the number of transplants performed in 2018 rose by 52% in recipients younger than 16 years and by 42% in those older than 60 years. In the last decade, significant temporal trends were observed in recipient characteristics (better pretransplant renal function, higher rates of diabetes, more urgent transplants, and greater use of pretrasplant circulatory support, particularly ventricular assist devices), donor characteristics (higher donor age, more female donors, and higher frequencies of cerebrovascular cause of death and predonation cardiac arrest and lower ischemia time). Survival significantly improved in the last decade, mainly due to lower mortality due to primary graft failure. CONCLUSIONS: The number of heart transplants is increasing in Spain, with a progressive improvement in survival.


Asunto(s)
Cardiología , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/estadística & datos numéricos , Sistema de Registros , Sociedades Médicas , Adolescente , Adulto , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Tasa de Supervivencia/tendencias , Adulto Joven
18.
Artículo en Ruso | MEDLINE | ID: mdl-31626154

RESUMEN

AIM: To study the impact of external counterpulsation (ECP) on endothelial function and microcirculation in patients after myocardial revascularization (stenting and coronary artery bypass grafting) for functional class (FC) II-III chronic heart failure (CHF). SUBJECTS AND METHODS: Sixty patients aged 50 to 75 years after myocardial revascularization for FC II-III CHF were examined. All the patients received one-hour ECP sessions 5 times per week. The treatment cycle consisted of 35 sessions. To evaluate the microcirculatory bed, capillary blood flow was studied by laser Doppler flowmetry. RESULTS: The cycle of ECP in patients with FC II-III CHF after myocardial revascularization had a corrective effect on the microhemodynamic system. Microcirculatory changes were due to the normalized myogenic and neurogenic tone of arterioles and to increased oscillations in the endothelial range. The pronounced beneficial effect of ECP on the cardiovascular system in the examined patients was confirmed by a significant increase in exercise tolerance and by a statistically significant improvement in the results of 6-minute walk test. There was a decrease in FC heart failure. CONCLUSION: ECP is an effective, non-invasive treatment in patients with heart failure.


Asunto(s)
Enfermedad Coronaria/cirugía , Contrapulsación , Insuficiencia Cardíaca/complicaciones , Microcirculación/fisiología , Anciano , Enfermedad Coronaria/fisiopatología , Insuficiencia Cardíaca/cirugía , Humanos , Persona de Mediana Edad , Resultado del Tratamiento
19.
Heart Surg Forum ; 22(5): E372-E374, 2019 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-31596714

RESUMEN

As a bridge to heart transplantation or destination treatment, implantation of the Heartmate 3 (HM3) left ventricular assist device is a viable option for patients with end-stage congestive heart failure. The recent Momentum 3 trial has shown favorable outcomes compared with Heartmate 2. We report the first case of aortic root thrombus occurring early after HM3 implantation as a bridge to heart transplantation. Our case suggests that bridging with an Impella 5.0 preceding HM3 implantation could potentially predispose patients to aortic root thrombus after HM3 implantation, due to Impella-related injury to the aortic valve and aortic root stasis after durable LVAD support.


Asunto(s)
Aorta/lesiones , Válvula Aórtica/lesiones , Enfermedades de las Válvulas Cardíacas/etiología , Corazón Auxiliar/efectos adversos , Complicaciones Posoperatorias/etiología , Trombosis/etiología , Aorta/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Trombosis/diagnóstico por imagen , Trombosis/cirugía
20.
Int Heart J ; 60(5): 1222-1225, 2019 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-31484879

RESUMEN

Bradycardia is a common complication at the early postoperative period after heart transplantation (HT). The heart rate (HR) usually recovers within a few weeks; however, several patients need a temporary pacemaker or chronotropic agents to stabilize their hemodynamics. Here, we report the first case of transient bradycardia associated with hemodynamic deterioration following HT, which was successfully treated with cilostazol, a phosphodiesterase-3-inhibiting agent. A 59-year-old man received HT for advanced heart failure due to ischemic cardiomyopathy. General fatigue persisted even after the HT. His HR was around 60 beats per minute (bpm) with sinus rhythm. Echocardiography showed no abnormal findings. Right heart catheterization showed that the cardiac index (CI) was 1.9 L/minute/m2. Continuous intravenous infusion of isoproterenol (0.003 µg/kg/minute) increased the HR to 80 bpm and CI to 2.7 L/minute/m2 and improved his symptoms. Isoproterenol was switched to oral administration of cilostazol (100 mg, twice a day), which maintained the HR at around 80 bpm and CI of 2.5 L/minute/m2. The patient's HR gradually recovered and cilostazol could be discontinued three months after the HT. Oral administration of cilostazol can be a therapeutic option for patients with sinus bradycardia following HT, who need positive chronotropic support.


Asunto(s)
Bradicardia/tratamiento farmacológico , Cilostazol/uso terapéutico , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/efectos adversos , Bradicardia/diagnóstico por imagen , Bradicardia/etiología , Gasto Cardíaco/efectos de los fármacos , Electrocardiografía/métodos , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Trasplante de Corazón/métodos , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/etiología , Edema Pulmonar/fisiopatología , Radiografía Torácica/métodos , Factores de Tiempo , Resultado del Tratamiento
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