scholarly journals Evaluation of Surgical Site Infections After Change in Surgical Prophylaxis in VAD Patients

2020 ◽  
Vol 41 (S1) ◽  
pp. s230-s231
Author(s):  
Emily Min ◽  
Timileyin Adediran ◽  
Kerri Thom ◽  
Emily Heil
Keyword(s):  
Antibiotic Prophylaxis ◽  
Medical Center ◽  
Surgical Site Infections ◽  
Surgical Prophylaxis ◽  
Ventricular Assist ◽  
Exact Test ◽  
Pertinent Data ◽  
Delayed Sternal Closure ◽  
Before And After ◽  
The Difference

Background: In October 2013, the University of Maryland Medical Center established a formal antibiotic prophylaxis protocol for patients undergoing ventricular assist device (VAD) placement, replacing a previous system of various broad-spectrum antibiotic combinations typically for prolonged durations based on surgeon preference. This new protocol consisted of a standardized regimen of 72 hours of vancomycin and ceftriaxone after the procedure. The objective of this project was to evaluate the rate of surgical site infection (SSI) related to VAD placement to ensure that implementing the new protocol did not cause an increase in SSI rates. Methods: The study was a retrospective cohort study of patients who had undergone VAD placement before the protocol change (January 1, 2011, to October 1, 2013) and after the change (October 1, 2013, to November 15, 2015). The primary outcomes was the difference in SSI rate before and after the protocol change using CDC NHSN definitions. Pertinent data points of interest included reason for VAD placement, duration/type of antibiotics used, delayed sternal closure, SSI, characterization of infection (bloodstream, driveline, or pocket), organism identified on culture and mortality at 30 days and 1 year. SSI rates were assessed using the Fischer exact test, and descriptive statistics were used for other outcome variables. Results: In total, 75 patients were included before the protocol and 46 after the protocol change. Overall, 27% and 17% of patients were on therapeutic antibiotics prior to the VAD placement, respectively (P = 0.23). Also, 8 (6.6%) patients in the preintervention group had an SSI compared to 1 patient (0.8%) in the postintervention group (P = .15). Adherence to the protocol was suboptimal, with 27% of patients in the postintervention group receiving non–protocol-adherent antibiotics and 65% of patients receiving antibiotics >96 hours postoperatively. When evaluating the patients collectively, SSI rates were the same when antibiotics were discontinued <72 hours postoperatively versus when antibiotics were continued beyond 72 hours postoperatively or were not given at all postoperatively (3.1% vs 10.7% vs 0%; P = .24). SSI rates were also no different among patients who received cefazolin monotherapy (0%), vancomycin and ceftriaxone (2.7%), vancomycin and piperacillin tazobactam (2%), and other antibiotic combinations (7.7%) for surgical prophylaxis (P = 0.1). Conclusions: No change in SSI rates was noted after a protocol change narrowing the spectrum and duration of antibiotic prophylaxis was implemented. Evaluation of optimal surgical prophylaxis in this patient population is difficult due to low event rates and frequent therapeutic indications for antibiotics outside the standard prophylaxis. Despite these challenges, this study supports the safety of studying SSI prophylaxis reduction in the VAD population. Further studies are reasonable and warranted.Funding: NoneDisclosures: None

scholarly journals 881. Efficacy of Antibiotic Prophylaxis with Vancomycin in Cardiothoracic Surgery

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S477-S477
Author(s):  
Margaret Cooper ◽  
Jing Zhao
Keyword(s):  
Primary Outcome ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Surgical Site Infections ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
High Incidence ◽  
The Difference ◽  
Gram Negative Organisms ◽  
Discernible Difference

Abstract Background Due to the high incidence of methicillin-resistant Staphylococcus aureus (MRSA) at the Detroit Medical Center, vancomycin is now routinely part of the prophylaxis regimen for cardiothoracic (CT) surgery. The study aims to compare the rate and types of surgical site infections (SSIs) when vancomycin is added to cefazolin for CT surgery compared to cefazolin alone. Methods This was a retrospective cohort study conducted at two university-affiliated hospitals. Patients who underwent CT surgery between January 2008 and August 2017 and had a readmission for SSI within 90 days of procedure were included. Patients who received cefazolin were compared to patients who received both cefazolin and vancomycin for CT surgery prophylaxis. The primary outcome was incidence of SSIs within 90 days of surgery as defined by the Centers for Disease Control and National Healthcare Safety Network. Results Out of 828 patients who underwent CT surgeries, there were 32 patients readmitted within 90 days for SSI. SSI occurred in 4.7% of patients who received cefazolin monotherapy, and 2.4% of patients who received both cefazolin and vancomycin (p=0.095). There was no discernible difference in types of SSI between groups. Pathogens were isolated in 78% of SSIs, with 75% Gram-positive and 19% Gram-negative organisms. SSIs resulted in an average 9.8 days in the hospital and 28.9 days of antibiotic therapy, and led to a total of 15 additional procedures. Conclusion Vancomycin added to cefazolin for prophylaxis in CT surgery resulted in lower incidence of SSI, however the difference was not statistically significant. Disclosures All Authors: No reported disclosures

Mortality of multiple myeloma diagnosed peri-hospitalization.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20553-e20553
Author(s):  
Sam Rubinstein ◽  
Elizabeth Sigworth ◽  
Sandip Chaugai ◽  
Qingxia M Chen ◽  
Robert F. Cornell ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Proportional Hazards ◽  
Medical Center ◽  
Staging System ◽  
Outpatient Setting ◽  
Cox Proportional Hazards ◽  
Early Mortality ◽  
Related Complication ◽  
Exact Test ◽  
Before And After

e20553 Background: Although modern therapeutics for multiple myeloma (MM) have resulted in improved overall survival (OS) in recent years, patients who present with an acute disease-related complication often have poor outcomes. We sought to compare the OS of patients diagnosed with MM in or shortly after hospitalization with those diagnosed in the outpatient setting. Methods: Patients treated for MM at Vanderbilt University Medical Center (VUMC) between 2000 and 2018 were included. OS was computed from date of diagnosis; patients still alive were censored at date last known alive or of last follow-up. Baseline laboratory and cytogenetic data were used to calculate Revised International Staging System (R-ISS) stage; age was also recorded. Dates of inpatient notes and encounter codes were identified and compared to date of diagnosis to identify patients diagnosed within 30 days of an inpatient stay; patients whose first encounter at VUMC was 30 days or more after their diagnosis date were excluded. Cox proportional hazards modeling was performed to investigate the effects of a diagnosis within 30 days of an inpatient encounter controlling for age and R-ISS on OS. Time-dependent coefficients were included to investigate the effects of a peri-hospitalization diagnosis on OS before and after 90 days. Mortality at 90 days for each group was compared using Fisher’s exact test. Results: A total of 681 patients were included, of whom 81 (11.8%) were diagnosed peri-hospitalization. Patients diagnosed peri-hospitalization had inferior OS within the first 90 days (adjusted HR 8.38, 95% CI 4.22-16.66, p < .001), but not after 90 days (Table). 90-day mortality for patients diagnosed peri-hospitalization was higher than for those not diagnosed peri-hospitalization (21.0% v. 3.3%, p < 0.001). Conclusions: Patients diagnosed with MM peri-hospitalization had high early mortality in this study, although patients surviving more than 90 days have similar mortality to those diagnosed as outpatients. Many factors could account for this finding, such as irreversible renal failure or immobility due to MM, hospital-related complications, or more aggressive MM phenotype. Predictive models of early mortality in MM should account for inpatient status at diagnosis. [Table: see text]

Effect of Preoperative Antibiotic Prophylaxis on Surgical Site Infections Complicating Cardiac Surgery

2014 ◽  
Vol 35 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Renato Finkelstein ◽  
Galit Rabino ◽  
Tania Mashiach ◽  
Yaron Bar-El ◽  
Zvi Adler ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Prophylaxis ◽  
Medical Center ◽  
Surgical Site Infections ◽  
Control Program ◽  
Risk Category ◽  
Infection Control Program ◽  
Preoperative Antibiotic Prophylaxis ◽  
Preoperative Hospital Stay ◽  
Preoperative Prophylaxis

Objective.To evaluate the effect of an optimized policy for antibiotic prophylaxis on surgical site infection (SSI) rates in cardiac surgery.Design.Prospective cohort study.Setting.Tertiary medical center in Israel.Methods.SSIs were recorded during a 10-year study period and ascertained through routine surveillance using the National Healthcare Safety Network (NHSN) methodology. Multivariable analyses were conducted to determine which significant covariates, including the administration of preoperative prophylaxis, affected these outcomes.Results.A total of 2,637 of 3,170 evaluated patients were included, and the overall SSI rate was 8.4%. A greater than 50% reduction in SSI rates was observed in the last 4 years of the study. Overall and site-specific infection rates were similar for patients receiving cefazolin or vancomycin. SSIs developed in 206 (8.1%) of the 2,536 patients who received preoperative prophylaxis (within 2 hours of the first incision) compared with 14 (13.9%) of 101 patients who received antibiotic prophylaxis at a different time (P= .04; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0–3.3). After accounting for covariates, preoperative hospital stay (5 days or more), an NHSN risk category (2 or 3), age (60 years or more), surgeon's role, and the period of measurement were significantly associated with SSIs. Emergency surgery, age, surgeon's role, and nonpreoperative prophylaxis were found to be independent predictors of superficial SSI.Conclusions.We observed a progressive and significant decrease in SSI rates after the implementation of an infection control program that included an optimized policy of preoperative prophylaxis in cardiac surgery.

scholarly journals Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

2021 ◽  
pp. 229255032199700
Author(s):  
Peter Mankowski ◽  
Abhiram Cherukupalli ◽  
Karen Slater ◽  
Nick Carr
Keyword(s):  
Antibiotic Prophylaxis ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Surgical Prophylaxis

Background: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. Methods: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. Results: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. Conclusion: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.

scholarly journals Comparative Evaluation of the Prognosis of Septic Shock Patients from before to after the Onset of the COVID-19 Pandemic: A Retrospective Single-Center Clinical Analysis

2022 ◽  
Vol 12 (1) ◽  
pp. 103
Author(s):  
Jae Hwan Kim ◽  
Chiwon Ahn ◽  
Myeong Namgung
Keyword(s):  
Septic Shock ◽  
Medical Center ◽  
Multivariable Analysis ◽  
Mortality Rates ◽  
Clinical Analysis ◽  
Simplified Acute Physiology Score ◽  
Before And After ◽  
System Data ◽  
The Difference ◽  
National Emergency

In this study, we investigated the mortality of septic shock patients visiting emergency departments (ED) before and after the coronavirus disease (COVID-19) pandemic onset. We retrospectively reviewed medical records and National Emergency Department Information System data of septic shock patients who visited the ED of a tertiary medical center in South Korea from February 2019 to February 2021. Following the COVID-19 pandemic onset, revised institutional ED processes included a stringent isolation protocol for patients visiting the ED. The primary goal of this study was to determine the mortality rate of septic shock patients from before and after the onset of the COVID-19 pandemic. Durations of vasopressor use, mechanical ventilation, intensive care unit stay, and hospitalization were investigated. The mortality rates increased from 24.8% to 35.8%, before and after COVID-19-onset, but the difference was not statistically significant (p = 0.079). No significant differences in other outcomes were found. Multivariable analysis revealed that the Simplified Acute Physiology Score III (SAPS III) was the only risk factor for mortality (OR 1.07; 95% CI 1.04-1.10), whereas COVID-19 pandemic was not included in the final model. The non-significant influence of the COVID-19 pandemic on septic shock mortality rates in the present study belies the actual mortality-influencing potential of the COVID-19 pandemic.

scholarly journals 808. Appropriate Use of Cephalotin Before and After Implementation of a Cardiac Surgery Antibiotic Prophylaxis Protocol in Guatemala

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S498-S498
Author(s):  
Herberth G Maldonado ◽  
Brooke M Ramay ◽  
Lourdes A Sandoval
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Prophylaxis ◽  
Patient Characteristics ◽  
Appropriate Use ◽  
Surgical Incision ◽  
Protocol Implementation ◽  
Delayed Sternal Closure ◽  
Hospitalization Costs ◽  
Duration Of Surgery ◽  
Before And After

Abstract Background The appropriate use of Surgical Antibiotic Prophylaxis (SAP) contributes to reducing the prevalence of Surgical Site Infections (SSI). Inappropriate use increases the risk of SSIs, hospitalization costs and potentially contributes to the emergence of antimicrobial resistance. We aimed to compare the appropriate use before and after implementing a SAP protocol in our institution Methods We conducted a retrospective chart review in patients older than 18 undergoing elective cardiac surgery with cardiopulmonary bypass using cephalotin as SSI prophylaxis. We excluded patients who received other antimicrobials for prophylaxis, those undergoing non-elective surgery, and patients with delayed sternal closure. We identified SSIs according to the Centers for Disease Prevention and Control criteria. We evaluated if appropriate dosing (2g-3g) and timing ( &gt;60 min.) occurred before the surgical incision, if redosing was administered, and if prophylaxis was administered &gt; 48 hours. We evaluated before and after implementation of the protocol (August 2016-July 2017; October 2017-2018) Results The study included 262 and 285 patients before and after protocol implementation, respectively. Patient characteristics were similar between comparator groups (Table 1). We found that 1.1% of patients vs. 63% of patients had appropriate dosing before the surgical incision, before and after protocol implementation, respectively (p &lt; 0.05). There was no difference in appropriate redosing when the duration of surgery was greater than 4 hours and no difference in inappropriate prophylaxis administration &gt; 48 hours after protocol implementation. A total of 8 SSIs were identified in each group, with no statistical difference in the incidence, length of stay, or clinical outcome between comparator groups Table 1. Patient Characteristics and Appropriate use of Cephalotin Before and After Implementation of a Cardiac Surgery Antibiotic Prophylaxis Protocol in Guatemala Conclusion Based on our findings, implementing a local guideline-protocol for SAP resulted in significant improvement of pre-surgical antimicrobial dosing. We observed continual unnecessary administration of antibiotic prophylaxis in the postoperative period that needs more proactive interventional pharmacy-guided strategies such as automatic stops or audits width feedback. Disclosures Lourdes A. Sandoval, Master of Science in Pharmacovigilance and Pharmacoepidemiology, Abbott (Employee)

Abstract WP230: Stroke Characteristics and Outcomes in Patients With Current Generation Centrifugal Flow Left Ventricular Assist Devices

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ovais Inamullah ◽  
Yuting Chiang ◽  
Martin Weiss ◽  
Michael Lutz ◽  
Carmelo Milano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Medical Center ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
The Difference ◽  
New Generation

Introduction: Stroke is a devastating complication of left ventricular assist device (LVAD) therapy and a leading cause of mortality in this group. The newer HeartMate (HVAD, 2012) and HeartMate 3 (HM3, 2017) devices use a continuous flow centrifugal pump with a magnetically levitated rotor that may cause less thrombosis and stroke. We aim to compare the rate and severity of strokes in the setting of the new generation LVADs. Methods: This was a single-center retrospective cohort study at a single US academic medical center. The cohort includes all subjects at Duke University Medical Center who received either an HM3 or HVAD LVAD between September 2009 through February 2018 and had a cerebrovascular accident while the LVAD was in place. Descriptive statistics were calculated to compare the clinical variables for individuals receiving either the HVAD or HM3 device. 95% confidence intervals were calculated when appropriate. Results: A total of 163 HVAD patients and 84 HM3 patients were included in the analysis. Strokes occurred more commonly among those with HVAD (14.7%, 9.7%-21.1%) compared to those with HM3 (6.0%, 2.0%-13.3%). About 62.1% of strokes were ischemic. Patients with HM3 were older and had a higher rate of cardiovascular risk factors. The initial mean NIHSS was higher in HM3 patients (24.6, 11.9-37.3) compared to those with HVADs (16, 10.9-21.1). Mortality within 30 days was higher in HM3 patients (60.0%, 14.7%-94.7%) compared to HVAD patients (45.8%, 25.6%-67.2%). Patients were more likely to be disabled (mRs> 3) at 3 months if they had an HM3 (80%, 28.4%-99.5%) compared to those who had an HVAD (54.2%, 32.8%-74.4%). Conclusion: Strokes occurred more commonly among those with HVAD compared to HM3, but the strokes in those with HM3 tended to be more severe at onset compared to HVAD with a higher 30 days mortality and more disability at 3 months. The difference in stroke frequency may suggest that the HM3 is less prone to thrombosis. The difference in mortality may have been secondary to patients with HM3 being older and with more cardiovascular risk factors or could be related to a reduction in minor strokes causing a shift to worse outcomes. Additional studies are needed to understand the predictors of stroke in the setting of the new generation LVADs.

Transfusion Reactions in Sickle Cell Disease (SCD) Patients Receiving Multiple Blood Transfusions.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 946-946
Author(s):  
Vishwas S. Sakhalkar ◽  
Diana M. Veillon ◽  
James D. Cotelingam ◽  
Linda M. Hawthorne ◽  
Gloria C. Caldito ◽  
...  
Keyword(s):  
Medical Center ◽  
Blood Type ◽  
P Value ◽  
Transfusion Reaction ◽  
Chi Square ◽  
Exact Test ◽  
Number Of Patients ◽  
Before And After ◽  
Patient Groups ◽  
Transfusion Reactions

Abstract Aim: To study transfusion reactions in our SCD patients before and after instituting the practice of transfusing C, E, K blood type negative (CEKneg) packed red blood cell (pRBC) units. Material and Methods: We retrospectively reviewed blood bank records of all SCD patients transfused pRBCs since 1990. Statistical analysis was performed using the Chi square test and Fischer’s exact test. Results: During 1990–2004, 500 SCD patients received pRBCs in our medical center. Of these, 387 received pRBC units crossmatched only for ABO and Rh blood types and suffered 37 transfusion reactions. Table I: General data of various patient groups Major patient groups Number of patients Median age in yrs # of pRBCs Tx Total (%) Sex (m/f) (range) Total units Median (range) Grand total of all patients 500 240/260 22 (0.7–79) 16617 14 (1–524) CEK (&ABO) matched transfusion patients 113 62/51 8 (0.5–35) 2354 10 (1–143) Regular (only ABORh) matched Tx patients 387 (100) 178/209 26 (0.7–79) 14263 18 (1–524) AlloAB forming patients 121 (31.3) 56/65 29 (5–70) 7338 26 (1–500) Non-alloAB forming pts 266 (68.7) 122/144 25 (0.7–79) 6925 12 (1–524) Table 2: Transfusion reactions in various patient groups Major patient groups Total # of pts Total # of pRBCs Transfusion reactions (% of pts) [Incidence/1000 Tx] Total Febrile Allergic dHTR CEK matched pts 113 2354 0 0 0 0 Regular (ABORh) Tx pts 387 14263 37 (10%)[2.594] 10 23 (6%)[1.61] 4 (1%)[0.28] AlloAB forming pts 121 7338 23 (19%)[3.134] 4 (3%)[0.55] 15 (12%)[2.04] 4 (3%)[0.55] Non-alloAB forming pts 266 6925 14 (5%)[2.0] 6(2%)[0.87] 8 (3%)[1.16] 0 P value (alloAB vs non-alloAB) # of pts 0.25 0.684 0.266 - P value (alloAB vs non-alloAB) # of Tx &lt;0.001 0.809 0.002 - 121 developed alloantibodies (alloABs). 113 patients always received CEKneg pRBCs (from 1997). The technologist required 30 more minutes and $153 extra in reagent costs for this extended CEK match. Most Rh negative pRBC units were also CEKneg. 90% of our donors are Caucasian. Discussion: ’Non-alloAB forming’ patients who received ABORh matched transfusions were 4 times less likely (and twice less likely when number of transfusions was considered) to develop allergic transfusion reaction (p=0.002), compared with ’alloAB forming’ counterparts. Similar finding is seen in patients receiving CEK matched pRBCs. It would be interesting to know if ’slow/rapid/non alloAB producer patients had any genetic predisposition accounting for early/slow/non-development of ABs and transfusion reactions or if alloAB formation transforms the immune system to a hyper-reactive state leading to autoAB formation/allergic reaction. Conclusions: This study showed that utilizing extended antigen (C, E, K) matching for pRBC transfusion ↓↓ alloAB(p&lt;0.01) and autoAB(p=0.005) formation in our SCD patients and eliminated transfusion reactions. Universal availability of leukopoor pRBCs may have eliminated febrile reactions. AlloAB forming patients were more prone to develop allergic transfusion reaction (p=0.002). AutoAB formation was more common in patients with alloABs and did not cause complications. dHTRs were rare and mild. CEK matching made it easier to find and transfuse blood due to less formation of ABs and reactions. However, it resulted in marked overuse of Rh negative pRBCs, extra cost and additional effort to find CEKneg pRBCs for every transfusion.

Procedural Apheresis Instrumentation Algorithm Minimizes Platelets Loss during Peripheral Blood Stem Cells Collection.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4146-4146
Author(s):  
Elie M. Richa ◽  
Edwin A. Burgstaler ◽  
Carl W. Greiner ◽  
Sandra C. Bryant ◽  
Hilmi Ege ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mononuclear Cell ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Hematopoietic Progenitor Cell ◽  
Peripheral Blood Stem Cells ◽  
Exact Test ◽  
Before And After ◽  
The Difference ◽  
Wbc Count

Abstract Introduction: Peripheral blood hematopoietic progenitor cell collection is a more popular source of stem cells for transplantation than bone marrow harvest. A number of automated cell separators exist which can be used to perform mononuclear cell collections. These separators collect varying amounts of other cells during the collection process, including them in the mononuclear cell product. Because of this, collection of mononuclear cells can result in significant reductions in platelet count and loss of red blood cells during the procedure. In order to minimize platelet transfusion support, we developed an algorithm to optimize mononuclear cell collections while minimizing platelet losses using the Gambro COBE Spectra and the Baxter Amicus Methods: Previously, patients were assigned randomly to any available apheresis machine. Starting August 2nd 2002, patients with a WBC count higher than 35×10 (9)/L were preferably assigned to Amicus for 5 hour collection with processing 1000 ml/cycle or as second choice Spectra for 5 hours run with maximum draw rate 65 ml/Min., for both instruments. If the WBC was lower than 35×10 (9)/L, the preferred machine would be Amicus for 5 hours run at 1400 ml/cycle with maximum draw rate 90ml/Min. or Spectra for 5 hours run with maximum draw 100 ml/Min. We reviewed the difference of pre and post procedure platelet counts of non Hodgkin’s Lymphoma patients undergoing stem cells collection for 6 months before and after the implementation of the above protocol from February 2002 till February 2003. All CBC were performed on the same Coulter analyzer. Results: 14 patients (2 on Amicus and 12 on Spectra) underwent stem cells collection before August 2nd, 2002. 13 patients (8 on Amicus and 5 on Spectra) were collected after this date. The Fisher’s exact test was used for this study. The median and mean differences in the first group were 141.5 ×10(9)/L and 135 ×10 (9)/L respectively (95% CI, p 0.0183). The second group had a median and mean of 45 ×10 (9)/L and 51 × 10(9)/L (95% I, p 0.0183). The minimum and maximum differences were 36 × 10(9)/L and 200 × 10(9)/L respectively in the first group and −19 ×10(9)/L and 121×10(9)/L for the second group. There was no difference in the numbers of the collections days in both groups in regard to the type of automated cell collector. Discussion: The implemented algorithm showed a net advantage. Even though none of the patients required blood transfusions, there was lesser drop of platelets counts with the new settings.

P6315Effects of chronic heart failure unconventional therapies on endothelial function

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Maloberti ◽  
E Piccinelli ◽  
J Zannoni ◽  
S Castelnuovo ◽  
P Vallerio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Endothelial Function ◽  
Median Time ◽  
Drug Effects ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Before And After ◽  
The Difference ◽  
Value Flow

Abstract Introduction Endothelial Dysfunction (ED) of peripheral arteries in Chronic Heart Failure (CHF) subjects has been demonstrated. Purpose We assessed endothelial function in subjects undergoing unconventional treatments for CHF, namely Heart Transplantation (HTX), continuous-flow Left Ventricular Assist Device implantation (LVAD), and repeated levosimendan infusions (r-LEVO). Methods Twenty HTX recipients (median time from HTX 21 months), 20 patients supported with LVAD (median time from implant 39 months), and 20 patients receiving monthly Levosimendan infusions (median time on treatment 28 months) were enrolled and compared to a group of 20 healthy subjects. ED was evaluated with ultrasound assessment of the diameter before and after ischemic stress at the brachial artery level. The difference between the two diameters normalized for the baseline value (Flow Mediated Dilation – FMD) has been used for the analysis. All the patients were stable at the time of FMD assessment, with those on r-LEVO being evaluated prior to infusion. Results FMD was significantly lower in HTX and LVAD groups with respect to controls (9.8±7.4, 9.3±5.7, and 15.6±6.4% respectively, p=0.01), but not in r-LEVO group (12.5±6.9%). When patients were analyzed according to time from the operation or on treatment, (< versus > of the median value), no differences were seen in HTX and r-LEVO group, while in LVAD group FMD was borderline significantly higher in patients with longer follow-up (8.4±6.4% versus 10.2±5.2%, p=0.05). Conclusions Based on this preliminary data we can inference the following: 1- FMD is abnormal in HTX recipients, despite their good functional status, probably due to factors unrelated to CHF (e.g. hypertension, renal insufficiency, denervation, and drug effects); 2- LVAD patients also show ED, with possible better adaptation in very long-term survivors; 3- Near-normal FMD values in CHF patients who remain stable with r-LEVO suggest that pulsed treatment may obtain favorable effects at peripheral level, persisting after clearance of the drug and its metabolites. Acknowledgement/Funding None

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