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1.
Georgian Med News ; (311): 7-16, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33814382

RESUMEN

The aim of the study is to establish the effectiveness of mechanical support of blood circulation of patients with end-stage heart failure depending on the method of surgical correction. The results of the study are based on the data of examination and dynamic observation of 73 patients (median age 44 (16-69) years, men 68 patients, women 5 patients) who were treated from 2008-2019 іn the following medical institutions: Republican Scientific and Practical Center «Cardiology¼, Minsk, Republic of Belarus; in the Center of Cardiac Surgery on the Basis of KL «Feofania¼ DUS. Patients were examined during the initial examination, after 3 months and after a year. The results of surgical treatment of patients with critical heart disease insufficiency: after direct UTS: 24 (92%) patients were treated with positive result, 2 (8%) patients died. There were 18 (46%) patients performed secondary UTS, patients who were on LVAD therapy. 18 (46%) patients who continue LVAD therapy. On LVAD-therapy 3 (8%) patients died. The cause of death is purulent-septic lesions. Which patients were on BiVAD - therapy: secondary UTS performed 4 patients (50%). 4 (50%) patients died on BIVAD therapy. The cause of death in 2 (50%)cases of purulent-septic lesions, and in 2 (50%) cases it is an organ field insufficiency. Analysis of the results of the differential approach to surgical treatment patients with heart failure III-IV FC according to NYHA: patients with critical heart failure in the presence of contraindications to direct transplantation heart rate, it is advisable to consider the use of long-term mechanical circulatory support based on LVAD therapy (p<0001) and BiVAD - therapy (p<0001) as a mechanical bridge to heart transplantation. Applied long-term mechanical support of blood circulation in patients with high indicators of pulmonary hypertension (p<0001), allows to normalize the pressure in the pulmonary artery and consider performing a secondary heart transplant.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Insuficiencia Cardíaca , Trasplante de Corazón , Corazón Auxiliar , Adulto , Femenino , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , República de Belarús , Resultado del Tratamiento
2.
Circ Heart Fail ; 14(4): e007957, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813838

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to afflict millions of people worldwide. Patients with end-stage heart failure and left ventricular assist devices (LVADs) may be at risk for severe COVID-19 given a high prevalence of complex comorbidities and functional impaired immunity. The objective of this study is to describe the clinical characteristics and outcomes of COVID-19 in patients with end-stage heart failure and durable LVADs. METHODS: The Trans-CoV-VAD registry is a multi-center registry of LVAD and cardiac transplant patients in the United States with confirmed COVID-19. Patient characteristics, exposure history, presentation, laboratory data, course, and clinical outcomes were collected by participating institutions and reviewed by a central data repository. This report represents the participation of the first 9 centers to report LVAD data into the registry. RESULTS: A total of 40 patients were included in this cohort. The median age was 56 years (interquartile range, 46-68), 14 (35%) were women, and 21 (52%) were Black. Among the most common presenting symptoms were cough (41%), fever, and fatigue (both 38%). A total of 18% were asymptomatic at diagnosis. Only 43% of the patients reported either subjective or measured fever during the entire course of illness. Over half (60%) required hospitalization, and 8 patients (20%) died, often after lengthy hospitalizations. CONCLUSIONS: We present the largest case series of LVAD patients with COVID-19 to date. Understanding these characteristics is essential in an effort to improve the outcome of this complex patient population.


Asunto(s)
/epidemiología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Pandemias , Anciano , /diagnóstico , Comorbilidad , Femenino , Insuficiencia Cardíaca/mortalidad , Ventrículos Cardíacos , Corazón Auxiliar/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estados Unidos/epidemiología
3.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(4): 365-371, 2021 Apr 12.
Artículo en Chino | MEDLINE | ID: mdl-33832025

RESUMEN

Objective: To explore the characteristics of sleep-disordered breathing (SDB) in chronic heart failure patients waiting for heart transplantation and the changes of SDB after transplantation. Methods: From September 2018 to December 2019, 34 patients with chronic heart failure were prospectively enrolled into this study, who were hospitalized for waiting for heart transplantation in the departments of cardiovascular medicine and cardiovascular surgery, Renmin Hospital of Wuhan University. All of them received portable sleep physiological monitoring. The characteristics of their SDB were analyzed before and after heart transplantation. Results: Of the 34 patients waiting for heart transplantation, 22 had central sleep apnea, 4 had obstructive sleep apnea and 8 had no SDB. The cycle length of Cheyne-Stokes respiration was negatively correlated with left ventricular ejection fraction. After heart transplantation, 15 patients received repeat sleep physiological monitoring and their results showed that the SDB was significantly improved, with the elimination of Cheyne-Stokes respiration. Conclusions: Patients waiting for heart transplantation had a high prevalence of SDB, with Cheyne-Stokes respiration with central sleep apnea as the main type. However, heart transplantation may eliminate the Cheyne-Stokes respiration in patients with chronic heart failure.


Asunto(s)
Insuficiencia Cardíaca , Trasplante de Corazón , Síndromes de la Apnea del Sueño , Respiración de Cheyne-Stokes , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/cirugía , Humanos , Volumen Sistólico , Función Ventricular Izquierda
4.
Mayo Clin Proc ; 96(4): 887-900, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33814091

RESUMEN

OBJECTIVE: To characterize the properties of the audible tones produced by current left ventricular assist device (LVAD) pumps approved for use, and to ascertain if changes in those may be present in the setting of pump thrombosis. PATIENTS AND METHODS: From August 31, 2016, to January 16, 2020, LVAD recipients consented to have surface recordings obtained using a high-fidelity digital stethoscope. Audio data were analyzed using digital recording and editing software to produce an acoustic spectrogram by Fast Fourier transformation. RESULTS: Recordings were obtained in 53 patient encounters (27 HeartMate II, 19 HeartWare and 7 HeartMate 3). In 12 patients (9 HeartMate II, 3 HeartWare) there was a clinical concern for pump thrombosis. In all patients and pump models, a fundamental frequency was noted, and the second and third harmonics were also clearly detectable. Where thrombosis occurred in the HeartMate II pump, the absolute (normal -46.9 [-57.5,-42.9] dB vs thrombosis -41.4 [-49.8,-26.8] dB; P=.08) and relative (normal 0.72 [0.62, 0.92] vs thrombosis 0.95 [0.86, 1.24]; P=.01) third harmonic frequencies were increased in amplitude. Where paired data were available, an increase in the absolute and relative third harmonic frequencies was observed in all patients. In the case of the HeartWare device, a consistent difference in harmonic amplitudes in the setting of thrombosis could not be identified. CONCLUSION: A consistent pattern of fundamental and harmonic frequencies is common to all LVADs currently approved for use. Alterations in the amplitude of higher order harmonics may signal the onset of pump thrombosis in axial flow LVADs.


Asunto(s)
Acústica , Circulación Sanguínea/fisiología , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Trombosis/prevención & control , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
5.
Med Sci Monit ; 27: e929791, 2021 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-33895770

RESUMEN

BACKGROUND We sought to create a model that incorporated ultrasound examinations to predict the risk of acute kidney injury (AKI) after percutaneous coronary intervention (PCI) or cardiopulmonary bypass (CPB) surgery. MATERIAL AND METHODS A total of 292 patients with AKI after PCI or CPB surgery were enrolled for the study. Afterwards, treatment-related information, including data pertaining to ultrasound examination, was collected. A random forest model and multivariate logistic regression analysis were then used to establish a predictive model for the risk of AKI. Finally, the predictive quality and clinical utility of the model were assessed using calibration plots, receiver-operating characteristic curve, C-index, and decision curve analysis. RESULTS Predictive factors were screened and the model was established with a C-index of 0.955 in the overall sample set. Additionally, an area under the curve of 0.967 was obtained in the training group. Moreover, decision curve analysis also revealed that the prediction model had good clinical applicability. CONCLUSIONS The prediction model was efficient in predicting the risk of AKI by incorporating ultrasound examinations and a number of factors. Such included operation methods, age, congestive heart failure, body mass index, heart rate, white blood cell count, platelet count, hemoglobin, uric acid, and peak intensity (kidney cortex as well as kidney medulla).


Asunto(s)
Lesión Renal Aguda/epidemiología , Puente Cardiopulmonar , Insuficiencia Cardíaca/cirugía , Intervención Coronaria Percutánea , Complicaciones Posoperatorias/epidemiología , Lesión Renal Aguda/etiología , Anciano , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Nomogramas , Estudios Retrospectivos , Riesgo , Ultrasonografía
7.
J Card Surg ; 36(7): 2342-2347, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33861471

RESUMEN

BACKGROUND: Left ventricular assist devices (LVAD) are standardly implanted via full sternotomy. Nonsternotomy approaches are gaining popularity, but potential benefits of this approach have not been well-studied. We hypothesized that LVAD implantation by bi-thoracotomy (BT) would demonstrate smaller and more consistent inflow cannula angles leading to improved postoperative outcomes compared to sternotomy. METHODS: Charts of patients who underwent LVAD implantation between June 2018 and June 2020 at a single academic institution were retrospectively reviewed. Patient demographics, surgical approach (sternotomy vs. BT), laboratory values, and postoperative course were compared. The inflow cannula angle was measured on the first chest radiograph available postoperatively. RESULTS: Of 40 patients studied, BT approach was used in 17 (42.5%). Mean inflow cannula angles were smaller in BT patients (23.0 vs. 37.1 degrees, p = .018) and had a smaller standard deviation (13.8 vs. 20.3). Excluding patients who went on to receive a heart transplant or died in the same hospitalization, there was no difference in median length of hospital stay after surgery (16.0 vs. 17.5 days, p = .768). However, BT patients required fewer days of postoperative inotrope support (4.0 vs. 7.0 days, p = .012). CONCLUSIONS: Our data suggest inflow cannula angles are smaller and more consistent with the BT approach, which leads to a shorter duration of postoperative inotropic support. This finding may suggest improved right heart function following LVAD implant via BT approach. Further study is warranted to determine additional benefits of the BT approach.


Asunto(s)
Insuficiencia Cardíaca , Corazón Auxiliar , Insuficiencia Cardíaca/cirugía , Humanos , Implantación de Prótesis , Estudios Retrospectivos , Esternotomía , Toracotomía
8.
J Card Surg ; 36(7): 2314-2328, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33908092

RESUMEN

BACKGROUND AND AIM: Thoracotomy approaches to left ventricular assist device (LVAD) implantation may reduce surgical morbidity and, through preservation of the pericardial restraint over the right heart, may reduce the incidence of right ventricular failure (RVF). METHODS: A meta-analysis of all original studies describing the effect of the surgical approach on postoperative outcomes after LVAD implantation was performed. Postoperative outcomes analyzed. RESULTS: Thirteen studies were included with 692 patients undergoing a sternotomy and 373 a thoracotomy approach. Patients undergoing a thoracotomy approach had a higher comorbid status (INTERMACS 1-2: 56% vs. 44%; p = .0004), but were less likely to undergo a concomitant procedure (4% vs. 15%; p = .0002) than patients undergoing a sternotomy approach. Patients undergoing a thoracotomy approach demonstrated a reduced incidence of RVF (OR, .47; CI, .23-.97; p = .04), reexploration for bleeding (OR, .55; CI, .32-.94; p = .03), perioperative blood transfusion (SMD, -.30; CI, -.49 to -.11; p = .002), LOS (-5.57; -10.56 to -.59; p = .03), and mortality (OR, .57; CI, .33-.98; p = .04), but no difference in RVAD requirement or stroke were noted. Metaregression demonstrated that the performance of a concomitant procedure did not modify the effect of the surgical approach on the primary endpoints of RVF or RVAD requirement. CONCLUSIONS: In the current meta-analysis including over 1000 patients undergoing LVAD implantation, a thoracotomy approach was associated with a reduced incidence of RVF (but not RVAD requirement), bleeding, LOS, and mortality. No difference in stroke rates was noted. These findings not only offer additional support as to the feasibility of a thoracotomy approach for LVAD implantation but also suggest a potential superiority over a sternotomy approach.


Asunto(s)
Insuficiencia Cardíaca , Corazón Auxiliar , Disfunción Ventricular Derecha , Insuficiencia Cardíaca/cirugía , Humanos , Estudios Retrospectivos , Esternotomía , Toracotomía
9.
J Mycol Med ; 31(2): 101125, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33857916

RESUMEN

Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.


Asunto(s)
/complicaciones , Trasplante de Corazón , Infecciones Fúngicas Invasoras/complicaciones , Mucormicosis/complicaciones , Complicaciones Posoperatorias/etiología , Rhizopus/aislamiento & purificación , Anciano , Antiinfecciosos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/etiología , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Terapia Combinada , Contraindicaciones de los Medicamentos , Desbridamiento , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/etiología , Susceptibilidad a Enfermedades , Resultado Fatal , Insuficiencia Cardíaca/cirugía , Humanos , Hidroxicloroquina/uso terapéutico , Inmunización Pasiva , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Contrapulsador Intraaórtico/instrumentación , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Masculino , Mucormicosis/tratamiento farmacológico , Mucormicosis/microbiología , Terapia de Presión Negativa para Heridas , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/virología , Infección de la Herida Quirúrgica/complicaciones , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/cirugía
10.
Georgian Med News ; (310): 60-67, 2021 Jan.
Artículo en Ruso | MEDLINE | ID: mdl-33658411

RESUMEN

The aim of the study was to optimize the methods of selecting patients for inclusion in the «WAITING LIST¼ for heart transplantation on the basis of available international data and the introduction of selection criteria. The results of the study are based on survey data and dynamic monitoring of 49 patients (median age 38 (16; 65) years, men 44 patients, women 5 patients) who were treated from 2008-2018 in the centers: Republican Scientific and Practical Center «Cardiology¼, Minsk, Republic of Belarus; in the Center of cardiac surgery on the basis of KL «Feofania¼ DUS, Kyiv, Ukraine. Patients were examined during the initial examination, after 3 months, 6 months and after 1 year. The first group consisted of 24 patients with CHF who were on the waiting list for orthotopic heart transplantation, for circulatory support, median age 40.95 (18.0; 65.0) years, men - 23, women - 1; the second group consisted of 25 patients with CHF who were on the waiting list for orthotopic heart transplantation without circulatory support, median age 38.56 (17.0; 64.0) years, men -21, women-4; Scientific novelty of the obtained results. Scientific novelty of the obtained results. For the first time in Ukraine, a road map has been developed and implemented and the dynamics of the movement of recipients who are in the "waiting list" for heart transplantation has been analyzed. Identified risk factors that affect the long-term outcomes and quality of life of patients with heart failure III-IV functional class according to the NYHA classification. Criteria for selection of patients for primary heart transplantation have been developed and implemented. For the first time in Ukraine, a "Waiting List" for a heart transplant has been formed.


Asunto(s)
Insuficiencia Cardíaca , Trasplante de Corazón , Anciano , Femenino , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , República de Belarús , Ucrania , Listas de Espera
11.
Kardiologiia ; 61(2): 91-98, 2021 Mar 06.
Artículo en Ruso | MEDLINE | ID: mdl-33715615

RESUMEN

This review focuses on major causes and risk factors for death of patients with atrial fibrillation (AF). The authors analyzed current therapeutic strategies for managing patients with AF with respect of their effects on prediction and mortality. Special attention is paid to the strategy of rhythm control and the clinical significance of catheter ablation in the treatment of patients with AF and heart failure.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Insuficiencia Cardíaca , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Insuficiencia Cardíaca/cirugía , Humanos , Pronóstico , Resultado del Tratamiento
12.
AJR Am J Roentgenol ; 216(5): 1267-1272, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33703927

RESUMEN

OBJECTIVE. The purpose of this study was to determine clinical outcomes of patients undergoing TIPS reduction. MATERIALS AND METHODS. In this institutional review board-approved, HIPAA-compliant study, all TIPS reductions performed at two institutions from January 1, 2008 to January 31, 2016, were retrospectively identified. Patients were divided into two groups according to pre-TIPS symptoms: volume overload due to ascites or hydrothorax (VO; n = 14) or variceal bleeding (VB; n = 12). Patient demographics, pre-TIPS model for end-stage liver disease score, pre- and post-TIPS portosystemic gradients, and clinical parameters were recorded. The primary endpoint was change in symptoms of hepatic encephalopathy (HE; West Haven criteria), right heart failure, or liver dysfunction. Secondary endpoints included paracentesis rate for the VO group and rebleeding for the VB group. RESULTS. The degree of HE increased in 24 of 26 patients (92%) after TIPS placement and decreased in 24 of 26 patients (92%) after TIPS reduction. Mean West Haven scores for the VO group decreased after TIPS reduction (from 2.57 ± 0.97 [SD] to 1.07 ± 0.70; p < .001). Mean West Haven scores for the VB group also decreased after TIPS reduction (from 2.45 ± 0.89 to 1.27 ± 0.86; p = .007). Right heart failure improved in two of three patients (67%), and total bilirubin improved in one of three patients (33%). Follow-up data were available up to median of 134 days (interquartile range, 44-286). TIPS reduction led to an increased paracentesis rate compared with before TIPS placement in four of 14 patients with VO (29%). One patient had a stable paracentesis rate after TIPS reduction compared with before TIPS placement. Variceal rebleeding did not occur in any patients with VB after TIPS reduction. At 54 days after TIPS reduction, one of the 12 patients with VB (9%) experienced hematemesis due to an endoscopically proven band-related ulcer. CONCLUSION. TIPS reduction successfully resolved HE and refractory right heart failure in most patients. In patients with VB, TIPS reduction with variceal embolization results in a low risk of short-term recurrent VB. However, in patients with VO, ascites may return or worsen after TIPS reduction despite improvement in HE.


Asunto(s)
Insuficiencia Cardíaca/cirugía , Encefalopatía Hepática/cirugía , Hepatopatías/cirugía , Derivación Portosistémica Intrahepática Transyugular/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
14.
Int J Cardiol ; 333: 98-104, 2021 06 15.
Artículo en Inglés | MEDLINE | ID: mdl-33647363

RESUMEN

BACKGROUND: We evaluated the 1-year success rate of maintaining sinus rhythm after catheter ablation (CA) for atrial fibrillation (AF) in patients with or without congestive heart failure (CHF). METHODS: In this single-centre retrospective matched-pair cohort study of 3,018 AF patients who underwent initial CA between January 2012 and June 2018, 227 pairs with (CHF group) or without CHF (control group) were matched using propensity scores. In the CHF group, 108 patients were assigned to the arrhythmia-induced cardiomyopathy (AIC) group whose left ventricular systolic dysfunction was explained only by lasting AF or atrial tachycardia; the remaining 119 had organic heart diseases (non-AIC group). We evaluated the 1-year AF-free survival and changes in clinical findings before and after CA. RESULTS: The CHF and control groups showed similar AF-free survival; however, AIC patients had significantly better survival than non-AIC patients. AF recurrence was significantly related to CHF re-hospitalisation, which was significantly more frequent in the non-AIC group than in the AIC group. The clinical outcomes of left atrial dilation, brain natriuretic peptide level, and left ventricular ejection function improved significantly before and after CA in both groups. The degree of improvement was significantly better in the AIC group than in the non-AIC group. CONCLUSIONS: The 1-year success rate was not significantly different between the CHF and control groups. The 1-year success rate in the AIC group was similar to that in the AIC-control group and was better than that in the non-AIC group. CHF clinical outcomes were improved significantly.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Insuficiencia Cardíaca , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/cirugía , Estudios de Cohortes , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/cirugía , Humanos , Estudios Retrospectivos , Resultado del Tratamiento
15.
Artículo en Inglés | MEDLINE | ID: mdl-33691041

RESUMEN

The HeartMate 3 is a ventricular assist device that supports the heart with a centrifugal continuous flow. It contains a fully levitated rotor to minimize hemolysis and was initially designed as an apical intrapericardial implant. It can be used as a bridge to a transplant, to recovery, or to destination therapy. After we excise the ventricles, we implant 2 HeartMate 3 devices as a total artificial heart (HeartMate 6). The patient was 35 years old when the devices were implanted and had been diagnosed with Yamaguchi syndrome (apical hypertrophic cardiomyopathy) at 13 years of age. Being listed for a transplant was not an option due to secondary pulmonary hypertension. Furthermore, the conventional method of apically implanting a left ventricular assist device was not possible due to the underlying pathology. A HeartMate 6 implant as a bridge to transplant therapy was planned. Additionally, a CardioMEMS HF System was implanted to monitor the pulmonary artery pressure. The video tutorial provides step-by-step instructions for implanting 2 HeartMate 3 devices as a total artificial heart.


Asunto(s)
Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/métodos , Ventrículos Cardíacos/cirugía , Corazón Auxiliar , Prótesis e Implantes , Adulto , Humanos , Masculino
16.
J Card Surg ; 36(4): 1344-1351, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33547707

RESUMEN

BACKGROUND: The aim of this study was to evaluate the impact of the surgical approach on the postoperative outcome in patients who underwent left ventricular assist device (LVAD) implantation after having received veno-arterial extracorporeal life support (va-ECLS) using data from a European registry (ECLS-VAD). Five hundred and thirty-one patients were included. METHODS: A propensity score-adjusted outcome analysis was performed, resulting in 324 patients in the full sternotomy (FS) group and 39 in the less invasive surgery (LIS) group. RESULTS: The surgery lasted in median 236 min in the FS group versus 263 min in the LIS group (p = 0.289). The median chest tube output during the first 24 h was similar in both groups. Patients who underwent implantation with an FS required more blood products during the first 24 postoperative hours (median 16 vs. 12, p = 0.033). The incidence of revision due to bleeding was also higher (35.5 vs. 15.4%, p = 0.016). A temporary postoperative right ventricular assist device was necessary in 45.1 (FS) versus 23.1% (LIS) of patients, respectively (p = 0.067). No stroke occurred in the LIS group during the first 30 days after surgery (7.4% in the FS group). The incidence of stroke and of renal, hepatic, and respiratory failure during the follow-up was similar in both groups. The 30-day and one-year survival were similar in both groups. CONCLUSION: LIS for implantation of a durable LVAD in patients on va-ECLS implanted for cardiogenic shock is associated with less revision due to bleeding, less administration of blood products and absence of perioperative stroke, with no impact on survival.


Asunto(s)
Oxigenación por Membrana Extracorpórea , Insuficiencia Cardíaca , Corazón Auxiliar , Insuficiencia Cardíaca/cirugía , Humanos , Implantación de Prótesis , Estudios Retrospectivos , Resultado del Tratamiento
17.
ASAIO J ; 67(3): 239-244, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33627595

RESUMEN

Left ventricular assist device (LVAD) implantation in patients with advanced heart failure due to hypertrophic or restrictive cardiomyopathy (HCM/RCM) presents technical and physiologic challenges. We conducted a systematic review of observational studies to evaluate the utilization and clinical outcomes associated with LVAD implantation in patients with HCM/RCM and compared these to patients with dilated or ischemic cardiomyopathy (DCM/ICM). We searched MEDLINE, EMBASE, and Scopus from inception through May 2019 and included appropriate studies describing the use of an LVAD in patients with HCM/RCM. We identified six studies with a total of 2,766 patients with HCM/RCM and advanced heart failure, among whom 338 patients (12.2%) underwent LVAD implantation. In patients listed for transplant, the rate of LVAD implantation was significantly lower in patients with HCM/RCM compared to that in patients with DCM/ICM (4.4% vs. 18.2%, p < 0.001). Adverse clinical outcomes were significantly higher in HCM/RCM than in DCM/ICM, including operative/short-term mortality (14.0% vs. 9.0%), right ventricular failure (50.0% vs. 21.0%), infection (15.5% vs. 11.2%), bleeding (40.2% vs. 12.5%), renal failure (15.0% vs. 5.1%), stroke (5.0% vs. 2.4%), and arrhythmias (18.0% vs. 7.7%) (all p values <0.001).


Asunto(s)
Cardiomiopatía Hipertrófica/cirugía , Cardiomiopatía Restrictiva/cirugía , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Adulto , Cardiomiopatía Restrictiva/complicaciones , Procedimientos Quirúrgicos Cardiovasculares/métodos , Procedimientos Quirúrgicos Cardiovasculares/mortalidad , Femenino , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto
18.
ASAIO J ; 67(3): 284-289, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33627602

RESUMEN

Although left ventricular assist device (LVAD) improves functional capacity, on average LVAD patients are unable to achieve the aerobic capacity of normal healthy subjects or mild heart failure patients. The aim of this study was to examine if markers of right ventricular (RV) function influence maximal exercise capacity. This was a single-center prospective study that enrolled 20 consecutive HeartWare ventricular assist device patients who were admitted at the Freeman Hospital (Newcastle upon Tyne, United Kingdom) for a heart transplant assessment from August 2017 to October 2018. Mean peak oxygen consumption (Peak VO2) was 14.0 ± 5.0 ml/kg/min, and mean peak age and gender-adjusted percent predicted oxygen consumption (%VO2) was 40.0% ± 11.5%. Patients were subdivided into two groups based on the median peak VO2, so each group consisted of 10 patients (50%). Right-sided and pulmonary pressures were consistently higher in the group with poorer exercise tolerance. Patients with poor exercise tolerance (peak VO2 below the median) had higher right atrial pressures at rest (10.6 ± 6.4 vs. 4.3 mmHg ± 3.2; p = 0.02) and the increase with passive leg raising was significantly greater than those with preserved exercise tolerance (peak VO2 above the median). Patients with poor functional capacity also had greater RV dimensions (4.4 cm ± 0.5 vs. 3.7 cm ± 0.5; p = 0.02) and a higher incidence of significant tricuspid regurgitation (moderate or severe tricuspid regurgitation in five patients in the poor exercise capacity group vs. none in the preserved exercise capacity group; p = 0.03). In conclusion, echocardiographic and hemodynamic markers of RV dysfunction discriminate between preserved and nonpreserved exercise capacity in HeartWare ventricular assist device patients.


Asunto(s)
Tolerancia al Ejercicio/fisiología , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Disfunción Ventricular Derecha/fisiopatología , Adulto , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
19.
BMC Surg ; 21(1): 64, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514381

RESUMEN

BACKGROUND: Myxoma is an uncommon disease and its symptoms vary greatly depending on size, location and mobility. Right-sided myxoma, especially right ventricular myxoma, is much rarer, and the symptoms are alien and uncharacteristic. The lack of understandings poses challenges to prompt diagnosis and timely treatment. CASE PRESENTATION: A 44-year-old female patient was diagnosed with giant right ventricular tumor. Right heart failure and systemic congestion caused by right ventricular outflow tract obstruction were observed on this case. Surgery was performed to excise the mass which was measured at 9.5 * 5.0 cm and confirmed as myxoma pathologically. CONCLUSIONS: Right-side myxoma is easy to be unnoticed due to its low incident rate and atypical symptoms. Delay in surgical intervention might cause unrecoverable complications. More comprehensive understanding of the symptoms is expected to help improving the diagnose and treat of right-sided myxoma.


Asunto(s)
Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/cirugía , Mixoma/complicaciones , Mixoma/cirugía , Adulto , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/cirugía , Humanos , Mixoma/diagnóstico por imagen , Enfermedades Raras , Resultado del Tratamiento
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