RESUMO
Left ventricular assist device (LVAD) implantation is one of the mechanical circulatory support (MCS) treatments for advanced heart failure (HF) patients. MCS has emerged as a lifesaving therapy that improves patients' quality of life. However, MCS remains limited by a paradoxical coagulopathy accompanied by thrombosis and bleeding. The mechanisms of MCS thrombosis are increasingly being defined, but MCS-related bleeding, which is related to shear-mediated alteration of platelet function, remains poorly understood. Complications might develop due to the high non-physiological shear stress in the device and as a consequence of individual variability in response to the antithrombotic therapy. Thromboelastography (TEG) and genotyping of gene polymorphisms that are involved in the coagulation cascade and in the metabolism of the antithrombotic therapy might be valuable sources of information for the reduction of complication development. The aim of the study was to identify genetic factors related to the development of device complications according to the implanted LVAD type. We compared the clinical and genetic data of HF patients (n = 98) with/without complications with three types of implanted devices: HeartWare HVAD (HW), HeartMate II (HMII), and HeartMate 3 (HM3). rs9923231 in VKORC1 (95%CI -6.28-0.22, p = 0.04) and rs5918 in ITGB3 genes (95%CI 0.003-4.36, p = 0.05) showed significant association with the TEG coagulation index parameter, which identified hyper- and hypo-coagulation states. The wild genotype of rs5918 in the ITGB3 gene prevailed in patients implanted with HM3 devices, which developed fewer complications than with HMII (p = 0.04). Individual genetic information could be useful in the management of patients with HF and the implantation of MCS to reduce the development of complications.
RESUMO
The left ventricular assist device (LVAD) is one of the alternative treatments for heart failure (HF) patients. However, LVAD support is followed by thrombosis, and bleeding complications which are caused by high non-physiologic shear stress and antithrombotic/anticoagulant therapy. A high risk of complications occurs in the presence of the genotype polymorphisms which are involved in the coagulation system, hemostasis function and in the metabolism of the therapy. The aim of the study was to investigate the influence of single-nucleotide polymorphisms (SNP) in HF patients with LVAD complications. We analyzed 21 SNPs in HF patients (n = 98) with/without complications, and healthy controls (n = 95). SNPs rs9934438; rs9923231 in VKORC1, rs5918 in ITGB3 and rs2070959 in UGT1A6 demonstrated significant association with HF patients' complications (OR (95% CI): 3.96 (1.42-11.02), p = 0.0057), (OR (95% CI): 3.55 (1.28-9.86), p = 0.011), (OR (95% CI): 5.37 (1.79-16.16), p = 0.0056) and OR (95% CI): 4.40 (1.06-18.20), p = 0.044]. Genotype polymorphisms could help to predict complications at pre- and post-LVAD implantation period, which will reduce mortality rate. Our research showed that patients can receive treatment with warfarin and aspirin with a personalized dosage and LVAD complications can be predicted by reference to their genotype polymorphisms in VKORC1, ITGB3 and UGT1A6 genes.
RESUMO
PURPOSE: The purpose of this study was to assess the impact of developed minimally invasive operation such as the partial lateral facetectomy (PLFE) with patella thickness resection in patients with lateral patellofemoral (PF) osteoarthritis on short-term clinical and radiographic outcomes. METHODS: This is a prospective study of 27 knees in 27 patients (18 females and 9 males, mean aged at surgery 59.1-year old) whom a PLFE with patella thickness resection using developed minimally invasive method was performed. Data of preoperative and postoperative questionnaires, physical examinations, and radiographs were analyzed. The minimum follow-up was 12 months (mean, 24.1 months; range, 12-36 months). RESULTS: The subjective outcomes included the anterior pain relief assessed by scores using the Western Ontario and McMaster Universities Arthritis Index score (scores improved considerably by 2.34 points with respect to pain and by 1.63 points with respect to function), visual analog scale, and Knee Society Score (that improved in 78% of the knees). The majority of these patients experienced improvement in their PF symptoms. The PF index decreased considerably after surgery. The mean patellar width and thickness were decreased after surgery, maintaining a width/thickness ratio of 1.8:1.0 after surgery. CONCLUSION: PLFE with patella thickness resection aiming to decrease the high pressure in the lateral facet and improving congruence of the patella confirmed frequent pain relief. This surgical procedure is minimally invasive, relatively simple, and effective in selected patients and can be a valid early alternative to more complex operations. Level of Evidence: Level IV Therapeutic study.
