3
|
Claeys MJ, Argacha JF, Collart P, Carlier M, Van Caenegem O, Sinnaeve PR, Desmet W, Dubois P, Stammen F, Gevaert S, Pourbaix S, Coussement P, Beauloye C, Evrard P, Brasseur O, Fierens F, Marechal P, Schelfaut D, Floré V, Hanet C. Impact of COVID-19-related public containment measures on the ST elevation myocardial infarction epidemic in Belgium: a nationwide, serial, cross-sectional study. Acta Cardiol 2021; 76:863-869. [PMID: 32727305 DOI: 10.1080/00015385.2020.1796035] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 02/06/2023]
Abstract
AIMS The current study assessed the impact of COVID-19-related public containment measures (i.e. lockdown) on the ST elevation myocardial infarction (STEMI) epidemic in Belgium. METHODS AND RESULTS Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive STEMI patients who were admitted to Belgian hospitals for percutaneous coronary intervention (PCI) were recorded during a three-week period starting at the beginning of the lockdown period on 13 March 2020. Similar data were collected for the same time period for 2017-2019. An evaluation of air quality revealed a 32% decrease in ambient NO2 concentrations during lockdown (19.5 µg/m³ versus 13.2 µg/m³, p < .001). During the three-week period, there were 188 STEMI patients admitted for PCI during the lockdown versus an average 254 STEMI patients before the lockdown period (incidence rate ratio = 0.74, p = .001). Reperfusion strategy was predominantly primary PCI in both time periods (96% versus 95%). However, there was a significant delay in treatment during the lockdown period, with more late presentations (>12 h after onset of pain) (14% versus 7.6%, p = .04) and with longer door-to-balloon times (median of 45 versus 39 min, p = .02). Although the in-hospital mortality between the two periods was comparable (5.9% versus 6.7%), 5 of the 7 (71%) COVID-19-positive STEMI patients died. CONCLUSION The present study revealed a 26% reduction in STEMI admissions and a delay in treatment of STEMI patients. Less exposure to external STEMI triggers (such as ambient air pollution) and/or reluctance to seek medical care are possible explanations of this observation.
Collapse
Affiliation(s)
- Marc J. Claeys
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | | | - Philippe Collart
- Centre de recherche en Epidémiologie, Biostatistiques et Recherche Clinique, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Carlier
- Department of Cardiology, GHDC, Charleroi, Belgium
| | - Olivier Van Caenegem
- Division of Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Peter R. Sinnaeve
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Walter Desmet
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | | | - Francis Stammen
- Department of Cardiology, Hospital Roeselare, Roeselare, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Christophe Beauloye
- Division of Cardiology and Pole of Cardiovascular Research, Institut de Recherche Experimentale et Clinique, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Patrick Evrard
- Department of Intensive Care, Belgium Catholic University Hospital Mont-Godinne, Brussels, Belgium
| | - Olivier Brasseur
- Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium
| | - Frans Fierens
- Belgian Interregional Environment Agency, Brussels, Belgium
| | - Patrick Marechal
- Department of Cardiology, University hospital of Liege, Liège, Belgium
| | | | - Vincent Floré
- Department of Cardiology, Hospital Maria Middelares, Ghent, Belgium
| | - Claude Hanet
- Department of Cardiology, Catholic University Hospital Mont-Godinne, Brussels, Belgium
| |
Collapse
|
4
|
Sinning C, Zengin E, Diller GP, Onorati F, Castel MA, Petit T, Chen YS, Lo Rito M, Chiarello C, Guillemain R, Coniat KNL, Magnussen C, Knappe D, Becher PM, Schrage B, Smits JM, Metzner A, Knosalla C, Schoenrath F, Miera O, Cho MY, Bernhardt A, Weimann J, Goßling A, Terzi A, Amodeo A, Alfieri S, Angeli E, Ragni L, Napoleone CP, Gerosa G, Pradegan N, Rodrigus I, Dumfarth J, de Pauw M, François K, Van Caenegem O, Ancion A, Van Cleemput J, Miličić D, Moza A, Schenker P, Thul J, Steinmetz M, Warnecke G, Ius F, Freyt S, Avsar M, Sandhaus T, Haneya A, Eifert S, Saeed D, Borger M, Welp H, Ablonczy L, Schmack B, Ruhparwar A, Naito S, Hua X, Fluschnik N, Nies M, Keil L, Senftinger J, Ismaili D, Kany S, Csengeri D, Cardillo M, Oliveti A, Faggian G, Dorent R, Jasseron C, Blanco AP, Márquez JMS, López-Vilella R, García-Álvarez A, López MLP, Rocafort AG, Fernández ÓG, Prieto-Arevalo R, Zatarain-Nicolás E, Blanchart K, Boignard A, Battistella P, Guendouz S, Houyel L, Para M, Flecher E, Gay A, Épailly É, Dambrin C, Lam K, Ka-Lai CH, Cho YH, Choi JO, Kim JJ, Coats L, Crossland DS, Mumford L, Hakmi S, Sivathasan C, Fabritz L, Schubert S, Gummert J, Hübler M, Jacksch P, Zuckermann A, Laufer G, Baumgartner H, Giamberti A, Reichenspurner H, Kirchhof P. Study design and rationale of the pAtients pResenTing with cOngenital heaRt dIseAse Register (ARTORIA-R). ESC Heart Fail 2021; 8:5542-5550. [PMID: 34510806 PMCID: PMC8712832 DOI: 10.1002/ehf2.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/25/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023] Open
Abstract
Aim Due to improved therapy in childhood, many patients with congenital heart disease reach adulthood and are termed adults with congenital heart disease (ACHD). ACHD often develop heart failure (HF) as a consequence of initial palliative surgery or complex anatomy and subsequently require advanced HF therapy. ACHD are usually excluded from trials evaluating heart failure therapies, and in this context, more data about heart failure trajectories in ACHD are needed to guide the management of ACHD suffering from HF. Methods and results The pAtients pResenTing with cOngenital heaRt dIseAse Register (ARTORIA‐R) will collect data from ACHD evaluated or listed for heart or heart‐combined organ transplantation from 16 countries in Europe and the Asia/Pacific region. We plan retrospective collection of data from 1989–2020 and will include patients prospectively. Additional organizations and hospitals in charge of transplantation of ACHD will be asked in the future to contribute data to the register. The primary outcome is the combined endpoint of delisting due to clinical worsening or death on the waiting list. The secondary outcome is delisting due to clinical improvement while on the waiting list. All‐cause mortality following transplantation will also be assessed. The data will be entered into an electronic database with access to the investigators participating in the register. All variables of the register reflect key components important for listing of the patients or assessing current HF treatment. Conclusion The ARTORIA‐R will provide robust information on current management and outcomes of adults with congenital heart disease suffering from advanced heart failure.
Collapse
Affiliation(s)
- Christoph Sinning
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Elvin Zengin
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | - Francesco Onorati
- Divisione Ospedaliero Universitaria Cardiochirurgia Verona, Verona, Italy
| | - María-Angeles Castel
- Heart Failure and Heart Transplantation Unit, Cardiology Department, ICCV, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Thibault Petit
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carmelina Chiarello
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Romain Guillemain
- Chirurgie cardio vasculaire, Hôpital Européen Georges-Pompidou HEGP, Paris, France
| | - Karine Nubret-Le Coniat
- Programme de transplantation et d'assistance cardiaque adulte et pédiatrique au CHU de Bordeaux, Haut Lévêque Hospital, Pessac, France
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dorit Knappe
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Centre of Cardiovascular Research DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Charité University Medicine Berlin, Corporate Member of Freie University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Centre of Cardiovascular Research DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Mi-Young Cho
- Department of Congenital Heart Surgery/Pediatric Heart Surgery German Heart Center Berlin, Berlin, Germany
| | - Alexander Bernhardt
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | - Antonio Amodeo
- Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Sara Alfieri
- Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Emanuela Angeli
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio - Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - Luca Ragni
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, University of Padova, Padova, Italy
| | - Nicola Pradegan
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, University of Padova, Padova, Italy
| | - Inez Rodrigus
- Department of Cardiac Surgery, Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
| | - Julia Dumfarth
- Department of Cardiac Surgery, University of Innsbruck, Innsbruck, Austria
| | - Michel de Pauw
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Katrien François
- Department of Cardiovascular Surgery, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Olivier Van Caenegem
- Division of Cardiovascular Intensive Care and Heart Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Arnaut Ancion
- Department of Cardiology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Davor Miličić
- Department of Cardiology, Medical Faculty University of Zagreb, Zagreb, Croatia
| | - Ajay Moza
- Department of Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Bochum, Bochum, Germany
| | - Josef Thul
- Department of Pediatric Cardiology, University Hospital Giessen/Marburg, Giessen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology, University Hospital Göttingen, Göttingen, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Susanne Freyt
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Sandhaus
- Department of Cardiovascular Surgery, University Hospital Jena, Jena, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sandra Eifert
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Henryk Welp
- Department of Cardiac Surgery, University Hospital Münster, Münster, Germany
| | - László Ablonczy
- Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Xiaoqin Hua
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Nina Fluschnik
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Moritz Nies
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Laura Keil
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Juliana Senftinger
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Djemail Ismaili
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Shinwan Kany
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Dora Csengeri
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | | | - Giuseppe Faggian
- Divisione Ospedaliero Universitaria Cardiochirurgia Verona, Verona, Italy
| | | | | | | | | | - Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana García-Álvarez
- Heart Failure and Heart Transplantation Unit, Cardiology Department, ICCV, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - María Luz Polo López
- Cirugia Cardiovascular, Servicio de Cirugia Cardiovascular Infantil y de Cardiopatías Congénitas, Hospital Universitario La Paz, Madrid, Spain
| | - Alvaro Gonzalez Rocafort
- Cirugia Cardiovascular, Servicio de Cirugia Cardiovascular Infantil y de Cardiopatías Congénitas, Hospital Universitario La Paz, Madrid, Spain
| | - Óscar González Fernández
- Heart Failure and Transplant Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Prieto-Arevalo
- Department of Cardiology, Gregorio Marañon University Hospital CIBER-CV, Madrid, Spain
| | | | | | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Pascal Battistella
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, France
| | - Soulef Guendouz
- Département de Cardiologie, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Lucile Houyel
- M3C-Necker Enfants malades, AP-HP, Université de Paris, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France
| | - Erwan Flecher
- Division of Thoracic and Cardiovascular Surgery, Rennes University Hospital, Rennes, France
| | - Arnaud Gay
- Thoracic and Cardiovascular Surgery Department, Rouen University Hospital, Rouen, France
| | - Éric Épailly
- Department of Cardiac Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Camille Dambrin
- Service de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Kaitlyn Lam
- Department of Cardiology, Fiona Stanly Hospital, Perth, Australia
| | - Cally Ho Ka-Lai
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University, Seoul, South Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Louise Coats
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK.,Congenital Heart Disease Research Group, Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | - David Steven Crossland
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK.,Congenital Heart Disease Research Group, Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | | | - Samer Hakmi
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Cumaraswamy Sivathasan
- Department of Cardiothoracic Surgery, Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Larissa Fabritz
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,Institute of Cardiovacsular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK.,Department of Cardiology, University Hospital Birmingham, Birmingham, UK
| | - Stephan Schubert
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Hübler
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Pediatric Cardiac Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Peter Jacksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Helmut Baumgartner
- Department of Cardiology III, University Hospital Münster, Münster, Germany
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Hermann Reichenspurner
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Institute of Cardiovacsular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK
| |
Collapse
|
5
|
Schettini AV, Llado L, Heimbach JK, Costello JG, Tranäng M, Van Caenegem O, Daly RC, Van den Bergh P, Casanovas C, Fabregat J, Poterucha JJ, Foguenne M, Ericzon BG, Lerut J. Symptomatic Val122del mutated hereditary transthyretin amyloidosis: Need for early diagnosis and prioritization for heart and liver transplantation. Hepatobiliary Pancreat Dis Int 2021; 20:323-329. [PMID: 34116942 DOI: 10.1016/j.hbpd.2021.05.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hereditary transthyretin (ATTRv) amyloidosis is an autosomal dominant disease linked to transthyretin gene mutations which cause instability of the transthyretin tetramer. After dissociation and misfolding they reassemble as insoluble fibrils (i.e. amyloid). Apart from the common Val30Met mutation there is a very heterogeneous group of non-Val30Met mutations. In some cases, the clinical picture is dominated by a rapidly evolving restrictive and hypertrophic cardiomyopathy. METHODS A case series of four liver recipients with the highly clinically relevant, rare and particularly aggressive Val122del mutation is presented. Medical and surgical therapeutic options, waiting list policy for ATTRv-amyloidosis, including the need for heart transplantation, and status of heart-liver transplantation are discussed. RESULTS Three patients needed a staged (1 patient) or simultaneous (2 patients) heart-liver transplant due to rapidly progressing cardiac failure and/or neurologic disability. Domino liver transplantation was impossible in two due to fibrotic hepatic transformation caused by cardiomyopathy. After a follow-up ranging from 3.5 to 9.5 years, cardiac (allograft) function was maintained in all patients, but neuropathy progressed in three patients, one of whom died after 80 months. CONCLUSIONS This is the first report in (liver) transplant literature about the rare Val122del ATTRv mutation. Due to its aggressiveness, symptomatic patients should be prioritized on the liver and, in cases with cardiomyopathy, heart waiting lists in order to avoid the irreversible neurological and cardiac damage that leads to a rapid lethal outcome.
Collapse
Affiliation(s)
- Adriano-Valerio Schettini
- Institute for Experimental and Clinical Research (IREC), Catholic University of Louvain (UCL), Avenue Hippocrate 55, Brussels 1200, Belgium
| | - Laura Llado
- Liver Transplant Unit, Department of Surgery, Hospital Universitari de Bellvitge, Calle de la Feixa Llarga, Barcelona 08907, Spain
| | - Julie K Heimbach
- Division of Transplantation Surgery, William J. von Liebig Transplant Center, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jose Gonzalez Costello
- Advanced Heart Failure and Transplant Unit, Cardiology Department, Hospital Universitari de Bellvitge, Calle de la Feixa Llarga, Barcelona 08907, Spain
| | - Marie Tranäng
- Familial Amyloidotic Polyneuropathy World Transplant Registry (FAPWTR), Division of Transplantation Surgery, Karolinska Universitetssjukhuset Huddinge, F82, Karolinska Institutet, Stockholm 141 86, Sweden
| | - Olivier Van Caenegem
- Cardiothoracic Intensive Care Unit, Department of Cardiovascular Diseases, University Hospitals Saint-Luc - UCL, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - Richard C Daly
- Cardiovascular Surgery Department, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Peter Van den Bergh
- Neuromuscular Reference Centre, University Hospital Saint-Luc - UCL, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - Carlos Casanovas
- Neuromuscular Unit, Neurology Department, Hospital Universitari de Bellvitge, Calle de la Feixa Llarga, Barcelona 08907, Spain
| | - Joan Fabregat
- Liver Transplant Unit, Department of Surgery, Hospital Universitari de Bellvitge, Calle de la Feixa Llarga, Barcelona 08907, Spain
| | - John J Poterucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester MN 08907, USA
| | - Maxime Foguenne
- Institute for Experimental and Clinical Research (IREC), Catholic University of Louvain (UCL), Avenue Hippocrate 55, Brussels 1200, Belgium
| | - Bo Göran Ericzon
- Division of Transplantation Surgery, CLINTEC, Karolinska Universitetssjukhuset Huddinge, F82, Karolinska Institutet, Stockholm 14186, Sweden
| | - Jan Lerut
- Institute for Experimental and Clinical Research (IREC), Catholic University of Louvain (UCL), Avenue Hippocrate 55, Brussels 1200, Belgium.
| |
Collapse
|
7
|
Van Caenegem O, Beauloye C, Bertrand L, Horman S, Lepropre S, Sparavier G, Vercruysse J, Bethuyne N, Poncelet AJ, Gianello P, Demuylder P, Legrand E, Beaurin G, Bontemps F, Jacquet LM, Vanoverschelde JL. Hypothermic continuous machine perfusion enables preservation of energy charge and functional recovery of heart grafts in an ex vivo model of donation following circulatory death. Eur J Cardiothorac Surg 2015; 49:1348-53. [PMID: 26604296 DOI: 10.1093/ejcts/ezv409] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 06/26/2015] [Accepted: 10/13/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cardiac transplantation using hearts from donors after circulatory death (DCD) is critically limited by the unavoidable warm ischaemia and its related unpredictable graft function. Inasmuch as hypothermic machine perfusion (MP) has been shown to improve heart preservation, we hypothesized that MP could enable the use of DCD hearts for transplantation. METHODS We recovered 16 pig hearts following anoxia-induced cardiac arrest and cardioplegia. Grafts were randomly assigned to two different groups of 4-h preservation using either static cold storage (CS) or MP (Modified LifePort© System, Organ Recovery Systems©, Itasca, Il). After preservation, the grafts were reperfused ex vivo using the Langendorff method for 60 min. Energetic charge was quantified at baseline, post-preservation and post-reperfusion by measuring lactate and high-energy phosphate levels. Left ventricular contractility parameters were assessed both in vivo prior to ischaemia and ex vivo during reperfusion. RESULTS Following preservation, the hearts that were preserved using CS exhibited higher lactate levels (57.1 ± 23.7 vs 21.4 ± 12.2 µmol/g; P < 0.001), increased adenosine monophosphate/adenosine triphosphate ratio (0.53 ± 0.25 vs 0.11 ± 0.11; P < 0.001) and lower phosphocreatine/creatine ratio (9.7 ± 5.3 vs 25.2 ± 11; P < 0.001) in comparison with the MP hearts. Coronary flow was similar in both groups during reperfusion (107 ± 9 vs 125 ± 9 ml/100 g/min heart; P = ns). Contractility decreased in the CS group, yet remained well preserved in the MP group. CONCLUSION MP preservation of DCD hearts results in improved preservation of the energy and improved functional recovery of heart grafts compared with CS.
Collapse
Affiliation(s)
- Olivier Van Caenegem
- Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Christophe Beauloye
- Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Luc Bertrand
- Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Sandrine Horman
- Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Sophie Lepropre
- Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Grégory Sparavier
- Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | | | - Noëlla Bethuyne
- Division of Cardiac Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Alain J Poncelet
- Division of Cardiac Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Gianello
- Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | | | - Eric Legrand
- Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Gwen Beaurin
- Pôle de chirurgie expérimentale et transplantation, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Bontemps
- Pôle de biochimie et recherche métabolique, Institut de Duve, Université catholique de Louvain, Brussels, Belgium
| | - Luc M Jacquet
- Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|