Immunosuppressive Drugs in Heart Transplantation

2019 ◽  
pp. 83-147
Author(s):  
Sule Apikoglu-Rabus ◽  
Murat B. Rabus ◽  
Rashida Muhammad Umar
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Adverse Effects ◽  
Heart Transplantation ◽  
Chronic Rejection ◽  
Cardiac Transplantation ◽  
Immunosuppressive Drugs ◽  
Life Threatening ◽  
End Stage

Congestive heart failure affects 23 million people worldwide [1]. Cardiac transplantation provides a lifesaving treatment for patients with end-stage heart disease. It offers a longer life with a higher quality to those who have no other treatment alternative. Although cardiac transplantation offers a relief from heart immunosuppression. The goal of immunosuppression immediately following surgery is to prevent hyperacute and acute rejections. Transplantation immunosuppression must be balanced in order to prevent rejection while minimizing the serious adverse effects of therapy including life-threatening infections and malignancies. Immunosuppressive regimens are classified as induction, maintenance, or anti-rejection regimens. Induction regimens consist of intense early post-operative immunosuppression while maintenance regimens are used indefinitely for prevention of acute and chronic rejection. This chapter will review the induction and maintenance immunosuppressive regimens used in heart transplantation with summaries of selected literature as well as the most common complications of these therapies and significant drug-drug interactions.

A contemporary review of paediatric heart transplantation and mechanical circulatory support

2016 ◽  
Vol 26 (5) ◽  
pp. 851-859 ◽  
Author(s):  
Steven J. Kindel ◽  
Melanie D. Everitt
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Fontan Patient ◽  
Number Of Children ◽  
Acquired Heart Disease ◽  
Number Of Publications ◽  
End Stage

AbstractImprovements in the care of children with cardiomyopathy, CHDs, and acquired heart disease have led to an increased number of children surviving with advanced heart failure. In addition, the advent of more durable mechanical circulatory support options in children has changed the outcome for many patients who otherwise would have succumbed while waiting for heart transplantation. As a result, more children with end-stage heart failure are being referred for heart transplantation, and there is increased demand for a limited donor organ supply. A review of important publications in the recent years related to paediatric heart failure, transplantation, and mechanical circulatory support show a trend towards pushing the limits of the current therapies to address the needs of this growing population. There have been a number of publications focussing on previously published risk factors perceived as barriers to successful heart transplantation, including elevated pulmonary vascular resistance, medication non-adherence, re-transplantation, transplantation of the failed Fontan patient, and transplantation in an infant or child bridged with mechanical circulatory support. This review will highlight some of these key articles from the last 3 years and describe recent advances in the understanding, diagnosis, and management of children with end-stage heart disease.

scholarly journals Postoperative Care of Two Patients With End-stage Heart Disease Combined With Type a Aortic Dissection

2021 ◽  
Author(s):  
Xiaofeng Xu ◽  
Yunqing Cheng ◽  
Juntao Kuang ◽  
Xuejun Xie ◽  
Jinsong Huang ◽  
...  
Keyword(s):  
Heart Disease ◽  
Aortic Dissection ◽  
Heart Transplantation ◽  
Type A ◽  
Acute Type ◽  
Donor Heart ◽  
Timely Manner ◽  
Type A Aortic Dissection ◽  
Life Threatening ◽  
End Stage

Abstract BackgroundHeart transplantation is a major method in the treatment of end-stage heart disease. Acute type A aortic dissection is a rare and life-threatening disease requiring emergency surgery. Although surgical treatment has achieved certain progress in terms of techniques and equipment in the recent years, the surgical mortality rate is still as high as 25%. It is very rare for patients with end-stage heart disease to simultaneously contract aortic dissection. This study will explore the main points of care after end-stage heart disease combined with aortic dissection.ResultsThe cold ischemic times of the donor heart of the two patients were 340 min and 361 min, and the cardiopulmonary bypass times were 381 min and 411 min. Both were successfully operated and discharged uneventfully. ConclusionsThe combination of heart transplantation with aortic dissection surgery is complicated and is prone to multiple postoperative complications. The nursing staff is required to master the main points of care after heart transplantation and aortic dissection, observe problems in a timely manner, intervene early, and promote the patient’s recovery.

scholarly journals Postoperative pericardial effusion: peculiarities of the development and course

2021 ◽  
Vol 23 (1) ◽  
pp. 131-139
Author(s):  
K. S. Kiriakov ◽  
V. M. Zakharevich ◽  
T. A. Khalilulin ◽  
N. Y. Zakharevich ◽  
N. N. Abramova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Pericardial Effusion ◽  
Heart Transplantation ◽  
Gold Standard ◽  
Standard Treatment ◽  
Life Threatening ◽  
End Stage

Heart transplantation continues to be the gold standard treatment for end-stage chronic heart failure. As with any cardiac surgery, heart transplantation is associated with postoperative complications. One of the most common complications is postoperative pericardial effusion. Heart recipients have a greater risk of developing pericardial effusion than patients after cardiac surgery on their own heart, due to surgical and immunological features. Severe pericardial effusions negatively affect the postoperative period and may be the cause of life-threatening conditions. Identification of risk factors, prevention, early diagnosis and treatment of this disease can significantly reduce the risks of adverse events in this group of patients. The purpose of this literature review is to analyze the development and course of pericardial effusion in heart recipients in world practice.

Support/Transplantation

ESC CardioMed ◽  
2018 ◽  
pp. 788-790
Author(s):  
Michael Burch ◽  
Dilveer Panesar
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Heart Transplantation ◽  
Congenital Heart ◽  
Therapeutic Option ◽  
Blood Transfusions ◽  
End Stage

Heart transplantation is the only realistic therapeutic option for children with end-stage heart disease. Unlike in adults, ischaemic heart failure is rare and most paediatric transplant referrals are for cardiomyopathy and the rest for congenital heart disease. Patients with congenital heart disease pose difficulties in terms of their anatomy and the chronicity of the illness, often having had multiple surgeries and blood transfusions prior to transplantation.

scholarly journals THE USE OF MELD SCORE (MODEL FOR END-STAGE LIVER DISEASE) AND DERIVATIVES IN CARDIAC TRANSPLANTATION

2018 ◽  
Vol 31 (2) ◽  
Author(s):  
Ana Claudia Oliveira de MORAES ◽  
Olival Cirilo Lucena da FONSECA-NETO
Keyword(s):  
Heart Failure ◽  
Liver Disease ◽  
Heart Transplantation ◽  
Cardiac Transplantation ◽  
Meld Score ◽  
Patients With Heart Failure ◽  
Cirrhotic Patients ◽  
End Stage Heart Failure ◽  
Score Model ◽  
End Stage

ABSTRACT Introduction: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. Objective: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. Method: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors “heart transplantation”, “liver disease” and “prognosis”. From the total of 111 articles found, six were selected and composed the sample. Results: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. Conclusion: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.

Anesthesia for Cardiac Transplantation

2019 ◽  
pp. 244-257
Author(s):  
Stefan Lombaard ◽  
Heather Reed ◽  
Samantha Arzillo
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Cardiac Transplantation ◽  
Treatment Options ◽  
Definitive Therapy ◽  
Patients With Heart Failure ◽  
End Stage Heart Failure ◽  
End Stage ◽  
Induction Agents

Heart transplantation is indicated when other treatment options for patients with heart failure are no longer effective or when a heart transplant would improve survival. There are currently a variety of treatment options for these patients; the options range from medical therapy to full mechanical support. Heart transplantation remains the definitive therapy for end-stage heart failure. This discussion focuses on the management of a patient who presents for a heart transplant as well as some of the challenging clinical issues that may present during this period. Anesthetic induction agents may depress cardiovascular function and result in cardiovascular collapse. Drugs should be chosen that have limited hemodynamic effects.

scholarly journals Clinical use of percutaneous mechanical circulatory assistance in a patient with end-stage right-sided heart failure and massive tricuspid insufficiency due to congenital heart disease: first-in-the-world case report

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Mario García Gómez ◽  
Aitor Uribarri ◽  
José Alberto San Román Calvar ◽  
Alexander Stepanenko
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Right Ventricle ◽  
Heart Transplantation ◽  
Right Ventricular ◽  
Congenital Heart ◽  
Ebstein’S Anomaly ◽  
Exclusion Criteria ◽  
End Stage

Abstract Background Due to improvement in the management of patients with congenital heart disease (CHD), the likelihood of their survival to adulthood is increasing. A relevant population suffers end-stage right ventricular failure (RVF) in their 3rd–4th decade of life. Hence, heart transplantation is still gold standard of treatment of end-stage heart failure, mechanical circulatory assistance has become a valuable tool in the bridging to heart transplant or definitive therapy. Use of implantable short-term or long-term devices is reported by others. However, within this clinical context, presence of significant tricuspid regurgitation (TR) or CHD is used as exclusion criteria for insertion of a percutaneous right ventricular circulatory support. Case summary We described a 36-year-old patient diagnosed with Ebstein's anomaly and severe TR who is admitted to hospital due to RVF refractory to standard medical treatment. After case presentation to the heart team, an Impella RP device insertion was scheduled, in spite of the presence of TR or CHD after evaluation of pulmonary valve competency and 3D reconstruction with virtual device implantation. During support, the patient improved clinically and haemodynamically. Due to device displacement to the right ventricle, it was bedside explanted after 30 days of support. After mechanical unloading during 30 days patients’ right ventricle recovered partially, permitting patient to improve his functional class. Discussion Although TR and CHD are exclusion criteria for the implantation of the Impella RP device, we report clinical experience in patient with Ebstein's anomaly and severe TR supported with percutaneous device as bridge to heart transplantation during 30 days.

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