Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.325
Filtrar
2.
Artigo em Russo | MEDLINE | ID: mdl-31626154

RESUMO

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.


Assuntos
Doença das Coronárias/cirurgia , Contrapulsação , Insuficiência Cardíaca/complicações , Microcirculação/fisiologia , Idoso , Doença das Coronárias/fisiopatologia , Insuficiência Cardíaca/cirurgia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Int Heart J ; 60(5): 1222-1225, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484879

RESUMO

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.


Assuntos
Bradicardia/tratamento farmacológico , Cilostazol/uso terapêutico , Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Bradicardia/diagnóstico por imagem , Bradicardia/etiologia , Débito Cardíaco/efeitos dos fármacos , Eletrocardiografia/métodos , Seguimentos , Insuficiência Cardíaca/diagnóstico , Transplante de Coração/métodos , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Radiografia Torácica/métodos , Fatores de Tempo , Resultado do Tratamento
4.
Methodist Debakey Cardiovasc J ; 15(2): 145-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384378

RESUMO

Steady advances in the diagnosis and management of congenital heart disease over the last few decades has resulted in a growing population of adults with congenital heart disease (ACHD). Consequently, there has been a parallel increase in the number of ACHD patients plagued with end-stage heart failure. Even so, the transplantation rate for these patients has remained low, at about 3% of all adult heart transplants. This review discusses the scope of transplantation for ACHD, including indications and contraindications, specific challenges and nuances, and post-transplant outcomes.


Assuntos
Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Adulto , Fatores Etários , Tomada de Decisão Clínica , Progressão da Doença , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/efeitos adversos , Transplante de Coração/mortalidade , Humanos , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Listas de Espera
5.
Braz J Cardiovasc Surg ; 34(4): 396-405, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454193

RESUMO

OBJECTIVE: To evaluate whether there is any difference on the results of patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in the setting of ischemic heart failure (HF). METHODS: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke. RESULTS: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459). CONCLUSION: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke.


Assuntos
Ponte de Artéria Coronária/mortalidade , Insuficiência Cardíaca/cirurgia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/mortalidade , Acidente Vascular Cerebral/etiologia , Idoso , Brasil/epidemiologia , Ponte de Artéria Coronária/efeitos adversos , Métodos Epidemiológicos , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Isquemia Miocárdica/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Literatura de Revisão como Assunto , Acidente Vascular Cerebral/mortalidade , Resultado do Tratamento
6.
World J Pediatr Congenit Heart Surg ; 10(4): 518-519, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307293

RESUMO

Progressive ventricular dysfunction is not uncommon in patients with univentricular hearts as they age. In the acute setting vasoactive support can be employed, but is not always sufficient and patients occasionally require mechanical support. We report the successful implantation and subsequent challenges of a percutaneous Abiomed Impella ventricular assist device as a rescue therapy for a 15-year old-patient with Fontan circulation and severe ventricular dysfunction after cardiac arrest.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Síndrome do Coração Esquerdo Hipoplásico/complicações , Doença Aguda , Adolescente , Desenho de Equipamento , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/cirurgia
8.
Arch Cardiovasc Dis ; 112(8-9): 485-493, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31353279

RESUMO

BACKGROUND: Data on the long-term outcome of heart transplantation in patients with a ventricular assist device (VAD) are scarce. AIM: To evaluate long-term outcome after heart transplantation in patients with a VAD compared with no mechanical circulatory support. METHODS: Consecutive all-comers who underwent heart transplantation were included at a single high-volume centre from January 2005 until December 2012, with 5 years of follow-up. Clinical and biological characteristics, operative results, outcomes and survival were recorded. Regression analyses were performed to determine predictors of 1-year and 5-year mortality. RESULTS: Fifty-two patients with bridge to transplantation by VAD (VAD group) and 289 patients transplanted without a VAD (standard group) were enrolled. The mean age was 46±11 years in the VAD group compared with 51±13 years in the standard group (P=0.01); 17% of the VAD group and 25% of the standard group were women (P=0.21). Ischaemic time was longer in the VAD group (207±54 vs 169±60minutes; P<0.01). There was no difference in primary graft failure (33% vs 25%; P=0.22) or 1-year mortality (17% vs 28%; P=0.12). In the multivariable analysis, preoperative VAD was an independent protective factor for 1-year mortality (odds ratio 0.40, 95% confidence interval 0.17-0.97; P=0.04). Independent risk factors for 1-year mortality were recipient age>60 years, recipient creatinine, body surface area mismatch and ischaemic time. The VAD and standard groups had similar long-term survival, with 5-year mortality rates of 35% and 40%, respectively (P=0.72). CONCLUSIONS: Bridge to transplantation by VAD was associated with a reduction in 1-year mortality, leading critically ill patients to similar long-term survival compared with patients who underwent standard heart transplantation. This alternative strategy may benefit carefully selected patients.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração , Coração Auxiliar , Implantação de Prótese/instrumentação , Volume Sistólico , Função Ventricular Esquerda , Adulto , Feminino , Sobrevivência de Enxerto , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/efeitos adversos , Transplante de Coração/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(3): 478-485, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31232552

RESUMO

The rotary left ventricular assist device (LVAD) has been an effective option for end-stage heart failure. However, while clinically using the LVAD, patients are often at significant risk for ventricular collapse, called suction, mainly due to higher LVAD speeds required for adequate cardiac output. Some proposed suction detection algorithms required the external implantation of sensors, which were not reliable in long-term use due to baseline drift and short lifespan. Therefore, this study presents a new suction detection system only using the LVAD intrinsic blood pump parameter (pump speed) without using any external sensor. Three feature indices are derived from the pump speed and considered as the inputs to four different classifiers to classify the pumping states as no suction or suction. The in-silico results using a combined human circulatory system and LVAD model show that the proposed method can detect ventricular suction effectively, demonstrating that it has high classification accuracy, stability, and robustness. The proposed suction detection system could be an important part in the LVAD for detecting and avoiding suction, while at the same time making the LVAD meet the cardiac output demand for the patients. It could also provide theoretical basis and technology support for designing and optimizing the control system of the LVAD.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Modelos Cardiovasculares , Sucção/efeitos adversos , Simulação por Computador , Ventrículos do Coração , Humanos
10.
J Cardiothorac Surg ; 14(1): 110, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31202281

RESUMO

BACKGROUND: Constrictive Pericarditis(CP) can be viewed as a constellation of syndromes resulting from compression of the heart, etiologies, course and types are well discussed in other reports. However, localized CP as a cause of right heart failure is rare, and presentation with interposed fluid under-pressure is extremely odd. CASE REPORT: A case of C.X. Z, male aged 39 years old, who presented to our department with sudden onset of symptoms of subacute right heart failure due localized CP. In January, 2018 C.X.Z presented to the county hospital with complaints of 10-day history of transient mild bilateral pedal edema. He was managed on diuretic therapy and symptoms resolved completely. 10 months later, he suddenly presented to the local facility with symptoms of subacute right heart failure. 7 days after on-set of symptoms, his condition shifted from NYHA I to III-IV. Although wake-up chest radiography appeared normal, standard medical therapy yielded no positives results. He was referred to our hospital, upon which after echocardiography and computed tomography investigations, aforementioned diagnosis was made. We performed off-pump partial pericardiectomy with no complications. After operation, he received analgesics and diuretics for pain and edema(ascites) respectively. He was discharged 7-days after operation on analgesics only, with no symptoms of right heart failure. CONCLUSION: Localized constrictive pericarditis as a cause of subacute right heart failure (RHF) has never been reported elsewhere, and presentation with interposed fluid is extremely odd. Progressive symptoms of Acute RHF in the absence of typical radiologic clue 'egg-shell' should heighten suspicion index of CP.


Assuntos
Insuficiência Cardíaca/diagnóstico , Pericardite Constritiva/diagnóstico , Disfunção Ventricular Direita/diagnóstico , Adulto , Diagnóstico Diferencial , Ecocardiografia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pericardiectomia , Pericardite Constritiva/complicações , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/cirurgia , Síndrome , Tomografia Computadorizada por Raios X , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/cirurgia
11.
EuroIntervention ; 15(7): 586-593, 2019 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-31147306

RESUMO

AIMS: The haemodynamic effects of primary implantation of an intra-aortic balloon pump (IABP) versus inotropes in decompensated heart failure and low output (DHF-LO), but without an acute coronary syndrome, have not been investigated. We therefore aimed to investigate the effect of primary IABP implantation as compared to inotropes on haemodynamics in DHF-LO with no acute ischaemia. METHODS AND RESULTS: Patients (n=32) with DHF-LO despite IV diuretics were randomised to primary 50 mL IABP or inotropes (INO: enoximone or dobutamine). The primary endpoint was the improvement of organ perfusion assessed by ∆ mixed-venous oxygen saturation (SvO2) at 3 hours; secondary endpoints included ∆ cardiac power output (CPO), NT-proBNP proportional change, cumulative fluid balance and ∆ dyspnoea severity score, all at 48 hours. Data are presented as median (IQR). Patients were 60 (48-69) years old and 72% were male. Baseline SvO2 was 44 (39-53)%. ∆SvO2 was higher in the IABP group (+17 [+9; +24] vs. +5 [+2; +9]%, p<0.05). IABP patients had a higher ∆CPO, a greater relative reduction in NT-proBNP, a more negative cumulative fluid balance, and a greater reduction in dyspnoea severity score. There were no IABP-related serious adverse events (SAEs). Thirty-day mortality was 23% (IABP) vs. 44% (INO). CONCLUSIONS: Primary circulatory support by IABP showed a significant increase in improved organ perfusion assessed by SvO2.


Assuntos
Débito Cardíaco/fisiologia , Cardiotônicos/uso terapêutico , Dobutamina/uso terapêutico , Enoximona/uso terapêutico , Insuficiência Cardíaca/cirurgia , Hemodinâmica/fisiologia , Balão Intra-Aórtico/métodos , Idoso , Débito Cardíaco/efeitos dos fármacos , Feminino , Coração Auxiliar , Hemodinâmica/efeitos dos fármacos , Humanos , Balão Intra-Aórtico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Gac Med Mex ; 155(2): 196-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056601

RESUMO

The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Isquemia Miocárdica/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Isquemia Miocárdica/complicações , Implantação de Prótese/métodos
13.
Pediatr Cardiol ; 40(6): 1159-1164, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31087144

RESUMO

Pediatric ventricular assist device (VAD) implantation outcomes are increasingly promising for children with dilated cardiomyopathy and advanced decompensated heart failure (ADHF). VAD placement in patients with clinical features such as complex congenital cardiac anatomy, small body size, or major comorbidities remains problematic. These comorbidities have been traditionally prohibitive for VAD consideration leaving these children as a treatment-orphaned population. Here we describe the quality bundle surrounding these patients with ADHF considered high risk for VAD implantation at our institution. Over a 7-year period, a quality bundle aimed at the peri-operative care for children with high-risk features undergoing VAD implantation was incrementally implemented at a tertiary children's hospital. Patients were considered high risk if they were neonates (< 30 days), had single-ventricle physiology, non-dilated cardiomyopathy, biventricular dysfunction, or significant comorbidities. The quality improvement bundle evolved to include (1) structured team-based peri-operative evaluation, (2) weekly VAD rounds addressing post-operative device performance, (3) standardized anticoagulation strategies, and (4) a multidisciplinary system for management challenges. These measures aimed to improve communication, standardize management, allow for ongoing process improvement, and incorporate principles of a high-reliability organization. Between January 2010 and December 2017, 98 patients underwent VAD implantation, 48 (49%) of which had high-risk comorbidities and a resultant cohort survival-to-transplant rate of 65%. We report on the evolution of a quality improvement program to expand the scope of VAD implantation to patients with high-risk clinical profiles. This quality bundle can serve as a template for future large-scale collaborations to improve outcomes in these treatment-orphaned subgroups.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Adolescente , Anticoagulantes/uso terapêutico , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/mortalidade , Criança , Pré-Escolar , Estudos de Coortes , Comorbidade , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Humanos , Lactente , Masculino , Período Pós-Operatório , Melhoria de Qualidade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
14.
Biomarkers ; 24(5): 448-456, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055944

RESUMO

Background: Left ventricular assist devices (LVADs) provide support for patients with end-stage heart failure. The aims of this study were to determine whether baseline analysis and early trends in routine laboratory data, platelet activity, and thromboinflammatory biomarkers following LVAD implantation reveal trends that predict personalized risks of one-year gastrointestinal (GI) bleeding, stroke, pump thrombosis, drive-line infections and mortality in patients on LVAD support. Methods: We performed an observational study at the University of Kentucky with 61 participants who underwent first-time LVAD implantation. Blood was collected at baseline and post-op days 0, 1, 3 and 6 as well as clinical follow-up. Demographics, clinical characteristics, one-year adverse events and routine laboratory data were collected from electronic medical records. Platelet function and plasma biomarkers were profiled. Results: Evaluation of routine laboratory results revealed that sustained thrombocytopenia and increased mean platelet volume (MPV) were associated with development of GI bleeding and mortality. Platelet function at follow-up visit predicted one-year bleeding events. Thrombotic biomarker sCD40L strongly predicted one-year GI bleeding at baseline before implantation and within the first week following LVAD implant. Conclusions: Early trends in routine bloodwork and platelet function may serve as novel signatures of patients at risk to experience adverse events.


Assuntos
Coração Auxiliar/efeitos adversos , Hemorragia , Trombocitopenia , Disfunção Ventricular Esquerda/cirurgia , Adulto , Idoso , Feminino , Insuficiência Cardíaca/cirurgia , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Mortalidade , Medicina de Precisão , Fatores de Risco , Trombocitopenia/sangue , Trombocitopenia/etiologia , Trombocitopenia/prevenção & controle
15.
Monaldi Arch Chest Dis ; 89(1)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30968658

RESUMO

Patients with advanced heart failure refractory to medical therapy can be treated with left ventricular assist devices, implanted to augment or replace left ventricular function. The most common postoperative complications are infection; bleeding; thromboembolic events; device malfunction; depression, and neurological dysfunction (stroke, transient ischemic attacks, encephalopathy). Their onset contributes to the interruption and delay in commencing a physiotherapy program. During the initial postoperative phase, patients with left ventricular assist devices are not generally able to tolerate an intensive rehabilitative programme, but they may be able to do so in a more advanced stage of recovery. Physiotherapy in the early period prepares the patient for a more complex and articulated rehabilitation, usually scheduled after hospital discharge. Supervised exercise should be implemented once the patient has been thoroughly instructed on how the device works and after a checklist to ensure that the patient understands the workings of the device, has been signed off. Although several studies have been published discussing postoperative rehabilitation in LVAD patients, to date it is not available yet an illustrated guide describing basic movements. Here, we describe a series of supervised physical exercises that can be executed daily. We aimed to illustrate a set of basic movements preparatory to a more complex and articulated exercise programme. A range of exercises involving all body parts is described as lying, sitting and standing postures.


Assuntos
Terapia por Exercício/métodos , Insuficiência Cardíaca/reabilitação , Coração Auxiliar , Insuficiência Cardíaca/cirurgia , Humanos , Modalidades de Fisioterapia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Fatores de Tempo , Função Ventricular Esquerda
17.
J Cardiothorac Surg ; 14(1): 80, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023326

RESUMO

BACKGROUND: Systemic inflammation during implant of a durable left ventricular assist device (LVAD) may contribute to adverse outcomes. We investigated the association of the preoperative inflammatory markers with subsequent right ventricular failure (RVF). MATERIALS AND METHODS: Prospective data was collected on 489 patients from 2003 through 2017 who underwent implantation of a durable LVAD. Uni- and multivariable correlation with leukocytosis was determined using linear and binary logistic regression. The population was also separated into low (< 10.5 K/ul, n = 362) and high (> 10.5 K/ul, n = 127) white blood cell count (WBC) groups. Mantel-Cox statistics was used to analyze survival data. RESULTS: Postop RVF was associated with a higher preop WBC (11.3 + 5.7 vs 8.7 + 3.1) and C-reactive protein (CRP, 5.6 + 4.4 vs 3.3 + 4.7) levels. Multivariable analysis identified an independent association between increased WBC preoperatively with increased lactate dehydrogenase (LDH, P < 0.001), heart rate (P < 0.001), CRP (P = 0.006), creatinine (P = 0.048), and INR (P = 0.049). The high WBC group was more likely to be on preoperative temporary circulatory support (17.3% vs 6.4%, P < 0.001) with a trend towards greater use of an intra-aortic balloon pump (55.9% vs 47.2%, P = 0.093). The high WBC group had poorer mid-term survival (P = 0.042). CONCLUSIONS: Postop RVF is associated with a preoperative pro-inflammatory environment. This may be secondary to the increased systemic stress of decompensated heart failure. Systemic inflammation in the decompensated heart failure may contribute to RVF after LVAD implant.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Adulto , Idoso , Circulação Assistida/efeitos adversos , Proteína C-Reativa/análise , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Balão Intra-Aórtico , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/etiologia
18.
Transplant Proc ; 51(3): 859-864, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30979476

RESUMO

BACKGROUND: Currently, there are no guidelines for management of moderate to severe mitral regurgitation (MR) in patients undergoing left ventricular assist device (LVAD) implantation. The present study aimed to investigate the impact of baseline MR on short and midterm survival in patients who had LVAD as destination therapy (DT). METHODS: The DT-LVAD patients were classified into 2 groups based on baseline MR status: ≥ moderate MR and < moderate MR. Baseline clinical characteristics and post-LVAD implant adverse events were compared. Unadjusted mortality rates at 30 days, 1 year, and 2 years were analyzed. RESULTS: Of 91 patients studied, 62 (68%) had ≥ moderate MR before LVAD implantation; ≥ moderate MR patients had a higher incidence of concomitant pulmonary disease (11% vs 0%; P = .001) and ≥ moderate tricuspid regurgitation (55% vs 23%, P = .004) than < moderate MR patients. Other baseline clinical characteristics were similar in both groups. Post-LVAD adverse events did not differ between the 2 groups. Survival rates at 30 days, 1 year, and 2 years for both groups (≥ moderate MR vs < moderate MR) were 90% vs 100% (P = .03), 63% vs 90% (P = .001), and 52% vs 83% (P = .002), respectively. On multivariable analysis, age, female sex, ≥ moderate tricuspid regurgitation, and ≥ moderate MR at baseline were found to be independent predictors of overall all-cause mortality. Overall survival was significantly lower in the ≥ moderate MR group than the < moderate MR group (log-rank test, P = .03). CONCLUSION: In DT LVAD patients, ≥ moderate MR is common and is associated with worse survival at both short and midterm follow-up.


Assuntos
Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/mortalidade , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
19.
Transplant Proc ; 51(3): 865-870, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30979477

RESUMO

BACKGROUND: Although low (but increasing) rates of lung/lung-heart transplantations of scleroderma (systemic sclerosis [SSc]) patients have been reported, exclusive heart transplantation is a rare approach for treatment of heart failure due to SSc. CASES: We report on 2 cases of SSc patients receiving a heart transplantation (HTx) due to severe and progressive right heart failure without pulmonary artery hypertension. One patient received a hepatitis C virus (HCV)-positive donor heart and recovered excellently from viral transmission after administration of a direct-acting antiviral (DAA) regimen. This is the first published case of an SSc patient who underwent HTx using an HCV-positive donor heart. The clinical course of both patients was monitored by different serum SSc biomarkers. Only xylosyltransferase activity proved to be a promising biomarker for disease stage determination and therapeutic monitoring, precisely reflecting fibrotic remodeling and successful organ recovery. CONCLUSIONS: Successful implementation of the 2 cases described here demonstrates that HTx is a safe and effective therapeutic option for defined SSc sub-patient groups despite the progressive character of the underlying disease. In the future, xylosyltransferase activity might be conducive to simplify the identification of patients with low systemic involvement but a strong indication for single heart transplantation. Finally, we demonstrate that treatment of HCV viral transmission from HCV-positive donor to organ recipient using DAA gives us new opportunities to consider HCV-positive donor organs for HTx and might reveal new possibilities to ease the lack of donor organs.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Hepatite C Crônica/etiologia , Escleroderma Sistêmico/complicações , Doadores de Tecidos , Transplantes/virologia , Adulto , Antivirais/uso terapêutico , Feminino , Insuficiência Cardíaca/etiologia , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/transmissão , Humanos
20.
Artigo em Inglês | MEDLINE | ID: mdl-30990580

RESUMO

Left ventricular assist device graft protection and its intraoperative orientation continues to be a major concern in bridge-to-transplant strategy. Different techniques have been described, including the adoption of a standard full sternotomy approach. We describe our institutional experience of placement of the with HeartWare HVAD® implantable continuous flow pump, with outflow graft tunnelling through the transverse sinus to prepare patients in need of eventual re-sternotomy. Surgical tips are provided in the tutorial videos both for HVAD® placement, and for explantation at the time of heart transplantation.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Seios Transversos/cirurgia , Idoso , Remoção de Dispositivo , Transplante de Coração , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esternotomia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA