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Chen QF, Hu J, Hu J, Nijjar PS, Xu J, Shi S, Liang D, Liao H, Gao J, Lin WH, You S, Zhou XD. Clinical characteristics and prognosis of patients with hypertrophic cardiomyopathy and heart failure with preserved ejection fraction. Clin Res Cardiol 2024; 113:761-769. [PMID: 38197895 PMCID: PMC11026190 DOI: 10.1007/s00392-023-02371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Whether heart failure with preserved ejection fraction (HFpEF) is associated with an increased risk of developing systolic dysfunction and a poor prognosis in hypertrophic cardiomyopathy (HCM) patients is unknown. OBJECTIVE We aimed to assess risk factors for the development of end-stage (ES) heart failure (HF) (ejection fraction < 50%) and compare the prognosis of different HF phenotypes. METHODS This retrospective study was conducted on patients with HCM in China between January 2009 and February 2023. Patients were stratified into three different groups: HCM-non-HF, HCM-HFpEF and HCM-heart failure with reduced ejection fraction (HCM-HFrEF). The primary outcome was a composite of major adverse cardiac events (MACEs), including all-cause deaths, HF hospitalization, sudden cardiac death and ventricular tachycardia. RESULTS Of 3,620 HCM patients enrolled, 1,553 (42.9%) had non-HF, 1,666 (46.0%) had HFpEF, and 579 patients (11.1%) had HFrEF at baseline. During the median follow-up period of 4.0 years (IQR 1.4-9.4 years), patients with HCM-HFpEF exhibited a higher incidence of ES-HF than those with HCM-non-HF (12.4% vs. 2.7%, P < 0.001). HFpEF was an independent risk factor for ES-HF development (HR 3.84, 2.54-5.80, P < 0.001). MACEs occurred in 26.9% with a higher incidence in HCM-HFpEF than HCM-non-HF (36.6% vs 12.2%, P < 0.001). HFpEF was an independent predictor of MACEs (HR 2.13, 1.75-2.59, P < 0.001). CONCLUSIONS HFpEF is common in HCM. Compared to non-HF, it increases the risk of LVEF decline and poor prognosis. It may aid in risk stratification and need close echocardiography follow-up.
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Affiliation(s)
- Qin-Fen Chen
- Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325100, China
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, 325000, China
| | - Jiandong Hu
- Department of Information, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jie Hu
- Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Prabhjot S Nijjar
- Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jiahui Xu
- Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shanzhen Shi
- Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Dongjie Liang
- Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Hetong Liao
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, 325000, China
| | - Jiaqi Gao
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, 325000, China
| | - Wei-Hong Lin
- Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325100, China
| | - Shenban You
- Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiao-Dong Zhou
- Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Yao S, Qin Y, Yue J, Lu S. Implanting left ventricular assist device in end-stage heart failure with massive ventricular aneurysm. Asian J Surg 2024:S1015-9584(24)00608-0. [PMID: 38604864 DOI: 10.1016/j.asjsur.2024.03.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/12/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Shaowen Yao
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Yannv Qin
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Jiarui Yue
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Shichun Lu
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
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Idrovo A, Hollander SA, Neumayr TM, Bell C, Munoz G, Choudhry S, Price J, Adachi I, Srivaths P, Sutherland S, Akcan-Arikan A. Long-term kidney outcomes in pediatric continuous-flow ventricular assist device patients. Pediatr Nephrol 2024; 39:1289-1300. [PMID: 37971519 DOI: 10.1007/s00467-023-06190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Continuous-flow ventricular assist devices (CF-VADs) are used increasingly in pediatric end-stage heart failure (ESHF) patients. Alongside common risk factors like oxidant injury from hemolysis, non-pulsatile flow constitutes a unique circulatory stress on kidneys. Post-implantation recovery after acute kidney injury (AKI) is commonly reported, but long-term kidney outcomes or factors implicated in the evolution of chronic kidney disease (CKD) with prolonged CF-VAD support are unknown. METHODS We studied ESHF patients supported > 90 days on CF-VAD from 2008 to 2018. The primary outcome was CKD (per Kidney Disease Improving Global Outcomes (KDIGO) criteria). Secondary outcomes included AKI incidence post-implantation and CKD evolution in the 6-12 months of CF-VAD support. RESULTS We enrolled 134 patients; 84/134 (63%) were male, median age was 13 [IQR 9.9, 15.9] years, 72/134 (54%) had preexisting CKD at implantation, and 85/134 (63%) had AKI. At 3 months, of the 91/134 (68%) still on a CF-VAD, 34/91 (37%) never had CKD, 13/91 (14%) developed de novo CKD, while CKD persisted or worsened in 49% (44/91). Etiology of heart failure, extracorporeal membrane oxygenation use, duration of CF-VAD, AKI history, and kidney replacement therapy were not associated with different CKD outcomes. Mortality was higher in those with AKI or preexisting CKD. CONCLUSIONS In the first multicenter study to focus on kidney outcomes for pediatric long-term CF-VAD patients, preimplantation CKD and peri-implantation AKI were common. Both de novo CKD and worsening CKD can happen on prolonged CF-VAD support. Proactive kidney function monitoring and targeted follow-up are important to optimize outcomes.
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Affiliation(s)
- Alexandra Idrovo
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's, Houston, TX, USA.
- Renal Section, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Seth A Hollander
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tara M Neumayr
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School, St. Louis, MO, USA
- Division of Nephrology, Department of Pediatrics, Washington University School, St. Louis, MO, USA
| | - Cynthia Bell
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Genevieve Munoz
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School, St. Louis, MO, USA
| | - Swati Choudhry
- Pediatrics, Cardiology Section, Baylor College of Medicine/Texas Children's, Houston, TX, USA
| | - Jack Price
- Pediatrics, Cardiology Section, Baylor College of Medicine/Texas Children's, Houston, TX, USA
| | - Iki Adachi
- Division of Congenital Heart Surgery, Department of Pediatrics, Baylor College of Medicine/Texas Children's, Houston, TX, USA
| | - Poyyapakkam Srivaths
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's, Houston, TX, USA
| | - Scott Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ayse Akcan-Arikan
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's, Houston, TX, USA
- Department of Pediatrics Critical Care Section, Baylor College of Medicine, Texas Children's, Houston, TX, USA
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Palenzuela DL, Agarwal D, Flanders K, Coglianese E, Tsao L, D'Alessandro D, Lewis GD, Fitzsimons M, Gee D. A second chance for a new heart? The role of metabolic and bariatric surgery in patients with end-stage heart failure. J Gastrointest Surg 2024; 28:389-393. [PMID: 38583888 DOI: 10.1016/j.gassur.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Obesity is an independent risk factor for heart failure (HF). Substantial weight loss has been shown to reverse obesity-related cardiomyopathy. This study aimed to report our institution's experience with laparoscopic sleeve gastrectomy (LSG) in patients with morbid obesity and end-stage HF. METHODS Between 2018 and 2022, 26 patients with end-stage HF were referred for LSG. Of 26 patients, 16 underwent an operation, and 10 did not. After institutional review board approval, a retrospective electronic medical record review was performed to evaluate (i) age, (ii) preoperative weight, (iii) decrease in body mass index (BMI) score, (iv) whether the patient underwent heart transplantation, and (v) mortality. Data analysis was performed using Stata/SE (version 17.0; StataCorp). The Wilcoxon rank-sum test was used to compare continuous variables between the cohorts, and the Pearson chi-square test was used for binary variables with Bonferroni correction applied. RESULTS The LSG and non-LSG cohorts had comparable ages (P = .088) and starting BMI score (P = .918), and a proportion of patients had a ventricular assist device (P = .191). Patients who underwent LSG lost significantly more weight than the patients who did not, with an average decrease in BMI score of 8.9 kg/m2 (SD, ±6.13) and 1.1 kg/m2 (SD, ±4.10), respectively (P = .040). Of note, 6 patients (37.5%) who underwent LSG eventually underwent transplantation, compared with 2 patients (20.0%) from the matched cohort (P = .884). Of the 26 patients, there were 6 deaths: 2 (12.5%) in the LSG cohort and 4 (40.0%) in the non-LSG cohort (P = .525). CONCLUSION LSG may be safe and effective for weight loss in patients with HF. This operation may provide patients affected by obesity with end-stage HF the lifesaving opportunity to achieve transplant candidacy.
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Affiliation(s)
- Deanna L Palenzuela
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
| | - Divyansh Agarwal
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Karen Flanders
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Erin Coglianese
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Lana Tsao
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - David D'Alessandro
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Gregory D Lewis
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Michael Fitzsimons
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
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5
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Li M, Jin L, Wang Y, Song Y. One case with end-stage heart failure undergoing left ventricular assisting device implantation. Asian J Surg 2024; 47:747-748. [PMID: 37879984 DOI: 10.1016/j.asjsur.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Mingliang Li
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Lin Jin
- Ningxia Medical University, Yinchuan, 750000, China
| | - Yun Wang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yanyan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China.
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6
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Hsu CY, Tzeng IS, Song JY, Tsai KT, Shen TC. Extended and Safe Support with the CentriMag® Temporary Ventricular Assist Device Implanted with Skirted-Cannula Technique. Acta Cardiol Sin 2024; 40:70-76. [PMID: 38264079 PMCID: PMC10801426 DOI: 10.6515/acs.202401_40(1).20230817a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/17/2023] [Indexed: 01/25/2024]
Abstract
Objectives CentriMag® (Abbott, Pleasanton, CA, USA) is indicated for temporary circulatory support for up to 30 days. Extended support is not uncommon, and the results vary considerably. Herein, we review our experience on extended support. Methods We retrospectively analyzed 19 patients supported with CentriMag as a bridge to recovery, long-term ventricular assist device or transplantation from September 2011 to October 2021. Results Nineteen patients (16 men and 3 women; mean age 51.7 ± 9.2 years) had CentriMag left ventricular assist device (LVAD) implantation with the skirted-cannula technique. Twelve (63.2%), 6 (31.6%), and 1 (5.3%) patient were in INTERMACS 1, 2, and 3, respectively. The aims of support were bridge-to-decision in 3 patients (15.8%), and bridge-to-transplantation in 16 patients (84.2%). Fourteen patients were supported for longer than 30 days, while 5 patients had their CentriMag removed before 30 days. Of the 5 patients supported for less than 30 days, 3 died early after implantation due to complications of prolonged shock. The other 2 patients were successfully transplanted. Among the 14 patients supported for longer than 30 days, 1 patient died after transplantation and 13 patients survived either after transplantation or weaning off CentriMag. The overall 1-year survival rate was 73.7%. The duration of support for all patients ranged from 6 to 191 days (64 ± 61 days; median 41 days). Conclusions The skirted cannula technique for apical cannulation in implantation of CentriMag LVAD is an easy, safe and durable technique. Immediate post-operative and long-term complications are not common. Its use over 30 days is associated with acceptable survival.
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Affiliation(s)
- Chan-Yang Hsu
- Division of Cardiovascular Surgery, Department of Surgery
| | - I-Shiang Tzeng
- Department of Research, Cooperative Research Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Jenn-Yeu Song
- Division of Cardiovascular Surgery, Department of Surgery
| | - Kuei-Ton Tsai
- Division of Cardiovascular Surgery, Department of Surgery
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ta-Chung Shen
- Division of Cardiovascular Surgery, Department of Surgery
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Inchaustegui CA, Patel A, Lamba HK, Brown A, Arunthamakun J, Ting K, Chatterjee S, Nair AP, George JK, Shafii AE, Liao KK, Civitello AB. Impact of time off anticoagulation in patients with continuous-flow left ventricular assist devices. J Artif Organs 2023; 26:275-286. [PMID: 36208373 DOI: 10.1007/s10047-022-01367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/20/2022] [Indexed: 10/10/2022]
Abstract
Patients with left ventricular assist devices (LVADs) receive anticoagulation to decrease the risk of thrombosis. Various circumstances require discontinuing anticoagulation in LVAD patients, but the risks entailed are not well defined. In a retrospective review of LVAD implantation procedures, we examined the effect of time off anticoagulation on thrombosis and mortality rates after implantation. An international normalized ratio ≤ 1.5 was used to screen for patients taken off anticoagulation. Patients were divided into three groups by the cumulative number of days off anticoagulation: no discontinuation, short-term discontinuation (< 30 days), and long-term discontinuation (≥ 30 days). Rates of ischemic stroke, pump thrombosis, and mortality were compared among groups. Of 245 patients who underwent LVAD implantation during the study, 70 (28.6%) were off anticoagulation during follow-up: 37 (15.1%) had short-term discontinuation (median, 11 days), and 33 (13.5%) had long-term discontinuation (median, 124 days). Patients with long-term discontinuation had a higher rate of ischemic stroke (adjusted hazard ratio 8.5, p = 0.001) and death (adjusted hazard ratio 3.9, p = 0.001). The three groups did not differ in pump thrombosis rate. We conclude that after LVAD implantation, discontinuing anticoagulation for ≥ 30 days is independently associated with an increased risk of ischemic stroke and death.
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Affiliation(s)
- Christian A Inchaustegui
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA.
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA.
| | - Ashley Patel
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA
| | - Harveen K Lamba
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Andrew Brown
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA
| | - Justin Arunthamakun
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA
| | - Kevin Ting
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Texas Heart Institute, Houston, TX, USA
| | - Ajith P Nair
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Joggy K George
- Texas Heart Institute, Houston, TX, USA
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexis E Shafii
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Kenneth K Liao
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew B Civitello
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Texas Heart Institute, Houston, TX, USA
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Nohno Y, Fujiu K, Kozu R, Maruyama S, Hasegawa T, Tsuchiya H, Yanagisawa T, Tachibana T, Kimura H, Yazaki Y. Conduction System Pacing Upgrade in Chronic Heart Failure with Severe Left Ventricular Dysfunction and Chronic Atrial Fibrillation. Int Heart J 2023; 64:768-774. [PMID: 37460323 DOI: 10.1536/ihj.22-614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Cardiac resynchronization therapy (CRT) is a standard treatment for patients with severe congestive heart failure. However, one-third of patients receiving CRT are non-responders. Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), has become an alternative to CRT therapy. Furthermore, CRT therapy with CSP has shown to be more effective than CRT alone. When an implantable cardiac defibrillator or CRT-defibrillator is implanted with CSP, the problem of which port the HBP lead and LBBAP lead should be connected to arises. We report 2 cases of upgrading to CRT with CSP by utilizing the atrial ports for HBP and LBBAP leads. The procedure is a simple, reasonable, and effective therapy for end-stage heart failure.
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Affiliation(s)
- Yasumasa Nohno
- Department of Cardiology, Saku Central Hospital Advanced Care Center
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Ryosuke Kozu
- Department of Cardiology, Saku Central Hospital Advanced Care Center
| | - Shusaku Maruyama
- Department of Cardiology, Saku Central Hospital Advanced Care Center
| | - Tomoya Hasegawa
- Department of Cardiology, Saku Central Hospital Advanced Care Center
| | - Hiromi Tsuchiya
- Department of Cardiology, Saku Central Hospital Advanced Care Center
| | | | | | - Hikaru Kimura
- Department of Cardiology, Saku Central Hospital Advanced Care Center
| | - Yoshikazu Yazaki
- Department of Cardiology, Saku Central Hospital Advanced Care Center
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Zhou W, Du Z, Tao Y, Zhang GX, Xu ZY, Han L, Ma SL, Hu DX, Fan XL, Li BL. Effect of preoperative pulmonary artery pressure on the prognosis of end-stage heart failure patients after heart transplantation. J Cardiothorac Surg 2023; 18:154. [PMID: 37069699 PMCID: PMC10111637 DOI: 10.1186/s13019-023-02253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/03/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE To evaluate the effect of preoperative pulmonary artery pressure on perioperative outcome of end-stage heart failure patients undergoing heart transplantation. METHODS Retrospective analysis was undertaken on the clinical data of patients receiving heart transplantation in the Department of Cardiovascular Surgery of our hospital from March 2017 to March 2022. A ROC curve analysis was developed between mean pulmonary artery pressure (mPAP) and postoperative mortality using mPAP as diagnostic criteria. Patients were divided into groups based on this threshold to determine the best mPAP threshold value for predicting postoperative nosocomial mortality, and the differences in preoperative and intraoperative data, postoperative complications, and clinical prognosis of patients in the two groups were compared. Patients were followed up to draw the survival curve of patients in the two groups. RESULTS The study enlisted the participation of 105 patients. ROC curve research revealed that preoperative pulmonary artery pressure was substantially linked with death following heart transplantation, with mPAP = 30.5mmHg being the best threshold. The group with mPAP ≥ 30.5mmHg had a greater incidence of postoperative ECMO support (28.2% vs. 10.6%, P = 0.021) and a higher incidence of in-hospital mortality (15.4% vs. 1.5%, P = 0.019) than the group with mPAP < 30.5mmHg. The postoperative survival rates of 105 patients were 91.3%, 88.7%, 81.6%, and 77.5% at 1, 2, 3, and 4 years, respectively, however, there was no significant difference between the two groups of patients in the postoperative intermediate-far survival rate (P = 0.431). CONCLUSIONS Preoperative pulmonary artery pressure in patients with end-stage heart failure is intimately correlated with perioperative prognosis of heart transplant recipients. The optimal cut-off mPAP value in predicting perioperative prognosis of heart transplant recipients is 30.5mmHg. In the high mPAP group, perioperative ECMO support rate and perioperative mortality rate are high, which do not affect the medium and long-term prognosis of the recipients undergoing heart transplantation.
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Affiliation(s)
- Wei Zhou
- Department of Critical Care Medicine, Shanghai East Hospital, Shanghai, 200120, China
| | - Zhen Du
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Yun Tao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Guan-Xin Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Zhi-Yun Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Lin Han
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Shao-Lin Ma
- Department of Critical Care Medicine, Shanghai East Hospital, Shanghai, 200120, China
| | - Dao-Xi Hu
- Department of Medical Imaging, Army 75 Group Military Hospital, Dali, 671000, China
| | - Xing-Li Fan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
| | - Bai-Ling Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
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10
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Numan L, Zimpfer D, Zadok OIB, Aarts E, Morshuis M, Guenther SPW, Riebandt J, Wiedemann D, Ramjankhan FZ, Oppelaar AM, Ben-Gal T, Ben-Avraham B, Asselbergs FW, Schramm R, Van Laake LW. Identifying patients at risk: multi-centre comparison of HeartMate 3 and HeartWare left ventricular assist devices. ESC Heart Fail 2023; 10:1656-1665. [PMID: 36798028 DOI: 10.1002/ehf2.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/09/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
AIMS Since the withdrawal of HeartWare (HVAD) from the global market, there is an ongoing discussion if and which patients require prophylactically exchange for a HeartMate 3 (HM3). Therefore, it is important to study outcome differences between HVAD and HM3 patients. Because centres differ in patient selection and standard of care, we performed a propensity score (PS)-based study including centres that implanted both devices and aimed to identify which HVAD patients are at highest risk. METHODS AND RESULTS We performed an international multi-centre study (n = 1021) including centres that implanted HVAD and HM3. PS-matching was performed using clinical variables and the implanting centre. Survival and complications were compared. As a sensitivity analysis, PS-adjusted Cox regression was performed. Landmark analysis with conditional survival >2 years was conducted to evaluate long-term survival differences. To identify which HVAD patients may benefit from a HM3 upgrade, Cox regression using pre-operative variables and their interaction with device type was performed. Survival was significantly better for HM3 patients (P < 0.01) in 458 matched patients, with a median follow-up of 23 months. Within the matched cohort, HM3 patients had a median age of 58 years, and 83% were male, 80% of the HVAD patients were male, with a median age of 59 years. PS-adjusted Cox regression confirmed a significantly better survival for HM3 patients when compared with HVAD, with a HR of 1.46 (95% confidence interval 1.14-1.85, P < 0.01). Pump thrombosis (P < 0.01) and ischaemic stroke (P < 0.01) occurred less in HM3 patients. No difference was found for haemorrhagic stroke, right heart failure, driveline infection, and major bleeding. Landmark-analysis confirmed a significant difference in conditional survival >2 years after implantation (P = 0.03). None of the pre-operative variable interactions in the Cox regression were significant. CONCLUSIONS HM3 patients have a significantly better survival and a lower incidence of ischaemic strokes and pump thrombosis than HVAD patients. This survival difference persisted after 2 years of implantation. Additional research using post-operative variables is warranted to identify which HVAD patients need an upgrade to HM3 or expedited transplantation.
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Affiliation(s)
- Lieke Numan
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Emmeke Aarts
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Northrhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Sabina P W Guenther
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Northrhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Julia Riebandt
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Faiz Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Anne-Marie Oppelaar
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Tuvia Ben-Gal
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Binyamin Ben-Avraham
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK and Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.,Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Rene Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Northrhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Linda W Van Laake
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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11
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Sugimura Y, Kalampokas N, Arikan M, Rellecke P, Dalyanoglu H, Tudorache I, Westenfeld R, Boeken U, Lichtenberg A, Akhyari P, Aubin H. Preoperative Levosimendan therapy reduces postoperative right ventricular failure in patients undergoing left ventricular assist device implantation. Interdiscip Cardiovasc Thorac Surg 2023; 36:6978238. [PMID: 36802258 PMCID: PMC9931070 DOI: 10.1093/icvts/ivac289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Perioperative mortality and complications still remain high after left ventricular assist device (LVAD) implantation, especially in highly compromised patient cohorts. Here, we evaluate the effects of preoperative Levosimendan therapy on peri- and postoperative outcomes after LVAD implantation. METHODS We retrospectively analysed 224 consecutive patients with LVAD implantation for end-stage heart failure between November 2010 and December 2019 in our centre with regard to short- and longer-term mortality as well as incidence of postoperative right ventricular failure (RV-F). Out of these, 117 (52.2%) received preoperative i.v. Levosimendan therapy within 7 days before LVAD implantation (Levo group). RESULTS In-hospital, 30-day and 5-year mortality was comparable (in-hospital mortality: 18.8% vs 23.4%, P = 0.40; 30-day mortality: 12.0% vs 14.0%, P = 0.65; Levo vs control group). However, in the multivariate analysis, preoperative Levosimendan therapy significantly reduced postoperative RV-F but increased postoperative vasoactive inotropic score ([RV-F: odds ratio 2.153, confidence interval 1.146-4.047, P = 0.017; vasoactive inotropic score 24 h post-surgery: odds ratio 1.023, confidence interval 1.008-1.038, P = 0.002). These results were further confirmed by 1:1 propensity score matching of 74 patients in each group. Especially in the subgroup of patients with normal preoperative RV function, the prevalence of postoperative RV-F was significantly lower in the Levo- group as compared to the control group (17.6% vs 31.1%, P = 0.03; respectively). CONCLUSIONS Preoperative Levosimendan therapy reduces the risk of postoperative RV-F, especially in patients with normal preoperative RV function without effects on mortality up to 5 years after LVAD implantation.
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Affiliation(s)
| | | | - Metin Arikan
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Phillip Rellecke
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Hannan Dalyanoglu
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Payam Akhyari
- Corresponding author. Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany. Tel: +49-241-8012345; fax: +49-241-80-33-12345; e-mail: (P. Akhyari)
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany
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12
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Godino C, Scotti A, Marengo A, Battini I, Brambilla P, Stucchi S, Slavich M, Salerno A, Fragasso G, Margonato A. Effectiveness and cost-efficacy of diuretics home administration via peripherally inserted central venous catheter in patients with end-stage heart failure. Int J Cardiol 2022; 365:69-77. [PMID: 35853499 DOI: 10.1016/j.ijcard.2022.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND End-stage heart failure (ESHF) is characterized by severe cardiac dysfunction with persistent disabling symptoms and recurrent acute decompensated heart failure (ADHF), despite guideline-directed medical therapy. The aim of this study was to evaluate the efficacy and safety of intravenous diuretics administration at home through a peripherally inserted central venous catheter (PICC) in ESHF patients. METHODS AND RESULTS Forty-one ESHF patients received PICC implantation for intravenous diuretic administration at home. The primary efficacy endpoint was the patient-level number of HF hospitalizations in the short (1-3 months), medium (six months), and long term (1 year), before and after PICC implantation. Pre- and post-PICC ADHF-free days were also evaluated as co-primary endpoint. Secondary endpoints comprised changes in clinical, laboratory and echocardiographic parameters, and device safety. A cost-effectiveness analysis was performed to estimate the economic impact of using PICC. For each time frame analyzed, a significant reduction in the number of hospitalizations due to ADHF was observed, resulting in a significant increase in ADHF-free days (71 ± 44 vs. 163 ± 136, p = 0.003). In matched patients' analysis, significant decrease in body weight (68 ± 16 kg vs. 63 ± 10 kg, p = 0.041) and mitral regurgitation grade 3/4 (55% vs. 18%, p < 0.001) were also observed. Freedom from PICC-related complications was observed in 61% of patients. A significant reduction in overall ADHF-hospitalizations cost was observed. CONCLUSIONS This proof-of-concept study demonstrates the effectiveness and safety of home administration of intravenous diuretic therapy via PICC in ESHF patients. This palliative cost-effective strategy can be taken in consideration for selected end-stage patients no longer responsive to conventional therapies.
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Affiliation(s)
- Cosmo Godino
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America; Cardiovascular Research Foundation, NY, New York, United States of America
| | - Alessandra Marengo
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Massimo Slavich
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Salerno
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Fragasso
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
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13
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Colvin M, Smith JM, Ahn Y, Skeans MA, Messick E, Bradbrook K, Gauntt K, Israni AK, Snyder JJ, Kasiske BL. OPTN/SRTR 2020 Annual Data Report: Heart. Am J Transplant 2022; 22 Suppl 2:350-437. [PMID: 35266620 DOI: 10.1111/ajt.16977] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
As we enter the third year of the new adult heart allocation policy, we are faced with the new challenges of the COVID-19 pandemic. In 2020, new listings (adult and pediatric) decreased slightly, with 4000 new listings in 2020, compared with 4087 in 2019; however, the number of adult heart transplants performed continued to increase, to 3715 in 2020. The number of pediatric heart transplants declined from 509 in 2019 to 465 in 2020. One-year and six-month posttransplant mortality rates in adult recipients have increased slightly since 2015 but have not significantly changed over the past decade. Overall, posttransplant mortality rates for adult recipients were 7.4% at six months and 9.4% at one year for transplants in 2019, 14.0% at three years for transplants in 2017, and 19.1% at five years for transplants in 2015. Although shorter-term posttransplant mortality rates have slightly increased, there has been a steady downward trend in longer-term mortality. Mortality rates for pediatric recipients were 5.7% at six months and 8.1% at one year for transplants in 2019, 11.6% at three years for transplants in 2017, and 15.2% at five years for transplants in 2015.
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Affiliation(s)
- M Colvin
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Cardiology, University of Michigan, Ann Arbor, MI
| | - J M Smith
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - Y Ahn
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - E Messick
- Organ Procurement and Transplantation Network, United Network for Organ Sharing
| | - K Bradbrook
- Organ Procurement and Transplantation Network, United Network for Organ Sharing
| | - K Gauntt
- Organ Procurement and Transplantation Network, United Network for Organ Sharing
| | - A K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - B L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
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14
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Sardu C, Amarelli C. Continuous flow left ventricular assist devices and cardiac resynchronization: Friends or foe? Int J Cardiol 2021; 344:138-139. [PMID: 34619261 DOI: 10.1016/j.ijcard.2021.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Department of Internal Medicine, "Saint Camillus University", Rome, Italy; Department of Cardiovascular Diseases and Cardiovascular Surgery, "Gemelli Molise Sp.a.", Campobasso, Italy
| | - Cristiano Amarelli
- Department of Cardiothoracic Surgery, "Monaldi Hospital", Naples, Italy.
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15
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Bayram Z, Dogan C, Efe SC, Karagoz A, Guvendi B, Uysal S, Aktas RB, Akbal OY, Yilmaz F, Tokgoz HC, Kirali MK, Kaymaz C, Ozdemir N. Effect of Group 2 Pulmonary Hypertension Subgroups on Outcomes: Impact of the Updated Definition of Pulmonary Hypertension. Heart Lung Circ 2021; 31:508-519. [PMID: 34756531 DOI: 10.1016/j.hlc.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/24/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a common complication of end-stage heart failure (ESHF) and associated with increased mortality. The definition of PH has recently been changed from a mean pulmonary arterial pressure (PAPm) ≥25 mmHg to a PAPm >20 mmHg. Since this change, there are no data evaluating group 2 PH subgroups on outcomes. The purpose of this study was to determine the impact of updated group 2 PH subgroups on outcomes, as well as to evaluate the clinical, echocardiographic, and haemodynamic characteristics of subgroups, and determine predictors of PH in patients with ESHF. METHOD A total of 416 patients with ESHF with left ventricle ejection fraction (LVEF) ≤25% were divided into three groups. Pulmonary hypertension was defined as PAPm >20 mmHg. Primary outcome was defined as left ventricular assist device (LVAD) implantation, urgent heart transplantation (HT), or death. Secondary outcome was defined as LVAD implantation and HT. RESULTS Over a median follow-up of 503.5 days, combined pre- and postcapillary PH (Cpc-PH) displayed greater risk of primary outcome than those with isolated postcapillary (Ipc-PH) (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.29-1.91; p<0.001) and those with no PH (HR, 2.47; 95% CI, 1.68-3.63; p<0.001). Patients with Ipc-PH demonstrated greater risk than those with no PH (HR, 1.57; 95% CI, 1.57-1.90; p<0.001). Likelihood ratios of updated PH criteria and old PH criteria (PAPm ≥25 mmHg) in identifying primary outcome were 75.6 (R2=0.179) and 72.09 (R2=0.164). Patients with PAPm 21-24 mmHg had a higher primary outcome than those with PAPm ≤20 mmHg. Severe mitral regurgitation, LVEF, grade 3 diastolic dysfunction, diabetes, and cardiac output were predictors of PH. CONCLUSIONS Pulmonary hypertension increases the risk of LVAD, urgent HT, or death, and Cpc-PH further increases risk in patients with ESHF. Compared to the previous definition, a new PH definition better discriminates death, going to urgent HT, or LVAD implantation for PH subgroups.
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Affiliation(s)
- Zubeyde Bayram
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul.
| | - Cem Dogan
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | | | - Ali Karagoz
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Busra Guvendi
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Samet Uysal
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Ravza Betul Aktas
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Ozgur Yasar Akbal
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Fatih Yilmaz
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | | | | | - Cihangir Kaymaz
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Nihal Ozdemir
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
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16
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Wang YH, Chen JL, Tsai CS, Tsai YT, Lin CY, Ke HY, Hsu PS. Effects of Levosimendan on Systemic Perfusion in Patients with Low Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Score: Experience from a Single Center in Taiwan. Acta Cardiol Sin 2021; 37:512-521. [PMID: 34584384 DOI: 10.6515/acs.202109_37(5).20210310b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022]
Abstract
Background Patients with cardiogenic shock have a high risk of mortality. Intravenous levosimendan can provide pharmacologic inotrope support. Objectives We aimed to investigate the effect of levosimendan in patients with extremely severe cardiogenic shock and low Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score with or without mechanical circulatory support. Methods From January 2017 to May 2019, 24 patients with INTERMACS 1-4 were enrolled in this retrospective study. All patients had systemic malperfusion and were treated with levosimendan. Biochemistry data related to systemic perfusion were recorded and compared before and at 24 and 72 hours after levosimendan administration. Echocardiography and Kansas City Cardiomyopathy Questionnaire (KCCQ) were completed 2 months later to assess left ventricular ejection fraction (LVEF) and quality of life (QoL), respectively. Results Arterial pressure and heart rate did not significantly differ before and after levosimendan administration. Atrial fibrillation and ventricular premature complex increased without significance. The dose of inotropes could be significantly tapered down. There were no significant differences in blood urea nitrogen, creatinine, and lactate levels. Urine output significantly increased (p = 0.018), and liver-related enzymes improved but without significance. B-type natriuretic peptide significantly decreased (p = 0.007) at 24 hours after levosimendan administration. Echocardiography showed significantly improved LVEF 2 months later (22.43 ± 8.13% to 35.87 ± 13.4%, p = 0.001). KCCQ showed significantly improved physical activity and greater relief of symptoms (p = 0.003). The survival-to-discharge rate was 75%. Conclusions We observed a decrease in B-type natriuretic peptide, better urine output, and alleviated hepatic injury in the levosimendan group. Most patients who survived without transplantation had significantly improved LVEF and better QoL after levosimendan administration.
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Affiliation(s)
| | - Jia-Lin Chen
- Department of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | - Yi-Ting Tsai
- Division of Cardiovascular Surgery, Department of Surgery
| | - Chih-Yuan Lin
- Division of Cardiovascular Surgery, Department of Surgery
| | - Hong-Yan Ke
- Division of Cardiovascular Surgery, Department of Surgery
| | - Po-Shun Hsu
- Division of Cardiovascular Surgery, Department of Surgery
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17
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Miller PE, Mullan CW, Chouairi F, Sen S, Clark KA, Reinhardt S, Fuery M, Anwer M, Geirsson A, Formica R, Rogers JG, Desai NR, Ahmad T. Mechanical ventilation at the time of heart transplantation and associations with clinical outcomes. Eur Heart J Acute Cardiovasc Care 2021; 10:843-851. [PMID: 34389855 DOI: 10.1093/ehjacc/zuab063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022]
Abstract
AIMS The impact of mechanical ventilation (MV) at the time of heart transplantation is not well understood. In addition, MV was recently removed as a criterion from the new US heart transplantation allocation system. We sought to assess for the association between MV at transplantation and 1-year mortality. METHODS AND RESULTS We utilized the United Network for Organ Sharing database and included all adult, single organ heart transplantations from 1990 to 2019. We utilized multivariable logistic regression adjusting for demographics, comorbidities, and markers of clinical acuity. We identified 60 980 patients who underwent heart transplantation, 2.4% (n = 1431) of which required MV at transplantation. Ventilated patients were more likely to require temporary mechanical support, previous dialysis, and had a shorter median waitlist time (21 vs. 95 days, P < 0.001). At 1 year, the mortality was 33.7% (n = 484) for ventilated patients and 11.7% (n = 6967) for those not ventilated at the time of transplantation (log-rank P < 0.001). After multivariable adjustment, patients requiring MV continued to have a substantially higher 90-day [odds ratio (OR) 3.20, 95% confidence interval (CI): 2.79-3.66, P < 0.001] and 1-year mortality (OR 2.67, 95% CI: 2.36-3.03, P < 0.001). For those that survived to 90 days, the adjusted mortality at 1 year continued to be higher (OR 1.48, 95% CI: 1.16-1.89, P = 0.002). CONCLUSION We found a strong association between the presence of MV at heart transplantation and 90-day and 1-year mortality. Future studies are needed to identify which patients requiring MV have reasonable outcomes, and which are associated with substantially poorer outcomes.
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Affiliation(s)
- P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,Yale National Clinicians Scholar Program, New Haven, CT, USA
| | - Clancy W Mullan
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Fouad Chouairi
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Katherine A Clark
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Samuel Reinhardt
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael Fuery
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Muhammad Anwer
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Richard Formica
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | - Joseph G Rogers
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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18
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Jeon J, Kwon HJ, Yoo H, Kim D, Cho YH, Choi JO, Kim K, Sung K, Jang HR. Clinical Factors Associated with Renal Outcome After Heart Transplantation. Int Heart J 2021; 62:850-857. [PMID: 34276011 DOI: 10.1536/ihj.20-775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiorenal syndrome (CRS) frequently occurs in end-stage heart failure patients waiting for heart transplantation (HT). Decision-making regarding simultaneous heart and kidney transplantation is an unresolved issue in these patients. We investigated clinical factors associated with renal outcome after HT. A total of 180 patients who received HT from 1996 to 2015 were included. Factors associated with early post-HT chronic kidney disease (CKD, estimated glomerular filtration rate [eGFR] < 60 mL/minute/1.73 m2 within 1 year post-HT), post-HT end-stage kidney disease (ESKD), and significant renal function improvement (%ΔeGFR > 15%) at 1 year post-HT were analyzed. Early post-HT CKD and post-HT ESKD developed in 61 (33.9%) and 8 (4.4%) of 180 patients, respectively. Old age was only independently associated with early post-HT CKD and preexisting CKD tended to be associated with early post-HT CKD. Old age and preexisting CKD were independently associated with post-HT ESKD. Low pre-HT eGFR and preoperative renal replacement therapy were not associated with early post-HT CKD or post-HT ESKD. Young age, low pre-HT eGFR, and high %ΔeGFR 1 month post-HT were independently associated with significant renal function improvement. Preoperative renal function, including preoperative RRT, was not associated with post-HT mortality. In conclusion, preexisting CKD may impact renal outcomes after HT, but preoperative severe renal dysfunction, even that severe enough to require RRT, may not be a contraindication for HT alone. Our data suggest the necessity of early HT in end-stage heart failure patients with CRS and the importance of careful management during the early postoperative period.
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Affiliation(s)
- Junseok Jeon
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hee Jin Kwon
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Heejin Yoo
- Statistics and Data Center, Samsung Medical Center, Research Institute for Future Medicine
| | - Darae Kim
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Oh Choi
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kyunga Kim
- Statistics and Data Center, Samsung Medical Center, Research Institute for Future Medicine
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hye Ryoun Jang
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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19
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Yalcin YC, Kooij C, Theuns DAMJ, Constantinescu AA, Brugts JJ, Manintveld OC, Yap SC, Szili-Torok T, Bogers AJJC, Caliskan K. Emerging electromagnetic interferences between implantable cardioverter-defibrillators and left ventricular assist devices. Europace 2021; 22:584-587. [PMID: 32003803 PMCID: PMC7132535 DOI: 10.1093/europace/euaa006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/26/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS To investigate the prevalence of electromagnetic interference (EMI) between left ventricular assist devices (LVADs) and implantable cardioverter-defibrillators (ICDs)/pacemakers (PMs). METHODS AND RESULTS A retrospective single-centre study was conducted, including all patients undergoing HeartMate II (HMII) and HeartMate 3 (HM3) LVAD implantation (n = 106). Electromagnetic interference was determined by the inability to interrogate the ICD/PM. Overall, 85 (mean age 59 ± 8, 79% male) patients had an ICD/PM at the time of LVAD implantation; 46 patients with HMII and 40 patients with HM3. Among the 85 LVAD patients with an ICD's/PM's, 11 patients (13%) experienced EMI; 6 patients (15%) with an HMII and 5 patients (11%) with an HM3 (P = 0.59). Electromagnetic interference from the HMII LVADs was only present in patients with a St Jude/Abbott device; 6 of the 23 St Jude/Abbott devices. However, in the HM3 patients, EMI was mainly present in patients with Biotronik devices: 4 of the 18 with only one (1/25) patient with a Medtronic device. While initial interrogation of these devices was not successful, none of the 11 cases experienced pacing inhibition or inappropriate shocks. CONCLUSION In summary, the prevalence of EMI between ICDs in the older and newer type of LVAD's remains rather high. While HMII patients experienced EMI with a St Jude/Abbott device (which was already known), HM3 LVAD patients experience EMI mainly with Biotronik devices. Prospective follow-up, preferably in large registries, is warranted to investigate the overall prevalence and impact of EMI in LVAD patients.
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Affiliation(s)
- Yunus C Yalcin
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands.,Department of Cardio-thoracic Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Claudette Kooij
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Dominic A M J Theuns
- Department of Cardio-thoracic Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardio-thoracic Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
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20
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de By TMMH, Antonides CFJ, Schweiger M, Sliwka J, Davies B, Berger F, Hübler M, Özbaran M, Maruszewski B, Pace Napoleone C, Zimpfer D, Sandica E, Antretter H, Meyns B, Miera O. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): second EUROMACS Paediatric (Paedi-EUROMACS) report. Eur J Cardiothorac Surg 2021; 57:1038-1050. [PMID: 32364221 DOI: 10.1093/ejcts/ezaa132] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES A second paediatric report has been generated from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The purpose of EUROMACS, which is operated by the European Association for Cardio-Thoracic Surgery, is to gather data related to durable mechanical circulatory support for scientific purposes and to publish reports with respect to the course of mechanical circulatory support therapy. Since the first report issued, efforts to increase compliance and participation have been extended. Additionally, the data provided the opportunity to analyse patients of younger age and lower weight. METHODS Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (≤19 years of age) performed from 1 January 2000 to 1 July 2019 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events including neurological dysfunction, device malfunction, major infection and bleeding. RESULTS Twenty-nine hospitals contributed 398 registered implants in 353 patients (150 female, 203 male) to the registry. The most frequent aetiology of heart failure was any form of cardiomyopathy (61%), followed by congenital heart disease and myocarditis (16.4% and 16.1%, respectively). Competing outcomes analysis revealed that a total of 80% survived to transplant or recovery or are ongoing; at the 2-year follow-up examination, 20% died while on support. At 12 months, 46.7% received transplants, 8.7% were weaned from their device and 18.5% died. The 3-month adverse events rate was 1.69 per patient-year for device malfunction including pump exchange, 0.48 for major bleeding, 0.64 for major infection and 0.78 for neurological events. CONCLUSIONS The overall survival rate was 81.5% at 12 months following ventricular assist device implant. The comparison of survival rates of the early and later eras shows no significant difference. A focus on specific subgroups showed that survival was less in patients of younger age (<1 year of age) (P = 0.01) and lower weight (<20 kg) (P = 0.015). Transplant rates at 6 months continue to be low (33.2%) The fact that the EUROMACS registry is embedded within the European Association for Cardio-Thoracic Surgery Quality Improvement Programme offers opportunities to focus on improving outcomes.
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Affiliation(s)
- Theo M M H de By
- EUROMACS, European Association for Cardio-Thoracic Surgery (EACTS), Windsor, UK
| | | | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Children's Hospital Zürich, Zürich, Switzerland
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Ben Davies
- Great Ormond Street Hospital, London, UK
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Michael Hübler
- Department of Congenital Pediatric Surgery, Children's Hospital Zürich, Zürich, Switzerland
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege Universitesi Tip Fakültesi, Izmir, Turkey
| | - Bohdan Maruszewski
- Pediatric Cardiothoracic Surgery Department, Children's Memorial Hospital, Warsaw, Poland
| | - Carlos Pace Napoleone
- Pediatric Cardiac Surgery Department, Regina Margherita Children's Hospital, Torino, Italy
| | | | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Germany
| | | | - Bart Meyns
- Cardiale Heelkunde, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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21
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Yalcin YC, Muslem R, Veen KM, Soliman OI, Manintveld OC, Darwish Murad S, Kilic A, Constantinescu AA, Brugts JJ, Alkhunaizi F, Birim O, Tedford RJ, Bogers AJJC, Hsu S, Caliskan K. Impact of preoperative liver dysfunction on outcomes in patients with left ventricular assist devices. Eur J Cardiothorac Surg 2021; 57:920-928. [PMID: 31828334 DOI: 10.1093/ejcts/ezz337] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/29/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES We evaluated the impact of preoperative liver function on early and 1-year postoperative outcomes in patients supported with a left ventricular assist device (LVAD) and subsequent evolution of liver function markers. METHODS A retrospective multicentre cohort study was conducted, including all patients undergoing continuous-flow LVAD implantation. The Model for End-stage Liver Disease (MELD) score was used to define liver dysfunction. RESULTS Overall, 290 patients with an LVAD [78% HeartMate II, 15% HVAD and 7% HeartMate 3, mean age 55 (18), 76% men] were included. Over 40 000 measurements of liver function markers were collected over a 1-year period. A receiver operating characteristic curve analysis for the 1-year mortality rate identified the optimal cut-off value of 12.6 for the MELD score. Therefore, the cohort was dichotomized into patients with an MELD score of less than or greater than 12.6. The early (90-day) survival rates in patients with and without liver dysfunction were 76% and 91% (P = 0.002) and 65% and 90% at 1 year, respectively (P < 0.001). Furthermore, patients with preoperative liver dysfunction had more embolic events and more re-explorations. At the 1-year follow-up, liver function markers showed an overall improvement in the majority of patients, with or without pre-LVAD liver dysfunction. CONCLUSIONS Preoperative liver dysfunction is associated with higher early 90-day and 1-year mortality rates after LVAD implantation. Furthermore, liver function improved in both patient groups. It has become imperative to optimize the selection criteria for possible LVAD candidates, since those who survive the first year show excellent recovery of their liver markers.
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Affiliation(s)
- Yunus C Yalcin
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Rahatullah Muslem
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Osama I Soliman
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ahmet Kilic
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Alina A Constantinescu
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Fatimah Alkhunaizi
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Ozcan Birim
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ryan J Tedford
- Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Ad J J C Bogers
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Steven Hsu
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Kadir Caliskan
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
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22
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Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA.
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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23
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Arora S, Atreya AR, Birati EY, Shore S. Temporary Mechanical Circulatory Support as a Bridge to Heart Transplant or Durable Left Ventricular Assist Device. Interv Cardiol Clin 2021; 10:235-249. [PMID: 33745672 DOI: 10.1016/j.iccl.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Advanced heart failure refractory to medical therapy can result in patients presenting with progressively worsening hypoperfusion and cardiogenic shock. Temporary mechanical circulatory support is often necessary as a bridge to heart transplant or durable ventricular assist devices. These devices increase cardiac output. Several options are available for left ventricular support. With the exception of venoarterial extracorporeal membrane oxygenation, all other devices decrease left ventricular end-diastolic pressure. The choice of device should be driven by patient needs and the treating teams comfort. Timely identification of cardiogenic shock and use of shock teams are potential strategies that can help improve survival.
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Affiliation(s)
- Sonali Arora
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences Hospitals, 1-8-31/1, Minister Road, Krishna Nagar Colony, Secunderabad, Telangana 500003, India
| | - Auras R Atreya
- Interventional Cardiology, AIG Institute of Cardiac Sciences and Research, 1, Mindspace Road, Gachibowli, Hyderabad, Telangana 500032, India
| | - Edo Y Birati
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Cardiovascular Medicine, Poriya Medical Center, Israel 152801; Perelman Center for Advanced Medicine, 11th Floor, South Tower, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Supriya Shore
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Michigan, Ann Arbor, MI 48103, USA; University of Michigan, North Campus Research Complex, 2800 Plymouth Road, 16-169C, Ann Arbor, MI 48109, USA.
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24
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Asaka M, Kotooka N, Yajima A, Node K. Advance care planning from the penultimate hospitalization in patients with end-stage heart failure: a single-center, 10-year experience. Heart Vessels 2021; 36:1290-1297. [PMID: 33677617 DOI: 10.1007/s00380-021-01807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
Advance care planning (ACP) is a key element of palliative care even in patients with heart failure (HF); however, the complexity of the clinical trajectory hampers its early introduction. We retrospectively evaluated the state of implementation and the quality of ACP from the penultimate hospitalization in patients with HF who died after repeated hospitalizations. Of the 1117 patients admitted to Saga University Hospital from 2007 to 2016, we excluded 934 patients who survived after discharge or changed hospital, 78 patients who died for a reason other than HF, 42 patients who died during their first HF hospitalization, and 23 patients who died during hospitalization in another hospital. The electronic medical records of the remaining 40 patients were evaluated by three trained physicians on the recently provided 12 recommended elements of ACP, using a 5-point Likert scale (1 = very poor to 5 = excellent). The mean ratings of the 12 ACP elements ranged from 1.0 to 1.9. A do not attempt resuscitation (DNAR) order was issued to 10 patients (25%) just before they died. Of the remaining 30 patients not issued a DNAR order, cardiopulmonary resuscitation was attempted for 23 (76.7%) patients. Among patients with HF who eventually died after repeated hospitalizations, ACP even after the penultimate hospitalization was not evaluated highly. It resulted in a DNAR order in the last few days, a CPR as if their death was sudden and unexpected at the final moment, or CPAOA.
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Affiliation(s)
- Machiko Asaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan.
| | - Ayumu Yajima
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
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25
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Unbehaun A, Kelm M, Miera O, Kempfert J. Transcatheter aortic valve implantation in a 13-year-old child with end-stage heart failure: a case report. Eur Heart J Case Rep 2021; 5:ytab034. [PMID: 33738418 PMCID: PMC7954252 DOI: 10.1093/ehjcr/ytab034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/07/2020] [Accepted: 01/13/2021] [Indexed: 12/03/2022]
Abstract
Background Left ventricular non-compaction cardiomyopathy (LVNC) has been reported in association with almost all types of congenital heart valve disease. The presence of LVNC-related ventricular dysfunction increases the perioperative risk in these patients. The advantages of transcatheter treatment modalities outweigh those of surgical strategies, as they avoid cardioplegic arrest and myocardial trauma. To our knowledge, there have been no reports on transcatheter treatment of pure aortic regurgitation in patients with a bicuspid aortic valve (BAV) and concomitant LVNC. Case summary In this article, we present the case of a 13-year-old boy with a regurgitant BAV and concomitant LVNC who presented with end-stage heart failure and severe pulmonary hypertension. As a bridge to definitive therapy, the patient underwent an uneventful transcatheter aortic valve implantation (TAVI) using a 26-mm balloon-expandable prosthesis. Device success without paravalvular regurgitation was achieved. At 17 months of follow-up, a steady reduction in pulmonary arterial pressure, persistent normalization of systolic left ventricular function and a tremendous improvement in the patient’s physical resilience was observed. The initially considered heart–lung transplantation was avoided and will not be necessary. Discussion To the best of our knowledge, this is the first case performed with TAVI for BAV regurgitation in the context of LVNC. With technical modifications and appropriate planning, TAVI in paediatric patients with a non-calcified BAV is feasible. Different imaging modalities revealed an intriguing relationship between aortic regurgitation and morphological signs of a left ventricular non-compaction myocardium.
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Affiliation(s)
- Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Potsdamer Straße 58, 10785 Berlin, Germany
| | - Marcus Kelm
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,Charité-Universitätsmedizin Berlin, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Potsdamer Straße 58, 10785 Berlin, Germany
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26
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Colvin M, Smith JM, Ahn Y, Skeans MA, Messick E, Goff R, Bradbrook K, Foutz J, Israni AK, Snyder JJ, Kasiske BL. OPTN/SRTR 2019 Annual Data Report: Heart. Am J Transplant 2021; 21 Suppl 2:356-440. [PMID: 33595196 DOI: 10.1111/ajt.16492] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The new adult heart allocation policy was approved in 2016 and implemented in October 2018. This year's Annual Data Report provides early insight into the effects of this policy. In 2019, new listings continued to increase, with 4086 new candidates. Also in 2019, 3597 heart transplants were performed, an increase of 157 (4.6%) from 2018; 509 transplants occurred in children and 3088 in adults. Short- and long-term posttransplant mortality rates improved. Overall, Mortality rates for adult recipients were 6.4% at 6 months and 7.9% at 1 year for transplants in 2018, 14.4% at 3 years for transplants in 2016, and 20.1% at 5 years for transplants in 2014. Mortality rates for pediatric recipients were 6.3% at 6 months and 8.2% at 1 year for transplants in 2018, 10.3% at 3 years for transplants in 2016, and 17.8% at 5 years for transplants in 2014.
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Affiliation(s)
- M Colvin
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Cardiology, University of Michigan, Ann Arbor, Ml
| | - J M Smith
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - Y Ahn
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - E Messick
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - R Goff
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - K Bradbrook
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - J Foutz
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - A K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - B L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
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27
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Bories MC, Abi Akar R. End-stage heart failure patients should be treated instantly despite a pandemic with all-time available technology to ensure best outcomes. Eur Heart J Suppl 2020; 22:P33-P37. [PMID: 33390868 PMCID: PMC7757713 DOI: 10.1093/eurheartj/suaa183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 02/06/2023]
Abstract
Since the earliest cases of coronavirus disease 2019 (COVID-19) infection were reported, our care delivery systems have been reorganized and challenged in unprecedent ways, specifically the cardiovascular community. COVID-19 poses a challenge for heart transplantation, affecting donor selection, immunosuppression, and posttransplant management. Left Ventricular Assist Device (LVAD) therapy is currently a viable option for patients with end-stage heart failure as a bridge to heart transplantation or destination therapy. Here, we present a therapeutic strategy for the management of acute HF with Intermacs profiles from 1 to 4, with or without Covid-19 infection, exemplified by serie of patients presenting with severe HF and successfully treated by LVAD therapy during the spread of the Covid-19 pandemic and the French national lockdown. This experience has shown that we still have the capacity to provide the right therapy for the right disease to the right patient. LVAD implantation seems to be the treatment of choice for advanced HF due to the lack of healthy donor hearts for cardiac transplantation. Covid or non-Covid context, we have to take care of our patients with end-stage HF the best we can.
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Affiliation(s)
- Marie-Cécile Bories
- Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of cardiology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ramzi Abi Akar
- Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Kassner A, Oezpeker C, Gummert J, Zittermann A, Gärtner A, Tiesmeier J, Fox H, Morshuis M, Milting H. Mechanical circulatory support does not reduce advanced myocardial fibrosis in patients with end-stage heart failure. Eur J Heart Fail 2020; 23:324-334. [PMID: 33038287 DOI: 10.1002/ejhf.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/07/2022] Open
Abstract
AIMS Mechanical unloading by ventricular assist devices (VADs) has become increasingly important for the therapy of end-stage heart failure during the last decade. However, VAD support was claimed to be associated with partial reverse remodelling. Unfortunately, the literature describes the contradictory effects of VAD systems on cardiac fibrosis, a hallmark of cardiac remodelling. To clarify these inconsistent results, the effects on cardiac fibrosis before and after mechanical unloading in 125 patients were examined. METHODS AND RESULTS Left ventricular myocardial tissue from ischaemic or non-ischaemic cardiomyopathy patients undergoing VAD implantation and subsequent cardiac transplantation and non-failing hearts of the control group were analysed for 4-hydroxyproline (4OH-P) content as a marker for collagen protein. In addition, collagen cross-linking and mRNAs of collagens I and III and transforming growth factor beta-1 were measured. 4OH-P content was significantly increased in failing hearts compared with the control group and increased (P < 0.05) after mechanical unloading (nmol/mg tissue, mean ± standard deviation: 16.74 ± 9.68 vs. 7.75 ± 2.39 and 18.57 ± 9.19). However, plotting of the 4OH-P ratios (post/pre-VAD) against the collagen content pre-VAD could be fitted by non-linear regression. Collagen cross-linking correlated strongly with the total collagen content in pre- and post-VAD myocardium (r2 = 0.73 and 0.71, respectively). In contrast to the total collagen content, all three mRNAs of fibrotic genes were significantly down-regulated during VAD support when compared to pre-VAD. CONCLUSIONS This investigation of a comparably large patient cohort revealed that cardiac fibrosis was strongly increased in heart failure and increased even after mechanical unloading. The mRNAs of collagens I and III are independently regulated from the collagen protein.
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Affiliation(s)
- Astrid Kassner
- Erich & Hanna Klessmann Institute for Cardiovascular Research & Development (EHKI), Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Cenk Oezpeker
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan Gummert
- Erich & Hanna Klessmann Institute for Cardiovascular Research & Development (EHKI), Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany.,Clinic for Thoracic and Cardiovascular Surgery, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Anna Gärtner
- Erich & Hanna Klessmann Institute for Cardiovascular Research & Development (EHKI), Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jens Tiesmeier
- Hospital Luebbecke-Rhaden, Muehlenkreis Hospitals, Medical-Campus OWL of the Ruhr-University Bochum, Luebbecke, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Hendrik Milting
- Erich & Hanna Klessmann Institute for Cardiovascular Research & Development (EHKI), Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
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daSilva-deAbreu A, Garikapati K, Alhafez BA, Desai S, Eiswirth C, Krim S, Patel H, Ventura HO, Lavie CJ, Loro-Ferrer JF, Mandras SA. Laparoscopic Sleeve Gastrectomy in Patients with Obesity and Ventricular Assist Devices: a Comprehensive Outcome Analysis. Obes Surg 2020; 31:884-890. [PMID: 32840719 DOI: 10.1007/s11695-020-04948-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
We analyzed in detail the outcomes of eight patients with ventricular assist devices (VADs) and obesity who underwent laparoscopic sleeve gastrectomy (LSG) at a single heart transplant (HT) center. This comprehensive analysis included body mass index (BMI) trends from VAD implantation to the time of LSG; BMI and percentage of excess BMI lost during follow-up; adverse outcomes; and changes in echocardiographic parameters, fasting lipids, unplanned hospitalizations, and functional status. We also identified the patients who achieved the following outcomes: listing for HT, HT, 50% excess BMI loss, and BMI < 35 kg/m2. Laparoscopic sleeve gastrectomy seems to be a reasonable and effective intervention to help patients with VADs and obesity to decrease excess BMI and become candidates for HT.
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Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA. .,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA. .,Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Kiran Garikapati
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | | | - Sapna Desai
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Clement Eiswirth
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Selim Krim
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Hamang Patel
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | | | - Stacy A Mandras
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
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30
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Gonuguntla K, Patil S, Rojulpote C, Cowden RG, Nasir M, Karambelkar P, Buch T, Aujla A, Bhattaru A, Borja ZE, Schulman P. A population based analysis of trends, risk factors and outcomes associated with gastrointestinal bleeding in patients with left ventricular assist devices. Am J Cardiovasc Dis 2020; 10:247-257. [PMID: 32923107 PMCID: PMC7486528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
Introduction: Prior to the utilization of continuous flow (CF) devices in 2010, Gastrointestinal (GI) bleeding was a common adverse event related to left ventricular assist device (LVADs) that was found to be even more frequent when CF devices were first introduced. Objective: Given the drastic increase in the use of new CF-LVADs, we sought to determine if CF-LVADs are associated with an increased number of GI bleeds and higher mortality. Methods: We analysed the data from a national inpatient sample database using the ICD-9 procedure code for LVAD use in end-stage heart failure among patients > 18 years. The total sample consisted of 2,359 patients (M age=55 ± 13.7 years). A majority of the sample was male (77%) and Caucasian (59%). Results: The Incidence of GI bleeding from 2010 to 2014 was 7.46% with no significant change in yearly incidence over five-year period (P=.793). After controlling for age, sex, and length of stay, multivariate logistic regression revealed that significant predictors of GI bleed were acute kidney injury (AOR=1.87, 95% CI=1.26, 2.80), peripheral vascular disease (AOR=1.77, 95% CI=1.02, 2.94), body mass index ≥ 25 (AOR=.46, 95% CI=.22, .87), hemiplegia or paraplegia (AOR=3.01, 95% CI=1.17, 7.05), moderate or severe liver disease (AOR=2.40, 95% CI=.97, 5.34), peptic ulcer disease (AOR=18.13, 95% CI=7.86, 42.38), surgical aortic valve replacement (AOR=2.46, 95% CI=1.12, 5.15), and venous thromboembolism (AOR=2.58, 95% CI=1.57, 4.15). Conclusion: The results of the study show that GI bleeding is highly prevalent in patients with LVADs and there was no improvement in rates of GI bleed over five years since the CF-LVADs were initially introduced and is associated with an increased likelihood of mortality.
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Affiliation(s)
- Karthik Gonuguntla
- Department of Internal Medicine and of Cardiology, University of ConnecticutFarmington, CT, USA
| | - Shivaraj Patil
- Department of Internal Medicine and of Cardiology, University of ConnecticutFarmington, CT, USA
| | - Chaitanya Rojulpote
- Department of Cardiology, University of PennsylvaniaPhiladelphia, PA, USA
- Department of Internal Medicine, The Wright Center for Graduate Medical EducationScranton, Pennsylvania, USA
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
| | - Richard G Cowden
- Department of Psychology, University of The Free StateBloemfontein, 9301, South Africa
| | - Myra Nasir
- Department of Internal Medicine and of Cardiology, University of ConnecticutFarmington, CT, USA
| | - Pranav Karambelkar
- Department of Internal Medicine, The Wright Center for Graduate Medical EducationScranton, Pennsylvania, USA
| | - Tapan Buch
- Department of Cardiology, The Wright Center for Graduate Medical EducationScranton, Pennsylvania, USA
| | - Amreet Aujla
- Department of Internal Medicine and of Cardiology, University of ConnecticutFarmington, CT, USA
| | - Abhijit Bhattaru
- Department of Cardiology, University of PennsylvaniaPhiladelphia, PA, USA
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
| | - Zoe E Borja
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
| | - Peter Schulman
- Department of Cardiology, University of ConnecticutFarmington, CT, USA
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31
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Suarez L, Dunlay SM, Schettle SD, Stulak JM, Staab JP. Associations of depressive symptoms with outcomes in patients implanted with left ventricular assist devices. Gen Hosp Psychiatry 2020; 64:93-98. [PMID: 32008725 DOI: 10.1016/j.genhosppsych.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We examined characteristics of depressive symptoms in patients who received left ventricular assist devices (LVAD) to assess their effects on negative outcomes post-implantation. METHODS We retrospectively identified 203 adults with pre-operative PHQ-9 scores who underwent LVAD placement as bridge to transplant (BTT) or destination therapy (DT). We analyzed effects of PHQ-9 total, somatic, and cognitive/affective scores and proportion of patients with clinical depression on all-cause mortality, rehospitalization, major bleeding, and neurologic events post-implantation, controlling for demographics and other medical comorbidities. RESULTS Mean total PHQ-9 scores did not differ between 81 BTT and 122 DT patients (BTT 6.4 vs. DT 7.5, p = 0.12). A higher proportion of DT patients had clinical depression (BTT 22% vs. DT 39%, p = 0.015). Somatic symptoms accounted for three-quarters of total scores in both groups. PHQ-9 domains were not associated with negative outcomes post-implantation. CONCLUSION Depression severity did not differ based on implant strategy, but more DT patients had clinical depression. Somatic symptoms were the biggest contributor to depressive symptoms. Pre-implantation PHQ-9 scores were not associated with outcomes, possibly because depression was mild in both groups. Additional work is needed in LVAD patients to better characterize depressive symptoms and their unique effects on clinical course and well-being.
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Affiliation(s)
- Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America; Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Sarah D Schettle
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
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32
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Ullah W, Sattar Y, Darmoch F, Al-Khadra Y, Mir T, Ajmal R, Moussa-Pacha H, Glazier J, Asfour A, Gardi D, Alraies MC. The impact of peripheral arterial disease on patients with mechanical circulatory support. Int J Cardiol Heart Vasc 2020; 28:100509. [PMID: 32300637 PMCID: PMC7150524 DOI: 10.1016/j.ijcha.2020.100509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/05/2020] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 01/05/2023]
Abstract
Patient having LVAD and history of PAD have a higher odd to develop acute myocardial infarction as compared to non-PAD. Major bleeding requiring transfusion, and thromboembolic complications were higher in patients with PAD disease. The LVAD placement in prior PAD can have high odds of surgical wound infections, and implant-related complications as compared to non-PAD. The odds of developing acute renal failure are high in LVAD with PAD as compared to non-PAD group. LVAD placement in history of PAD can have high in-hospital mortality are high as compared to non-PAD group.
Background Left ventricular assist devices (LVAD) are indicated as bridging or destination therapy for patients with advanced (Stage D) heart failure and reduced ejection fraction (HFrEF). Due to the clustering of the mutual risk factors, HFrEF patients have a high prevalence of peripheral arterial disease (PAD). This, along with the fact that continuous flow LVAD influence shear stress on the vasculature, can further deteriorate the PAD. Methods We queried the National Inpatient Sample (NIS) database (2002–2014) to identify the burden of pre-existing PAD cases, its association with LVAD, in-hospital mortality, and other complications of LVAD. The adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using the Cochran–Mantel–Haenszel test. Results A total of 20,817 LVAD patients, comprising of 1,625 (7.8%) PAD and 19,192 (91.2%) non-PAD patients were included in the study. The odds of in-hospital mortality in PAD patients were significantly higher compared to non-PAD group (OR 1.29, CI, 1.07–1.55, P = 0.007). The PAD group had significantly higher adjusted odds as compared to non-PAD group for acute myocardial infarction (aOR 1.29; 95% CI, 1.07–1.55, P = 0.007), major bleeding requiring transfusion (aOR, 1.286; 95% CI, 1.136–1.456, P < 0.001), vascular complications (aOR, 2.360; 95% CI, 1.781–3.126, P < 0.001), surgical wound infections (aOR, 1.50; 95% CI, 1.17–1.94, P = 0.002), thromboembolic complications (aOR, 1.69; 95% CI, 1.36–2.10, P < 0.001), implant-related complications (aOR, 1.47; 95% CI, 1.19–1.80, P < 0.001), and acute renal failure (aOR, 1.26; 95% CI, 1.12–1.43, P < 0.001). Conclusion PAD patients can have high LVAD associated mortality as compared to non-PAD.
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Key Words
- BiVAD, biventricular assist device
- CABG, coronary artery bypass surgery
- CAD, coronary artery disease
- CKD, chronic kidney disease
- End-stage heart failure
- LOS, length of stay
- LVAD, left ventricular assist device
- Left ventricular assist device
- MCS, mechanical circulatory support
- NIS, National Inpatient Sample
- OMT, optimal medical therapy
- PAD, peripheral arterial disease
- PCI, percutaneous coronary intervention
- Peripheral arterial disease
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Affiliation(s)
- Waqas Ullah
- Abington Hospital - Jefferson Health, United States
| | - Yasar Sattar
- Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, United States
| | - Fahed Darmoch
- Beth Israel Hospital, Harvard University, United States
| | | | - Tanveer Mir
- Wayne State University, Detroit Medical Center, United States
| | - Rasikh Ajmal
- Wayne State University, Detroit Medical Center, United States
| | - Homam Moussa-Pacha
- University of Texas Health Science Center, McGovern Medical School, Memorial Hermann Heart & Vascular Institute, USA
| | - James Glazier
- Wayne State University, Detroit Medical Center, United States
| | | | - Delair Gardi
- Wayne State University, Detroit Medical Center, United States
| | - M Chadi Alraies
- Wayne State University, Detroit Medical Center, United States
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Sert DE, Kervan Ü, Kocabeyoğlu SS, Karahan M, Küçüker ŞA, Özatik MA, Paç FA, Paç M. Early and long-term results of heart transplantation with reoperative sternotomy. Turk Gogus Kalp Damar Cerrahisi Derg 2020; 28:120-6. [PMID: 32175152 DOI: 10.5606/tgkdc.dergisi.2020.18586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/16/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the effects of reoperative sternotomy on early and long-term outcomes after heart transplantation. Methods We retrospectively reviewed data of a total of 92 patients (72 males, 20 females; mean age 36 years; range, 3 to 61 years) who underwent orthotopic heart transplantation between May 1998 and July 2014. The patients were divided into three groups. Group A (n=23) included patients who underwent previous cardiac surgery with sternotomy other than ventricular assist device implantation; Group B (n=12) included patients who were bridged-to-transplant with a ventricular assist device; and Group C (n=57) included patients who for the first time underwent heart transplantation without previous sternotomy. Preoperative and operative data of the three groups were compared. The short- and long-term outcomes of all groups were analyzed. Results There was no significant difference among the groups, except for the age and preoperative international normalized ratio. Total ischemia time in the ventricular assist device group was longer than Group C. The length of intensive care unit stay was also longer in the ventricular assist device group than the other groups. The amount of postoperative chest tube drainage and blood transfusion was higher in Group A. Early mortality rate was significantly higher in Group A. There was no significant difference in survival among the three groups in the long-term. According to the logistic regression analysis, no variable was found to be a significant risk factor for mortality. Conclusion Reoperative sternotomy other than ventricular assist device implantation was found to be a risk factor for early mortality; however, mid and long-term survival rates were similar to patients in whom transplantation was the primary procedure. In patients with reoperative sternotomy, heart transplantation can be performed with similar risks to patients without resternotomy with careful selection and accurate pre- and intraoperative surgical approach.
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Gürcü ME, Altaş Yerlikhan Ö, Özer T, Erkılınç A, Altınay E, Erdem E, Gücün M, Bekiroğlu N, Kırali K. The mid-term effect of left ventricular assist devices on renal functions. Turk Gogus Kalp Damar Cerrahisi Derg 2019; 27:320-8. [PMID: 32082879 DOI: 10.5606/tgkdc.dergisi.2019.17568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/31/2019] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to investigate the mid-term effects of left ventricular assist devices on kidney functions. Methods Between January 2015 and December 2017, a total of 61 patients (53 males, 8 females; mean age 46.4±11.2 years; range, 20 to 67 years) who underwent left ventricular assist device implantation were retrospectively analyzed. Glomerular filtration rate was evaluated preoperatively and at 24 and 48 h, at one week, and at one, three, and six months postoperatively. According to the preoperative glomerular filtration rates, the patients were divided into three groups: glomerular filtration rates ?60 mL/min/1.73 m2 ( Group 1 ), g lomerular f iltration rates 61-90 mL/min/1.73 m2 (Group 2), and glomerular filtration rates >90 mL/min/1.73 m2 (Group 3). Results In all groups, the glomerular filtration rate significantly increased at one week and one month postoperatively, compared to preoperative values (p<0.001 and p<0.01, respectively). However, the glomerular filtration values at six months significantly decreased, compared to the values at one week and one month postoperatively (p<0.001 and p<0.001, respectively). The most significant drop to preoperative values was observed in Group 3 (p=0.02) at three months and it dropped below the preoperative level at six months (p<0.001). Conclusion Our study results suggest that left ventricular assist devices can significantly increase the glomerular filtration rate in short-term, irrespective of baseline values. However, this improvement may recede later, particularly in patients with normal renal functions, and it may even disappear following the third postoperative month.
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Colvin M, Smith JM, Hadley N, Skeans MA, Uccellini K, Goff R, Foutz J, Israni AK, Snyder JJ, Kasiske BL. OPTN/SRTR 2018 Annual Data Report: Heart. Am J Transplant 2020; 20 Suppl s1:340-426. [PMID: 31898418 DOI: 10.1111/ajt.15676] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The new adult heart allocation policy was approved in 2016 and implemented in October 2018, so its effect was not yet evident in 2018 data. However, the more granular data being collected are anticipated to allow for improved analyses. In 2018, new listings continued to increase; 3883 new adult and 685 new pediatric candidates were added. In 2018, 3440 heart transplants were performed, an increase of 167 over 2017; 473 transplants occurred in pediatric recipients and 2967 in adult recipients. Short-term and long-term posttransplant mortality improved. Overall 1-year survival for adults who underwent heart transplant in 2011-2013 was 90.3%, 3-year survival was 84.7%, and 5-year survival was 79.6%. Mortality rates for pediatric recipients were 4.5% at 6 months and in 5.9% at 1 year posttransplant, 12.5% at 3 years for transplants in 2014-2015, 14.8% at 5 years for transplants in 2012-2013, and 29.8% at 10 years for transplants performed in 2008-2009.
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Affiliation(s)
- M Colvin
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Cardiology, University of Michigan, Ann Arbor, MI
| | - J M Smith
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - N Hadley
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - K Uccellini
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - R Goff
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - J Foutz
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - A K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - B L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
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de By TMMH, Mohacsi P, Gahl B, Zittermann A, Krabatsch T, Gustafsson F, Leprince P, Meyns B, Netuka I, Caliskan K, Castedo E, Musumeci F, Vincentelli A, Hetzer R, Gummert J. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio-Thoracic Surgery (EACTS): second report. Eur J Cardiothorac Surg 2019; 53:309-316. [PMID: 29029117 DOI: 10.1093/ejcts/ezx320] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/08/2017] [Accepted: 08/13/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was founded in Berlin, Germany. EUROMACS is supported fully by the European Association for Cardio-Thoracic Surgery (EACTS) and, since 2014, has functioned as a committee of the EACTS. The purpose of having the EUROMACS as a part of the EACTS is to accumulate clinical data related to long-term mechanical circulatory support for scientific purposes and to publish annual reports. METHODS Participating hospitals contributed surgical and cardiological pre-, peri- and long-term postoperative data of mechanical circulatory support implants to the registry. Data for all implants performed from 1 January 2011 to 31 December 2016 were analysed. Several auditing methods were used to monitor the quality of the data. Data could be provided for in-depth studies, and custom data could be provided at the request of clinicians and scientists. This report includes updates of patient characteristics, implant frequency, mortality rates and adverse events. RESULTS Fifty-two hospitals participated in the registry. This report is based on 2947 registered implants in 2681 patients. Survival of adult patients (>17 years of age) with continuous-flow left ventricular assist devices with a mean follow-up of 391 days was 69% (95% confidence interval 66-71%) 1 year after implantation. On average, patients were observed for 12 months (median 7 months, range 0-70 months). When we investigated for adverse events, we found an overall event rate per 100 patient-months of 3.56 for device malfunction, 6.45 for major bleeding, 6.18 for major infection and 3.03 for neurological events within the first 3 months after implantation. CONCLUSIONS Compared to the first EUROMACS report, the number of participating hospitals increased from 21 to 52 (+148%), whereas the number of registered implants more than tripled from 825 to 2947 (+257%). The increase in the number of participating hospitals led us to increase the quality control measures through data input control, on-site audits and statistical analyses.
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Affiliation(s)
| | - Paul Mohacsi
- Swiss Cardiovascular Center, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Brigitta Gahl
- Swiss Cardiovascular Center, University Hospital Bern (Inselspital), Bern, Switzerland
| | | | | | | | - Pascal Leprince
- Université Pierre et Marie Curie, Hôpital La-Pitié Salpetrière, Paris, France
| | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Evaristo Castedo
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - André Vincentelli
- Centre Hospitalier Régional Universitaire de Lille, France, Lille, France
| | | | - Jan Gummert
- Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
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Huang B, Li YJ, Shen J, Yang Y, Liu G, Luo SX. D-dimer level and long-term outcome in patients with end-stage heart failure secondary to idiopathic dilated cardiomyopathy. J Geriatr Cardiol 2019; 16:621-9. [PMID: 31555330 DOI: 10.11909/j.issn.1671-5411.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices, represented by elevated D-dimer, had prognostic significance in patients with compatible or acute decompensated HF. However, the impact of D-dimer on the outcome in patients with end-stage HF remains unclear. Methods A total of 244 consecutive patients with end-stage HF due to idiopathic dilated cardiomyopathy (DCM) were prospectively enrolled from February 2011 to September 2014. D-dimer levels were measured and its prognostic value was assessed. Primary endpoint was all-cause mortality during the follow-up period. Secondary endpoints were stroke, bleeding, occurrence of sustained ventricular tachycardia or ventricular fibrillation, and major adverse cardiovascular events (MACE). Results D-dimer was significantly elevated in the non-survivors (median: 0.8 vs. 1.1 mg/L, P < 0.001). Traditional markers including B-type natriuretic peptide, troponin I, left ventricular ejection fraction, and left ventricular end-diastolic dimension provided limited prognostic value; but the addition of D-dimer refined the risk stratification. The optimal cut-off value of D-dimer to predict all-cause mortality was 0.84 mg/L by receiver operator characteristic analysis. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (HR = 2.315, 95% CI: 1.570–3.414, P < 0.001) and MACE (HR = 1.256, 95% CI: 1.058–1.490, P = 0.009), and the predictive value was independent of age, sex, atrial fibrillation and anticoagulation status. Conclusions Elevated D-dimer level was independently associated with poor long-term outcome in patients with end-stage HF secondary to idiopathic DCM, and the predictive value was superior to that of traditional prognostic markers.
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Colvin M, Smith JM, Hadley N, Skeans MA, Uccellini K, Lehman R, Robinson AM, Israni AK, Snyder JJ, Kasiske BL. OPTN/SRTR 2017 Annual Data Report: Heart. Am J Transplant 2019; 19 Suppl 2:323-403. [PMID: 30811894 DOI: 10.1111/ajt.15278] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 2017, 3273 heart transplants were performed in the United States. New listings continued to increase, and 3769 new adults were listed for heart transplant in 2017. Over the past decade, posttransplant mortality has declined. The number of new pediatric listings increased over the past decade, as did the number of pediatric heart transplants, although some fluctuation has occurred more recently. New listings for pediatric heart transplants increased from 481 in 2007 to 623 in 2017. The number of pediatric heart transplants performed each year increased from 330 in 2007 to 432 in 2017, slightly fewer than in 2016. Short-term and long-term mortality improved. Among pediatric patients who underwent transplant between 2015-2016, 4.8% had died by 6 months and 6.2% by 1 year.
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Affiliation(s)
- M Colvin
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Cardiology, University of Michigan, Ann Arbor, MI
| | - J M Smith
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - N Hadley
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - K Uccellini
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - R Lehman
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - A M Robinson
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - A K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - B L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
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Khayata M, Al-Kindi SG, Oliveira GH. Contemporary characteristics and outcomes of adults with familial dilated cardiomyopathy listed for heart transplantation. World J Cardiol 2019; 11:38-46. [PMID: 30705741 PMCID: PMC6354074 DOI: 10.4330/wjc.v11.i1.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/01/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Familial dilated cardiomyopathy (FDCM) account for 20%-30% of non-ischemic cardiomyopathies (NICM). Previous published data showed that some patients with FDCM tend to have rapidly progressive disease; however, five-year mortality was not significantly different in the familial and non-familial forms of NICM with optimal medical therapy.
AIM To better define the characteristics and clinical outcomes of FDCM patients listed for heart transplantation (HT).
METHODS We queried the United Network for Organ Sharing Registry to identify FDCM patients listed for HT between January 2008 and September 2015 and compared them to NICM and ischemic cardiomyopathy (ICM) patients. We included all patients ≥ 18 years old and we separated patients to three groups: FDCM, NICM and ICM. Chi-square test was used to compare between categorical variables, the t-test was used to compare between continues variables, and Cox-proportional hazards model was used to perform time-dependent survival analyses.
RESULTS Of the 24809 adults listed for HT, we identified 677 patients (2.7%) with the diagnosis of FDCM. Compared to patients with NICM and ICM, FDCM patients were younger (FDCM 43.9 ± 13.5 vs NICM 50.9 ± 12.3, P < 0.001, vs ICM 58.5 ± 8.1, P < 0.001), more frequently listed as status 2 (FDCM 35.2% vs NICM 26.5%, P < 0.001), with significantly lower left ventricular assist device (LVAD) utilization (FDCM 18.4% vs NICM 25.1%, P < 0.001; vs ICM 25.6%, P < 0.001), but higher use of total artificial heart (FDCM 1.3% vs NICM 0.6%, P = 0.039; vs ICM 0.4%, P = 0.002). Additionally, patients with FDCM were less frequently delisted for clinical deterioration or death and more likely to be transplanted compared to those with NICM [hazard ratio (HR): 0.617, 95% confidence interval (CI): 0.47-0.81; HR: 1.25, 95%CI: 1.14-1.37, respectively], and ICM (HR: 0.5, 95%CI: 0.38-0.66; HR: 1.18, 95%CI: 1.08-1.3, respectively). There was more frequent rejection among patients with FDCM (FDCM 11.4% vs NICM 9.8%, P = 0.28; vs ICM 8.4%, P = 0.034). One, three, and five post-transplant survival of patients with FDCM (91%, 88% and 80%) was similar to those with NICM (91%, 84%, 79%, P = 0.225), but superior to those with ICM (89%, 82%, 75%, P = 0.008), respectively.
CONCLUSION End-stage FDCM patients are more likely to be transplanted, more likely to have early rejection, and have similar or higher survival than patients with other cardiomyopathies.
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Affiliation(s)
- Mohamed Khayata
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
| | - Sadeer G Al-Kindi
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
| | - Guilherme H Oliveira
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
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Harmon DM, Tecson KM, Lima B, Collier JDG, Shaikh AF, Still S, Baxter RD, Lew N, Thakur R, Felius J, Hall SA, Gonzalez-Stawinski GV, Joseph SM. Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation. Cardiorenal Med 2019; 9:100-107. [PMID: 30673661 DOI: 10.1159/000492476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although acute kidney injury (AKI) is a common complication following cardiac surgery, less is known about the occurrence and consequences of moderate/severe AKI following left ventricular assist device (LVAD) implantation. METHODS All patients who had an LVAD implanted at our center from 2008 to 2016 were reviewed to determine the incidence of, and risk factors for, moderate/severe (stage 2/3) AKI and to compare postoperative complications and mortality rates between those with and those without moderate/severe AKI. RESULTS Of 246 patients, 68 (28%) developed moderate/severe AKI. A multivariable logistic regression comprising body mass index and prior sternotomy had fair predictive ability (area under the curve = 0.71). A 1-unit increase in body mass index increased the risk of moderate/severe AKI by 7% (odds ratio = 1.07; 95% confidence interval: 1.03-1.11); a prior sternotomy increased the risk more than 3-fold (odds ratio = 3.4; 95% confidence interval: 1.84-6.43). The group of patients with moderate/severe AKI had higher rates of respiratory failure and death than the group of patients with mild/no AKI. Patients with moderate/severe AKI were at 3.2 (95% confidence interval: 1.2-8.2) times the risk of 30-day mortality compared to those without. Even after adjusting for age and Interagency Registry for Mechanically Assisted Circulatory Support profile, those with moderate/severe AKI had 1.75 (95% confidence interval: 1.03-3.0) times the risk of 1-year mortality compared to those without. DISCUSSION Risk-stratifying patients prior to LVAD placement in regard to AKI development may be a step toward improving surgical outcomes.
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Affiliation(s)
- David M Harmon
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Kristen M Tecson
- Texas A&M University College of Medicine, Dallas, Texas, USA.,Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Brian Lima
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA.,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Justin D G Collier
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | - Asad F Shaikh
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | - Sasha Still
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | - Ronald D Baxter
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | - Nicole Lew
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Richa Thakur
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Shelley A Hall
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Gonzalo V Gonzalez-Stawinski
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA.,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Susan M Joseph
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA, .,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA,
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Abstract
The clinical use of left ventricular assist devices (LVADs) in the growing epidemic of heart failure has improved quality of life and long-term survival for this otherwise devastating disease. The current generation of commercially available devices offers a smaller profile that simplifies surgical implantation, a design that optimizes blood flow characteristics, with less adverse events and improved durability than their predecessors. Despite this, the risk for adverse events remains significant, as do burdens for patients and their caregivers. Appropriate patient selection remains key to optimal LVAD outcomes.
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Affiliation(s)
- Manreet K Kanwar
- Section of Heart Failure/Transplant/MCS and Pulmonary Hypertension, Cardiovascular Institute, Allegheny Health Network, Temple University School of Medicine, 320 East North Avenue, 16th Floor ST, Pittsburgh, PA 15212, USA.
| | - Stephen Bailey
- Department of Cardiothoracic Surgery, Cardiovascular Institute, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
| | - Srinivas Murali
- Department of Cardiothoracic Surgery, Cardiovascular Institute, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
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Apostolopoulou SC, Vagenakis GA, Tsoutsinos A, Kakava F, Rammos S. Ambulatory Intravenous Inotropic Support and or Levosimendan in Pediatric and Congenital Heart Failure: Safety, Survival, Improvement, or Transplantation. Pediatr Cardiol 2018; 39:1315-1322. [PMID: 29777282 DOI: 10.1007/s00246-018-1897-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/05/2018] [Indexed: 11/30/2022]
Abstract
End-stage heart failure (HF) frequently needs continuous inotropic support in hospital and has high morbidity and mortality in absence of heart transplantation. This study reports outcome, efficacy, and safety of continuous ambulatory inotropes (AI) and/or periodic levosimendan (LS) infusions in pediatric HF patients. The study included 27 patients, median age 9.4 (0.1-26.1) years, with severe HF (6 myocarditis, 13 dilated cardiomyopathy, 2 restrictive cardiomyopathy, 6 repaired congenital heart disease). Dobutamine and milrinone AI were administered in 21 patients through a permanent central catheter for median duration 1.0 (0.3-3.7) years. Additionally, 14 AI patients and the remaining 6 study patients received periodic LS infusions for median duration 1.1 (0.2-4.2) years. During median follow-up 2.1 (0.3-21.3) years, 4 patients died of worsening HF after 0.8-2.1 years AI, 6 patients underwent heart transplantation with only 3 survivors, while the rest remained stable out of the hospital with complications 4 line infections treated with antibiotics and 4 catheter reinsertions due to dislodgement. Severe pulmonary hypertension was reversed with AI in 2 patients, allowing successful heart-only transplantation. Therapy with AI was discontinued after 1.4-0.4 years in 6 improved myocarditis and 3 cardiomyopathy patients without deterioration. In conclusion, prolonged AI and/or LS infusions in HF are safe and beneficial even in small infants, allowing stabilization and reasonable social and family life out of the hospital. It may provide precious time for heart transplantation or myocardial remodeling, improvement, and possible discontinuation even after long periods of support.
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Affiliation(s)
- Sotiria C Apostolopoulou
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 356 Syngrou Ave, 176 74, Athens, Greece.
| | - George A Vagenakis
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 356 Syngrou Ave, 176 74, Athens, Greece
| | - Alexandros Tsoutsinos
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 356 Syngrou Ave, 176 74, Athens, Greece
| | - Felicia Kakava
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 356 Syngrou Ave, 176 74, Athens, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, 356 Syngrou Ave, 176 74, Athens, Greece
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Nakamura K, Kinugasa Y, Sugihara S, Hirai M, Yanagihara K, Haruki N, Matsubara K, Kato M, Yamamoto K. Sex differences in surrogate decision-maker preferences for life-sustaining treatments of Japanese patients with heart failure. ESC Heart Fail 2018; 5:1165-1172. [PMID: 30264449 PMCID: PMC6300817 DOI: 10.1002/ehf2.12352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 05/07/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022] Open
Abstract
AIMS Patients with end-stage heart failure (HF) often require surrogate decision making for end-of-life care owing to a lack of decision-making capacity. However, the clinical characteristics of surrogate decision making for life-sustaining treatments in Japan remain to be investigated. METHODS AND RESULTS Among 934 patients admitted to our hospital for HF from January 2004 to December 2015, we retrospectively reviewed the medical records of consecutive 106 patients who died in hospital (mean age 73 ± 13 years; male, 52.6%). During hospitalization, attending physicians conducted an average of 2.1 ± 1.4 end-of-life conversations with patients and/or their families. Only 4.7% of patients participated in the conversations and declared their preferences; surrogates made medical care decisions in 95.3% of cases. Most decisions by surrogates (98.1%) were made without the patient's advance directive. During initial end-of-life conversations, 49.4% of surrogates requested cardiopulmonary resuscitation (CPR). However, 72.0% of CPR preferences were changed to do not attempt resuscitation (DNAR) orders in the final conversation. Female surrogates were more likely to change the preference from CPR to DNAR than were male surrogates (47.1% vs. 25.0%, P = 0.023). CONCLUSIONS Compared with male surrogates, female surrogates wavered more often in their decisions regarding life-sustaining treatments of Japanese patients with end-stage HF.
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Affiliation(s)
- Kensuke Nakamura
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Yoshiharu Kinugasa
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Shinobu Sugihara
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Masayuki Hirai
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Kiyotaka Yanagihara
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Nobuhiko Haruki
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Koichi Matsubara
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Masahiko Kato
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
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Geis NA, Pleger ST, Bekeredjian R, Chorianopoulos E, Kreusser MM, Frankenstein L, Ruhparwar A, Katus HA, Raake PWJ. Haemodynamic effects of percutaneous mitral valve edge-to-edge repair in patients with end-stage heart failure awaiting heart transplantation. ESC Heart Fail 2018; 5:892-901. [PMID: 30058757 PMCID: PMC6165942 DOI: 10.1002/ehf2.12313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/20/2017] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022] Open
Abstract
Aims Functional mitral regurgitation is complicating end‐stage heart failure and potential heart transplantation by increasing pulmonary artery pressures. The aim of the present study was to investigate feasibility and haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair using the MitraClip™ device in patients with end‐stage heart failure awaiting heart transplantation. Methods and results In this retrospective study, we identified nine patients suffering from end‐stage heart failure listed for heart transplantation in whom moderate–severe or severe functional mitral regurgitation was recognized and treated with percutaneous mitral valve edge‐to‐edge repair. Twenty‐two patients listed for heart transplantation and presenting with moderate–severe or severe functional mitral regurgitation treated in the pre‐MitraClip™ era served as controls. Patients were analysed at two separate time points: MitraClip™ group: pre‐procedure and post‐procedure (follow‐up: 215 ± 53 days) and control group: study entry with recognition of moderate–severe or severe functional mitral regurgitation (follow‐up: 197 ± 47 days). Percutaneous mitral valve edge‐to‐edge repair with the MitraClip™ was feasible and safe in our high‐risk end‐stage heart failure population. The intervention resulted in significant reduction of mitral regurgitation (grade 3.0 [0.5] to 1.5 [0.5]; P = 0.009), left atrial diameter (51 mm [16] to 49 mm [4]; follow‐up MitraClip™ vs. control group P = 0.0497), pulmonary artery pressures (sPA 50 mmHg [15] to 45 mmHg [10]; P = 0.02; mPA 34 mmHg [8] to 30 mmHg [10]; P = 0.02), and New York Heart Association class (3.5 [1.0] to 3.0 [0.5]; P = 0.01) and improved mixed‐venous oxygen saturation (57% [11] to 55% [7]; follow‐up MitraClip™ vs. control group P = 0.02). No changes in the control group were observed. Conclusions MitraClip™ implantation as ‘bridge‐to‐transplant’ strategy in patients with end‐stage heart failure and severe functional mitral regurgitation awaiting heart transplantation is feasible and appears to result in favourable haemodynamic effects.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Emmanuel Chorianopoulos
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Faillace RT, Yost GW, Chugh Y, Adams J, Verma BR, Said Z, Sayed II, Honushefsky A, Doddamani S, Berger PB. Is 30-Day Mortality after Admission for Heart Failure an Appropriate Metric for Quality? Am J Med 2018; 131:201.e9-201.e15. [PMID: 28941750 DOI: 10.1016/j.amjmed.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/23/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services (CMS) model for publicly reporting national 30-day-risk-adjusted mortality rates for patients admitted with heart failure fails to include clinical variables known to impact total mortality or take into consideration the culture of end-of-life care. We sought to determine if those variables were related to the 30-day mortality of heart failure patients at Geisinger Medical Center. METHODS Electronic records were searched for patients with a diagnosis of heart failure who died from any cause during hospitalization or within 30 days of admission. RESULTS There were 646 heart-failure-related admissions among 530 patients (1.2 admissions/patient). Sixty-seven of the 530 (13%) patients died: 35 (52%) died during their hospitalization and 32 (48%) died after discharge but within 30 days of admission; of these, 27 (40%) had been transferred in for higher-acuity care. Fifty-one (76%) died from heart failure, and 16 (24%) from other causes. Fifty-five (82%) patients were classified as American Heart Association Stage D, 58 (87%) as New York Heart Association Class IV, and 30 (45%) had right-ventricular systolic dysfunction. None of the 32 patients who died after discharge met recommendations for beta-blockers. Criteria for prescribing angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor blockers were not met by 33 of the 34 patients (97%) with heart failure with reduced ejection fraction not on one of those drugs. Fifty-seven patients (85%) had a do-not-resuscitate (DNR) status. CONCLUSION A majority of heart failure-related mortality was among patients who opted for a DNR status with end-stage heart failure, limiting the appropriateness of administering evidence-based therapies. No care gaps were identified that contributed to mortality at our institution. The CMS 30-day model fails to take important variables into consideration.
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Martens P, Vercammen J, Ceyssens W, Jacobs L, Luwel E, Van Aerde H, Potargent P, Renaers M, Dupont M, Mullens W. Effects of intravenous home dobutamine in palliative end-stage heart failure on quality of life, heart failure hospitalization, and cost expenditure. ESC Heart Fail 2018; 5:562-569. [PMID: 29341466 PMCID: PMC6073033 DOI: 10.1002/ehf2.12248] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/06/2017] [Accepted: 11/27/2017] [Indexed: 01/06/2023] Open
Abstract
Aims In patients with palliative end‐stage heart failure, interventions that could provide symptomatic relief and prevent hospital admissions are important. Ambulatory continuous intravenous inotropes have been advocated by guidelines for such a purpose. We sought to determine the effect of intravenous dobutamine on symptomatic status, hospital stay, mortality, and cost expenditure. Methods and results All consecutive end‐stage heart failure patients not amenable for advanced therapies and discharged with continuous intravenous home dobutamine from a single tertiary centre between April 2011 and January 2017 were retrospectively analysed. Dobutamine (fixed dose) was infused through a single‐lumen central venous catheter with a small pump that was refilled by a nurse on a daily basis. Symptomatic status was longitudinally assessed as the change in New York Heart Association class and patient global assessment scale. Antecedent and incident heart failure hospitalizations were determined in a paired fashion, and cost impact was assessed. A total of 21 patients (age 77 ± 9 years) were followed up for 869 ± 647 days. At first follow‐up (6 ± 1 weeks) after the initiation of dobutamine, patients had a significant improvement in New York Heart Association class (−1.29 ± 0.64; P < 0.001), global assessment scale (<0.001), and N‐terminal pro‐brain natriuretic peptide (6247 vs. 2543 pg/mL; P = 0.033). Incident heart failure hospitalizations assessed at 3, 6, and 12 months were significantly reduced (P < 0.001 for all) in comparison with antecedent heart failure hospitalizations over the same time period. Cost expenditure was significantly lower at 3 (P < 0.001), 6 (P = 0.005), and 12 months (P = 0.001) after initiation of dobutamine. Mortality rate at 1 year was 48% with 9/12 (75%) patients dying at home, most often from progressive pump failure. Conclusions Continuous intravenous home dobutamine in patients with palliative end‐stage heart failure is feasible and associated with improved symptomatic status, heart failure hospitalizations, and health‐care‐related costs. Nevertheless, results should be interpreted in the context of the small and retrospective design. Larger studies are necessary to evaluate the effect of dobutamine in palliative end‐stage heart failure.
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Affiliation(s)
- Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan Vercammen
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Wendy Ceyssens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Linda Jacobs
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Evert Luwel
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | | | | | - Monique Renaers
- Clinic Care Pathway Home-Dobutamine, Wit-Geel Kruis, Limburg, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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47
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Colvin M, Smith JM, Hadley N, Skeans MA, Carrico R, Uccellini K, Lehman R, Robinson A, Israni AK, Snyder JJ, Kasiske BL. OPTN/SRTR 2016 Annual Data Report: Heart. Am J Transplant 2018; 18 Suppl 1:291-362. [PMID: 29292604 DOI: 10.1111/ajt.14561] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 2016, 3209 heart transplants were performed in the United States. New, active listings increased 57% since 2005. The number of adult heart transplant survivors continued to increase, and in 2016, 30,622 recipients were living with heart transplants. Patient mortality following transplant has declined. The number of pediatric candidates and transplants performed also increased. New listings for pediatric heart transplants increased from 454 in 2005 to 624 in 2016. The number of pediatric heart transplants performed each year increased from 319 in 2005 to 445 in 2016. Among pediatric patients who underwent transplant in 2015, death occurred in 5.9% at 6 months and 7.2% at 1 year.
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Affiliation(s)
- M Colvin
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Cardiology, University of Michigan, Ann Arbor, MI
| | - J M Smith
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - N Hadley
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - R Carrico
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - K Uccellini
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - R Lehman
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - A Robinson
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - A K Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - B L Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
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48
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Feldmann C, Chatterjee A, Haverich A, Schmitto JD. Left Ventricular Assist Devices - A State of the Art Review. Adv Exp Med Biol 2018; 1067:287-94. [PMID: 29532330 DOI: 10.1007/5584_2018_145] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Cardiovascular diseases are the leading cause of mortality rates throughout the world. Next to an insufficient number of healthy donors, this has led to increasing numbers of patients on heart transplant waiting lists with prolonged waiting times. Innovative technological advancements have led to the production of ventricular assist devices that play an increasingly important role in end stage heart failure therapy. This review is intended to provide an overview of current implantable left ventricular assist devices, different design concepts and implantation techniques. Challenges such as infections and thromboembolic events that may occur during LVAD implantations have also been discussed.
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49
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den Uil CA, Galli G, Jewbali LS, Caliskan K, Manintveld OC, Brugts JJ, van Mieghem NM, Lenzen MJ, Boersma E, Constantinescu AA. First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices. Cardiology 2017; 138:1-8. [PMID: 28501864 DOI: 10.1159/000471846] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/20/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients. METHODS A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016. RESULTS At 24 h, lactate decreased from 3.2 (2.1-6.8) to 1.8 (1.2-2.2) mmol/L (p < 0.001). Eighteen patients (67%) defined as IABP responders were successfully bridged to either recovery (n = 7), left ventricular assist device (n = 5), or heart transplantation (n = 6). IABP failed in 9 patients (non-responders, 33%) who either died (n = 7) or needed support by extracorporeal membrane oxygenation (n = 2). At 24 h of IABP support, urinary output was higher (2,660 [1,835-4,440] vs. 1,200 [649-2,385] mL; p = 0.02) and fluid balance more negative (-1,564 [-2,673 to -1,086] vs. -500 [-930 to +240] mL; p < 0.001) in responders than non-responders. Overall survival at 1 year was 63%. CONCLUSION In most patients, first-line support by IABP in end-stage cardiomyopathy is associated with improvement in organ perfusion and clinical stabilisation for at least 24 h allowing time for decision making on next therapies.
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Affiliation(s)
- Corstiaan A den Uil
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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50
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Colvin M, Smith JM, Skeans MA, Edwards LB, Uccellini K, Snyder JJ, Israni AK, Kasiske BL. OPTN/SRTR 2015 Annual Data Report: Heart. Am J Transplant 2017; 17 Suppl 1:286-356. [PMID: 28052610 DOI: 10.1111/ajt.14128] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The number of heart transplant candidates and transplants performed continued to rise each year. In 2015, 2819 heart transplants were performed. In addition, the number of new adult candidates on the waiting list increased 51% since 2004. The number of adult heart transplant survivors continued to increase, and in 2015, 29,172 recipients were living with heart transplants. Patient mortality following transplant has declined. The number of pediatric candidates and transplants performed also increased. New listings for pediatric heart transplants increased from 451 in 2004 to 644 in 2015. The number of pediatric heart transplants performed each year increased from 297 in 2004 to 460 in 2015. Among pediatric patients who underwent transplant in 2014, death occurred in 7.2% at 6 months and 9.6% at 1 year.
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Affiliation(s)
- M Colvin
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Cardiology, University of Michigan, Ann Arbor, MI
| | - J M Smith
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - L B Edwards
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - K Uccellini
- Organ Procurement and Transplantation Network, Richmond, VA.,United Network for Organ Sharing, Richmond, VA
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - A K Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - B L Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
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