scholarly journals A 6-YEAR EXPERIENCE OF HEART TRANSPLANTATION IN FEDERAL ALMAZOV NORTH-WEST MEDICAL RESEARCH CENTRE

2017 ◽  
Vol 18 (4) ◽  
pp. 33-42 ◽  
Author(s):  
E. V. Shlyakhto ◽  
M. L. Gordeev ◽  
M. A. Karpenko ◽  
G. V. Nikolaev ◽  
A. S. Gnevashev ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Medical Research ◽  
Heart Transplant ◽  
Graft Loss ◽  
Research Centre ◽  
Tricuspid Valve Repair ◽  
North West ◽  
Transplant Candidates ◽  
Batista Procedure ◽  
High Level

Aim. To estimate the results of 6-year experience of heart transplantation (HT) in Federal Almazov North-West Medical Research Centre. Methods. From 2010 to 2015 we have performed 65 HT. Mean age was 44.3 ± 14 years old (from 10 to 64 years old). We used biventricular assist device (BIVAD, Berlin Heart Excor) support in 7 heart transplant candidates before HT. 19 patients (29%) received thymoglobulin, whereas 46 patients (71%) had basiliximab to induce immunosuppression.Results.Extracorporeal membrane oxygenation machines were implanted in 5 patients (7.7%) after HT due to acute right ventricular failure. Suture annuloplasty (the Batista procedure) for tricuspid valve repair was carried out in 3 cases (4.6%). Venovenous hemodiafi ltration was used in 11 patients (16.9%). A total of 598 endomyocardial biopsies (EMB) were performed after HT. Evidence of cellular rejection (R1 and R2) was presented in 286 biopsies (48%). The 30-day in-hospital mortality rate was 3.1%. The 6-month survival rate after HT was 92%, 1-year – 91% and overall survival for the 6-year period of observation – 89.2%. Maximum observation period was 71 months.Conclusions.The 6-year experience of HT in our Center has shown a high level of survival. BIVAD Excor support can be effectively used as a «bridge» to HT. Prevention of graft loss due to acute rejection in heart transplant recipients can be achieved only through regular EMB monitoring. The rate of viral infection increased in 2 months after HT.

scholarly journals Involvement in Health Behavior After Heart Transplantation: The Role of Personal Resources and Health Status. Single-Center Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna Mierzyńska ◽  
Andrzej Kokoszka ◽  
Grażyna Jerzak-Wodzyńska ◽  
Małgorzata Sobieszczańska-Małek ◽  
Tomasz Zieliński ◽  
...  
Keyword(s):  
Health Status ◽  
Locus Of Control ◽  
Health Behavior ◽  
Heart Transplantation ◽  
Personality Traits ◽  
Heart Transplant ◽  
Self Efficacy ◽  
Health Locus Of Control ◽  
Transplant Patients ◽  
High Level

Introduction: Heart transplantation affects all spheres of the patients’ functioning - their physical well-being and coping with everyday situations, as well as their identity and social functioning. Its long-term effects depend on the effective cooperation with the transplant team. Post-transplant patients are expected to be committed to adherence to recommendations. Patients’ subjective characteristics could increase the risk of difficulties during treatment or might have a protective effect. The major aim of the study was to evaluate the level of engagement in health behavior in heart transplant recipients in relation to their personal resources, such as personality traits, and their health status.Material and Method: The observational ex post facto model was proposed. Participants completed a set of psychological questionnaires. In the study, there were used questionnaires regarding health behavior (HBI), personality traits (NEO-FFI), health locus of control (MHLC), self-efficacy (GSES) and health status (GHQ-28). The group included in the analyses consisted of 107 heart transplant patients. They ranged in age from 19 to 75 years; 10.3% of them were women.Results: According to norms, 71% patients reported high level of engagement in health behavior. There were significant differences in the level of dietary habits and other types of health behaviors. The best predictors of overall health behavior were conscientiousness (β = 0.20, p < 0.05) and health locus of control (Powerful Others) (β = 0.25, p < 0.05). The prophylaxis behavior was related significantly to the level of conscientiousness (p < 0.05) and health locus of control (Internal and Powerful Others) (p < 0.05; p < 0.01). The level of positive mental attitude was related significantly to agreeableness (p < 0.05), health locus of control (Powerful Others) (p < 0.01), and self-efficacy (p < 0.01). Everyday healthy practices were related significantly to openness to experience (p < 0.01) and health locus of control (all categories: Internal, Powerful Others and Chance) (p < 0.05; p < 0.01; p < 0.05, respectively).Conclusion: Majority of heart transplant patients is engaged in high level of health behavior. Among the various forms of health-relevant habits, heart transplant patients adhere significantly less frequently to a healthy diet. Among examined resources, the best predictors of caring about health are generalized self-efficacy and age at the time of HTx.

scholarly journals 1390. A Novel Application of the Interferon-Gamma Release Assay (IGRA) Among End-Stage Heart Failure Patients Awaiting Heart Transplantation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S505-S505
Author(s):  
Ming-Jui Tsai ◽  
Aristine Cheng ◽  
Hsin-Yun Sun ◽  
Yih-Sharng Chen ◽  
Nai-Kuan Chou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Interferon Gamma ◽  
Heart Transplant ◽  
Interferon Γ ◽  
Positive Control ◽  
Cell Mediated Immunity ◽  
Release Assay ◽  
Transplant Candidates ◽  
Overall Mortality

Abstract Background The optimal approach to assay the immune status in heart failure is challenging because of the inherent complexity of chronic inflammation. Interferon-gamma release assays (IGRAs) measure an aspect of cell-mediated immunity encompassing both the innate and adaptive immunity. In this study, we evaluated the utility of a commercial IGRA for predicting mortality and infectious complications among heart transplant candidates. Methods This prospective cohort study was conducted between August 1, 2014 and January 31, 2019 at a medical center in Taiwan. All heart transplant candidates received an IGRA (QuantiFERON®-TB Gold In-Tube, QFT-GIT) at baseline as part of the initiative to screen for latent tuberculosis. Impaired cell-mediated immunity was defined as the release of <1 IU/mL of interferon-γ (IFN-γ) in response to the common mitogen in the positive control tube.The patients were then followed until death or January 31, 2019. Results A total of 102 patients were enrolled; of whom, 23 (22.5%) had impaired cell-mediated immunity at baseline. During the study period with a median follow-up of 1.90 years (IQR 1.17–3.56), 23 (22.5%) patients died and 45 (44.1%) patients developed an infectious complication. Overall mortality was significantly greater among those with impaired cell-mediated immunity [39.1% (9/23) vs. 17.7% (14/79), P = 0.031]. A trend toward higher rates of infection was observed among impaired cell-mediated immunity group [60.9% (14/23) vs. 39.2% (31/79), P = 0.066]. The most common cause of death was infection (56.5%). No patient developed active tuberculosis during the study and the most common infection was bacteremia (35.6%). In the age-adjusted multivariate analysis, impaired cell-mediated immunity was an independent predictor of mortality (HR 2.87, CI 1.23–6.68, P = 0.014) and subsequent infectious event (HR 3.00, CI 1.56–5.76, P = 0.001). Conclusion An interferon-γ release assay utilizing the positive control tube of the QuantiFERON®-TB Gold In-Tube kit was predictive of overall mortality and infections among patients with advanced heart failure awaiting heart transplantation. Disclosures All authors: No reported disclosures.

scholarly journals On the possibility to increase sensitivity of diagnostic tests for fixed pulmonary hypertension in heart transplant candidates

2019 ◽  
Vol 47 (3) ◽  
pp. 212-220 ◽  
Author(s):  
M. A. Bortsova ◽  
A. E. Bautin ◽  
A. S. Yakovlev ◽  
P. A. Fedotov ◽  
Yu. V. Sazonova ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
False Negative ◽  
Waiting List ◽  
Heart Catheterization ◽  
Manuscript Submission ◽  
Right Heart ◽  
Transplant Candidates

Background: Fixed pulmonary hypertension (PH) in heart transplant candidates is a risk factor for right ventricular failure in the postoperative period and early mortality. Patients with fixed PH are not included in the waiting list. Thus, the correct assessment of the pulmonary circulation before the operation affects both clinical management and prognosis. Aim: To reduce the risk of incorrect patient non-inclusion to the waiting list by reduction of false negative test results for PH reversibility.Materials and methods: Fourteen heart transplant candidates were included in this retrospective cohort single center study. Fixed PH with pulmonary vascular resistance (PVR) exceeding 3.5 Wood's units was found in all these patients using right heart catheterization and pulmonary vasoreactivity tests. Initially, these patients had not been put into the waiting list. Pulmonary catheterization was performed in the intensive care unit with a Swan-Ganz catheter and pre-pulmonary thermodilution technique. To perform pulmonary vasoreactivity tests, inhaled iloprost (n = 12) or nitric oxide (n = 2) were used. Subsequently all patients received levosimendan infusion at a dose of 12.5 (0.05–0.2) mg/kg/min, with repeated pulmonary artery catheterization and pulmonary vasoreactivity tests at 72 hours after the infusion. Pulmonary vasoreactivity tests results allowed 13 patients to be included into the waiting list. Heart transplantation was performed in 8 recipients, with postoperative assessment of their hemodynamic and clinical parameters. Data are presented as median [25th percentile; 75th percentile].Results: After the levosimendan infusion, there was a decrease in the pulmonary artery mean pressure from 45 [36; 47] to 29.5 [23; 37] mm Hg (p < 0.01), and in PVR from 6.9 [4.9; 8.9] to 3.6 [2.9; 5.9] Wood's units (p <0.01). In 7 patients, PVR decreased to less than 3.5 Wood's units: the rest of the patients underwent pulmonary vasoreactivity tests. As a result, 13 of 14 patients showed reversible PH and were included into the waiting list. By the date of the manuscript submission, heart transplantation has been performed in 8 patients. Their PVR 6 hours after surgery was 2.2 [2; 3.1] Wood's units; there were no cases of fixed PH and right heart failure. There was a single death associated to a hemorrhagic stroke at day 6 after heart transplantation. The sensitivity of pre-operative pulmonary vasoreactivity tests with the use of levosimendan was 87.5%.Conclusion: Levosimendan infusion may increase the sensitivity of the pulmonary vasoreactivity tests before patients' inclusion into the waiting list for heart transplantation.

scholarly journals THE EXPERIENCE OF PEDIATRIC HEART TRANSPLANTATION ON NORTH-WEST OF RUSSIAN FEDERATION

2018 ◽  
Vol 20 (2) ◽  
pp. 37-46 ◽  
Author(s):  
M. A. Simonenko ◽  
T. M. Pervunina ◽  
P. A. Fedotov ◽  
Yu. V. Sazonova ◽  
E. S. Vasichkina ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Clinical Signs ◽  
Calcineurin Inhibitors ◽  
Research Centre ◽  
North West ◽  
Bridge To Transplant ◽  
National Medical ◽  
Long Term Follow Up ◽  
Pediatric Heart Transplantation

Aim:to estimate early and long-term outcomes in recipients under 18 years old who have been heart transplanted in Almazov National Medical Research Centre.Materials and methods. From April 2011 to September 2017 we performed 5 heart transplantations (HTx) in recipients under 18 years old (female) old) from adults donors. The median of age were 15 years (range 10–16 years), LVEF prior HTx – 17% (10–33%). Causes of heart failure were dilated cardiomyopathy (n = 2), non-compacted myocardium (n = 1), arrhythmogenic ventricular dysplasia (n = 1) and Ebstein’s anomaly (n = 1). They spent in HT waiting list 76 days (12–684 days). One patient underwent biventricular assist device Berlin Heart EXCOR implantation (days on support – 250) as a «bridge» to transplant. Due to coronary angiography (CAG) results 1 patient underwent HTx and CABG simultaneously. All recipients treated by triple-drug therapy (steroids, calcineurin inhibitors, mycophenolate mofetil), induction (thymoglobulin – n = 4, basiliximab – n = 1). We evaluated retrospectively laboratory-instrumental investigations and frequency of complications after HTx.Results.The median of survival after HT was 35,93 months (4,4–73,7 months), all of them are alive. Patients spent in ICU 12 days (4–18 days), but one – 18 days due to posterior reversible encephalopathy syndrome (PRES), tacrolimus was switched to cyclosporine. They required inotropic support during 3 days (3–8 days). In 1 yr after HT TTE results got to normal values, the same as VO2peak signifi cantly improved. According to EMB (n = 48) results there were no clinical signs of rejection, acute cellular rejection (R2) was diagnosed in 12,5% cases. In long-term follow-up there was no signifi cant post transplant complications and comorbidities.Conclusion.Pediatric heart transplantation is an effective treatment of terminal CHF. There was no signifi cant clinical rejection under combined immunosuppressive regimens. All patients recovered and went back to normal life. Physical capacity improved in all recipients. 

Using the Theory of Planned Behavior to Explore Pediatric Heart Transplant Recipients’ Dietary Behavior

2018 ◽  
Vol 25 (2) ◽  
pp. 43-52
Author(s):  
Jo Wray ◽  
Claire Orrells ◽  
Helen Latch ◽  
Michael Burch
Keyword(s):  
Theory Of Planned Behavior ◽  
Heart Transplantation ◽  
Planned Behavior ◽  
Vegetable Consumption ◽  
Graft Loss ◽  
Dietary Behaviors ◽  
Food Groups ◽  
Tpb Model ◽  
Eating Fruit ◽  
End Stage

Abstract. Heart transplantation is the treatment of choice for children with end-stage heart disease. Coronary artery vasculopathy is, however, a significant morbidity and leading cause of late graft loss, and hyperlipidemia a risk factor for its development. Improving diet in this population could have important benefits for patients. We wanted to understand what influences decisions about food intake in this patient group. Dietary intentions and behavior were examined using a questionnaire based on the Theory of Planned Behavior (TPB) with 67 children who had undergone heart transplantation at least 12 months previously. The TPB model was significant for both healthy and unhealthy dietary behaviors, explaining 55% and 38% of the variance, respectively. Ten percent of children reported not eating any fruit and/or vegetables in the previous week and only 29% reported eating fruit and/or vegetables every day. The Theory of Planned Behavior provides a framework for explaining some specific dietary behaviors related to individual food groups in children who have undergone heart transplantation. These preliminary data support using this approach to inform the development of interventions to improve fruit and vegetable consumption but the approach may be less useful for explaining and developing interventions to reduce the consumption of unhealthy foods.

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