M264 HYPEREOSINOPHILIA, EOSINOPHILIC ENDOCARDIAL INFILTRATES, HEART FAILURE, AND LIVER MASS IN A TODDLER WITH HEART TRANSPLANT

Abstract Background The role of intra-aortic balloon pump (IABP) in advanced heart failure (HF) treatment is still under debate. Some heart transplant (HTx) candidates on the waiting list require mechanical support, and IABP may be the simple and most available device. Purpose Describe the impact of IABP treatment in advanced HF patients who underwent HTx. Methods We retrospectively analysis patients who underwent HTx from a single center intensive care unit (ICU), between 2009 and 2018, to evaluate the use of IABP as bridge therapy. Selection included decompensated chronic HF patients that required intensive care with optimized intravenous drugs before IABP placement. Exclusion criteria were acute myocardial infarction or cardiac surgery 90 days prior to admission, and implant of ventricular assist device before HTx. Results We included 134 HF patients with IABP therapy before HTx. Insertion site was exclusively femoral. Mean time of IABP onset to HTx were 26±21 days, and hospital admission to HTx 65±45 days. The main cardiomyopathy etiology was Chagas Disease (46%) and mean LVEF was 23±6% (TABLE 1). Clinical and laboratory data were compared before and 96 hours after IABP therapy. Mean central venous oxygen saturation (SvO2) increased from 49.7±14.6% to 67.4±11.3% (p<0.001), creatinine decreased from 1.77±0.9 mg/dL to 1.40±0.6 mg/dL (p<0.001), and urine output increased from 1552±886 mL/24h to 2189±1029 mL/24h (p<0.001). These differences were sustained or improved until the day before HTx (FIGURE 1). After 96 hours dobutamine was maintained in 98% of patients, nitroprusside increased from 56% to 67%, milrinone decreased from 26% to 20%, and norepinephrine decreased from 18% to 3%. Significant IABP complications were few (5.2%; n=7: 3 infections, 2 major bleeding, 2 arterial injury). Conclusion In this single center ICU sample, IABP improved hemodynamic status and renal function in refractory HF patients waiting for HTx. IABP can be a reasonable, available and effective bridging therapy. Figure 1 Funding Acknowledgement Type of funding source: None

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Impact of ventricular assistance devices on patients submitted to heart transplantation

European Heart Journal ◽

10.1093/ehjci/ehaa946.3404 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Perez-Ortega ◽

J Prats ◽

E Querol

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiopulmonary Resuscitation ◽

Heart Transplant ◽

Life Support ◽

Extracorporeal Life Support ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Terminal Heart Failure ◽

One Year ◽

Ventricular Assistance

Abstract Background The introduction of veno-arterial extracorporeal life support (v-a ECLS) widens the spectrum of patients that can be included in the heart transplant program, some examples are extended myocardial infarction, fulminant myocarditis or advanced cardiac insufficiency. In addition to this, the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) extends even more the range of patients that can be benefitted of this therapy as a bridge to transplant. Purpose Our objective is to describe the incidence of v-a ECLS in those patients submitted to a heart transplant and to establish whether or not this technique increases the risk of mortality in this population. Methods Retrospective and descriptive statistical analysis of 82 consecutive patients submitted to heart transplant between 2015 and 2019 in a High Technology University Hospital. Demographic and clinical data, extracorporeal life support, extracorporeal cardiopulmonary resuscitation and assistance device type, together with survival at 30 days and one year were collected. Results 82 patients were transplanted during the study period distributed as follows: 47 (51.69%) were elective and 35 (48.1%) emergent being 25 (30.12%) of grade 1A and 10 (12.19%) of grade 1B. 52% had prior intra-aortic balloon contrapulsation. Patients transplanted under ECLS were 80% men and average age of 53 (SD 15) years old. The most prevalent diagnosis was acute myocardial infarction Killip IV (32%), followed by terminal heart failure (28%). 32% of the patients were under peripheral ECMO, 36% under left ventricular assistance, 20% under biventricular assist device, and 12% required ECPR. 72% of devices were implanted in the operating room and 16% in the ICU. The one-year survival of the sample was 88%. 2 patients died after transplantation (8%) during the first month, and 1 patient died within the first year. All three patients had terminal heart failure and the VAD implant was inserted electively Conclusions ECLS prior to cardiac transplantation allow selected patients to arrive alive to the transplant. The choice among devices is related to the diagnosis and expected duration of the therapy but we have not found in our series effects on subsequent mortality. Survival at one year in the subjects analysed is greater than the national registry of the last 10 years, although the tendency is to improve every year. This new scenario implies an increment of the complexity in the management of these patients and requires an special effort in terms of staff ratio and training. In our centre, the implementation of ECLS resulted in an increment of our staff and formative sessions. Funding Acknowledgement Type of funding source: None

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Phentolamine continuous infusion in a pediatric patient with uncontrolled hypertension

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab133 ◽

2021 ◽

Author(s):

Andrew Hatt

Keyword(s):

Heart Failure ◽

Continuous Infusion ◽

Heart Transplant ◽

Ventricular Assist Device ◽

Antihypertensive Agents ◽

Uncontrolled Hypertension ◽

Hemodynamic Stability ◽

Assist Device ◽

Ventricular Assist ◽

Pharmacologic Management

Abstract Purpose A case of uncontrolled hypertension nonresponsive to traditional pharmacologic management in a pediatric patient with a ventricular assist device awaiting a heart transplant is reported. Summary A 4-month-old male in heart failure was experiencing uncontrolled hypertension. Because of a lack of hemodynamic stability, he was unable to be listed as a heart transplant candidate. He received multiple antihypertensive agents (calcium channel blockers, β-blockers, and direct-acting vasodilators) as both intermittent and continuous infusions over the course of several days without achieving normotension. The decision was then made to administer intravenous phentolamine as a continuous infusion to pursue a different mechanism than with traditional antihypertensive agents to achieve hemodynamic stability. Within 8 hours of initiation of the continuous phentolamine infusion, the patient became normotensive and was listed for a heart transplant. The continuous phentolamine infusion was administered over the next 4 days to maintain normotension, and on day 4 the patient underwent successful orthotopic heart transplantation. Conclusion A 4-month-old male in heart failure with a ventricular assist device, experiencing uncontrolled hypertension nonresponsive to traditional pharmacologic management, was successfully treated with a continuous intravenous infusion of phentolamine.

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Echocardiography for Hemodynamic Assessment of Patients With Advanced Heart Failure and Potential Heart Transplant Recipients 11To discuss this article on line, visit the ACC Home Page at www.acc.org/membersand click on the JACC Forum

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)00384-7 ◽

1997 ◽

Vol 30 (7) ◽

pp. 1765-1772 ◽

Cited By ~ 57

Author(s):

James H Stein ◽

Alex Neumann ◽

Lynn M Preston ◽

Maria Rosa Costanzo ◽

Joseph E Parrillo ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplant ◽

Advanced Heart Failure ◽

Home Page ◽

Transplant Recipients ◽

Hemodynamic Assessment ◽

On Line ◽

Heart Transplant Recipients

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Evaluation of serum markers in heart failure: Study in heart transplant and assist device candidates

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2004.11.224 ◽

2005 ◽

Vol 24 (2) ◽

pp. S108

Author(s):

S. Buz ◽

N. Qedra ◽

F. Wagner ◽

C. Knosalla ◽

M. Pasic ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplant ◽

Serum Markers ◽

Assist Device

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Long-Term Risk of Heart Failure-Related Death and Heart Transplant After Congenital Heart Surgery in Childhood (from the Pediatric Cardiac Care Consortium)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2021.11.052 ◽

2022 ◽

Author(s):

Lydia K. Wright ◽

Rachel Zmora ◽

Yijian Huang ◽

Matthew E. Oster ◽

Courtney McCracken ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplant ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Cardiac Care

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Abstract 16329: Survival Prospects in Congenitally Corrected Transposition of the Great Arteries: Results From a Multi-institutional Study

Circulation ◽

10.1161/circ.142.suppl_3.16329 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alexandra van Dissel ◽

Alexander Opotowsky ◽

Jamil A Aboulhosn ◽

Martijn Kauling ◽

Salil Ginde ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplant ◽

Cumulative Incidence ◽

Primary Outcome ◽

Large Cohort ◽

Atrial Arrhythmia ◽

History Of ◽

Congenitally Corrected Transposition ◽

Corrected Transposition

Background: Occasionally patients with congenitally corrected transposition of the great arteries (ccTGA) exhibit little clinical evidence of cardiovascular limitation even to their 8th decade. We aimed to assess survival prospects in a large cohort of ccTGA adults. Methods & Results: We included 555 ccTGA adults (median age 33.0 years, 48.3% female) under regular follow-up at 28 institutions between 2002 and 2019. The primary outcome was a composite of death, mechanical circulatory support (MCS) and heart transplant. During a median follow-up of 8.1 [IQR 4.4 - 13.3] years, 56 (10.1%) patients died, 10 (1.8%) patients underwent MCS and 14 (2.5%) had a heart transplant. Median age at time of primary outcome was 51.1 [IQR 37.5 - 63.2] years and cumulative incidence at 15 years from baseline was 21.5% [95% CI 16.1 - 26.5]. Leading causes of death were worsening of heart failure (43%) and sudden death (10%). Patients who died were more likely to use heart failure (HF) medications. In multivariable Cox analyses for baseline variables, age, prior atrial arrhythmia and HF admission were each associated with an increased risk of the primary outcome. Figure shows cumulative incidence according to history of atrial arrhythmia. During follow-up, 91 (16.4%) were admitted for HF, pacemaker implantation was performed in 68 (12.3%) patients, ICD in 82 (14.7%), and major cardiac surgery (mostly for systemic AV-valve) in 89 (15.8%) patients. Conclusion: In this large cohort of ccTGA adults, survival seemed to be primarily determined by heart failure-related complications. Prior atrial arrhythmia also seems to be a harbinger for adverse outcome. Few patients underwent advanced HF therapies. Figure: Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 14 years from first visit at an adult congenital heart disease clinic since 2002 stratified according to history of atrial arrhythmia. Shading represents upper and lower 95% confidence limits.

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Abstract 16314: Late Survival After Atrial Switch in Transposition of the Great Arteries: Results From a Multi-institutional Study

Circulation ◽

10.1161/circ.142.suppl_3.16314 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alexandra van Dissel ◽

Alexander Opotowsky ◽

Jamil Aboulhosn ◽

Martijn Kauling ◽

Salil Ginde ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplant ◽

Cumulative Incidence ◽

Primary Outcome ◽

Pacemaker Implantation ◽

Circulatory Support ◽

Atrial Switch ◽

Increased Risk ◽

Late Survival

Background: Although several factors have been cited for risk stratification in patients with simple transposition of the great arteries (dTGA), no single predictor emerges consistently. We aimed to assess survival and determine factors associated with survival in a large cohort of dTGA adults with atrial switch. Methods and Results: We included 1,169 dTGA adults (median age 28.1 years, 38.7% female) under regular follow-up at 28 institutions between 2002 and 2019. The primary outcome was a composite of death, mechanical circulatory support (MCS) and heart transplant. During a median follow-up of 9.2 [IQR 5.5-14.2] years, 67 (5.7%) patients died, six (0.5%) patients underwent MCS and 21 (1.8%) had a heart transplant. Cumulative incidence of composite endpoint at 15 years was 12.8% [95% CI 9.8 - 15.7], see Figure). Median age at time of primary outcome was 39.5 [IQR 33.9 - 45.1] years. Leading causes of death were worsening of heart failure (34%), non-cardiac (21%) and sudden unexplained death (12%). In multivariable Cox analyses for baseline variables, age, VSD, ventricular arrhythmia and heart failure admission were each associated with increased risk of the outcome, whereas prior pacemaker (26% of patients) was not. New pacemaker implantation was performed in 107 (9.1%), ICD in 109 (9.3%), and cardiac surgery in 35 (3%) patients. Patients who died were more likely to develop arrhythmias, be admitted for heart failure or require surgery during follow-up. Conclusion: In this large contemporary cohort of dTGA adults after atrial switch, late survival was excellent and seemed to be determined by arrhythmia and heart failure-related complications. Few patients underwent advanced heart failure therapies. Figure. Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 15 years from first visit at an adult congenital heart disease clinic since 2002. Shading represents upper and lower 95% confidence limits.

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