Lung Allograft Ischemic Time

Objective We have observed that minimally invasive left ventricular assist device (LVAD) insertion leads to more facile re-entry and easier cardiac transplantation. We hypothesize minimally invasive LVAD implantation results in improved outcomes at the time of subsequent heart transplant. Methods All adults undergoing cardiac transplantation between October 2015 and March 2019 at our institution were retrospectively reviewed. Those bridged to transplantation with a HeartWare HVAD were identified and divided into 2 cohorts based upon the surgical approach: those who underwent HVAD placement by conventional sternotomy versus minimally invasive insertion via lateral thoracotomy and hemisternotomy (LTHS). Patient demographics, as well as perioperative transplant outcomes, including survival, length of stay (LOS), blood utilization, ischemic time, bypass time, and postoperative extracorporeal membrane oxygenation (ECMO) were compared between cohorts. Results Forty-two patients were bridged to heart transplant with a HVAD implanted via either sternotomy ( n = 22) or LTHS technique ( n = 20). Demographics were similar between groups. There was 1 predischarge death in the sternotomy group and none in the LTHS group. Body surface area, cardiopulmonary bypass time, ischemic time, ECMO utilization, and reoperation for bleeding were similar. Red blood cell units transfused were significantly lower in the LTHS cohort (3.0 [1.0-5.0] vs 6.0 [2.5-10.0] P = 0.046). The LTHS cohort had a significantly shorter hospital LOS (12.0 [11.0-28.0] vs 22.5 [15.7-41.7] P = 0.022) with a trend toward shorter intensive care unit LOS (6.0 [5.0-10.5] vs 11.0 [6.0-21.5] days P = 0.057). Conclusions Minimally invasive HVAD implantation improves outcomes at subsequent heart transplantation, resulting in shorter LOS and less red cell transfusion. Larger multi-institutional studies are necessary to validate these findings.

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Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

Journal of Clinical Medicine ◽

10.3390/jcm10132968 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2968

Author(s):

Alessandro Bellis ◽

Giuseppe Di Gioia ◽

Ciro Mauro ◽

Costantino Mancusi ◽

Emanuele Barbato ◽

...

Keyword(s):

Myocardial Infarction ◽

Reperfusion Injury ◽

Therapeutic Strategy ◽

Ventricular Remodeling ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Ischemic Time ◽

St Elevation

The significant reduction in ‘ischemic time’ through capillary diffusion of primary percutaneous intervention (pPCI) has rendered myocardial-ischemia reperfusion injury (MIRI) prevention a major issue in order to improve the prognosis of ST elevation myocardial infarction (STEMI) patients. In fact, while the ischemic damage increases with the severity and the duration of blood flow reduction, reperfusion injury reaches its maximum with a moderate amount of ischemic injury. MIRI leads to the development of post-STEMI left ventricular remodeling (post-STEMI LVR), thereby increasing the risk of arrhythmias and heart failure. Single pharmacological and mechanical interventions have shown some benefits, but have not satisfactorily reduced mortality. Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far. On the basis of the results of the consistent clinical studies analyzed in this review, we try to design a randomized clinical trial aimed at evaluating the effects of a reasoned multitarget therapeutic strategy on the prevention of post-STEMI LVR. In fact, we believe that the correct timing of pharmacological and mechanical intervention application, according to their specific ability to interfere with survival pathways, may significantly reduce the incidence of post-STEMI LVR and thus improve patient prognosis.

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P5264There is no significant effect of ischemic time and elapse time since cardiac allograft transplant on myocardial T1 relaxation time

European Heart Journal ◽

10.1093/eurheartj/ehz746.0235 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Vietheer ◽

C Unbehaun ◽

K Classen ◽

M Richter ◽

A Rieth ◽

...

Keyword(s):

Allograft Rejection ◽

T1 Mapping ◽

Cardiac Allograft ◽

Elapse Time ◽

Ischemic Time ◽

Elapsed Time ◽

Native T1 ◽

Transplant Patients ◽

T1 Relaxation ◽

Stress Cmr

Abstract Background Graft failure caused by allograft rejection and vasculopathy is the most common cause of mortality after heart transplantation. To detect an early allograft rejection, endomyocardial biopsy is still needed. Tissue characterization by T1-mapping and Late gadolinium enhancement is well established in acute and chronic myocardial tissue alterations. Therefore several studies investigated T1-mapping as a potential noninvasive parameter to monitor cardiac allograft vasculopathy and allograft rejection. However it is unclear if T1 is also influenced by pretransplant ischemic time and elapsed time since transplantation. Purpose It was the aim of our study to examine the influence of ischemic and elapsed time since transplantation to the cardiac allograft tissue characteristics measured by CMR T1 relaxation times. Methods Allograft transplant patients underwent stress CMR on a yearly routine. T1-maps were acquired using a modified look locker sequence (MOLLI 3(2)3(2)5) in the midventricular septum. Uni- and multi linear regression analysis was used to predict T1 by ischemic time, time since transplantation, troponin and NT-Pro-BNP. Results 49 cardiac allograft transplanted patients underwent stress CMR (mean age 58.6±11.7 years, left ventricular ejection fraction 62.1±6.8%; indexed enddiastolic volume 68.4±14.7 ml/m2; native T1 1120±51 ms, extracellular volume 0.27±0.04). A significant correlation was found between T1 and NT-Pro-BNP (1519±3639 pg/ml, p=0.003) and a trend for troponin (17.0±12.8 ng/dl, p=0.051). We saw no correlation between T1 and the ischemic time (198.4±44.9 minutes, p=0.1172) and elapse time since transplantation (47±7 month, p=0.9868). In the multivariate regression analysis none of the four parameters were independently associated with the T1 time (p=0.1017). Table 1 Characteristics Mean ± SD p Ischemic time (minutes) 198.4±44.9 0.1172 Time since transplant (month) 47±7 0.9868 NT-Pro-BNP (pg/ml) 1519±3639 0.003 Troponine (ng/dl) 17.0±12.8 0.051 Conclusion There was no significant effect of pretransplant ischemic time and elapse time since transplantation on native T1 times, whereas native T1 was significantly correlated with troponine and NT-Pro-BNP-Levels. T1 is excellently suited to detect acute changes in allograft transplant patients without being influenced by aging of the transplanted heart and the heart's pretransplant condition.

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680: Extended Donor Ischemic Time Is Not Associated with Poor Outcome in Pediatric Heart Transplantation

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2008.11.687 ◽

2009 ◽

Vol 28 (2) ◽

pp. S301-S302 ◽

Cited By ~ 1

Author(s):

J. Linam ◽

Y. Law ◽

L. Permut ◽

D.M. McMullan ◽

A. Morscheck ◽

...

Keyword(s):

Heart Transplantation ◽

Ischemic Time ◽

Poor Outcome ◽

Pediatric Heart Transplantation

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Progression of myocardial injury during coronary occlusion in the collateral-deficient heart: a non-wavefront phenomenon

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00590.2007 ◽

2007 ◽

Vol 293 (3) ◽

pp. H1799-H1804 ◽

Cited By ~ 13

Author(s):

Bradley G. Leshnower ◽

Hiroaki Sakamoto ◽

Hirotsugu Hamamoto ◽

Ahmad Zeeshan ◽

Joseph H. Gorman ◽

...

Keyword(s):

Infarct Size ◽

Functional Capacity ◽

Collateral Circulation ◽

Coronary Occlusion ◽

Regional Blood Flow ◽

Microvascular Dysfunction ◽

Canine Model ◽

Ischemic Time ◽

Coronary Collaterals ◽

Wide Range

It is widely accepted that, during acute coronary occlusion, ischemic cell death progresses from the subendocardium to the subepicardium in a wavefront fashion. This concept, which implies that the subendocardium is the most susceptible myocardial region to ischemic injury, was established using a canine model with an extensive system of subepicardial coronary collaterals. In humans, particularly in those with coronary artery disease, there is a wide range in the distribution and functional capacity of the collateral circulation, which may affect the pattern of infarct evolution. Using an ovine model with a limited system of preformed subendocardial coronary collaterals, we characterized the effect of increasing lengths of ischemia on regional blood flow and infarct size in three regions of the ventricular wall: subendocardium, midmyocardium, and subepicardium. Our results demonstrate that the myocardium and microvasculature in these three regions are equally susceptible to injury after 45 min of ischemia. When ischemic time is increased to 1 h, infarct size in the midmyocardium (90 ± 2%) is greater than in the subendocardium (76 ± 4%, P = 0.004) and subepicardium (84 ± 3%, P = 0.13). Microvascular dysfunction as assessed as a percentage of baseline flow is also greater in the midmyocardium (14 ± 5%) compared with the subendocardium (20 ± 3%, P = 0.23) and subepicardium (51 ± 9%, P = 0.007). These findings suggest that, in subjects with a limited system of coronary collateral circulation, the midmyocardium is the most susceptible myocardial region to ischemia and the subendocardium is the most resistant. Myocardial viability during coronary occlusion appears to be primarily determined by the distribution and functional capacity of the collateral circulation.

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One-Stage Repair of Cardiac and Arch Anomalies without Circulatory Arrest

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230301100315 ◽

2003 ◽

Vol 11 (3) ◽

pp. 250-254 ◽

Cited By ~ 1

Author(s):

Kona Samba Murthy ◽

Robert Coelho ◽

Christopher Roy ◽

Snehal Kulkarni ◽

Benjamin Ninan ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Aortic Arch ◽

Septal Defect ◽

Circulatory Arrest ◽

Coarctation Of The Aorta ◽

Innominate Artery ◽

Double Outlet Right Ventricle ◽

Interrupted Aortic Arch ◽

Ischemic Time ◽

Arch Obstruction

Between 1999 and 2002, 23 patients underwent single-stage complete repair of cardiac anomalies and aortic arch obstruction, without circulatory arrest. Median age was 1.2 years. Intracardiac defects included ventricular septal defect in 9, double-outlet right ventricle in 6, d-transposition of the great arteries and ventricular septal defect in 2, subaortic obstruction in 3, and atrial septal defect in 3. Fourteen patients had coarctation of the aorta, 6 had coarctation with hypoplastic aortic arch, and 3 had interrupted aortic arch. Simple techniques were employed such as cannulation of the ascending aorta near the innominate artery and maintaining cerebral and myocardial perfusion. After correction of arch obstruction, intracardiac repair was undertaken. The mean cardiopulmonary bypass time was 169 min, aortic crossclamp time was 51 min, and arch repair took 16 min. There was no operative mortality or neurological deficit. In follow-up of 1–43 months, no patient had residual coarctation. This simplified technique avoids additional procedures, reduces ischemic time, and prevents problems related to circulatory arrest.

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