RESUMO
BACKGROUND: Insufficient data delineate outcomes for Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 patients with the total artificial heart (TAH). METHODS: We studied 66 consecutive patients implanted with the TAH at our institution from 2006 through 2012 and compared outcome by INTERMACS profile. INTERMACS profiles were adjudicated retrospectively by a reviewer blinded to clinical outcomes. RESULTS: Survival after TAH implantation at 6 and 12 months was 76% and 71%, respectively. INTERMACS profile 1 patients had decreased 6-month survival on the device compared with those in profiles 2-4 (74% vs 95%, log rank: P = .015). For the 50 patients surviving to heart transplantation, the 1-year posttransplant survival was 82%. There was no difference in 1-year survival when comparing patients in the INTERMACS 1 profile with less severe profiles (79% vs 84%; log rank test P = .7; hazard ratio [confidence interval] 1.3 [0.3-4.8]). CONCLUSIONS: Patients implanted with the TAH as INTERMACS profile 1 had reduced survival to transplantation compared with less sick profiles. INTERMACS profile at the time of TAH implantation did not affect 1-year survival after heart transplantation.
Assuntos
Causas de Morte , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Coração Auxiliar/estatística & dados numéricos , Sistema de Registros , Adulto , Estudos de Coortes , Estado Terminal , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Transplante de Coração/mortalidade , Coração Auxiliar/efeitos adversos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos , Listas de EsperaRESUMO
The total artificial heart (TAH) is effective for bridging patients with biventricular heart failure (BiVHF) to transplantation. It consists of two pneumatic pumps with four mechanical valves that replace nearly the entire myocardium, thus also making it effective therapy for heart failure from alternative (ALT) anatomical and pathophysiological causes that preclude left ventricular assist device (LVAD). This report reviews the clinical indications and outcomes for TAH implantation at our institution from 2006 to 2012. We sought to characterize and compare survival to transplant for patients with BiVHF to those with ALT indications. The overall survival to transplant for all patients was 86% (57/66). There was a trend towards decreased survival to transplantation in the ALT group compared with the BiVHF group (77% vs. 93%, HR 0.42 [95% confidence interval 0.1, 1.7], log-rank test: p = 0.2). This was likely driven by certain high risk subgroups of allograft failure, LVAD failure, and acute postinfarct shock.
Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/mortalidade , Coração Artificial , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The epidemiology of infective endocarditis is changing due to a number of factors, including more frequent and varied antibiotic use, the emergence of resistant microorganisms, and an increase in the implantation of cardiovascular devices. This review outlines and consolidates the most recent guidelines, including the 2007 and 2010 AHA/ACC guidelines and scientific statements for the prevention and management of infective endocarditis and for the management of cardiovascular device infections. The evidence-based guidelines, including the 2009 HRS consensus document, for the treatment of patients with cardiovascular device-related infections are also reviewed. Only patients with prosthetic valves, patients with prior endocarditis, cardiac transplant patients with a valvulopathy, and certain congenital heart disease patients now require endocarditis prophylaxis. There is an increasing incidence of cardiovascular device-related infections due to the higher frequency of implanted devices and higher morbidity and mortality rates in older patients.
Assuntos
Antibacterianos/uso terapêutico , Endocardite , Infecções Relacionadas à Prótese/terapia , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/prevenção & controle , Cardiopatias Congênitas/tratamento farmacológico , Transplante de Coração , Doenças das Valvas Cardíacas/tratamento farmacológico , Humanos , Guias de Prática Clínica como Assunto , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/prevenção & controleRESUMO
Foreign bodies in the heart are a rare occurrence and can result from intravenous drug abuse, trauma or iatrogenic causes. There are no current guidelines for the treatment of a cardiac foreign body. We hereby present a brief review of the available literature and report a case of a woman with chest pain subsequently complicated by cardiogenic shock due to tamponade secondary to a needle fragment perforating her right ventricular free wall.
Assuntos
Dor no Peito/etiologia , Corpos Estranhos/complicações , Traumatismos Cardíacos/complicações , Ventrículos do Coração/lesões , Ferimentos Penetrantes Produzidos por Agulha/complicações , Dor no Peito/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Corpos Estranhos/diagnóstico , Traumatismos Cardíacos/diagnóstico , Humanos , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Radiografia TorácicaRESUMO
A case of methadone-induced torsades de pointes is presented to demonstrate clinical features that predispose patients to this serious cardiac arrhythmia. A patient who was receiving methadone maintenance treatment for heroin addiction presented to the hospital with dizziness and near-syncope. He was taking a relatively high dose of methadone but was not taking any concomitant cytochrome P450 inhibitor or QT-prolonging drugs. He had prolonged corrected QT interval, hypokalemia, and hypomagnesemia on admission and was later found to have severe left ventricular dysfunction. On admission to a telemetry unit, the patient experienced chest discomfort and palpitations with corresponding torsades de pointes that was terminated with correction of hypokalemia and hypomagnesemia. The corrected QT interval became shorter but remained profoundly prolonged until methadone was substituted with buprenorphine.
Assuntos
Analgésicos Opioides/efeitos adversos , Metadona/efeitos adversos , Torsades de Pointes/induzido quimicamente , Dependência de Heroína , Humanos , Hipopotassemia/induzido quimicamente , Deficiência de Magnésio/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Disfunção Ventricular Esquerda/induzido quimicamenteRESUMO
BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by an exaggerated increase in heart rate that occurs during standing, without orthostatic hypotension. Women are most frequently affected, and may present with palpitations, chest discomfort, shortness of breath, weakness, exercise intolerance, lightheadedness, presyncope, and syncope. METHODS: We present three cases of POTS in otherwise healthy women, and discuss the clinical management of different types of this orthostatic intolerance. RESULTS AND CONCLUSION: The diagnosis was established with a tilt-table test in 1 patient who became symptom-free with ß-blockade and nonpharmacologic treatment, including fluid therapy, liberal sodium intake, support hose, and a reconditioning exercise program. The other 2 were diagnosed through a standing test, serum norepinephrine levels, and red-cell volumes. One patient had neuropathic POTS and partially responded to b-blockade and nonpharmacotherapy. The other patient had hyperadrenergic POTS and responded well to nonpharmacotherapy, a dualacting b-blocker, and a vasoconstrictor agent. Postural orthostatic tachycardia syndrome is not an uncommon clinical entity and making a correct diagnosis is crucial in providing appropriate treatment to restore patients' functional capability and quality of life.