1
|
Yang Z, Subramanian MP, Yan Y, Schilling JD, Puri V, Itoh A. Paradoxical outcome of heart transplantation associated with institutional case volume. Clin Transplant 2021; 35:e14471. [PMID: 34546591 DOI: 10.1111/ctr.14471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies in heart transplantation have shown an association between institutional case volume and outcomes. We aim to determine the case volume associated with optimal 1-year survival after transplantation. METHODS AND RESULTS The United Network for Organ Sharing (UNOS) national database was analyzed for adult patients who underwent orthotopic heart transplantation between January 2013 and December 2017. A total of 11,196 cases at 128 transplant centers were included. Risk-adjusted restricted cubic splines revealed a non-linear association between institutional case volume and 1-year post-transplant survival. In the risk-adjusted, random-effect Cox model with segmented linear splines, higher heart transplant volume up to 24 cases per year was associated with better 1-year survival (HR = .978 every additional case, 95% CI .963-.993), and optimal survival was maintained between 24 and 38 cases per year. However, further increase in volume above 38 transplants per year was associated with mildly decreased 1-year survival (HR = 1.007 every additional case, 95% CI 1.002-1.013). CONCLUSIONS The relationship between institutional case volume and heart transplant 1-year survival is non-linear, with optimal survival observed at institutional case volume of 24-38 cases per year.
Collapse
Affiliation(s)
- Zhizhou Yang
- Washington University School of Medicine, Division of Cardiothoracic Surgery, St. Louis, Missouri, USA
| | - Melanie P Subramanian
- Washington University School of Medicine, Division of Cardiothoracic Surgery, St. Louis, Missouri, USA
| | - Yan Yan
- Washington University School of Medicine, Division of Public Health Sciences, St. Louis, Missouri, USA
| | - Joel D Schilling
- Washington University School of Medicine, Division of Cardiovascular Diseases, St. Louis, Missouri, USA
| | - Varun Puri
- Washington University School of Medicine, Division of Cardiothoracic Surgery, St. Louis, Missouri, USA
| | - Akinobu Itoh
- Washington University School of Medicine, Division of Cardiothoracic Surgery, St. Louis, Missouri, USA
| |
Collapse
|
2
|
Gómez-Mesa JE, Peña-Zárate E, Zapata-Vásquez IL, López-Ponce de León JD, Olaya-Rojas P, Carrillo-Gómez DC, Manzi-Tarapues E, Rincón-Escobar E, Galindo-Coral S, Flórez-Alarcón N. Factores asociados a la mortalidad en el primer año postrasplante cardíaco. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
3
|
Alyaydin E, Welp H, Reinecke H, Tuleta I. Predisposing factors for late mortality in heart transplant patients. Cardiol J 2020; 28:746-757. [PMID: 32052856 DOI: 10.5603/cj.a2020.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/30/2019] [Accepted: 01/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Because of the growing prevalence of terminal heart failure on the one hand and organ shortage on the other hand, an optimal care of heart transplant recipients based on the knowledge of potential risk factors not only early, but also in a long-term course after heart transplantation is of great importance. Therefore, the aim of the present study was to identify predisposing factors for late mortality in this patient collective. METHODS Data from long-term heart transplant patients collected during follow-up visits in the current center were retrospectively analyzed. Clinical, laboratory, including immune monitoring and apparative examination results were studied with regard to all-cause mortality. RESULTS One hundred and seventy-two patients after heart transplantation (mean: 13.2 ± 6.4 years) were divided into two groups: survivors (n = 133) and non-survivors (n = 39). In comparison with survivors, non-survivors were characterized by significantly more pronounced renal insufficiency with more frequent dialysis, anemia and worse functional status. Additionally, non-survivors obtained hearts from relevantly more obese donors. In a multivariate Cox regression analysis the following parameters were shown to be independent risk factors for increased mortality: CD4 percentage < 42%, C-reactive protein ≥ 0.5 mg/dL, presence of rejections requiring therapies in the past, onset of cardiac allograft vasculopathy < 5 years following heart transplantation and no use of beta-blockers. CONCLUSIONS Low CD4+ cell percentages, sustained inflammation, relevant organ rejections, early onset of transplant vasculopathy and no use of beta-blockers are risk factors for higher mortality in a long-term follow-up after heart transplantation.
Collapse
Affiliation(s)
- Emyal Alyaydin
- Department of Cardiology I, University of Muenster, Germany
| | - Henryk Welp
- Department of Cardiothoracic Surgery, University of Muenster, Germany
| | | | - Izabela Tuleta
- Department of Cardiology I, University of Muenster, Germany.
| |
Collapse
|
4
|
Truby LK, DeRoo S, Spellman J, Jennings DL, Takeda K, Fine B, Restaino S, Farr M. Management of primary graft failure after heart transplantation: Preoperative risks, perioperative events, and postoperative decisions. Clin Transplant 2019; 33:e13557. [PMID: 30933386 DOI: 10.1111/ctr.13557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/30/2022]
Abstract
Primary graft failure (PGF) after heart transplantation (HT) is a devastating and unexpected event characterized by failure of the graft to adequately support recipient circulation necessitating high doses of vasopressors and inotropes and/or temporary mechanical circulatory support. Although it represents an increasingly common event in the current era, there remains a high degree of variability in prevalence, reported risk factors, and approach to this clinical entity. The purpose of the current review is to highlight preoperative considerations including known incidence and risk factors, perioperative issues involving the identification and management of PGF, and postoperative decisions related to weaning of mechanical circulatory support and titration of immunosuppressive therapy. Lastly, we highlight future directions in PGF research, involving basic and translational research, that have the potential to uncover novel strategies of risk stratification and treatment. CASE: Our patient is a 53-year-old man with end-stage non-ischemic dilated cardiomyopathy complicated by ventricular tachycardia (VT), post-capillary pulmonary hypertension, and renal insufficiency. After progressing to NYHA Class IV symptoms, he underwent implantation of a durable left ventricular assist device (LVAD) as bridge to transplant (BTT). On device support, he developed recurrent VT resulting in multiple defibrillator discharges and hospital admission for intravenous anti-arrhythmic therapy. He is subsequently upgraded to a higher status on the waiting list. A suitable donor is identified, with an appropriate predicted heart mass and an anticipated ischemic time of <4 hours. He is taken to the operating room, where at the time of anesthesia induction he develops vasodilatory shock, requiring high-dose vasopressors, and cardiopulmonary bypass (CPB) support for dissection. After surgical anastomosis, cross clamp removal and reperfusion, graft function is extremely poor, there is significant bradycardia requiring pacing, and the patient is unable to be weaned successfully from CPB. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is initiated, and the patient is transferred to the intensive care unit. Retrospective flow crossmatch is negative. This patient is suffering from severe primary graft failure.
Collapse
Affiliation(s)
- Lauren K Truby
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Scott DeRoo
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Jessica Spellman
- Department of Anesthesia, Columbia University Irving Medical Center, New York, New York
| | - Douglas L Jennings
- Department of Pharmacology, New York Presbyterian Hospital, New York, New York
| | - Koji Takeda
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Barry Fine
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Susan Restaino
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Maryjane Farr
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
5
|
Comparison of In-Hospital Outcomes of Patients With-Versus-Without Ischemic Cardiomyopathy Undergoing Left Ventricular Assist Device Placement. Am J Cardiol 2019; 123:414-418. [PMID: 30545482 DOI: 10.1016/j.amjcard.2018.10.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 01/04/2023]
Abstract
The objective of this study was to evaluate the impact of heart failure (HF) etiology (ischemic cardiomyopathy [ICM] versus nonischemic cardiomyopathy) on in-hospital outcomes in patients undergoing left ventricular assist device (LVAD) placement using the Nationwide Inpatient Sample database. We identified patients who underwent LVAD placement from 2011 to 2014. The primary end point was the effect of ICM on in-hospital mortality. Secondary end points included periprocedural vascular complications requiring surgery, postoperative myocardial infarction, stroke, and hemorrhage requiring transfusion. We also assessed length of stay and cost of hospitalization. A mixed effects logistic model was used for clinical end points and a linear mixed model was used for cost and length of stay. In 3,511 patients who underwent LVAD placement (23.32% women and 56.23 ± 13.51 years old), the incidence of ICM was 53.5%. After adjusting for patient- and hospital-level characteristics, ICM was not found to influence in-hospital mortality (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.78 to 1.23). ICM was associated with an increased risk in periprocedural hemorrhage requiring transfusion (OR 1.29, 95% CI 1.08 to 1.53), vascular complications requiring surgery (OR 1.58 95% CI 1.10 to 2.28) and postoperative ST-segment myocardial infarction (OR 7.38 95% CI 5.33 to 10.24). In conclusion, ICM did not impact in-hospital mortality in patients who underwent LVAD placement but was associated with increased vascular complications, hemorrhage requiring transfusion, and postoperative myocardial infarction.
Collapse
|
6
|
Banga A, Mohanka M, Mullins J, Bollineni S, Kaza V, Huffman L, Peltz M, Bajona P, Wait M, Torres F. Incidence and variables associated with 30-day mortality after lung transplantation. Clin Transplant 2019; 33:e13468. [PMID: 30578735 DOI: 10.1111/ctr.13468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/25/2018] [Accepted: 12/05/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the introduction of the lung allocation score (LAS), sicker patients are prioritized for lung transplantation (LT). There is a lack of data regarding variables independently associated with 30-day mortality after LT. METHODS We queried the UNOS database for adult patients undergoing LT between 1989 and 2014. Patients with dual organ or previous transplantation and those with missing survival data were excluded. Mortality during the first 30 days after LT was the primary outcome variable. RESULTS The yearly trends indicate a statistically significant reduction in the 30-day mortality during the study period (P < 0.001, overall mortality: 5.5%) which has continued in the post-LAS era (P = 0. 014, overall mortality: 3.6%). Among patients with 30-day mortality, "primary non-function" (n = 118, 72.8%) was reported as the most common etiology. Transplant indication of vascular diseases, history of non-transplant cardiac or lung surgery, mean pulmonary pressures >35 mm Hg, disabled functional status, ECMO support, high LAS, ischemic time >6 hours, and blunt injury as the mechanism of donor death are independently associated with 30-day mortality. CONCLUSION The incidence of early mortality after LT continues to decline in the post-LAS era. Apart from the mechanism of donor death and ischemic time, early mortality appears to be primarily driven by the recipient characteristics.
Collapse
Affiliation(s)
- Amit Banga
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Manish Mohanka
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jessica Mullins
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Srinivas Bollineni
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vaidehi Kaza
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lynn Huffman
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthias Peltz
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Pietro Bajona
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Wait
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fernando Torres
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
7
|
Successful Orthotopic Heart Transplantation in a Patient With Chronic Pancreatitis: Selective Medical and Surgical Considerations. Pancreas 2018; 47:e41-e42. [PMID: 29912855 DOI: 10.1097/mpa.0000000000001081] [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: 12/10/2022]
|
8
|
Jha AK, Hittalmani SK. Septic Shock in Low-Cardiac-Output Patients With Heart and Lung Transplantation: Diagnosis and Management Dilemma. J Cardiothorac Vasc Anesth 2017; 31:1389-1396. [PMID: 28094175 DOI: 10.1053/j.jvca.2016.11.003] [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: 09/14/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Ajay Kumar Jha
- Department of Cardiac Anesthesiology (Heart-Lung Transplantation), Global Health City, Chennai, India.
| | | |
Collapse
|
9
|
Salehi M, Bakhshandeh AR, Latifi S, Rahmanian M. Heart transplant survival rate in Iran: a single-center registry report. Asian Cardiovasc Thorac Ann 2014; 22:534-8. [PMID: 24867026 DOI: 10.1177/0218492313498758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM to determine 1-month and 1-year survival rate in recipients of heart transplants in Imam Khomeini Medical Center. METHODS we analyzed the outcomes of 69 patients who underwent heart transplantation between 2007 and 2010. The 1-month and 1-year survival rates were calculated, and we assessed prognostic factors such as donor and recipient age and sex, graft ischemic time during surgery, and liver and kidney function tests. RESULTS increased donor age had a significant negative effect on survival rate (p = 0.005). Sex differences between donor and recipient had no association with transplant outcome and survival rate. The overall 1-month and 1-year survival was 82.6% (n = 54) and 70% (n = 48), respectively. CONCLUSION heart transplantation is a lifesaving procedure for end-stage heart disorders. Mortality after heart transplantation depends on numerous factors, and thus survival rates differ among centers. The 1-month and 1-year survival rates after heart transplant in our center currently stand at 82.6% and 70%, respectively.
Collapse
Affiliation(s)
- Mehrdad Salehi
- Department of Cardiovascular and Transplantation Surgery, Imam Komeini Hospital Complex, Tehran, Iran
| | - Ali Reza Bakhshandeh
- Department of Cardiovascular and Transplantation Surgery, Imam Komeini Hospital Complex, Tehran, Iran
| | - Sahar Latifi
- Department of Medical Statistics, Imam Komeini Hospital Complex, Tehran, Iran
| | - Mehrzad Rahmanian
- Department of Cardiovascular and Transplantation Surgery, Imam Komeini Hospital Complex, Tehran, Iran
| |
Collapse
|
10
|
Kim HJ, Jung SH, Kim JJ, Kim JB, Choo SJ, Yun TJ, Chung CH, Lee JW. Early postoperative complications after heart transplantation in adult recipients: asan medical center experience. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:426-32. [PMID: 24368968 PMCID: PMC3868689 DOI: 10.5090/kjtcs.2013.46.6.426] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 06/30/2013] [Accepted: 08/05/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. METHODS Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of 58.4±43.6 months. RESULTS Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). CONCLUSION Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.
Collapse
Affiliation(s)
- Ho Jin Kim
- Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Sung-Ho Jung
- Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Jae Joong Kim
- Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Joon Bum Kim
- Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Suk Jung Choo
- Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Tae-Jin Yun
- Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Cheol Hyun Chung
- Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Jae Won Lee
- Division of Cardiology, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| |
Collapse
|
11
|
Variations in institutional staffing and clinical practice are predictive of center-specific 1-year survival post-transplant. J Heart Lung Transplant 2013; 32:1196-204. [DOI: 10.1016/j.healun.2013.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 08/15/2013] [Accepted: 09/10/2013] [Indexed: 11/17/2022] Open
|
12
|
Extracorporeal rescue for early and late graft failure after cardiac transplantation: short result and long-term followup. ScientificWorldJournal 2013; 2013:364236. [PMID: 24228000 PMCID: PMC3817658 DOI: 10.1155/2013/364236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/27/2013] [Indexed: 01/07/2023] Open
Abstract
Objectives. Graft failure after heart transplantation led to poor outcomes. We tried to analyze the outcomes of extracorporeal membrane oxygenation (ECMO) rescue in graft survival after transplantation. Methods. A retrospective review of 385 consecutive heart transplants revealed 46 patients of graft failure requiring ECMO rescue (48 episodes). The pretransplant and ECMO-related variables were evaluated. Results. The median age was 37.7 ± 18.8 years, and the median support time was 155 ± 145 hours. Success rate was 47.9% (23/48). Pretransplant ECMO use was 25% (12/48) and they had 58.3% mortality. The success rate in “early” graft failures was 51.4% (18/35) and 50% for “late” graft failure. The ischemic time with graft failure (178 ± 70 min) was significantly longer than that without graft failure. Preoperative status and the longer ischemic time may be the major factors for failure. Long-term 5-year survival demonstrated significant survival difference between graft failure and nongraft failure. No survival difference was shown between “early” and “late” graft failure. Conclusions. Graft failure still carried high mortality if advanced circulatory support was required. Early graft failure and late graft failure had similar outcomes. Further investigation of the risk factors shows that ECMO does play a role of rescue in catastrophic conditions.
Collapse
|
13
|
Beiras-Fernandez A, Kur F, Kaczmarek I, Frisch P, Weis M, Reichart B, Weis F. Levosimendan for Primary Graft Failure After Heart Transplantation: A 3-Year Follow-up. Transplant Proc 2011; 43:2260-2. [DOI: 10.1016/j.transproceed.2011.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
Segovia J, Cosío MDG, Barceló JM, Bueno MG, Pavía PG, Burgos R, Serrano-Fiz S, García-Montero C, Castedo E, Ugarte J, Alonso-Pulpón L. RADIAL: A novel primary graft failure risk score in heart transplantation. J Heart Lung Transplant 2011; 30:644-51. [DOI: 10.1016/j.healun.2011.01.721] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 01/28/2011] [Accepted: 01/29/2011] [Indexed: 12/17/2022] Open
|
15
|
Jung SH, Kim JJ, Choo SJ, Yun TJ, Chung CH, Lee JW. Long-term mortality in adult orthotopic heart transplant recipients. J Korean Med Sci 2011; 26:599-603. [PMID: 21532848 PMCID: PMC3082109 DOI: 10.3346/jkms.2011.26.5.599] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/15/2011] [Indexed: 11/20/2022] Open
Abstract
Heart transplantation is now regarded as the treatment of choice for end-stage heart failure. To improve long-term results of the heart transplantation, we analyzed causes of death relative to time after transplantation. A total of 201 consecutive patients, 154 (76.6%) males, aged ≥ 17 yr underwent heart transplantation between November 1992 and December 2008. Mean ages of recipients and donors were 42.8 ± 12.4 and 29.8 ± 9.6 yr, respectively. The bicaval anastomosis technique was used since 1999. Mean follow up duration was 6.5 ± 4.4 yr. Two patients (1%) died in-hospital due to sepsis caused by infection. Late death occurred in 39 patients (19.4%) with the most common cause being sepsis due to infection. The 1-, 5-, and 10-yr survival rates in these patients were 95.5% ± 1.5%, 86.9% ± 2.6%, and 73.5% ± 4.1%, respectively. The surgical results of heart transplantation in adults were excellent, with late mortality due primarily to infection, malignancy, and rejection. Cardiac deaths related to cardiac allograft vasculopathy were very rare.
Collapse
Affiliation(s)
- Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Joong Kim
- Department of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Tae-Jin Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| |
Collapse
|
16
|
McIlroy DR, Wallace S, Roubos N. Brain Natriuretic Peptide (BNP) as a Biomarker of Myocardial Ischemia-Reperfusion Injury in Cardiac Transplantation. J Cardiothorac Vasc Anesth 2010; 24:939-45. [DOI: 10.1053/j.jvca.2010.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Indexed: 01/20/2023]
|
17
|
Levosimendan: A New Therapeutic Option in the Treatment of Primary Graft Dysfunction After Heart Transplantation. J Heart Lung Transplant 2009; 28:501-4. [DOI: 10.1016/j.healun.2009.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 11/11/2008] [Accepted: 01/14/2009] [Indexed: 11/19/2022] Open
|
18
|
Amir NL, Gerber IL, Edmond JJ, Langlands JM, Richards AM, Ruygrok PN. Plasma B-type natriuretic peptide levels in cardiac donors. Clin Transplant 2009; 23:174-7. [DOI: 10.1111/j.1399-0012.2009.00954.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
|
20
|
Hackert T, Hartwig W, Fritz S, Schneider L, Strobel O, Werner J. Ischemic acute pancreatitis: clinical features of 11 patients and review of the literature. Am J Surg 2008; 197:450-4. [PMID: 18778810 DOI: 10.1016/j.amjsurg.2008.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/07/2008] [Accepted: 04/10/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Besides alcohol and gallstones, pancreatic ischemia can cause acute pancreatitis (AP). This entity should be considered when no other reasons can be defined. The aim of the current study was to define ischemic AP with its pathophysiologic, radiologic, and clinical conditions. METHODS Eleven patients with ischemic AP of different origin were analyzed regarding course, severity, and outcome, as well as diagnostic and therapeutic measures. RESULTS Ischemic AP was caused by hemorrhage and hypotension (7 patients) or mesenteric macrovessel occlusion (4 patients). Therapy was conservative (4 patients) or operative with hemostasis, necrosectomy, and drainage (7 patients). Seven patients died within 38 days, and 4 patients recovered. CONCLUSION Pancreatic hypoperfusion is an important etiology of AP. Severity of the disease ranges from moderate reversible changes to severe courses with fatal outcome. The indication for surgical intervention in ischemic AP is more aggressive; diagnostic and conservative therapeutic procedures are similar to AP of other etiologies.
Collapse
Affiliation(s)
- Thilo Hackert
- Department of Surgery, University of Heidelberg, Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
21
|
Boilson BA, Miller DV, Pereira NL. Late Allograft Failure After Heart Transplantation: 2 Unusual Cases. J Heart Lung Transplant 2008; 27:1050-4. [DOI: 10.1016/j.healun.2008.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/29/2008] [Accepted: 05/21/2008] [Indexed: 11/16/2022] Open
|
22
|
Ibrahim M, Hendry P, Masters R, Rubens F, Lam BK, Ruel M, Davies R, Haddad H, Veinot JP, Mesana T. Management of acute severe perioperative failure of cardiac allografts: a single-centre experience with a review of the literature. Can J Cardiol 2007; 23:363-7. [PMID: 17440641 PMCID: PMC2649186 DOI: 10.1016/s0828-282x(07)70769-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Early graft failure is associated with high mortality and is the main cause of death within the first 30 days after transplantation. The purpose of the present study was to examine the investigators' experience of severe perioperative acute graft failure and to review the literature. METHODS Nine of 385 cardiac transplants (2.3%) performed from 1984 through 2005 developed severe perioperative acute graft failure either in the operating room or within 24 h after cardiac transplantation. Four patients had primary graft failure, two had right heart failure secondary to pulmonary hypertension, one had hyperacute rejection, one had accelerated acute rejection and one possibly sustained a particulate coronary embolus intraoperatively. RESULTS All except the two patients who had right heart failure secondary to pulmonary hypertension received mechanical circulatory support. Three patients were supported with total artificial hearts, two patients received a left ventricular assist device, one patient was supported with extracorporeal life support followed by a right ventricular assist device when the left ventricle recovered, and one patient was supported for several hours with cardiopulmonary bypass. Three patients were retransplanted after mechanical circulatory support, but only one survived. Only one of the nine patients (11%) survived; this patient was supported with a total artificial heart followed by retransplantation. CONCLUSION The outcome of severe perioperative acute graft failure is very poor. Mechanical circulatory support and retransplantation are not as successful as in other situations. Due to the shortage of donors and poor outcomes, retransplantation for hyperacute rejection is not advisable.
Collapse
Affiliation(s)
- Moheb Ibrahim
- Section of Cardiac Surgery, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Affiliation(s)
- Ron-Bin Hsu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine
| |
Collapse
|
24
|
Abstract
Gastrointestinal complications are common after kidney, liver, pancreas, heart, and lung transplantation. Complications can include gastrointestinal conditions preceding the transplantation, viral, fungal, and bacterial gastrointestinal infections, and gastrointestinal side effects of medications including immunosuppressive agents. Establishing the etiology of gastrointestinal complaints is often difficult because any one or a combination of these factors might be contributory in the same patient.
Collapse
Affiliation(s)
- Amitabh Gautam
- Brown Medical School, Division of Organ Transplantation, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
| |
Collapse
|
25
|
Sezgin A, Gültekin B, Ozkan S, Akay T, Uğuz E, Tokalak I, Akpek E, Dönmez A, Müderrisoğlu H, Aslamaci S. Our Experience in Cardiac Transplantation in Baskent University. Transplant Proc 2006; 38:633-5. [PMID: 16549193 DOI: 10.1016/j.transproceed.2006.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recently cardiac transplantation has an important place in treatment of end-stage cardiac failure. In Turkey between 2003 and 2005 at 10 centers 64 cardiac transplantations were performed including five at our facility. Herein we have presented our results. All patients were men of mean age 34.2 +/- 10.7 (17 to 44) years. Upon preoperative echocardiography their mean ejection fraction was 18% +/- 3.27% (17% to 23%). Pulmonary vascular resistance was 4.47 wood unit in one patient and in one case, there was Rh incompatibility between donor and recipient. We used HTK solution for protection of donor hearts. Mean ischemia time was 251.2 +/- 62.7 minutes (155 to 314). Mean aortic clamping time was 84 +/- 4.7 minutes (80 to 90). In all patients we performed a biatrial anastomosis technique. Hemofiltration was used to prevent hemodilution during operation. In the postoperative period four patients had acute renal dysfunction; one, a minor cerebrovascular accident; two, reoperated because of bleeding; one, cholestasis; one, temporary atrio-ventricular block; and one, mediastinitis. Mean follow-up time was 15.6 +/- 19.7 months (2 to 50). Neither early nor late mortality has occurred. All patients are in New York Heart Association class I. In all cases we used triple immunosuppressive therapy. In the follow-up period the mean number of cardiac biopsies per patient was 4.2 +/- 3.03 (2 to 8). Two cases had cardiac catheterization. As a complication of cardiac biopsy, pericardial tamponade developed in one patient; in another one we observed a right ventricular aneursym after cardiac biopsy. Cardiac transplantation was performed with low mortality and morbidity rates in end-stage cardiac failure patients with longer life expectancy and higher life quality. Unfortunately in our country, because of difficulties to find donor hearts, cardiac transplantations were small in number. For better results, we need a larger series.
Collapse
Affiliation(s)
- A Sezgin
- Department of Cardiovascular Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey [corrected]
| | | | | | | | | | | | | | | | | | | |
Collapse
|