scholarly journals The Man with 2 Hearts: 25 Years from Heterotopic to Orthotopic Heart Transplantation

2019 ◽  
Vol 46 (3) ◽  
pp. 199-202
Author(s):  
Elizabeth L. Godfrey ◽  
Michael L. Kueht ◽  
Abbas Rana ◽  
O.H. Frazier
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Heart Function ◽  
Human Leukocyte ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Orthotopic Heart Transplantation ◽  
Orthotopic Transplantation ◽  
Heterotopic Heart Transplantation ◽  
Coronary Artery Stent

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft that was a complete human leukocyte antigen mismatch. The graft functioned normally for 20 years until the patient had a myocardial infarction that necessitated placement of a coronary artery stent. Subsequent treatments involved many interventions, including insertion of an intra-aortic balloon pump, medical therapy for heart failure, implantation of a total artificial heart, and, ultimately, orthotopic transplantation. To our knowledge, our patient is the longest surviving recipient of a heterotopic heart transplant, with a remarkable 25-year graft survival despite poor histocompatibility and an almost complete lack of native heart function. The strategies used for his treatment make him a living case study that can add valuable information to the history of cardiac support.

Combined Heart Transplantation and Thoracic Endovascular Aortic Repair for Heart Failure Secondary to Tricuspid Atresia Palliated with Potts Shunt

2013 ◽  
Vol 8 (3) ◽  
pp. 242-244 ◽  
Author(s):  
Bobby Yanagawa ◽  
Lucas Collazo ◽  
Nelson Burton ◽  
Niv Ad ◽  
Alan M. Speir
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Heart Function ◽  
Normal Activity ◽  
Tricuspid Atresia ◽  
Orthotopic Heart Transplantation ◽  
Endovascular Stent ◽  
Endovascular Stent Graft ◽  
Progressive Heart Failure

A 57-year-old-man with known tricuspid atresia previously palliated with a Potts shunt had developed progressive heart failure refractory to medical management. He underwent a combined thoracic endovascular stent graft procedure to eliminate the Potts shunt and orthotopic heart transplantation. At 3-month follow-up, right-sided heart function and pulmonary artery pressures as well as pulmonary vascular resistance had normalized, and at 7 months, the patient had returned to normal activity. The surgical management and its principles as well as postoperative follow-up are described.

scholarly journals Orthotopic Heart Transplantation and Mechanical Circulatory Support in Cancer Survivors: Challenges and Outcomes

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Nina Ghosh ◽  
John Hilton
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Significant Proportion ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Orthotopic Heart Transplantation ◽  
Advanced Therapies ◽  
End Stage Heart Failure ◽  
End Stage

Chemotherapy-induced cardiomyopathy (CCMP) is a significant cause of morbidity and mortality. Compared to cardiomyopathy due to other causes, anthracycline-induced cardiomyopathy is associated with a worse survival. As cancer survival improves, patients with CCMP can be expected to comprise a significant proportion of patients who may require advanced therapies such as inotropic support, cardiac transplantation, or left ventricular assist device (LVAD). Distinct outcomes related to advanced therapies for end-stage heart failure in this patient population may arise due to unique demographic characteristics and comorbidities. We review recent literature regarding the characteristics of patients who have survived cancer undergoing orthotopic heart transplantation and mechanical circulatory support for end-stage heart failure. The challenges and outcomes of advanced therapies for heart failure related specifically to anthracycline-induced cardiomyopathy are emphasized.

scholarly journals Total Artificial Heart Imaging and Complications: a Pictorial Review

2016 ◽  
Author(s):  
Carrie K. Gomez ◽  
Susan Hobbs
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Artificial Heart ◽  
Early Recognition ◽  
Imaging Modality ◽  
Therapeutic Option ◽  
Total Artificial Heart ◽  
Orthotopic Heart Transplantation ◽  
Bridge To Transplant ◽  
Pictorial Review

Heart failure is a serious cause of morbidity and mortality with many patients ultimately requiring heart transplantation. As the rate of heart failure continues to increase and surpass the number of available donor hearts, the need for cardiac assist devices is rapidly rising. The total artificial heart has emerged as an effective therapeutic option in patients with end-stage biventricular heart failure who are awaiting orthotopic heart transplantation. The TAH replaces the patient’s native ventricle and valves and has one of the highest bridge to transplant rates. Many complications have been associated with the TAH including infections, bleeding, thrombosis, device malfunction, neurological complications among others. CT is the imaging modality of choice that aids in early recognition of TAH complications. The aim of this review is to illustrate the TAH components and CT based imaging of TAH complications. Recognition of TAH complications can help to plan for early intervention and therefore improve patient’s survival.

scholarly journals Pediatric Palliative Care in the Heart Failure, Ventricular Assist Device and Transplant Populations: Supporting Patients, Families and Their Clinical Teams

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 468
Author(s):  
Kyle D. Hope ◽  
Priya N. Bhat ◽  
William J. Dreyer ◽  
Barbara A. Elias ◽  
Jaime L. Jump ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Heart Transplantation ◽  
Ventricular Assist Device ◽  
Mechanical Circulatory Support ◽  
Pediatric Palliative Care ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Patients With Heart Failure

Heart failure is a life-changing diagnosis for a child and their family. Pediatric patients with heart failure experience significant morbidity and frequent hospitalizations, and many require advanced therapies such as mechanical circulatory support and/or heart transplantation. Pediatric palliative care is an integral resource for the care of patients with heart failure along its continuum. This includes support during the grief of a new diagnosis in a child critically ill with decompensated heart failure, discussion of goals of care and the complexities of mechanical circulatory support, the pensive wait for heart transplantation, and symptom management and psychosocial support throughout the journey. In this article, we discuss the scope of pediatric palliative care in the realm of pediatric heart failure, ventricular assist device (VAD) support, and heart transplantation. We review the limited, albeit growing, literature in this field, with an added focus on difficult conversation and decision support surrounding re-transplantation, HF in young adults with congenital heart disease, the possibility of destination therapy VAD, and the grimmest decision of VAD de-activation.

Surgical methods of treatment of chronic heart failure and their place in modern clinical recommendations

2020 ◽  
Vol 22 (4) ◽  
pp. 183-191
Author(s):  
O. T. Kotsoeva ◽  
A. V. Koltsov ◽  
V. V. Tyrenko ◽  
A. A. Ialovets
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Surgical Methods ◽  
The Moment

This review discusses a number of aspects of surgical methods for treating severe chronic heart failure: resynchronizing therapy, mechanical circulatory support systems, and heart transplantation. Surgical methods for the treatment of heart failure are a rapidly developing field of modern cardiology and cardiac surgery. The main surgical method of treatment was and remains orthotopic transplantation of a donor heart. The advent of implantable systems has affected the problem of heart transplantation. Over the past decade, the use of mechanical circulatory support systems has grown significantly. At the moment, there are 3 main directions: creating devices for auxiliary blood circulation, various modes and methods of electrical stimulation of the myocardium, creating devices that mechanically remodel the heart chambers (left ventricle). All of these directions to some extent (depending on the evidence base) have found their place in modern recommendations for the treatment of chronic heart failure. The use of mechanical left ventricular remodeling shows good results in patients suffering from symptomatic heart failure, which leads to a significant and persistent decrease in the volume of the left ventricle and improvement of its function, symptoms and quality of life. Despite the fact that at the moment the geography and prevalence of their use is small, the number of implanted devices will only grow. Thus, given the need for frequent hospitalizations and high treatment costs, it is necessary to improve modern methods of surgical treatment of severe and terminal heart failure, make them more accessible, which will affect the duration and quality of life of these patients.

Total 12-Lead QRS Voltage in Patients Having Orthotopic Heart Transplantation for Heart Failure Caused by Adriamycin-Induced Cardiomyopathy

Cardiology ◽  
2018 ◽  
Vol 141 (3) ◽  
pp. 172-175 ◽  
Author(s):  
William C. Roberts ◽  
Sarah Haque ◽  
Shelley A. Hall
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Cardiac Amyloidosis ◽  
Cardiac Sarcoidosis ◽  
Medical Center ◽  
Severe Heart Failure ◽  
Orthotopic Heart Transplantation ◽  
S Wave ◽  
Baylor University ◽  
Before And After

Objective: Although several studies have described the effects of adriamycin on the heart, electrocardiographic total 12-lead QRS voltage (distance in millimeters from the peak of the R wave to the nadir of either the Q or S wave, whichever was deeper, with 10 mm [1 mV] being standard) both before and after orthotopic heart transplantation (OHT) has not been reported. This study describes the total 12-lead QRS voltage in 8 patients studied at Baylor University Medical Center at Dallas, from 1994 to June 2018, who underwent OHT for severe heart failure caused by anthracycline-induced cardiomyopathy. Method: Prior to OHT, the total 12-lead non-paced QRS voltages ranged from 86 to 189 mm (mean 125 ± 56) and for paced QRS voltages from 82 to 113 mm (mean 97 ± 15). The total 12-lead QRS voltages post-OHT ranged from 100 to 190 mm (mean 130 ± 30). Total 12-lead QRS voltages were lower in patients with a pacemaker than without. Results/Conclusion: These low voltages are like those found in patients with carcinoid syndrome, severe cardiac adiposity, cardiac amyloidosis, and cardiac sarcoidosis.

scholarly journals Value of SERCA2a as a Biomarker for the Identification of Patients with Heart Failure Requiring Circulatory Support

2021 ◽  
Vol 11 (11) ◽  
pp. 1122
Author(s):  
Meryem Ezzitouny ◽  
Esther Roselló-Lletí ◽  
Manuel Portolés ◽  
Ignacio Sánchez-Lázaro ◽  
Miguel Ángel Arnau-Vives ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sarcoplasmic Reticulum ◽  
Heart Transplantation ◽  
Predictive Value ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Bridge To Recovery ◽  
Blood Samples ◽  
Cytoplasmic Transport ◽  
Patients With Heart Failure

Background: Heart failure (HF) alters the nucleo-cytoplasmic transport of cardiomyocytes and reduces SERCA2a levels, essential for intracellular calcium homeostasis. We consider in this study whether the molecules involved in these processes can differentiate those patients with advanced HF and the need for mechanical circulatory support (MCS) as a bridge to recovery or urgent heart transplantation from those who are clinically stable and who are transplanted in an elective code. Material and method: Blood samples from 29 patients with advanced HF were analysed by ELISA, and the plasma levels of Importin5, Nucleoporin153 kDa, RanGTPase-Activating Protein 1 and sarcoplasmic reticulum Ca2+ ATPase were compared between patients requiring MCS and those patients without a MCS need prior to heart transplantation. Results: SERCA2a showed significantly lower levels in patients who had MCS compared to those who did not require it (0.501 ± 0.530 ng/mL vs. 1.123 ± 0.661 ng/mL; p = 0.01). A SERCA2a cut-off point of 0.84 ng/mL (AUC 0.812 ± 0.085, 95% CI: 0.646–0.979; p = 0.004) provided a 92% sensitivity, 62% specificity, 91% negative predictive value and 67% positive predictive value. Conclusions: In this cohort, patients with advanced HF and a need for MCS have shown significantly lower levels of SERCA2a as compared to stable patients without a need for MCS prior to heart transplantation. This is a small study with preliminary findings, and larger-powered dedicated studies are required to confirm and validate these results.

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