1
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Semenova Y, Shaisultanova S, Beyembetova A, Asanova A, Sailybayeva A, Novikova S, Myrzakhmetova G, Pya Y. Examining a 12-year experience within Kazakhstan's national heart transplantation program. Sci Rep 2024; 14:10291. [PMID: 38704426 PMCID: PMC11069499 DOI: 10.1038/s41598-024-61131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/02/2024] [Indexed: 05/06/2024] Open
Abstract
Kazakhstan has one of the lowest heart transplantation (HTx) rates globally, but there are no studies evaluating the outcomes of HTx. This study aimed to provide a comprehensive analysis of the national HTx program over a 12-year period (2012-2023). Survival analysis of the national HTx cohort was conducted using life tables, Kaplan‒Meier curves, and Cox regression methods. Time series analysis was applied to analyze historical trends in HTx per million population (pmp) and to make future projections until 2030. The number of patients awaiting HTx in Kazakhstan was evaluated with a regional breakdown. The pmp rates of HTx ranged from 0.06 to 1.08, with no discernible increasing trend. Survival analysis revealed a rapid decrease in the first year after HTx, reaching 77.0% at 379 days, with an overall survival rate of 58.1% at the end of the follow-up period. Among the various factors analyzed, recipient blood levels of creatinine and total bilirubin before surgery, as well as the presence of infection or sepsis and the use of ECMO after surgery, were found to be significant contributors to the survival of HTx patients. There is a need for public health action to improve the HTx programme.
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Affiliation(s)
- Yuliya Semenova
- School of Medicine, Nazarbayev University, Astana, 010000, Kazakhstan.
| | | | - Altynay Beyembetova
- RSE on PCV "Republican Center for Coordination of Transplantation and High-Tech Medical Services" of the Ministry of Health, Astana, 010000, Kazakhstan
| | - Aruzhan Asanova
- Corporate Fund "University Medical Center", Astana, 010000, Kazakhstan
| | - Aliya Sailybayeva
- Corporate Fund "University Medical Center", Astana, 010000, Kazakhstan
| | - Svetlana Novikova
- Corporate Fund "University Medical Center", Astana, 010000, Kazakhstan
| | | | - Yuriy Pya
- Corporate Fund "University Medical Center", Astana, 010000, Kazakhstan
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2
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George TJ, Aldrich A, Smith RL, Ryan WH, DiMaio JM, Kabra N, Afzal A, Rawitscher DA. Development of a non‐transplant left ventricular assist device program. J Card Surg 2022; 37:3188-3198. [DOI: 10.1111/jocs.16790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Timothy J. George
- Department of Advanced Heart Failure and MCS, Baylor Scott and White The Heart Hospital Plano Texas USA
| | - Allison Aldrich
- Department of Advanced Heart Failure and MCS, Baylor Scott and White The Heart Hospital Plano Texas USA
| | - Robert L. Smith
- Department of Advanced Heart Failure and MCS, Baylor Scott and White The Heart Hospital Plano Texas USA
| | - William H. Ryan
- Department of Advanced Heart Failure and MCS, Baylor Scott and White The Heart Hospital Plano Texas USA
| | - J. Michael DiMaio
- Department of Advanced Heart Failure and MCS, Baylor Scott and White The Heart Hospital Plano Texas USA
| | - Nitin Kabra
- Department of Advanced Heart Failure and MCS, Baylor Scott and White The Heart Hospital Plano Texas USA
| | - Aasim Afzal
- Department of Advanced Heart Failure and MCS, Baylor Scott and White The Heart Hospital Plano Texas USA
| | - David A. Rawitscher
- Department of Advanced Heart Failure and MCS, Baylor Scott and White The Heart Hospital Plano Texas USA
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3
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Zhalbinova MR, Rakhimova SE, Kozhamkulov UA, Akilzhanova GA, Kaussova GK, Akilzhanov KR, Pya YV, Lee JH, Bekbossynova MS, Akilzhanova AR. Association of Genetic Polymorphisms with Complications of Implanted LVAD Devices in Patients with Congestive Heart Failure: A Kazakhstani Study. J Pers Med 2022; 12:jpm12050744. [PMID: 35629166 PMCID: PMC9143784 DOI: 10.3390/jpm12050744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Madina R. Zhalbinova
- National Laboratory Astana, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.R.Z.); (S.E.R.); (U.A.K.)
- Department of General Biology and Genomics, L. N. Gumilyov Eurasian National University, Nur-Sultan 010000, Kazakhstan
| | - Saule E. Rakhimova
- National Laboratory Astana, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.R.Z.); (S.E.R.); (U.A.K.)
| | - Ulan A. Kozhamkulov
- National Laboratory Astana, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.R.Z.); (S.E.R.); (U.A.K.)
| | - Gulbanu A. Akilzhanova
- Semey Medical University, Pavlodar Branch, Pavlodar 140000, Kazakhstan; (G.A.A.); (K.R.A.)
| | | | - Kenes R. Akilzhanov
- Semey Medical University, Pavlodar Branch, Pavlodar 140000, Kazakhstan; (G.A.A.); (K.R.A.)
| | - Yuriy V. Pya
- National Research Cardiac Surgery Center, Nur-Sultan 010000, Kazakhstan; (Y.V.P.); (M.S.B.)
| | - Joseph H. Lee
- Sergievsky Center, Taub Institute, Columbia University Irving Medical Centerx, 630 W, New York, NY 10032, USA;
| | | | - Ainur R. Akilzhanova
- National Laboratory Astana, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.R.Z.); (S.E.R.); (U.A.K.)
- Department of General Biology and Genomics, L. N. Gumilyov Eurasian National University, Nur-Sultan 010000, Kazakhstan
- Correspondence: ; Tel.: +7-7172-706501
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4
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Pienta M, Shore S, Pagani FD, Likosky DS. Rates and types of infections in left ventricular assist device recipients: A scoping review. JTCVS OPEN 2021; 8:405-411. [PMID: 36004147 PMCID: PMC9390679 DOI: 10.1016/j.xjon.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/06/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Michael Pienta
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Supriya Shore
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Donald S. Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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5
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Pya Y, Medressova A, Faizov L, Kuanyshbek A, Kaliyev R, Myrzakhmetova G, Fleur PL. Response to the manuscript "ex vivo donor heart preservation in heart transplantation (HTx)-Is this the solution to increase the donor pool?". J Card Surg 2021; 36:4837-4838. [PMID: 34499393 DOI: 10.1111/jocs.15975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Yuriy Pya
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
| | - Assel Medressova
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
| | - Linar Faizov
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
| | - Aidyn Kuanyshbek
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
| | - Rymbai Kaliyev
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
| | | | - Philip la Fleur
- Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
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6
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Pya Y, Abdiorazova A. Elimination of drive exit line: transcutaneous energy transmission. Ann Cardiothorac Surg 2021; 10:393-395. [PMID: 34159122 DOI: 10.21037/acs-2020-cfmcs-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yuriy Pya
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan.,University Medical Center, Nur-Sultan, Kazakhstan
| | - Aigerim Abdiorazova
- Patient Relations Department, National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
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7
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Schaeffer T, Pfister O, Mork C, Mohacsi P, Rueter F, Scheifele S, Morgen A, Zenklusen U, Doebele T, Maurer M, Erb J, Fassl J, Cueni N, Siegemund M, Pargger H, Gahl B, Osswald S, Eckstein F, Grapow M. 5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital. J Cardiothorac Surg 2021; 16:64. [PMID: 33789723 PMCID: PMC8011141 DOI: 10.1186/s13019-021-01447-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background In Switzerland, long-term circulatory support programs have been limited to heart transplant centers. In 2014, to improve the management of patients with end-stage heart failure not eligible for transplantation, we implemented a left ventricular assist device (LVAD) program for destination therapy at the University Hospital of Basel. Methods We described the program set-up with practical aspects. Patients aged 65 and above with therapy refractory end-stage heart failure without major contraindication for LVAD implantation were included. Younger patients with bridge-to-candidacy profile were also considered. Using the Kaplan-Meier estimate, we retrospectively analyzed the overall survival and freedom from major adverse events after LVAD implantation. We compared our results to internationally reported data. Results Between October 2014 and September 2019, 16 patients received an LVAD in our center. The mean age at implantation was 67.1 years. The mean EuroSCORE II was 24.4% and the median INTERMACS level was 4. Thirteen patients received an LVAD as destination therapy and three patients as bridge-to-candidacy. The overall survival was 87.5 and 70% at 1 and 2 years, respectively. Freedom from stroke was 81.3% at 1 and 2 years. Freedom from device infection was 67.7 and 58.7% at 1 and 2 years, respectively. Freedom from gastrointestinal bleeding was 75 and 56.3% at 1 and 2 years, respectively. Freedom from readmission was 50 and 31.3% and at 6 months and 1 year, respectively. Conclusions The Basel experience demonstrated the possible implementation of an LVAD program for destination therapy or bridge-to-candidacy in a non-transplant comprehensive heart-failure center with midterm survival results and freedom from major adverse events comparable to international registries. Patient selection remains crucial. Trial registration This study was registered on the ClinicalTrials.gov database (NCT04263012).
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Affiliation(s)
- Thibault Schaeffer
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Otmar Pfister
- Department of cardiology, University Hospital of Basel, Basel, Switzerland
| | - Constantin Mork
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Paul Mohacsi
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Florian Rueter
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Simon Scheifele
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Anne Morgen
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Urs Zenklusen
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Thomas Doebele
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Markus Maurer
- Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Joachim Erb
- Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Jens Fassl
- Institute of Cardiac Anesthesiology, Heart Center of the Technical University of Dresden, Dresden, Germany
| | - Nadine Cueni
- Department of Intensive Care, University Hospital of Basel, Basel, Switzerland
| | - Martin Siegemund
- Department of Intensive Care, University Hospital of Basel, Basel, Switzerland
| | - Hans Pargger
- Department of Intensive Care, University Hospital of Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of cardiology, University Hospital of Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Martin Grapow
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland. .,HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zürich, Switzerland.
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8
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Kaliyev R, Lesbekov T, Bekbossynov S, Nurmykhametova Z, Bekbossynova M, Novikova S, Medressova A, Smagulov N, Faizov L, Samalavicius R, Pya Y. Heart transplantation of patients with ventricular assist devices: impact of normothermic ex-vivo preservation using organ care system compared with cold storage. J Cardiothorac Surg 2020; 15:323. [PMID: 33109229 PMCID: PMC7590799 DOI: 10.1186/s13019-020-01367-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/18/2020] [Indexed: 01/09/2023] Open
Abstract
Background Organ Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Impact of normothermic ex-vivo preservation using OCS compared with cold storage (CS) for prolonged heart preservation especially beneficial for high-risk recipients bridged to transplantation with Mechanical Circulatory Support (MCS). Methods Between 2012 and 2018, we performed a retrospective single-center review of prospectively collected data. All patients who underwent heart transplantation with MCS using the OCS Heart (n = 25) versus standard cold storage (n = 10) were included in this study. Results During this period, 353 patients were implanted with left ventricular assisted device (LVAD) and 35 (10%) were bridged to heart transplantation. There was no significant difference in donor and recipient characteristics and risk factors. The Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was a trend towards higher estimated risk of death at 1y in the OCS group (14.2 vs. 10.8% p = 0.083). Mean total ischemic time during preservation was statistically significantly longer in CS vs OCS group (210 (23) Vs 74.6 (13) min p = 0.001). Median ex vivo normothermic heart perfusion time in OCS was 348.4(132; 955) min. There was significant difference in total out of body time between OCS group 423(67) Vs CS group 210(23) min p = 0.002). All patients were alive on the 30th days post implant in CS groups and 96% in OCS group (p = 0.5). Conclusion Normothermic ex-vivo preservation of the allograft during transportation with the organ care system might be beneficial for long-time out of body organ preservation in comparison of cold storage especially for recipients on mechanical circulatory support.
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Affiliation(s)
- Rymbay Kaliyev
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Timur Lesbekov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Serik Bekbossynov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | | | - Svetlana Novikova
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Assel Medressova
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Nurlan Smagulov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Linar Faizov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | - Yuriy Pya
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
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9
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Anker MS, von Haehling S, Papp Z, Anker SD. ESC Heart Failure receives its first impact factor. Eur J Heart Fail 2019; 21:1490-e8. [PMID: 31883221 DOI: 10.1002/ejhf.1665] [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: 11/11/2022] Open
Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, University of Göttingen Medical Center, George August University, Göttingen, Germany and German Center for Cardiovascular Medicine (DZHK), partner site Göttingen, Göttingen, Germany
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany, DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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10
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Kaliyev R, Lesbekov T, Bekbossynov S, Bekbossynova M, Nurmykhametova Z, Novikova S, Smagulov N, Medressova A, Faizov L, Ashyrov Z, la Fleur P, Samalavicius R, Pya Y. Comparison of Custodiol vs warm blood cardioplegia and conditioning of donor hearts during transportation with the organ care system. J Card Surg 2019; 34:969-975. [PMID: 31332833 PMCID: PMC6852406 DOI: 10.1111/jocs.14162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives Cold crystalloid cardioplegia for donor heart harvesting and cold ischemic storage conditions during the transportation is the standard of care during heart transplantation procedure. Organ care system (OCS) was introduced for more prolonged and reliable ex vivo organ management. This study evaluated the two different techniques used for myocardial preservation during the procurement and transportation of the heart using the OCS. Methods We performed prospective analysis of 43 patients with heart failure undergoing heart transplantation and using the OCS for donor organ transport. Donor hearts were arrested using blood cardioplegia and conditioning (n = 30) or standard Custodiol (SC) solution (
n = 13). Perfusion and cardiac function parameters were continuously monitored while the donor hearts were perfused in the OCS. Impact of preservation techniques on biochemical parameters and clinical outcomes were evaluated. Results All donor hearts had stable perfusion and lactate characteristics in the OCS, with similar measures between the two groups at the beginning of the ex vivo perfusion. Ex vivo heart perfusion mean ending concentration of Interleukin (IL)‐6 and IL‐8 was significantly lower in the blood cardioplegia group compared to the standard care group. Clinical outcomes were comparable between the two groups of patients. Conclusions The use of blood cardioplegia and conditioning could be a safe method for myocardial protection in distant procurement and preservation of donor hearts in the OCS.
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Affiliation(s)
- Rymbay Kaliyev
- National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Timur Lesbekov
- National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | | | | | | | | | - Nurlan Smagulov
- National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Assel Medressova
- National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Linar Faizov
- National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Zhanibek Ashyrov
- National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Philip la Fleur
- Nazarbayev University School of Medicine, Astana, Kazakhstan
| | | | - Yuriy Pya
- National Research Center for Cardiac Surgery, Astana, Kazakhstan
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11
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Zhigalov K, Szczechowicz M, Mashhour A, Mkalaluh S, Safonov D, Enginoev S, Easo J, Ennker J, Eichstaedt HC, Weymann A. Impact of preoperative extracorporeal life support on left ventricular assist device outcomes: A comparative study. Int J Artif Organs 2019; 42:338-346. [PMID: 30919730 DOI: 10.1177/0391398819837696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: To investigate whether preoperative short-term extracorporeal life support therapy in patients undergoing continuous-flow left ventricular assist device implantation has an impact on the outcome regarding survival and adverse events. Methods: Between January 2011 and May 2018, 100 consecutive patients received HeartMate II, HeartWare, or HeartMate III for end-stage heart failure. Mean age was 64.2 ± 10.3 years. Three patient groups were identified: without preoperative extracorporeal life support (non-extracorporeal life support group, n = 80), with preoperative extracorporeal life support due to postcardiotomy shock after conventional cardiac surgery (postcardiotomy shock group, n = 9), and with preoperative extracorporeal life support without previous surgery (non-postcardiotomy shock group, n = 11). The primary endpoint was overall survival after device implantation. Secondary endpoints were adverse events during the follow-up period. Results: Survival was significantly different between the groups (p < 0.05): 30-day, 6-month, and 1-year survival rates were 85%, 68%, and 61% for non-extracorporeal life support group; 44%, 22%, and 22% for postcardiotomy shock group; and 45%, 27%, and 24% for non-postcardiotomy shock group, respectively. Furthermore, in both extracorporeal life support groups (postcardiotomy shock and non-postcardiotomy shock), there were a higher incidence (p < 0.05) of postoperative right heart failure (30% vs 66.7% vs 54.5%), acute renal failure requiring dialysis (20% vs 77.8% vs 54.5%), and respiratory failure (31.3% vs 88.9% vs 81.8%). Conclusion: Continuous-flow left ventricular assist device implantation with prior extracorporeal life support appears to have a worse outcome regarding survival, right heart failure, renal and respiratory dysfunction (p < 0.05). Future studies have to be done to evaluate the outcome after extracorporeal life support bridge pre-left ventricular assist device, especially as ultima ratio in postcardiotomy shock patients.
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Affiliation(s)
- Konstantin Zhigalov
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Ahmed Mashhour
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Sabreen Mkalaluh
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Dmitrii Safonov
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Soslan Enginoev
- Federal Center for Cardiovascular Surgery, Astrakhan State Medical University, Astrakhan, Russia
| | - Jerry Easo
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Juergen Ennker
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Harald C Eichstaedt
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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12
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Anker MS, von Haehling S, Papp Z, Anker SD. The new Heart Failure Association journal - ESC Heart Failure. Eur J Heart Fail 2018; 20:1657-1663. [PMID: 30561163 DOI: 10.1002/ejhf.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Markus S Anker
- Department of Cardiology (CBF), Charité, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Charité, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Charité, Berlin, Germany
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13
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Nestorovic E, Schmitto JD, Kushwaha SS, Putnik S, Terzic D, Milic N, Mikic A, Markovic D, Trifunovic D, Ristic A, Ristic M. Successful establishment of a left ventricular assist device program in an emerging country: one year experience. J Thorac Dis 2018; 10:S1743-S1750. [PMID: 30034847 DOI: 10.21037/jtd.2018.04.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background The primary goal of this study was to evaluate the outcomes of patients with end-stage heart failure (HF) who underwent continuous flow left ventricular assist device (CF-LVAD) in a developing country and to compare to those reported by more developed countries. The secondary goal was on determining factors that may be connected to improved survival. Methods We prospectively analyzed 47 consecutive patients who underwent CF-LVAD at our institution. After one year the survival and adverse event profiles of patients were evaluated. At 3, 6 and 12 months, the cardiac, renal and liver function outcomes were assessed. Results The 30-day, 6-month and 1-year survival rates were 89%, 85% and 80%, respectively. A significant improvement in dimensions and ejection fraction of left ventricle, BNP, functional capacity, blood urea nitrogen (BUN) and total bilirubin (P<0.05 for all) were noticed 3 months post-CF-LVAD implantation, and patients were stable throughout the entire first year follow up. In the group of patients with baseline renal dysfunction (RD) there were significant improvements of renal function (P=0.004), with no changes on follow up. 57% of patients exhibited some kind of adverse event, commonly in the form of bleeding. In multivariate Cox regression analysis renal failure was found to be as an independent risk factor for the overall survival (HR =13.1, P<0.001). Conclusions In conclusion, our data extends previous findings from centers of developed countries, that CF-LVAD is an adequate treatment option for patients suffering from end-stage HF, and encourages expansion of CF-LVAD implantation in developing countries with nascent HT program.
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Affiliation(s)
- Emilija Nestorovic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sudhir S Kushwaha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Svetozar Putnik
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dusko Terzic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Milic
- Department for Medical Statistics and Informatics, Medical Faculty University of Belgrade, Belgrade, Serbia.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Aleksandar Mikic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dejan Markovic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Arsen Ristic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Miljko Ristic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
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Adverse Event Rates Change Favorably Over Time for Patients Bridged With the HeartWare Left Ventricular Assist Device. ASAIO J 2018; 63:745-751. [PMID: 28475561 DOI: 10.1097/mat.0000000000000585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The HeartWare Ventricular Assist System (HVAD) provides significant improvements in survival and quality of life, and here, we seek to evaluate temporal differences in the adverse event (AE) rates. Patients (n = 382) in the ADVANCE bridge-to-transplant and continued access protocol trial were assessed for bleeding, cardiac arrhythmia, infection, ischemic and hemorrhagic stroke, and right heart failure during predetermined time periods (≤30, >30-180, >180-365, >365-730, >730-1,095 days) after HVAD implant. The Kaplan-Meier survival at 30 days, 6 months, 1, 2, and 3 years was 98%, 90%, 84%, 71%, and 63%, respectively. There were significantly fewer total AEs in days >30-180 (events per patient year [EPPY] = 5.34) compared with the first 30 days post HVAD implantation (EPPY = 30.36; p < 0.0001). The total AE rate in days >180-365 (EPPY = 4.09) was also significantly lower than the event rate in days >30-180 (EPPY = 5.34; p < 0.0001). Incidence of cardiac arrhythmias, infections, strokes, and right heart failure were highest immediately post implant and lower rates occurred after 6 months. After 1 year, all AEs exhibited stable rates that were comparable up to 3 years of support (all p > 0.05). This changing risk over time has clinically meaningful implications toward improving patient management.
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15
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Pya Y, Bekbossynova M, Jetybayeva S, Bekbossynov S, Andossova S, Salov R, Medressova A, Novikova S, Murzagaliyev M. Initial 3-year outcomes with left ventricular assist devices in a country with a nascent heart transplantation program. ESC Heart Fail 2015; 3:26-34. [PMID: 27774264 PMCID: PMC5061086 DOI: 10.1002/ehf2.12066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/09/2015] [Accepted: 08/26/2015] [Indexed: 12/21/2022] Open
Abstract
AIMS The need for the left ventricular assist devices (LVAD) in patients with end-stage heart failure is well established, but prior to 2011, this was not available to patients in Kazakhstan. We describe the development of the sole LVAD programme in the context of a nascent heart transplantation programme and clinical outcomes for the first three years. METHODS AND RESULTS From November 2011 to November 2014, 146 patients underwent implantation of 152 VADs (approximately 50 devices implanted per year). We retrospectively analyzed data from 135 LVAD patients who received HeartMate II (n = 95) or HeartWare (n = 40) devices. In 75 patients LVAD was used as a bridge-to-transplantation and in 60 patients as destination therapy, but only 3 of 135 LVAD patients received heart transplant. Forty-three patients of the LVAD cohort had died by the end of the follow-up period. The mean time on LVAD was 466 ± 330 days (range 5-1200 days). Kaplan-Meier survival estimates for patients who continued on LVAD support were 93% after 1 month, 86% after 6 months and 77% after 12 months. The most common complications within the first 30 days after implant included right ventricular failure (n = 20, 1.85 events/patient-year), renal failure (n = 19, 1.76 events/patient-year) and bleeding (n = 33, 3.0 events/patient-year). Beyond 30 days adverse events included driveline infections (n = 46, 0.56 events/patient-year) and stroke (n = 33, 0.21 events/patient-year). CONCLUSIONS LVADs are an important therapeutic alternative to heart transplantation in the context of a developing heart transplant programme with outcomes that are comparable to those reported by other centres.
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Affiliation(s)
- Yuriy Pya
- JSC National Research Center for Cardiac Surgery Astana Kazakhstan
| | | | | | | | | | - Roman Salov
- JSC National Research Center for Cardiac Surgery Astana Kazakhstan
| | - Assel Medressova
- JSC National Research Center for Cardiac Surgery Astana Kazakhstan
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