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Nitta D, Kinugawa K, Amiya E, Hatano M, Kinoshita O, Nawata K, Ono M, Komuro I. B-type Natriuretic Peptide Before Discharge after Left Ventricular Assist Device Implantation Is Associated With Subsequent Hospitalization due to Cardiac Causes. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.08.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Komae H, Nawata K, Kinoshita O, Hoshino Y, Kimura M, Yamauchi H, Amiya E, Hosoya Y, Hatano M, Ono M. 2 Case Reports of Successful Treatment by Central ECMO with LV Venting for Severe Heart Failure Complicated with Alveolar Hemorrhage. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.08.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nitta D, Kinugawa K, Imamura T, Iino J, Endo M, Amiya E, Hatano M, Kinoshita O, Nawata K, Ono M, Komuro I. Association of the Number of HLA-DR Mismatches With Early Post-transplant Acute Cellular Rejection Among Heart Transplantation Recipients: A Cohort Study in Japanese Population. Transplant Proc 2017; 49:125-129. [PMID: 28104119 DOI: 10.1016/j.transproceed.2016.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although many risk factors are reported about graft rejection after heart transplantation (HTx), the effect of HLA mismatch (MM) still remains unknown, especially in the Japanese population. The aim of the present study was to investigate the influence of HLA MM on graft rejection among HTx recipients in Japan. METHODS We retrospectively investigated the association of the number of HLA MM including class I (A, B) and class II (DR) (for each locus MM: 0 to 2, total MM: 0 to 6) and the incidence of moderate to severe acute cellular rejection (ACR) confirmed by endomyocardial biopsy (International Society for Heart and Lung Transplantation grade ≥ 3A/2R) within 1 year after HTx. RESULTS Between 2007 and 2014, we had 49 HTx cases in our institute. After excluding those with insufficient data and positive donor-specific antigen, finally 35 patients were enrolled. Moderate to severe ACR was observed in 16 (45.7%) patients. The number of HLA-DR MM was significantly associated with the development of ACR (ACR+: 1.50 ± 0.63, ACR-: 1.11 ± 0.46, P = .029). From univariate analysis, DR MM = 2 was the only independent risk factor for ACR episodes (P = .017). The frequency of ACR within 1 year was significantly higher in those with DR MM = 2 (DR MM = 0 to 1: 0.3 ± 0.47, DR MM = 2: 1.17 ± 1.34 times, P = .007). CONCLUSIONS The number of HLA-DR MMs was associated with the development and recurrence of ACR episodes among HTx recipients within 1 year after transplantation in Japanese population.
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Kitahara H, Nawata K, Kinoshita O, Itoda Y, Shintani Y, Fukayama M, Ono M. Implantation of a Left Ventricular Assist Device for Danon Cardiomyopathy. Ann Thorac Surg 2017; 103:e39-e41. [PMID: 28007270 DOI: 10.1016/j.athoracsur.2016.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/12/2016] [Accepted: 07/05/2016] [Indexed: 10/20/2022]
Abstract
This is the first report of Danon cardiomyopathy managed with a left ventricular assist device (LVAD). Danon disease is an X-linked dominant inheritance disorder. Heart failure with Danon cardiomyopathy results in a poor prognosis, and heart transplantation is the treatment of choice. We present two cases of successful implantation of an LVAD for Danon cardiomyopathy. Patient 1 was in the dilatated phase of hypertrophic cardiomyopathy (HCM) with Danon cardiomyopathy, and she underwent LVAD implantation. She is waiting for transplantation. Patient 2 had dilatated cardiomyopathy with Danon cardiomyopathy and received transplantation 990 days after LVAD implantation without myopathy or intellectual disability.
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Okamura K, Nawata K, Kimura M, Kinoshita O, Masuzawa A, Yamauchi H, Hirata Y, Owada Y, Oshiro Y, Okamoto H, Ohkohchi N, Ono M. The Prevalence of Hepatitis E Virus Serum Antibodies and RNA in Heart Transplant Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kimura M, Nawata K, Kinoshita O, Yamauchi H, Itoda Y, Imamura T, Hatano M, Kinugawa K, Ono M. Cerebrovascular Accident Rate Is Different Between Centrifugal and Axial-Flow Pumps, but Survival and Driveline Infection Rates Are Similar. Transplant Proc 2017; 49:121-124. [DOI: 10.1016/j.transproceed.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Amao R, Imamura T, Nakahara Y, Noguchi S, Kinoshita O, Yamauchi H, Ono M, Haga N. Reversible Motor Paralysis and Early Cardiac Rehabilitation in Patients With Advanced Heart Failure Receiving Left Ventricular Assist Device Therapy. Int Heart J 2016; 57:766-768. [PMID: 27829642 DOI: 10.1536/ihj.16-153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Advanced heart failure (HF) is sometimes complicated with brain impairment because of a microthrombosis caused by decreased left ventricular contraction or reduced brain circulation. Some patients may recover after left ventricular assist device (LVAD) implantation. However, little is known about the perioperative therapeutic strategy in patients suffering from such complications, particularly from a cardiac rehabilitation viewpoint. We report on a 58-year-old male patient with a previous history of poliomyelitis and a light paralysis in the left upper extremity, who suffered left hemiplegia with no evidence of stroke after hemodynamic deterioration. The combination therapy of perioperative cardiac rehabilitation and LVAD therapy improved his left hemiplegia as well as activities of daily living, and the patient was discharged on foot on postoperative day 72 after briefing the family on LVAD home management. Early initiation of cardiac rehabilitation before LVAD implantation may be a key for the smooth discharge and resocialization of patients suffering from brain impairment complicated with advanced HF.
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Itoda Y, Nawata K, Yamauchi H, Kinoshita O, Kimura M, Ono M. Central aortic valve closure successfully treated aortic insufficiency of the patient with Jarvik 2000 continuous flow left ventricular assist device: a case report. J Artif Organs 2016; 20:99-101. [DOI: 10.1007/s10047-016-0929-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
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Kashima Y, Kinoshita O, Ikeda U, Yajima N, Imamura H, Urayama H, Iwashita T, Sekiguchi Y, Akita S, Wada N, Okamoto K. Incomplete Ventricular Septal Rupture Following Blunt Chest Trauma. Angiology 2016; 57:373-7. [PMID: 16703199 DOI: 10.1177/000331970605700315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This report describes a case of traumatic incomplete rupture of the ventricular septum, a rare complication caused by blunt chest trauma. Although a serial ECG progressed its course similar to acute anteroseptal myocardial infarction in this case, there was little clinical clue of septal tear. The diagnosis was established by transthoracic echocardiography. The authors chose a conservative line of management rather than surgical repair for incomplete septal rupture because of the patent’s stable clinical course and hemodynamic status. A sequence of echocardiography during a 32-day stay in the hospital showed no change in the extent of incomplete septal rupture, septal structure, systolic function, and shape of left ventricle and also obtained no evidence of shunting through the rupture. In conclusion, echocardiography is a useful investigation to make a diagnosis as well as for follow-up in case of incomplete ventricular septal rupture. A close follow-up of incomplete septal rupture with serial echocardiography should be performed, because several cases of delayed ventricular septal rupture following blunt chest trauma have been reported.
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Ohtomo K, Shigeeda T, Hirose A, Ohno T, Kinoshita O, Fujita H, Ando J, Nagai R, Takamoto S, Kadowaki T, Kato S. Frequency of diabetic retinopathy and related factors in patients with diabetes having coronary artery disease. Diabetes Res Clin Pract 2016; 118:154-5. [PMID: 27371781 DOI: 10.1016/j.diabres.2016.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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Imamura T, Kinugawa K, Murasawa T, Kawasaki H, Yoshida M, Kashiwa K, Kinoshita O, Nawata K, Ono M. Optimal Device Selection to Reduce Driveline Infection During Ventricular Assist Device Therapy—Relationship Between Feature of Driveline and Driveline Infection. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Imamura T, Murasawa T, Kawasaki H, Kashiwa K, Kinoshita O, Nawata K, Ono M. Correlation between driveline features and driveline infection in left ventricular assist device selection. J Artif Organs 2016; 20:34-41. [PMID: 27448017 DOI: 10.1007/s10047-016-0923-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/13/2016] [Indexed: 01/10/2023]
Abstract
Although the survival rate for left ventricular assist device (LVAD) therapy has improved, device-related complications are an unpredictable threat to the patient's quality of life. We focused on driveline infection, and aimed to determine whether specific features of drivelines affect the frequency of infection. We enrolled patients who underwent LVAD implantation and were followed-up at our institute between 2007 and 2015. We counted the occurrences of driveline infection requiring any antibiotic therapy over a 2-year study period. Furthermore, we experimentally measured and compared the outer diameters and stiffness of three devices. Of all, 72 patients received an LVAD during the enrollment period. LVADs were HeartMate II (n = 32), EVAHEART (n = 22), and DuraHeart (n = 18). The outer diameters and stiffness were measured in five of each device. HeartMate II group had the highest driveline infection-free rate among all three devices during the study period (p = 0.042). The driveline of the HeartMate II LVAD had a significantly smaller outer diameter and lower stiffness than that of the other two devices (p < 0.05 for both). In conclusion, device-specific driveline features may affect the development of driveline infection during LVAD therapy.
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Yamauchi H, Nawata K, Nakao T, Daimon M, Kawata T, Hirokawa M, Kinoshita O, Itoda Y, Kimura M, Komuro I, Ono M. LONG-TERM OUTCOMES AND AORTIC VALVE MOTION AFTER REIMPLANTATION TECHNIQUES OF VALVE SPARING AORTIC ROOT REPLACEMENT, USING GRAFTS WITH PSEUDOSINUSES OF VALSALVA. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nawata K, Kinoshita O, Kimura M, Yamauchi H, Itoda Y, Yoshitake S, Hoshino Y, Ono M. Outcomes of Heart Transplantation after Long-Term Circulatory Support by Ventricular Assist Devices with Driveline/Pump Infection. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Imamura T, Kinugawa K, Nitta D, Hatano M, Itoda Y, Kimura M, Kinoshita O, Yamauchi H, Nawata K, Ono M. Novel Effect of Everolimus in Heart Transplant Recipients - Attenuation of Myocardial Hypertrophy and Improvement of Diastolic Function. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Imamura T, Kinugawa K, Nitta D, Kinoshita O, Nawata K, Ono M. Everolimus Attenuates Myocardial Hypertrophy and Improves Diastolic Function in Heart Transplant Recipients. Int Heart J 2016; 57:204-10. [PMID: 26973270 DOI: 10.1536/ihj.15-320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Everolimus (EVL), one of the mammalian targets of rapamycin, is a next generation immunosuppressant that may have accessory anti-proliferative effects in heart transplant (HTx) recipients. However, little is known about the clinical relationship between EVL and regression of cardiac hypertrophy. A total of 42 HTx recipients received EVL therapy at post-HTx 150 days on median and had been followed at our institute for > 1 year between 2008 and 2014 [EVL (+) group]. We also observed 18 patients without EVL from post-HTx 150 days for 1 year [EVL (-) group]. There were no significant differences in baseline variables between the two groups. Left ventricular mass index (LVMI) and the ratio of early transmitral filling velocity to the peak early diastolic mitral annular motion velocity (E/e') decreased significantly during 1-year EVL treatment compared with the EVL (-) group. There were no differences in blood pressure and medications between the 2 groups. Improvement of LVMI and the E/e' ratio was not associated with trough levels of calcineurin inhibitors or EVL, but correlated with each baseline value. In conclusion, this EVL-incorporated immunosuppressant regimen attenuated cardiac hypertrophy as well as diastolic dysfunction in HTx recipients.
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Shoda K, Ikoma H, Yamamoto Y, Kinoshita O, Morimura R, Konishi H, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, Nakanishi M, Ichikawa D, Fujiwara H, Okamoto K, Sakakura C, Ochiai T, Taniguchi H, Yasukawa S, Otsuji E. A case of long-term survival following hepatectomy for liver metastasis of Merkel cell carcinoma. Surg Case Rep 2016; 1:30. [PMID: 26943398 PMCID: PMC4747964 DOI: 10.1186/s40792-015-0015-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare endocrine tumor that presents as a rapidly growing skin nodule of the body, and it is aggressive with regional nodal and distant metastases without clearly defined treatment. There are no reports of long survivors among patients with liver metastasis of MCC. The current case was a patient who underwent surgical resection for liver metastasis of Merkel cell carcinoma. CASE PRESENTATION This case describes a 73-year-old female with a papule on the dorsal side of the right third finger and liver tumor. The papule of the right third finger was histologically diagnosed as MCC by the skin biopsy. She underwent extensive resection and lymph node dissection of the right third finger and partial resection of the liver. The liver tumor was histologically diagnosed as liver metastasis of MCC. The patient remains well without any evidence of tumor recurrence more than 5 years after surgery. CONCLUSIONS This is the first report of a long-term survival of more than 5 years following liver metastasis of MCC, which was surgically resected. Patients with small and solitary metastatic liver tumor of MCC may have a chance for a long-term survival following the hepatic resection.
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Imamura T, Kinugawa K, Nitta D, Kinoshita O, Nawata K, Ono M. Fontan-Like Hemodynamics Complicated With Ventricular Fibrillation During Left Ventricular Assist Device Support. Int Heart J 2016; 57:515-8. [DOI: 10.1536/ihj.16-008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nitta D, Kinugawa K, Imamura T, Endo M, Amiya E, Hatano M, Takahashi Y, Iriyama T, Kinoshita O, Nagamatsu T, Nawata K, Ono M, Komuro I. Successful Pregnancy and Delivery in a Heart Transplantation Recipient. Int Heart J 2016; 57:383-5. [DOI: 10.1536/ihj.15-414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kinoshita O, Kishimoto M, Murayama Y, Kuriu Y, Nakanishi M, Sakakura C, Otsuji E, Yanagisawa A. The number of metastatic lymph nodes exhibiting poorly differentiated clusters predicts survival in patients with pStage III colorectal cancer. Int J Colorectal Dis 2016; 31:283-90. [PMID: 26412250 PMCID: PMC4744259 DOI: 10.1007/s00384-015-2393-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Many studies have proposed alternative designations for lymph node (LN) status in colorectal cancer (CRC); however, knowledge of histopathological features in metastatic lymph nodes (MLNs) is limited. This study investigated the clinicopathological significance of poorly differentiated clusters (PDCs) in MLNs. METHODS Slides from 159 patients with pathological Stage III CRC were reviewed. Those with <12 dissected LNs (DLNs) were ineligible. PDCs composed of ≥5 cancer cells lacking full glandular formation and ≥10 PDCs under ×20 objective lens were defined as positive, and the number of MLNs with positive PDCs (MLNs-PDCs) was counted. Results were correlated with patient survival and comparisons made with other indications of LN status. RESULTS The mean numbers of MLNs and MLNs-PDCs were 2.8 and 1.0, respectively, and were moderately and positively correlated with each other. Univariate analysis identified cutoffs of ≥5 MLNs (86 vs. 55%, p = 0.024), ≥2 MLNs-PDCs (85 vs. 63%, p = 0.008), and ≥30% LN ratio (85 vs. 44%, p = 0.036) to indicate a positive LN status. However, no cutoff for DLNs was obtained. MLNs-PDCs (≥2) were associated with pT4 tumor (p = 0.0035), open surgery (p = 0.016), greater number of MLNs (p < 0.0001), and positive-PDC primary tumor (p < 0.0001). In multivariate analysis, a prognostic model incorporating ≥2 MLNs-PDCs provided the lowest Akaike information criterion value; consequently, both pT4 tumors (p < 0.001) and ≥2 MLNs-PDCs (p = 0.038) were revealed to be significant prognosticators. CONCLUSION Results showed that applying the number of MLNs-PDCs could improve stratification in pStage III CRC and may be a valuable candidate for LN status.
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Kinoshita O, Ichikawa D, Ichijo Y, Komatsu S, Okamoto K, Kishimoto M, Yanagisawa A, Otsuji E. Histological evaluation for chemotherapeutic responses of metastatic lymph nodes in gastric cancer. World J Gastroenterol 2015; 21:13500-13506. [PMID: 26730161 PMCID: PMC4690179 DOI: 10.3748/wjg.v21.i48.13500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/22/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of preoperative chemotherapy (pre-CTx) for metastatic lymph nodes (MLNs) of gastric cancer (GC).
METHODS: A retrospective cohort of patients with advanced GC, who underwent pre-CTx followed by gastrectomy, was reviewed. The histological tumor regression grade (TRG), which considered the percentage of residual cancer in the visible tumor bed, was applied to primary tumors and individual MLNs: G1a (complete response), G1b (< 10%), G2 (10%-50%) and G3 (> 50%). The clinical response to pre-CTx was retrospectively evaluated using only MLNs information, and we compared the histological and clinical evaluations of MLNs.
RESULTS: Twenty-eight patients were enrolled. A total of 438 MLNs were retrieved, and 22 (5%), 48 (11%), 63 (14%) and 305 (70%) LNs were assigned as G1a, G1b, G2 and G3, respectively. Stratification of the residual MLNs based on the TRGs was as follows: 28 G1b MLNs (9%), 48 G2 MLNs (15%), and 253 G3 MLNs (76%) in the D1 region; 20 (23%), 15 (17%), and 52 (60%) in the D2 region, respectively. However, no significant correlation was found between TRGs in MLNs and clinical response in the subgroup for which evaluation of clinical response was available.
CONCLUSION: Pre-CTx does not provide any outstanding histological benefit for MLNs, and an appropriate D2 lymphadenectomy should routinely be performed to offer the chance of curative resection.
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Nitta D, Kinugawa K, Imamura T, Endo M, Inaba T, Maki H, Amiya E, Hatano M, Kinoshita O, Nawata K, Kyo S, Ono M. Novel Scoring System to Predict Ineligibility for Bridge to Implantable Left Ventricular Assist Device as Destination Therapy Before Extracorporeal Ventricular Assist Device Implantation - For the Coming Era of Destination Therapy in Japan. Circ J 2015; 80:387-94. [PMID: 26638871 DOI: 10.1253/circj.cj-15-1030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although destination therapy (DT) is now expected to be a promising strategy for those who are not suitable for heart transplantation in Japan, there has not been any investigation into ineligibility for bridging to implantable left ventricular assist device (I-LVAD) as DT among patients with extracorporeal LVAD. METHODS AND RESULTS We retrospectively studied 85 patients who had received an extracorporeal LVAD. To assess ineligibility for a bridge to I-LVAD for DT, we defined DT ineligibility (DTI) as BiVAD requirement, death within 6 months, and persistent end-organ dysfunction (medium or high J-VAD risk score) at 6 months after extracorporeal LVAD implantation. DTI was recorded for 32 patients. Uni/multivariate analysis showed that smaller left ventricular diastolic dimension (<64 mm; [odds ratio (OR) 4.522]), continuous hemodiafiltration (OR 4.862), past history of cardiac surgery (OR 6.522), and low serum albumin level (<3.1 g/dl; OR 10.064) were significant predictors of DTI. By scoring 2, 2, 3, 4 points, respectively, considering each OR, we constructed a novel scoring system for DTI (DTI score), which stratified patients into 3 risk strata: low (0-3 points), medium (4-6 points), and high (7-11 points), from the view point of DTI risk (low 8%, medium 46%, high 93%, respectively). CONCLUSIONS DTI score is a promising tool for predicting ineligibility for I-LVAD as DT before extracorporeal VAD implantation.
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Imamura T, Kinugawa K, Nitta D, Hatano M, Kinoshita O, Nawata K, Ono M. Pulsatility and Aortic Insufficiency during Left Ventricular Assist Device Treatment. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.08.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kimura M, Nawata K, Kinoshita O, Hatano M, Imamura T, Kinugawa K, Ono M. Successful Treatment of Intractable Fluid Retention Using Tolvaptan After Treatment for Postoperative Mediastinitis in a Patient With a Left Ventricular Assist Device. Int Heart J 2015; 56:574-7. [PMID: 26370363 DOI: 10.1536/ihj.14-412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The use of implantable continuous-flow left ventricular assist devices (LVADs) as a bridge to transplant is effective for patients with congestive heart failure (HF). However, some patients develop congestive symptoms due to right-sided HF even with LVAD support. Tolvaptan, a vasopressin type 2 receptor antagonist, corrects both congestion and hyponatremia in patients with advanced HF. We report herein a case involving a patient who underwent LVAD implantation and developed hyponatremia and congestive symptoms after negative-pressure wound therapy and omental transposition for postoperative mediastinitis. Hemodynamic evaluation performed after negative-pressure wound therapy revealed elevation of both right arterial pressure and pulmonary capillary wedge pressure, and suggested biventricular dysfunction despite LVAD support. Symptoms improved after starting administration of tolvaptan. Tolvaptan may be useful for correcting hyponatremia and volume overload in patients under LVAD support.
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Kato NP, Okada I, Imamura T, Kagami Y, Endo M, Nitta D, Fujino T, Muraoka H, Minatsuki S, Maki H, Inaba T, Kinoshita O, Nawata K, Hatano M, Yao A, Kyo S, Ono M, Jaarsma T, Kinugawa K. Quality of Life and Influential Factors in Patients Implanted With a Left Ventricular Assist Device. Circ J 2015; 79:2186-92. [PMID: 26255662 DOI: 10.1253/circj.cj-15-0502] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Improving quality of life (QOL) has become an important goal in left ventricular assist device (LVAD) therapy. We aimed (1) to assess the effect of an implantable LVAD on patients' QOL, (2) to compare LVAD patients' QOL to that of patients in different stages of heart failure (HF), and (3) to identify factors associated with patients' QOL. METHODS AND RESULTS The QOL of 33 Japanese implantable LVAD patients was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Short-form 8 (SF-8), before and at 3 and 6 months afterwards. After LVAD implantation, QOL significantly improved [MLHFQ, SF-8 physical component score (PCS), SF-8 mental component score (MCS), all P<0.05]. Implanted LVAD patients had a better QOL than extracorporeal LVAD patients (n=33, 32.1±21.9 vs. n=17, 47.6±18.2), and Stage D HF patients (n=32, 51.1±17.3), but the score was comparable to that of patients who had undergone a heart transplant (n=13). In multiple regression analyses, postoperative lower albumin concentration and right ventricular failure were independently associated with poorer PCS. Female sex and postoperative anxiety were 2 of the independent factors for poorer MCS (all P<0.05). CONCLUSIONS Having an implantable LVAD improves patients' QOL, which is better than that of patients with an extracorporeal LVAD. Both clinical and psychological factors are influence QOL after LVAD implantation.
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