Abstract 17262: Outcomes following High Risk Surgery provided as an Alternative to Transplant in patients with End-stage Heart Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroyuki Kawajiri ◽  
Lisa Garrard ◽  
Cedric Manlhiot ◽  
Heather Ross ◽  
Diego Delgado ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
Senior Author ◽  
Conventional Surgery ◽  
Severe Left Ventricular Dysfunction ◽  
Kaplan Meier ◽  
End Stage ◽  
Type Of Surgery

Background: Heart transplant (Tx) and ventricular assist device (VAD) have become established treatments for end stage heart failure; however, both treatments still have unsolved problems. Patients referred for Tx or VAD are often found to have cardiac lesions amenable to surgical intervention. We examined the results of conventional surgery in patients with severe left ventricular dysfunction to explore the possibility of high risk surgery as an alternative option. Methods: We reviewed our institutional database and identified all surgical patients referred to our senior author with severe LV dysfunction (EF<20%). We then selected patients who were initially referred for consideration of Tx or VAD, but were instead offered conventional surgery. All patients underwent evaluation for Tx candidacy and thus were prospectively stratified into Tx eligible (Tx-E) or Tx non-eligible (Tx-NE) groups. We compared outcomes stratified by Tx eligibility as well as by type of surgery. Results: A total of 133 patients were enrolled. 68 patients were Tx-E, and 65 were Tx-NE. Tx-E patients were younger than Tx-NE (57±8 vs 70±8 year-old, p<0.01). Isolated CABG was performed in 77 patients, while 56 had other procedures. In-hospital mortality was 8.8% in Tx-E, and 15.4% in Tx-NE (p=0.29). Kaplan-Meier analysis demonstrated that survival in Tx-E was comparable to ISHLT Tx data, while survival in Tx-NE was comparable to INTERMACS DT data (Figure1). When stratified by type of surgery, in-hospital mortality was lower for isolated CABG (6.5% vs 19.6%, p=0.03). Isolated CABG seemed to have comparable survival to ISHLT Tx and INTERMACS DT by Kaplan-Meier analysis (Figure2). Conclusion: The mortality and morbidity in patients undergoing alternative surgeries appears to be similar to the contemporary results of Tx and VAD destination therapy. Particularly if the pathology of heart failure is graftable coronary artery disease, isolated CABG may be a good option for highly selected patients.

Abstract 289: Hospital Volume of LVAD Procedures Determines Patient Outcome

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Katherine Feldman ◽  
Rami Doukky ◽  
Tricia Johnson ◽  
David Levine ◽  
Sam Hohmann
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
The United States ◽  
Left Ventricular ◽  
Policy Implications ◽  
Ventricular Assist Devices ◽  
Categorical Variables ◽  
Procedure Volume ◽  
End Stage Heart Failure ◽  
End Stage

Background: Left ventricular assist devices (LVADs) provide mechanical circulatory support to patients with end-stage heart failure. The use of these devices in the United States has been increasing since the FDA approved the first device in 1994. There are no published studies that have evaluated the relationship between LVAD procedural volume and hospital mortality, despite large variation across hospitals in the volume of LVAD procedures performed. This study sought to explore whether a correlation exists between hospital and surgeon’s procedural volumes and patient outcomes, and also to identify a critical threshold. Methods: We conducted a retrospective cross-sectional analysis of all patient discharges from UHC member hospitals from January 2008 through June 2012 after an insertion of an LVAD during their hospitalization. Patients were identified from UHC’s Clinical Database/Resource Manager (CDB/RM) on the basis of the principal or secondary International Classification of Diseases Ninth Revision, Clinical Modification ( ICD-9-CM) procedure code 37.66. The primary outcome was all cause mortality. Results: There were 87 hospitals that admitted at least 1 patient for an LVAD procedure during the study period (77.5 percent males, mean age 54.3). The mean length of stay was 42.1 days and a mean total cost of $299,067. We identified variation of in-hospital mortality by hospital LVAD procedure volume quartile. Quartile 1 included hospitals performing 1-9 procedures (38.8% mortality), quartile 2 performed 10-46 procedures (18.1% mortality), quartile 3 performed 55-97 procedures (12.8% mortality), and the fourth quartile performed 107-319 procedures (16.1% mortality) during the study period. Categorical variables were compared with the Chi-Square Test, and continuous variables were compared with t-tests. There was significant variation in the mortality for almost all study variables including age, gender, admission severity of illness, and admission risk of mortality, and the variation persisted by volume quartile. Conclusion: Initial results suggest that there is a correlation between hospital LVAD procedure volume and in-hospital mortality. LVADs are becoming an increasingly common treatment method for patients with end-stage heart failure and are either awaiting transplant or will receive the device as the final method of therapy. Identifying critical volume thresholds could improve outcomes and ultimately improve the efficiency and value of care. Implications: Identifying mortality associated with LVAD procedures at these hospitals will provide patients and physicians with more information when seeking treatment options for heart failure. This study may also have health policy implications for cardiac treatment by implementing guidelines that LVAD hospital and surgeon programs must adhere to.

scholarly journals Cardiotoxicity After Anthracycline Chemotherapy for Childhood Cancer in a Multiethnic Asian Population

2021 ◽  
Vol 9 ◽  
Author(s):  
Varen Zhi Zheng Tan ◽  
Nicole Min Chan ◽  
Wai Lin Ang ◽  
Soe Nwe Mya ◽  
Mei Yoke Chan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Function ◽  
Systolic Function ◽  
Asian Population ◽  
Left Ventricular ◽  
Children's Hospital ◽  
Asian Populations ◽  
Kaplan Meier ◽  
Children’S Hospital ◽  
End Stage

Background: Anthracyclines are widely used to treat childhood cancers; however, they cause cardiotoxicity. To address the paucity of clinical data from Asian populations, this study investigated the epidemiology of pediatric anthracycline-induced cardiotoxicity, during and after chemotherapy, in a multiethnic Asian population.Procedure: This was a single-center, retrospective analysis of 458 anthracycline-treated pediatric oncology patients at KK Women's and Children's Hospital, a tertiary children's hospital in Singapore from 2005 through 2015. We investigated cardiotoxicity (defined as left ventricular fractional shortening &lt;28% on echocardiography) and its risk factors using univariate logistic regression as well as survival estimates through the Kaplan-Meier method to compare survival distribution between patients with and without cardiotoxicity.Results: Over a follow-up period of almost 4 years, we found that 7% (32/458) of the cohort developed cardiotoxicity, with 37.5% (12/32) of these manifesting as clinical heart failure, whilst the rest were asymptomatic. The cardiotoxic cohort demonstrated a significantly higher mortality rate compared to the non-cardiotoxic group at 46.9 vs. 19.2% (p &lt; 0.001), of whom 3 (9.4%) died from end-stage heart failure. We found that traditional predictors such as female sex, age at diagnosis, and cumulative doxorubicin equivalent dose were not predictors of cardiotoxicity.Conclusion: Our study reaffirms that freedom from symptoms does not ensure normal heart function and suggests that children with abnormal ventricular systolic function have higher mortality risk compared to those with normal systolic function. The findings contribute to improved understanding of the Asian burden to aid development of measures to prevent or reduce the risk of cardiotoxicity.

Cardiac tamponade from anticoagulant-related spontaneous haemopericardium in a patient with ischaemic cardiomyopathy and heart failure

2020 ◽  
Vol 13 (12) ◽  
pp. e238047
Author(s):  
Alicia Lefas ◽  
Neil Bodagh ◽  
Jiliu Pan ◽  
Ali Vazir
Keyword(s):  
Heart Failure ◽  
Cardiac Tamponade ◽  
Ventricular Dysfunction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Left Ventricular ◽  
Heart Failure Therapy ◽  
Severe Left Ventricular Dysfunction ◽  
Ischaemic Cardiomyopathy ◽  
Common Causes

We describe the case of an 86-year-old man with a background of severe left ventricular dysfunction and ischaemic cardiomyopathy who, having been optimised for heart failure therapy in hospital, unexpectedly deteriorated again with hypotension and progressive renal failure over the course of 2 days. Common causes of decompensation were ruled out and a bedside echocardiogram unexpectedly diagnosed new pericardial effusion with tamponade physiology. The patient underwent urgent pericardiocentesis and 890 mL of haemorrhagic fluid was drained. Common causes for haemopericardium were ruled out, and the spontaneous haemopericardium was thought to be related to introduction of rivaroxaban anticoagulation. The patient made a full recovery and was well 2 months following discharge. This case highlights the challenges of diagnosing cardiac tamponade in the presence of more common disorders that share similar non-specific clinical features. In addition, this case adds to growing evidence that therapy with direct oral anticoagulants can be complicated by spontaneous haemopericardium, especially when coadministered with other agents that affect clotting, renal dysfunction and cytochrome P3A5 inhibitors.

AIM2-driven inflammasome activation in chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Ruppert ◽  
Z.S Onodi ◽  
P Leszek ◽  
V.E Toth ◽  
G Koncsos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Animal Models ◽  
Left Ventricular ◽  
Inflammasome Activation ◽  
Coronary Artery Ligation ◽  
Funding Source ◽  
Human Cardiomyocytes ◽  
Pannexin 1 ◽  
End Stage

Abstract Background Inflammation and cytokine release have been implicated in the pathogenesis of chronic heart failure (CHF). Of particular interest, Canakinumab, a monoclonal antibody against interleukin-1b (IL-1β), had provided benefit against cardiovascular events, suggesting that blockade of IL-1β secretion and signaling might be a promising new therapeutic target. Although, recent studies have provided evidence that inflammasome activation is the main contributor to IL-1β maturation, the role of inflammasome activation in CHF remains unknown. Objective Therefore, we aimed to assess inflammasome activation in myocardial samples from end-stage failing hearts. Methods Inflammasome activation was assessed by immunoblotting in left ventricular myocardial specimens harvested from patients with end-stage CHF. Furthermore, immunoblot measurements were also performed on translational animal models of CHF (e.g. rat models of permanent coronary artery ligation and transverse aortic constriction). Left ventricular monocyte and macrophage infiltration was detected by immunohistochemistry. To investigate the molecular background of inflammasome activation, a series of cell culture experiments were performed on AC16 human cardiomyocytes and THP-1 human monocytic cell lines. Results Out of the 4 major inflammasome sensors tested, expression of the inflammasome protein absent in melanoma 2 (AIM2) and NLR family CARD domain-containing protein 4 (NLRC4) increased in human CHF while the NLRP1 and NLRP3 (NLR family, pyrin domain containing 1 and 3) inflammasome showed no change. A similar expression pattern in AIM2 and NLRC4 was also noted in CHF animal models. Furthermore, robust infiltration of Iba1+ monocytes/macrophages was observed in human failing hearts as well as in different animal models of CHF. In vitro AIM2 inflammasome activation, as induced by transfection with double-stranded DNA [poly(deoxyadenylic-deoxythymidylic)] was reduced significantly by the pharmacological blockade of pannexin-1 channels. Conclusions AIM2 and NLRC4 inflammasome activation might contribute to chronic inflammation in CHF. Our findings suggest that pannexin-1 channels might be a promising novel target to reduce inflammasome activation. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): NVKP_16-1-2016-0017

Right ventricular rather than left ventricular systolic dysfunction predicts outcome in patients undergoing transcatheter aortic valve implantation: insights from cardiac magnetic resonance imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Koschutnik ◽  
C Nitsche ◽  
C Dona ◽  
V Dannenberg ◽  
A.A Kammerlander ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Prognostic Information ◽  
Transcatheter Aortic Valve ◽  
Kaplan Meier ◽  
Lv Volumes ◽  
Valve Implantation ◽  
Rv Function

Abstract Background Right ventricular (RV) function is strongly associated with outcome in heart failure. Whether it also adds important prognostic information in patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. Methods We consecutively enrolled patients with severe aortic stenosis (AS) scheduled for TAVI and preprocedural cardiac magnetic resonance (CMR) imaging. Kaplan-Meier estimates and multivariate Cox regression analyses were used to identify factors associated with outcome. A composite of heart failure hospitalization and/or cardiovascular death was selected as primary study endpoint. Results 423 consecutive patients (80.7±7.3 years; 48% female) were prospectively included, 201 (48%) underwent CMR imaging. 55 (27%) patients presented with RV systolic dysfunction (RVSD) defined by RV ejection fraction (RVEF) &lt;45%. RVSD was associated with male sex (69 vs. 40%; p&lt;0.001), New York Heart Association (NYHA) functional status (NYHA ≥ III: 89 vs. 57%; p&lt;0.001), NT-proBNP serum levels (9365 vs. 2715 pg/mL; p&lt;0.001), and history of atrial fibrillation (AF: 51 vs. 30%; p=0.005). On CMR, RVSD was associated with left ventricular (LV) volumes (end-diastolic: 187 vs. 137 mL, end-systolic: 119 vs. 53 mL; p&lt;0.001) and EF (39 vs. 64%; p&lt;0.001). A total of 51 events (37 deaths, 14 hospitalizations for heart failure) occurred during follow-up (9.8±9 months). While LVSD (LVEF &lt;50%) was not significantly associated with outcome (HR 0.83, 95% CI: 0.33 – 2.11; p=0.694), RVSD showed a strong and independent association with event-free survival by multivariate Cox regression analysis (HR 2.47, 95% CI: 1.07–5.73; p=0.035), which was adjusted for all relevant CMR parameters (LV volumes and EF), cardiovascular risk factors (sex, NYHA, AF, diabetes mellitus type II, use of diuretics), and routine biomarkers (NT-proBNP, creatinine). Conclusions RVSD rather than LVSD, as determined on CMR, is an important predictor of outcome in patients undergoing TAVI. RV function might thus add useful prognostic information on top of established risk factors. Figure 1. Kaplan-Meier survival curves Funding Acknowledgement Type of funding source: None

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