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1.
Circ Rep ; 3(11): 647-653, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34805604

RESUMO

Background: Both hypo- and hyperkalemia are associated with adverse events in heart failure patients. Their effects on patients with left ventricular assist devices (LVADs) remains unknown. Methods and Results: The cohort included consecutive patients undergoing LVAD implantation between 2014 and 2018. In all, 170 patients (median age 56 years; 117 males) were stratified according to serum potassium levels 1 month after implantation into 3 groups: hypokalemia (<3.5 mEq/L; n=15), normokalemia (n=146), and hyperkalemia (>5.0 mEq/L; n=9). Compared with the normokalemia group, the adjusted hazard ratios for 1-year mortality were 0.91 (95% confidence interval [CI] 0.21-3.92) for hypokalemia and 4.14 (95% CI 1.47-11.65) for hyperkalemia. In the hyperkalemia group, the prevalence of renin-angiotensin-aldosterone system inhibitors decreased and serum potassium levels normalized following the first month. Conclusions: Hyperkalemia was associated with increased mortality during LVAD support. Management of serum potassium needs further investigation.

3.
J Card Surg ; 36(11): 4054-4060, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34423475

RESUMO

BACKGROUND: Aortic cusp extension is a technique for aortic valve (AV) repairs in pediatric patients. The choice of the material used in this procedure may influence the time before reoperation is required. We aimed to assess postoperative and long-term outcomes of patients receiving either pericardial or synthetic repairs. METHODS: We conducted a single-center, retrospective study of pediatric patients undergoing aortic cusp extension valvuloplasty (N = 38) with either autologous pericardium (n = 30) or CorMatrix (n = 8) between April 2009 and July 2016. Short- and long-term postoperative outcomes were compared between the two groups. Freedom from reoperation was compared using Kaplan-Meier analysis. Degree of aortic stenosis (AS) and aortic regurgitation (AR) were recorded at baseline, postoperatively, and at outpatient follow-up. RESULTS: At 5 years after repair, freedom from reoperation was significantly lower in the CorMatrix group (12.5%) compared to the pericardium group (62.5%) (p = .01). For the entire cohort, there was a statistically significant decrease in the peak trans-valvar gradient between preoperative and postoperative assessments with no significant change at outpatient follow-up. In the pericardium group, 28 (93%) had moderate to severe AR at baseline which improved to 11 (37%) postoperatively and increased to 21 (70%) at time of follow-up. In the biomaterial group, eight (100%) had moderate to severe AR which improved to three (38%) postoperatively and increased to seven (88%) at time of follow-up. CONCLUSION: In terms of durability, the traditional autologous pericardium may outperform the new CorMatrix for AV repairs using the cusp extension method.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Procedimentos Cirúrgicos Cardíacos , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Criança , Humanos , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
5.
J Card Surg ; 36(3): 1159-1161, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33533108

RESUMO

Unplanned readmissions frequently occur following the implantation of a durable left ventricular assist device (LVAD) due to complications such as gastrointestinal bleeding and driveline infection. There is a paucity of literature describing the incidence of unplanned readmission in patients with a HeartMate 3 (HM3) Left Ventricular Assist System. In this report, we present the successful outcome of a patient with an HM3 LVAD who has experienced no unplanned readmissions in the 4-year post-implant phase. To our knowledge, this is the longest readmission-free case after HM3 implantation. A successful patient outcome was enabled by the use of the modular HM3 device, the postoperative prescription of beta-blockers and omega-3, the presence of strong social support, and open communication between the patient's caregivers and the LVAD team. Reducing the instance of unplanned readmission confers clinical benefits to the patient, as well as reducing the cost burden on the patient and the healthcare system.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Insuficiência Cardíaca/terapia , Ventrículos do Coração , Humanos , Período Pós-Operatório , Estudos Retrospectivos
6.
Cardiol Young ; 31(5): 848-850, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33487195

RESUMO

Loeys-Dietz syndrome is a connective tissue disorder known to cause aggressive aortopathy in paediatric patients, but it is extremely rare for cardiovascular events to present during infancy. We report the first successful aortic repair in a neonate with LDS presenting in extremis with an early onset, massive aortic aneurysm.


Assuntos
Aneurisma da Aorta Torácica , Síndrome de Loeys-Dietz , Procedimentos Cirúrgicos Reconstrutivos , Aneurisma da Aorta Torácica/cirurgia , Criança , Humanos , Recém-Nascido , Síndrome de Loeys-Dietz/complicações , Síndrome de Loeys-Dietz/diagnóstico , Síndrome de Loeys-Dietz/cirurgia , Procedimentos Cirúrgicos Vasculares
7.
Int J Artif Organs ; 44(2): 110-114, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32779494

RESUMO

BACKGROUND: Tobacco smoking is a significant source of morbidity in patients with a durable left ventricular assist device. While various cessation strategies have been investigated, the ability of ventricular assist device centers to implement a successful tobacco cessation program remains uncertain. We explored various cessation strategies employed by ventricular assist device centers and assessed perspectives of their effectiveness, as well as institutional investment in these programs. METHODS: A 37-question online self-report survey was created using Survey Monkey® and distributed worldwide. We investigated (1) programmatic strategies utilized for smoking cessation, (2) the respondent's perspective on the effectiveness of these strategies, (3) the structure with which these therapies are administered, and (4) overall organizational support for these treatments. RESULTS: A total of 47 centers worldwide completed the survey. The most common methods of tobacco cessation were pharmacologic and nicotine replacement therapy (78% and 66%). However, only about half (47% and 50%, respectively) of the centers indicated that these strategies were effective. When asked whether a respondent's center perceives that tobacco smoking should be a deciding factor in destination therapy evaluations, nearly a third (15, 32%) responded in the affirmative. CONCLUSION: While significant overlap exists among centers regarding treatments used for smoking cessation with left ventricular assist device patients, the most common treatments are not thought to be effective. While the current recommendations require tobacco smoking cessation in only bridge-to-transplant patients and not destination therapy patients, a number of centers disagree with the national guidelines and believe smoking should be prohibited in both populations.


Assuntos
Insuficiência Cardíaca , Abandono do Hábito de Fumar , Fumar Tabaco , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Feminino , Saúde Global , Insuficiência Cardíaca/psicologia , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Política Organizacional , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos , Inquéritos e Questionários , Fumar Tabaco/epidemiologia , Fumar Tabaco/psicologia , Fumar Tabaco/terapia
8.
Ann Thorac Surg ; 111(5): e339-e341, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33069680

RESUMO

Many instances of coronary artery anomalies are documented in the literature; however, the detection and treatment of an asymmetric, large aortic cusp causing obstruction of a coronary ostium in a symptomatic infant remains unreported. We present a case of a 2-month-old infant with an enlarged right coronary cusp obstructing the left coronary ostium, requiring emergent repair by relocating the left coronary button and reconstructing the sinus of Valsalva with autologous pericardium. This procedure preserved native aortic valve function, and the child remains asymptomatic months after discharge.


Assuntos
Insuficiência da Valva Aórtica/congênito , Valva Aórtica/anormalidades , Oclusão Coronária/complicações , Parada Cardíaca/etiologia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Cateterismo Cardíaco , Oclusão Coronária/diagnóstico , Ecocardiografia , Eletrocardiografia , Feminino , Parada Cardíaca/diagnóstico , Humanos , Lactente
9.
ASAIO J ; 67(9): 1051-1059, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33181541

RESUMO

Infants are a unique transplant population due to a suspected immunologic advantage, in addition to differences in size and physiology. Consequently, we expect infants to have significantly different diagnoses, comorbidities, and outcomes than pediatric transplant recipients. In this study, we compare patterns and trends in pediatric and infant heart transplantation during three decades. The United Network for Organ Sharing (UNOS) database was queried for transplants occurring between January 1990 and December 2018. Patients were categorized as pediatric (1-17) or infant (0-1). Congenital heart disease (CHD) primary diagnoses have increased from 37% to 42% in pediatric patients (p = 0.001) and decreased from 80% to 61% in infants during the 1990s and 2010s (p < 0.001). Those with CHD had worse outcomes in both age groups (p < 0.001). Infants who underwent ABO-incompatible transplants had similar survival as compared to those with compatible transplants (p = 0.18). Overall, infants had better long-term survival and long-term graft survival than pediatric patients; however, they had worse short-term survival (p < 0.001). Death due to rejection or graft failure was less likely in infants (p = 0.034). However, death from infection was over twice as common (p < 0.001). In summary, pediatric and infant heart transplant recipients differ in diagnoses, comorbidities, and outcomes, necessitating different care for these populations.


Assuntos
Cardiopatias Congênitas , Transplante de Coração , Sistema ABO de Grupos Sanguíneos , Criança , Bases de Dados Factuais , Rejeição de Enxerto , Sobrevivência de Enxerto , Cardiopatias Congênitas/cirurgia , Transplante de Coração/efeitos adversos , Humanos , Lactente , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento
10.
Cardiol Young ; 31(3): 476-478, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33272339

RESUMO

A full-term, female presented on her date of birth with severe pulmonary hypertension (PH) and mitral regurgitation (MR), requiring veno-arterial extracorporeal membrane oxygenation. After the treatment, her PH and MR were resolved with no anatomic abnormality present. We propose a positive feedback loop of PH causing right ventricular dilation and interventricular septal shifts, worsening MR, and elevated left atrial, and potentially pulmonary, pressures.


Assuntos
Oxigenação por Membrana Extracorpórea , Hipertensão Pulmonar , Insuficiência da Valva Mitral , Feminino , Átrios do Coração , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Lactente , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico
11.
Artif Organs ; 45(6): 587-592, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33236371

RESUMO

Worsening systemic congestion is often the central trigger of hospitalization in patients with heart failure. However, accurate assessment of congestion is challenging. The prognostic impact of systemic congestion following durable continuous-flow left ventricular assist device (LVAD) implantation remains unknown. Consecutive patients who received durable continuous-flow LVAD implantation between January 2014 and June 2017 and were followed for 1 year were included. The association of preoperative plasma volume status, which was calculated using patients' body weight and hematocrit and expressed as a deviation from ideal plasma volume, with 1-year mortality following LVAD implantation was investigated. In total, 186 patients (median 57 years and 138 males) were included. Baseline plasma volume status was -30.1% (-37.1%, -19.4%) on median. Eighty-eight patients (47%) had higher plasma volume status (>-29.8%), and their 1-year survival was significantly lower than those without (67% vs. 87%, P = .001). High plasma volume status was an independent predictor of 1-year death with an adjusted hazard ratio of 4.52 (95% confidence interval 1.52-13.5). Baseline systemic congestion, as defined by the high plasma volume status, was associated with higher mortality following durable continuous-flow LVAD implantation. The implication of improving preoperative plasma volume remains an area of needed investigation.


Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Coração Auxiliar , Volume Plasmático , Idoso , Feminino , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
12.
Int J Artif Organs ; 44(3): 188-193, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32907458

RESUMO

BACKGROUND: The seasonal variation of incidence and severity of heart failure is well known. However, the impact of seasonal variation on clinical outcomes following left ventricular assist device (LVAD) implantation remains unknown. METHODS: We retrospectively reviewed consecutive patients who received LVAD implantation between January 2014 and December 2016 along with their first year of post-implant outcomes. Clinical outcomes were compared between those with winter LVAD implantation (between October and March) and those with non-winter LVAD implantation. RESULTS: 168 patients with a median age of 57 years and 130 males were included. There was no seasonal difference in the number of LVAD implantations. One-year survival free from major adverse events was significantly lower in the winter implant group (n = 88) compared to the non-winter group (n = 80) (44% vs 61%) with an adjusted hazard ratio of 1.81 (95% confidence interval 1.11-2.90, p = 0.014), largely due to a higher rate of heart failure readmission in the winter implant patients (incidence rate ratio 2.29, 95% confidence interval 0.89-5.84). CONCLUSION: Patients who underwent LVAD implantation during the winter season had a higher heart failure readmission rate. A detailed mechanism and therapeutic strategy given our findings warrant further investigation.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Estações do Ano , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Coração Auxiliar/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Modelos de Riscos Proporcionais , Falha de Prótese , Estudos Retrospectivos , Índice de Gravidade de Doença
13.
Prog Transplant ; 30(4): 355-359, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32954968

RESUMO

BACKGROUND: Advanced technology and improved outcomes have led to rapid growth of ventricular assist devices (VADs) throughout the world, but little exists regarding their structure. We sought to study trends in VAD programs on a global level. METHODS: We distributed a 26-question online survey to 321 individuals who work within those programs. Four categories of questions were formed: patient management, coordinator role, multidisciplinary support, and leadership. RESULTS: Fifty-eight surveys (47 United States, 11 international) were analyzed. The majority of programs cared for 26 to 100 device-assisted patients (62%), 26% cared for ≤25 patients, and 12% cared for ≥100 patients. Advanced practice providers (APPs) were used in 69% of programs as a device coordinator. In-hospital rounding was performed equally among the APPs and registered nurses. Most programs used a social worker (90%), nutritionist (74%), pharmacist (72%), palliative care (66%), and finance coordinator (64%). Less than half (43%) included a case manager and only 33% used a pharmacist. The program leader was identified as a cardiologist (31%) or surgeon (26%) or both equally (43%). CONCLUSION: This study demonstrates differences and similarities between VAD program structures. Additional research is warranted to evaluate the effect of program structure on outcomes, job satisfaction, and retention regions.


Assuntos
Saúde Global/normas , Coração Auxiliar/estatística & dados numéricos , Coração Auxiliar/normas , Procedimentos Cirúrgicos Torácicos/métodos , Procedimentos Cirúrgicos Torácicos/estatística & dados numéricos , Procedimentos Cirúrgicos Torácicos/normas , Disfunção Ventricular/cirurgia , Adulto , Idoso , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
14.
J Card Surg ; 35(11): 3070-3077, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32939865

RESUMO

BACKGROUND: The negative impact of baseline hypoalbuminemia on clinical outcome following left ventricular assist device (LVAD) implantation is well known. However, the implications of perioperative change in serum albumin levels on post-LVAD outcomes remain uninvestigated. METHODS: Among consecutive patients with baseline serum albumin <3.5 g/dl who received durable LVAD implantation between April 2014 and August 2017 and were followed for 1 year, the impact of perioperative change in serum albumin level from baseline to 3 months post-LVAD on the incidence of adverse events was investigated. RESULTS: Sixty-eight patients (median 60 years and 69% male) were included. Serum albumin change was an independent predictor of the occurrence of adverse events with an adjusted hazard ratio of 0.32 (95% confidence interval, 0.13-0.78) and a cutoff change of 0.7 g/dl. Those with albumin increase >0.7 g/dl had higher 1-year freedom from adverse events (45% vs. 14%, p = .008), dominantly due to lower incidence of death or sepsis compared with those without (p < .05 for both). CONCLUSION: Among those with baseline hypoalbuminemia, a considerable perioperative increase in serum albumin levels following LVAD implantation was associated with lower mortality and morbidity. The implication of aggressive nutrition intervention on LVAD patients is the next concern.


Assuntos
Coração Auxiliar , Albumina Sérica , Idoso , Feminino , Seguimentos , Ventrículos do Coração , Coração Auxiliar/efeitos adversos , Humanos , Hipoalbuminemia/complicações , Hipoalbuminemia/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Terapia Nutricional , Período Perioperatório , Prognóstico , Sepse/epidemiologia , Sepse/etiologia , Fatores de Tempo , Resultado do Tratamento
15.
Head Neck ; 42(11): E30-E34, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32767409

RESUMO

BACKGROUND: Patients requiring intensive upper airway reconstruction are anatomically restricted in terms of the respiratory support they can receive. While intraoperative extracorporeal membrane oxygenation (ECMO) has been effectively utilized, little has been shown regarding the utility of ECMO for long-term support in these patients. METHODS: We demonstrate how a patient with tongue and hypopharyngeal squamous cell carcinoma that necessitated upper airway reconstruction was supported with veno-venous (VV) ECMO due to postoperative respiratory failure and an inability to maintain a stable airway. RESULTS: By initiating VV ECMO, we were able to decrease positive pressure ventilation and FiO2 , thereby minimizing ventilator-associated trauma and irritation to facilitate wound healing. Over time, ventilatory support was increased in parallel with decreasing ECMO support, allowing discharge to rehabilitation after 74 days of ECMO. CONCLUSION: ECMO can effectively support patients with ongoing respiratory requirements following upper airway reconstruction when standard ventilatory techniques are inadequate or not feasible.


Assuntos
Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório , Humanos , Alta do Paciente , Período Pós-Operatório , Traqueia
16.
J Card Surg ; 35(11): 2913-2919, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32741008

RESUMO

BACKGROUND: Active smoking is associated with worse clinical outcomes following left ventricular assist device (LVAD) implantation. However, the effect of sex differences in conjunction with smoking status remains uninvestigated. METHODS: Consecutive patients who underwent LVAD implantation between January 2013 and September 2018 were included. Clinical outcomes were retrospectively compared between the current smokers and never smokers among male cohorts and female cohorts separately. RESULTS: About 130 patients, with a median age of 56 years, were included. Among the male cohort (N = 85), the current smokers (N = 25/85) had a higher total readmission rate than the never smokers (N = 60/85) with an adjusted incidence rate ratio of 2.38 (95% confidence interval, 1.16-3.85, P = .014), dominantly due to higher rates of gastrointestinal bleeding, stroke, and hemolysis. Among the female cohorts (N = 45), never smokers (N = 36/45) had a statistically comparable total readmission rate (2.80 vs 2.50 events per year; P = .37) compared with current smokers (N = 9/45). CONCLUSION: Among male patients with LVAD, active smoking was associated with higher rates of adverse events. Female patients with LVAD had a high rate of adverse events irrespective of smoking status. Gender-specific therapeutic approaches might be required to prevent LVAD-related comorbidities.


Assuntos
Coração Auxiliar , Caracteres Sexuais , Fumar/efeitos adversos , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Coração Auxiliar/efeitos adversos , Hemólise , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
17.
Int Heart J ; 61(3): 547-552, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32350211

RESUMO

The use of opioids during left ventricular assist device (LVAD) support is increasing, but the implication remains unknown. We investigated the association between the use of opioid and morbidities during LVAD supports. We retrospectively reviewed the clinical data of patients who received LVAD between 2014 and 2017, which were stratified by the use of opioid at post-LVAD 3 months. Among 136 patients, 77 (57%) were in the opioid group. Hemoglobin and albumin were lower, and C-reactive protein was higher at baseline and 3 months later in the opioid group (P < 0.05 for all). The opioid group displayed worse hemodynamics, with higher pulmonary capillary wedge pressure and central venous pressure (P < 0.05 for both). Furthermore, the opioid group had higher incidences of gastrointestinal bleeding (31% versus 17%, P = 0.043) and sepsis (30% versus 13%, P = 0.036) during the 1 year observational period, whereas survivals were not stratified by the use of opioid (83% versus 90%, P = 0.27). Opioid use was associated with morbidities accompanied by poor hemodynamics during LVAD supports. The detailed causality of opioid use on morbidities remains a future concern.


Assuntos
Analgésicos Opioides/administração & dosagem , Coração Auxiliar , Idoso , Pressão Venosa Central , Chicago/epidemiologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pressão Propulsora Pulmonar , Estudos Retrospectivos , Sepse/epidemiologia
18.
Circ Heart Fail ; 13(4): e006666, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32264715

RESUMO

BACKGROUND: The NuPulseCV intravascular ventricular assist system (iVAS) provides extended duration ambulatory counterpulsation via a durable pump placed through the distal subclavian artery. METHODS: We performed a prospective, single-arm, multicenter, US Food and Drug Administration-approved feasibility trial of iVAS therapy as a bridge to transplant or decision following the FIH (First-In-Human) trial. RESULTS: Forty-seven patients were enrolled, and 45 patients (median 61 years old, 37 males, and 30 listed on United Network of Organ Sharing) received iVAS support for median 44 (25-87) days. There were no intraoperative complications. Success was defined as survival or transplant on iVAS therapy free from disabling stroke. Outcome success at 30 days (the primary end point of this study) and at 6 months was 89% and 80%, respectively. During 6 months of iVAS support, 2 patients died and 2 patients experienced disabling neurological dysfunction. Six-minute walk distance, 2-minute step test, and Kansas City Cardiomyopathy Questionnaire score improved during 4-week iVAS support. CONCLUSIONS: This feasibility trial demonstrated promising short-term outcomes of iVAS therapy with improved functional capacity and quality of life during the therapy. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02645539.


Assuntos
Contrapulsação/instrumentação , Tolerância ao Exercício , Insuficiência Cardíaca/terapia , Coração Auxiliar , Qualidade de Vida , Idoso , Contrapulsação/efeitos adversos , Contrapulsação/mortalidade , Estudos de Viabilidade , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Recuperação de Função Fisiológica , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
19.
J Card Surg ; 35(6): 1357-1359, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32333435

RESUMO

We report a case of successful heart and liver transplantation requiring intraoperative extracorporeal membrane oxygenation (ECMO) for primary cardiac allograft dysfunction in a patient with Fontan failure. A successful outcome for both the heart and the liver can be achieved with the timely management of ECMO support. In describing our experiences treating a Fontan patient requiring multiorgan transplantation, we have shown that challenging cases such as this one can have successful outcomes if multidisciplinary collaborations and proper treatment strategies are utilized at the optimal timing, along with family support and patient cooperation.


Assuntos
Oxigenação por Membrana Extracorpórea , Técnica de Fontan , Transplante de Coração , Cuidados Intraoperatórios , Transplante de Fígado , Disfunção Primária do Enxerto/terapia , Adulto , Aloenxertos , Feminino , Humanos , Comunicação Interdisciplinar , Cooperação do Paciente , Falha de Tratamento , Resultado do Tratamento
20.
Artif Organs ; 44(7): 693-699, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32017136

RESUMO

Despite the well-established correlation between the tobacco use and cardiovascular disease, little is known about postoperative outcomes following the left ventricular assist device (LVAD) implantation. We aimed to elucidate the effect of tobacco smoking on post-LVAD implant outcomes. Patients who received LVADs from 2013 to 2018 were retrospectively characterized as current, former, or never smokers at the time of implant. We examined 1-year survival, total hospital readmissions, and specific hospital readmissions for LVAD-related adverse events based on patient's smoking status. Of the enrolled patients (n = 292), 55% were former smokers, 33% were never smokers, and 11% were current smokers. The majority of patients were African-American (48%) with a median age of 58 years. Never smokers were younger and less likely to be Caucasian compared to former or current smokers (P < .05, for both). The category of former smokers had statistically comparable total readmission rates with never smokers (2.49 vs. 2.13 event/year), whereas current smokers had significantly higher rates compared to never smokers (2.81 events/year, P < .05), with odds ratio 2.12 (95% CI = 1.35-3.32) adjusted for age and Caucasian race for >5 times of total readmissions per year. The rates of driveline infection, stroke, and hemolysis were statistically comparable between the never smokers and former smokers, while current smokers had significantly higher rates compared to never smokers (P < .05 for all).


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Sepse/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fumar Tabaco/efeitos adversos , Adulto , Idoso , Ex-Fumantes/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/mortalidade , Hemólise , Humanos , Masculino , Pessoa de Meia-Idade , não Fumantes/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Sepse/etiologia , Fumantes/estatística & dados numéricos , Acidente Vascular Cerebral/etiologia , Fumar Tabaco/epidemiologia
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