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Bowles CT, Hards R, Wrightson N, Lincoln P, Kore S, Marley L, Dalzell JR, Raj B, Baker TA, Goodwin D, Carroll P, Pateman J, Black JJM, Kattenhorn P, Faulkner M, Parameshwar J, Butcher C, Mason M, Rosenberg A, McGovern I, Weymann A, Gwinnutt C, Banner NR, Schueler S, Simon AR, Pitcher DW. Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices. Emerg Med J 2017; 34:842-850. [PMID: 29127102 PMCID: PMC5750371 DOI: 10.1136/emermed-2016-206172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/27/2017] [Accepted: 09/02/2017] [Indexed: 11/04/2022]
Abstract
Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients.
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Affiliation(s)
- Christopher T Bowles
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rachel Hards
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Neil Wrightson
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Paul Lincoln
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Shishir Kore
- Department of Cardiothoracic Transplantation, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Laura Marley
- Department of Cardiothoracic Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jonathan R Dalzell
- Scottish Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Binu Raj
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Tracey A Baker
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Diane Goodwin
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Petra Carroll
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jane Pateman
- Anaesthetic Department, Royal Sussex County Hospital, Brighton, UK
| | - John J M Black
- Clinical Directorate, South Central Ambulance Service Foundation Trust, Oxfordshire, UK
| | - Paul Kattenhorn
- East of England Ambulance Service Headquarters, Whiting Way, Melbourn, Cambs., SG8 6EN., East of England Ambulance Service Headquarters, Melbourn, Cambs, UK
| | - Mark Faulkner
- London Ambulance Service, Medical Directorate Office, London, UK
| | - Jayan Parameshwar
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Charles Butcher
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mark Mason
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alexander Rosenberg
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ian McGovern
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alexander Weymann
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Nicholas R Banner
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stephan Schueler
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Andre R Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Dobarro D, Urban M, Booth K, Wrightson N, Castrodeza J, Jungschleger J, Robinson-Smith N, Woods A, Parry G, Schueler S, MacGowan GA. Impact of aortic valve closure on adverse events and outcomes with the HeartWare ventricular assist device. J Heart Lung Transplant 2017; 36:42-49. [DOI: 10.1016/j.healun.2016.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/30/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022] Open
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Kirk R, Peng E, Woods A, Flett J, Hewitt T, Griselli M, Schueler S, Wrightson N, Hasan A. Successful HeartWare Bridge to Recovery in a 3-Year Old: A Game Changer? Ann Thorac Surg 2016; 101:1984-7. [DOI: 10.1016/j.athoracsur.2015.07.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/30/2015] [Accepted: 07/09/2013] [Indexed: 10/21/2022]
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Peng E, Kirk R, Wrightson N, Duong P, Ferguson L, Griselli M, Butt T, O'Sullivan JJ, MacGowan GA, Crossland D, Schueler S, Hasan A. An Extended Role of Continuous Flow Device in Pediatric Mechanical Circulatory Support. Ann Thorac Surg 2016; 102:620-7. [PMID: 27130250 DOI: 10.1016/j.athoracsur.2016.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/16/2015] [Accepted: 02/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mechanical circulatory support in the pediatric population is currently limited to pulsatile ventricular assist devices (VAD). In recent years, the use of durable, newer generation, continuous flow devices have increased substantially among adults with end-stage heart failure. We examined the extended role of this device in the pediatric population (aged less than 18 years). METHODS Between 2010 and 2015, 12 patients (median age 7.1 years; range, 3.7 to 17.0; one third of patients were aged 5 years or less) received a HeartWare ventricular assist device (HVAD; HeartWare, Framingham, MA), 11 for cardiomyopathy and 1 for posttransplant rejection. Right VAD support (n = 5; 42%) was provided by a short-term device (Levitronix, Zurich, Switzerland). RESULTS Overall, 1 patient died (day 638), 8 patients (67%) underwent transplantation, 1 patient (8.3%) recovered, and 2 patients (17%) remain on HVAD. The mean length of support was 150 days (range, 16 to 638). Four patients (33.3%) were discharged home (all left VAD). In the left VAD group (n = 7), 3 patients subsequently received transplants (days 185, 201, and 234, respectively), 1 recovered (day 149), 1 died (day 638), 1 remained on HVAD (day 198), and 1 needed conversion to biventricular assist device (BIVAD [day 73]). In the BIVAD group (n = 5), right VAD was weaned in 3 (60%), all subsequently received transplants, and 2 remained on BIVAD support until transplant (days 16 and 17, respectively). One BIVAD patient required conversion to central cannulation for longer-term support. Four BIVAD patients (80%) were in Interagency Registry for Mechanically Assisted Circulatory Support level 1 before VAD compared with 2 (29%) in the left VAD group (p = not significant). The actuarial survival rate was 100% at 1 year with no neurologic events. CONCLUSIONS The third-generation, continuous flow device can provide durable support in the pediatric population. The selection strategy for patients who benefit most from the device continues to evolve. It is anticipated that a smaller design in the future will benefit an even wider pediatric population with heart failure.
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Affiliation(s)
- Ed Peng
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Richard Kirk
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Neil Wrightson
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Phuoc Duong
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Lee Ferguson
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Massimo Griselli
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Tanveer Butt
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - John J O'Sullivan
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Guy A MacGowan
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - David Crossland
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Stephan Schueler
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Asif Hasan
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
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Woods A, MacGowan G, Schueler S, Smith NR, Wrightson N. A Review of Warfarin Management in Patients Supported with a Heartware HVAD Using Home INR Testing. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bhagra S, Bhagra C, Özalp F, Butt T, Ramesh B, Parry G, Roysam C, Woods A, Robinson-Smith N, Wrightson N, MacGowan GA, Schueler S. Development of de novo aortic valve incompetence in patients with the continuous-flow HeartWare ventricular assist device. J Heart Lung Transplant 2016; 35:312-319. [DOI: 10.1016/j.healun.2015.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/14/2015] [Accepted: 10/14/2015] [Indexed: 11/29/2022] Open
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McMinn J, Wrightson N, Parry G, Clark S, Scheuler S, MacGowan G. 48 Who and When to Refer for Advanced Heart Failure? A Survey of Clinicians Referring to the Freeman Hospital. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Miera O, Kirk R, Buchholz H, Schmitt K, Rebeyka I, Wrightson N, Berger F, Griselli M, Conway J. Multicenter Review of Heartware Ventricular Assist Device in Small Children. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Schlöglhofer T, Robson D, Bancroft J, Soerensen G, Kaufmann F, Sweet L, Wrightson N. Results of the HVAD Outpatient Management and Monitoring Survey for Optimal Outcomes. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Peng E, O’Sullivan JJ, Griselli M, Roysam C, Crossland D, Chaudhari M, Wrightson N, Butt T, Parry G, MacGowan GA, Schueler S, Hasan A. Durable Ventricular Assist Device Support for Failing Systemic Morphologic Right Ventricle: Early Results. Ann Thorac Surg 2014; 98:2122-9. [DOI: 10.1016/j.athoracsur.2014.06.054] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/03/2014] [Accepted: 06/11/2014] [Indexed: 10/24/2022]
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Wrightson N, Robinson-Smith N, Butt T, Ramesh B, Oezalp F, MacGowan G, Donado A, Schueler S. 022 * NOVEL MINIMALLY INVASIVE DECOMMISSIONING OF HEARTWARE LEFT VENTRICULAR ASSIST DEVICE FOLLOWING MYOCARDIAL RECOVERY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Özalp F, Bhagra S, Bhagra C, Butt T, Ramesh B, Robinson-Smith N, Wrightson N, Parry G, Griselli M, Hasan A, Schueler S, MacGowan GA. Four-year outcomes with third-generation centrifugal left ventricular assist devices in an era of restricted transplantation. Eur J Cardiothorac Surg 2014; 46:e35-40. [PMID: 24980558 PMCID: PMC4128784 DOI: 10.1093/ejcts/ezu258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Third-generation ventricular assist devices (VADs) are associated with improved outcomes, though in recent clinical trials bridge-to-transplant (BTT) rates are ∼30% at 6 months, so that transplantation can be used as a ‘bail out’ for serious complications. In the UK, there was a significant reduction in heart transplantation rates over the last decade, so that transplantation from VADs is much less frequent. The objective of this study was to determine outcomes and their predictors in this situation of low BTT rates, and as patients were exposed to long-term support, the incidence and outcomes of VAD thrombosis. METHODS We analysed outcomes for 102 consecutive patients between 2009 and 2013 (mean age 47 ± 13; VentrAssist n = 6 and HeartWare n = 96). The median duration of support was 462 ± 426 days. RESULTS Survival rates on the device were 75 and 66% at 1 and 2 years, respectively. Older age and more acute INTERMACS groups were significantly related to reduced survival within the first 90 days (P = 0.030 and 0.010, respectively). Poor preoperative right ventricular (RV) function had a negative effect on survival after 1 year (P = 0.009), though not earlier. VAD thrombosis (n = 24 HeartWare and n = 1 VentrAssist) occurred at 0.18 events per patient-year for HeartWare and 0.07 for VentrAssist devices at a median time of onset at 404 ± 281 days. There was no significant effect of VAD thrombosis on survival. Only 14 of 102 patients were transplanted at a median of 334 ± 347 days, and only 3 were transplanted within the first 6 months. CONCLUSIONS Third-generation left ventricular assist device implants with a low rate of transplantation have similar survival to destination therapy, and are susceptible to long-term complications of VAD thrombosis and right heart failure.
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Affiliation(s)
- Faruk Özalp
- Departments of Cardiothoracic Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sai Bhagra
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Catriona Bhagra
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Tanveer Butt
- Departments of Cardiothoracic Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bandigowdanapalya Ramesh
- Departments of Cardiothoracic Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Robinson-Smith
- Departments of Cardiothoracic Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil Wrightson
- Departments of Cardiothoracic Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gareth Parry
- Departments of Cardiothoracic Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Massimo Griselli
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Asif Hasan
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Departments of Cardiothoracic Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy A MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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Butt T, Ozalp F, Wrightson N, Robinson Smith N, Woods A, Parry G, Griselli M, Hasan A, Schueler S, MacGowan G. Extended Bridge To Transplant: 4 Years Outcomes With 3rd Generation LVADs in an Era of Restricted Transplantation. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Peng E, Griselli M, O’Sullivan J, Crossland D, Chaudhari M, Wrightson N, Butt T, Roysam C, Parry G, MacGowan G, Schueler S, Hasan A. Mechanical Circulatory Support for Failing Systemic Right Ventricle Using Left Ventricular Assist Device - An Option To Decide and Bridge? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Woods A, Schueler S, MacGowan G, Wrightson N, Robinson-Smith N. A New Outpatient Surveillance Program Improves Home Based Care in Long Term LVAD Recipients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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McKenna M, Wrightson N, Regnard C, Clark S. Response to withdrawal of life-sustaining medical devices and advance care planning. BMJ Support Palliat Care 2014; 3:10. [PMID: 24644321 DOI: 10.1136/bmjspcare-2012-000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wrightson N, Schueler S, Butt T, Robinson Smith N, Siddique A, Özalp F, Pillay T, MacGowan G. Driveline Exit Site in Long Term LVAD’s – Patient Choice or Surgeon’s Decision. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sajjad M, Butt T, Oezalp F, Siddique A, Wrightson N, Crawford D, Pillay T, Schueler S. An alternative approach to explantation and exchange of the HeartWare left ventricular assist device. Eur J Cardiothorac Surg 2012; 43:1247-50. [DOI: 10.1093/ejcts/ezs585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McDiarmid A, Gordon B, Wrightson N, Robinson-Smith N, Pillay T, Parry G, Schueler S, MacGowan GA. Hemodynamic, Echocardiographic, and Exercise-Related Effects of the HeartWare Left Ventricular Assist Device in Advanced Heart Failure. ACTA ACUST UNITED AC 2012; 19:11-5. [DOI: 10.1111/j.1751-7133.2012.00302.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wrightson N, Louw S, Regnard C, Clark S. 803 Guidelines for Withdrawal of VAD Therapy at End of Life. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Collins J, Winter C, Wrightson N, MacGowan G, Pillay T, Gould F, Schueler S. 805 LVAD Patient Pack; a Potential Reservoir for Pathogenic Organisms. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yousafzai S, Butt T, Oezalp F, Wrightson N, Nicola R, Thasee P, Guy M, Parry G, Siddique A, Schueler S. 573 Improved Surgical Technique of Left Ventricular Assist Device Drive Line Placement. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Clark S, Wrightson N, Louw S, Regnard C. Guidelines for withdrawal of ventricular assist devices. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gordon B, McDiarmid A, Robinson N, Wrightson N, Parry G, Schueler S, MacGowan G. 83 Clinical and haemodynamic status beyond 3 months of mechanical support with the heartware ventricular assist device. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Irving CA, Kirk R, Parry G, Hamilton L, Dark JH, Wrightson N, Griselli M, Hasan A. Outcomes following more than two decades of paediatric cardiac transplantation. Eur J Cardiothorac Surg 2011; 40:1197-202. [PMID: 21493085 DOI: 10.1016/j.ejcts.2011.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 02/03/2011] [Accepted: 02/08/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There have been significant changes in the field of paediatric cardiac transplantation over the last two decades. We report experience of over 22 years from a single UK transplant centre. METHODS A total of 189 orthotopic cardiac transplants were performed in 182 children aged <18 years between March 1987 and March 2009 in our institution. Patients were identified and outcomes reviewed using the cardiopulmonary transplant database and hospital medical records. RESULTS 182 patients underwent cardiac transplantation, mean age 8.3 years (0.1-17.9 years), 91 (50%) male. Mean follow-up time was 9.0 years (0.3-22.3 years). 117 patients (64%) had a diagnosis of cardiomyopathy, 65 (36%) had congenital heart disease. There was no significant difference in age at transplant between the group with cardiomyopathy and the group with congenital heart disease. 32 patients (17.6%) were on mechanical support prior to transplant. Three (1.6%) patients have required long-term renal replacement therapy post transplant, and 16 (8.8%) developed post-transplant lymphoproliferative disease. Survival was 93% at 30 days, 89% at 1 year, 85% at 5 years, 70% at 10 years and 67% at 15 years with a decrease in mortality over time. Seven patients (3.8%) were re-transplanted. CONCLUSIONS Outcomes following cardiac transplantation in childhood are improving with increased experience. There has been a reduction in 30-day mortality over time.
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Affiliation(s)
- Claire A Irving
- Department of Paediatric Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
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Abstract
AIMS To determine which factors predict outcomes in a group of patients with advanced heart failure, and in particular if NT-proBNP provides additional clinical and prognostic information to other haemodynamic and biochemical data. METHODS AND RESULTS Ninety-one patients were studied who were being evaluated for heart transplantation, with 166 assessments. The patients had advanced heart failure as determined by median cardiac index of 2.0 l/min/m(2), left ventricular end-diastolic diameter of 7.0 mm and levels of NT-proBNP of 2473 pg/ml. Median follow-up time was 359 days. Clinicians were blinded to NT-proBNP levels. NT-proBNP significantly correlated with cardiac index (R = -0.44, p < 0.001), right atrial pressure (R = 0.40, p < 0.001), pulmonary arterial wedge pressure (R = 0.38, p < 0.001) and albumin (R = -0.52, p < 0.001), and total bilirubin with right atrial pressure (R = 0.59, p < 0.001). Cardiac index was the most important independent predictor of outcome (p = 0.0001), although bilirubin (p = 0.001) and NT-proBNP (p < 0.05) were also significant. In patients with a 50% increase in NT-proBNP, 64% had adverse outcomes, whereas those in whom levels were stable, 22% had adverse outcomes (p < 0.05). CONCLUSION Cardiac index is the primary independent predictor of outcome in advanced heart failure when haemodynamic deterioration is evident. In situations where invasive haemodynamics are not available, total bilirubin (reflecting hepatic congestion) and NT-proBNP (related to haemodynamics) also provide important prognostic information.
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Affiliation(s)
- G A MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.
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Searl C, Butt T, Samuel A, Wrightson N, Fisher A, Dark J. 26: Novalung Enables Protective Ventilation in Primary Graft Dysfunction. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Wearmouth D, Reed L, MacGowan G, Pillay T, Schueler S, Wrightson N, Gould K. 191: Importance of VAD Insertion Site Colonisation. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Botha P, Chaudhari M, Wrightson N, Parry G, Griselli M, Hamilton L, Dark J, Hasan A. 494: Cardiac Transplantation for the Failing Fontan Circulation. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Botha P, Wrightson N, Butt T, Corris P, Dark J, Fisher A, Schueler S. 381: Safe Extension of Ischaemic Time in Lung Transplantation – Where Is the Limit? J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Van De Wauwer C, Villavicencio M, Wrightson N, Butt T, Clark S, Pillay T, Tocewiczs K, Ledingham S, Forty J, Schueler S. 452: Non-Utilization of Donor Organs for Non Medical Reasons – Impact on Patients Waiting for Heart and Lung Transplantation. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Gupta A, Eastham KM, Wrightson N, Spencer DA. Hypomagnesaemia in cystic fibrosis patients referred for lung transplant assessment. J Cyst Fibros 2007; 6:360-2. [PMID: 17412651 DOI: 10.1016/j.jcf.2007.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 01/25/2007] [Accepted: 01/31/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hypomagnesaemia in patients with cystic fibrosis (CF) is under-recognized although the true incidence is unknown. Many patients are asymptomatic, although severe deficiency may be associated with muscle weakness, cramps and tetany. Hypomagnesaemia may be a risk factor for post-transplant complications including convulsions, which may be exacerbated by the use of calcineurin inhibitors. The aims of the present study were to describe serum magnesium levels and to investigate the relationship between magnesium levels and age, and renal function measurements in patients with CF referred to a transplant centre for lung transplant assessment. METHODS We reviewed the data of all 106 CF patients referred for transplant assessment from January 1995 to December 2003. Demographic and biochemical data were recorded and the explanatory variables were subjected to univariate analysis and linear regression analysis. RESULTS Mean serum magnesium level was 0.75 mmol/L (range 0.46-1.03, normal range 0.74-1.1). 57% of patients had hypomagnesaemia. Serum magnesium levels were not associated with age, serum creatinine or GFR. CONCLUSIONS Hypomagnesaemia is a common finding in patients with CF referred for lung transplant assessment. Serum magnesium levels should be monitored in all CF patients being referred for lung transplant irrespective of the results of other renal function tests.
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Affiliation(s)
- A Gupta
- Department of Respiratory Paediatrics, Freeman Hospital, Freeman Road, Heaton, Newcastle upon Tyne, United Kingdom
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Chaudhari M, Sturman J, O'Sullivan J, Smith J, Wrightson N, Parry G, Bolton D, Haynes S, Hamilton L, Hasan A. Rescue cardiac transplantation for early failure of the Fontan-type circulation in children. J Thorac Cardiovasc Surg 2005; 129:416-22. [DOI: 10.1016/j.jtcvs.2004.06.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wrightson N, Neades B. Should we change the law on organ donation? Nurs Times 2004; 100:19. [PMID: 15471263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Wrightson N, Blake A, English L. Care of the heart transplant patient. Nurs Times 2002; 98:34-7. [PMID: 12168377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Cardiac transplantation is recognised as an effective treatment option for severe heart failure in carefully selected recipients. This article emphasises the importance of a multidisciplinary team approach and focuses on the first 24-48 hours of postoperative care. It discusses organ rejection; pain control; infection; psychological implications and rehabilitation. Survival rates and a brief history of transplantation are also provided.
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Hasan A, Corris PA, Healy M, Wrightson N, Gascoigne AD, Waller DA, Wilson I, Hilton CJ, Gould FK, Forty J. Bilateral sequential lung transplantation for end stage septic lung disease. Thorax 1995; 50:565-6. [PMID: 7597674 PMCID: PMC1021232 DOI: 10.1136/thx.50.5.565] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Bilateral sequential lung transplantation (BSLT) has been widely adopted as an alternative to combined heart and lung transplantation for the management of end stage septic lung disease in many transplant centres. METHODS A retrospective review was undertaken of the first 32 consecutive patients with septic lung disease to undergo BSLT at the Freeman Hospital. RESULTS Between April 1988 and October 1994 32 patients underwent BSLT. Survival at 30 days was 85% and actuarial survival at one year was 70%. Improved pulmonary function was seen in all surviving patients. CONCLUSION BSLT for septic lung disease offers comparable survival to heart-lung transplantation, with excellent functional results. Long term results may be superior because the disadvantages of transplanting the heart are avoided.
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Affiliation(s)
- A Hasan
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
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Wrightson N, Thompson A, Blake A. Transplants. Breathing new life. Nurs Times 1993; 89:38-41. [PMID: 7685878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Wrightson N, Townsend A. Critical care. Open to discussion. Nurs Stand 1991; 5:53. [PMID: 1903279 DOI: 10.7748/ns.5.26.53.s55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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