scholarly journals Revisiting the transplantation of donor heart with left ventricular myocardial hypertrophy

2020 ◽  
Vol 12 (1) ◽  
pp. 42-48
Author(s):  
M. A. Popov ◽  
D. V. Shumakov ◽  
D. I. Zybin ◽  
E. G. Agafonov
Keyword(s):  
Myocardial Hypertrophy ◽  
Left Ventricular ◽  
Long Term Results ◽  
Circulatory Support ◽  
Heart Transplants ◽  
Donor Pool ◽  
Number Of Patients ◽  
Optimal Drug ◽  
Expanded Criteria ◽  
End Stage

Despite the widespread use of mechanical circulatory support systems, modern optimal drug therapy and various interventional methods of heart transplantation remain the "gold standard" for the treatment of end-stage heart failure patients.At the same time the required number of heart transplants is significantly increasing due to the progressively increasing number of patients needing transplants and the actual donor pool. In recent years there has been a trend towards the increase in the number of recipients and the decrease in the number of donor organs. However, the use of donor hearts with pathological changes, including left ventricular myocardial hypertrophy, remains a controversial topic. It is believed that the use of expanded criteria significantly increases the risk of graft failure in the post-transplant period and leads to deterioration of immediate and long-term results. This work aimed to analyze the data on using donor hearts with left ventricular myocardial hypertrophy for allotransplantation.Authors declare no conflict of interest.

scholarly journals Organizational, medical and epidemiological prerequisites for reviewing donor criteria in heart transplantation

2020 ◽  
Vol 22 (3) ◽  
pp. 43-52
Author(s):  
E. A. Tenchurina ◽  
M. G. Minina
Keyword(s):  
Heart Transplantation ◽  
Epidemiological Data ◽  
Heart Transplants ◽  
Donor Pool ◽  
Practice Characteristics ◽  
Expanded Criteria ◽  
Total Pool ◽  
End Stage ◽  
Donor Criteria ◽  
Epidemiological Characteristics

Organ donation and transplantation in Moscow have witnessed changes in the last decade. These changes have led not only to quantitative growth in the number of effective donors but also to fundamentally new (for Russian medical practice) characteristics of the donor pool. As a result, the selection criteria for organ donors have undergone some radical revisions. Objective: to analyze the medical and epidemiological characteristics of the pool of effective heart donors and assess their impact on selection of heart transplants. Materials and methods. In our study, we used the medical and epidemiological data of 650 brain-dead donors whose organs were procured from January 1, 2012 to December 31, 2017. Results. During the study period, the number of effective heart donors in Moscow increased from 4.4 (2012) to 11.2 (2017) per million population per year. The medical and epidemiological characteristics of the total pool of donors and the pool of heart donors underwent major changes. Among effective heart donors, there was a dynamic increase in the average age from 38.4 to 47 years, predominance of a proportion of donors with stroke 38.2 (2012) vs 83.2 (2017) and, accordingly, an increase in the frequency of such comorbid conditions, as hypertension and diabetes. Conclusion. The results presented in the study indicate a growing practice of working with expanded criteria donors. This practice is most effectively developed in the field of heart transplantation than in transplantation of other extrarenal organs. Undoubtedly, the experience under study is unique and relevant not only for the Russian Federation, but also for the world of transplantology, as it allows to provide vital assistance to patients with end-stage heart failure within a reasonable timeframe.

Beta blocker therapy in recipients of twin-to-twin transfusion syndrome

2018 ◽  
Vol 104 (5) ◽  
pp. F541-F543
Author(s):  
Kerstin Gruendler ◽  
Christoph E Schwarz ◽  
Laila Lorenz ◽  
Christian F Poets ◽  
Axel R Franz
Keyword(s):  
Cardiac Output ◽  
Beta Blocker ◽  
Left Ventricular Outflow Tract ◽  
Myocardial Hypertrophy ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Circulatory Support ◽  
Low Cardiac Output ◽  
Left Ventricular Outflow

Recipients of severe twin-to-twin transfusion syndrome (TTTS) may suffer from low cardiac output caused by myocardial hypertrophy and sudden postnatal drop in preload. Our hypothesis was that selective beta-1 adrenergic blockers improve cardiac function in TTTS recipients with left ventricular outflow tract obstruction. We analysed data from two TTTS recipients treated with esmolol/metoprolol. Despite intense circulatory support, both patients showed severe hypotension and tachycardia before therapy. Echocardiographic findings included hypertrophic ventricles with thickened intraventricular septum, reduced aortic valve velocity time integral (AV-VTI), left ventricular outflow tract obstruction and collapsing ventricles in systole. Beta blocker improved blood pressure as well as AV-VTI, which served as a surrogate parameter for left ventricular stroke volume, reduced heart rate and need for circulatory support. In conclusion, beta blockade may improve left ventricular function in TTTS recipients with low cardiac output due to myocardial hypertrophy.

Nutrition Management in Mechanical Circulatory Support

2019 ◽  
Author(s):  
Dane A Coyne ◽  
Mitali P Shah ◽  
Kris M Mogensen ◽  
John C Klick
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Nutritional Support ◽  
Mechanical Circulatory Support ◽  
Disease Process ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Number Of Patients ◽  
End Stage Heart Failure ◽  
End Stage

Heart failure is a devastating progressive disease process that is rising in incidence throughout the world. For patients with end-stage heart failure, orthotopic heart transplantation had been the only therapeutic option. Unfortunately, the number of patients requiring such therapy far exceeds the number of available organs. Recent advancements in technology have made implantable cardiac assist devices a reality. Outcomes with these devices are superior to maximal medical therapy and may serve either as a bridge to the availability of a donor organ or as “destination” therapy for the patient with end-stage heart failure. In addition, new technology can also provide temporary mechanical support for patients with acute decompensated cardiogenic shock, allowing preservation of end-organ function until more definitive long-term mechanical support can be coordinated. Patients with end-stage heart failure experience unique nutritional challenges. Mechanical circulatory support adds yet another unique dimension to the nutritional support challenges of this patient population. This review contains 2 figures, 5 tables, and 29 references. Key words: cardiogenic shock, enteral nutrition, extracorporeal membrane oxygenation, heart failure, mechanical circulatory support, nutritional support, parenteral nutrition, ventricular assist device

Innovations in Ventricular Assist Devices for End-Stage Heart Failure

2019 ◽  
Vol 70 (1) ◽  
pp. 33-44 ◽  
Author(s):  
Robert J.H. Miller ◽  
Jeffrey J. Teuteberg ◽  
Sharon A. Hunt
Keyword(s):  
Heart Failure ◽  
Patient Management ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Number Of Patients ◽  
End Stage Heart Failure ◽  
End Stage

The number of patients with end-stage heart failure (HF) continues to increase over time, but there has been little change in the availability of organs for cardiac transplantation, intensifying the demand for left ventricular assist devices (LVADs) as a bridge to transplantation. There is also a growing number of patients with end-stage HF who are not transplant candidates but may be eligible for long-term support with an LVAD, known as destination therapy. Due to this increasing demand, LVAD technology has evolved, resulting in transformative improvements in outcomes. Additionally, with growing clinical experience patient management continues to be refined, leading to iterative improvements in outcomes. With outcomes continuing to improve, the potential benefit from LVAD therapy is being considered for patients earlier in their course of advanced HF. We review recent changes in technology, patient management, and implant decision making in LVAD therapy.

scholarly journals Correlations of myocardial bridges with left ventricle myocardial hypertrophy and prepontin coronary atherosclerosis

2021 ◽  
Vol 64 (5) ◽  
pp. 21-26
Author(s):  
Mihail Tasnic ◽  
◽  
Valeriu Revenco ◽  
Ilia Catereniuc ◽  
◽  
...  
Keyword(s):  
Left Ventricle ◽  
Coronary Atherosclerosis ◽  
Myocardial Hypertrophy ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Arterial Stenosis ◽  
Vascular Compression ◽  
Myocardial Bridges ◽  
Number Of Patients ◽  
Clinical Records

Background: Of particular interest are the studies researching the correlations of myocardial bridges with hypertrophic cardiomyopathy and correlations of thick myocardial bridges with the development of coronary atherosclerosis in the proximal to the bridge arterial part. Material and methods: Assessment of the correlation between myocardial bridges, coronary atherosclerosis, and the degree of hypertrophy of the left ventricle was performed by retrospective analysis of 6168 coronary angiography protocols (2012-2019) and echocardiographic data from patients’ clinical records. Results: Moderate systolic compression predominated, and the number of patients detected with severe under the bridge systolic coronary stenosis was double as in patients with nonsignificant coronary atherosclerosis. From the total number, patients with myocardial hypertrophy and myocardial bridges were twice less when compared with the patients with the normal myocardial thickness. The comparative research did not show any interdependence between the degree of vascular compression and the degree of left ventricular myocardial hypertrophy. Proximal to the bridges atherosclerosis was detected in 32% of cases without correlation with the force of the myocardial bridge. Conclusions: The study showed the absence of the correlation between the degree of arterial stenosis caused by the bridge and the degree of hypertrophy of the ventricular myocardium as well as the degree of proximal to the bridge atherosclerosis. Important finding was that the degree of coronary systolic compression is higher in patients with moderate and severe proximal to the bridge atherosclerosis.

scholarly journals Mortality and long-term outcomes of palliative inotropes in ischemic and non-ischemic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Tolia ◽  
M Khan ◽  
S Khan ◽  
D Alexander ◽  
M Soltys ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Ischemic Cardiomyopathy ◽  
Circulatory Support ◽  
Complication Rates ◽  
Number Of Patients ◽  
Significant Difference ◽  
History Of ◽  
End Stage Heart Failure ◽  
End Stage

Abstract Background Palliative inotropes are frequently utilized for symptom management in patients with end stage heart failure who are unable to undergo durable advanced heart failure therapies. With the advent of improved medical management and early intervention, palliative inotropes may allow for improved patient outcomes than seen previously. In this study, we aim to investigate the survival and outcomes of palliative inotrope therapy and its impacts on ischemic versus non-ischemic cardiomyopathy. Methods We retrospectively analyzed 220 patients with American Heart Association Stage D heart failure who were discharged with palliative inotrope therapy after January 1, 2010. Patients who underwent mechanical circulatory support (MCS) or those who underwent heart transplant were excluded. Those with a history of coronary artery disease, myocardial infarction, history of percutaneous intervention, or coronary artery bypass grafting were assigned to ischemic cardiomyopathy (ICM), while patients without these findings were assigned to non-ischemic cardiomyopathy (NICM). Statistical analysis was completed using Chi-Square and Student's t-tests, wherein p<0.05 was considered statistically significant. Results Of the 220 patients, 87 had NICM as opposed to 133 with ICM. Mean age was found to be higher among patients with ICM (70 [62–79]) compared to NICM (65 [55–72], p-value <0.01). No significant difference was seen in total days on inotrope therapy (p=0.6). While more patients in both groups were placed on milrinone as opposed to dobutamine, there was no difference between patients with ischemic and NICM (p=0.66 and 0.51 respectively). Although a greater number of patients with NICM had been lost to follow up, admitted to hospice, or expired at 2 years (p<0.01), survival at 3 months, 1 year, and 2 years showed no difference between both groups. No difference was seen in number of hospitalizations or clinic visits in one year. Both groups had similar complication rates with intravenous-access related PICC line infections and new arrhythmias. (See Table). Conclusion Despite more frequent use of durable mechanical support devices, many patients who are deemed unsuitable for invasive measures are treated with palliative inotrope therapy. We have found that there is no significant difference in survival, complications, and outcomes of patients on palliative inotropes among ischemic and NICM. These findings show the versatility of palliative inotrope therapy in end stage heart failure. Further studies with larger populations need to be evaluated. FUNDunding Acknowledgement Type of funding sources: None.

Ex vivo lung perfusion for donor lung assessment and repair: a review of translational interspecies models

2020 ◽  
Vol 319 (6) ◽  
pp. L932-L940
Author(s):  
Aizhou Wang ◽  
Aadil Ali ◽  
Shaf Keshavjee ◽  
Mingyao Liu ◽  
Marcelo Cypel
Keyword(s):  
Therapeutic Potential ◽  
Ex Vivo ◽  
Small Animal ◽  
Lung Perfusion ◽  
Contributing Factors ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Advantages And Disadvantages ◽  
Number Of Patients ◽  
End Stage

For patients with end-stage lung disease, lung transplantation is a lifesaving therapy. Currently however, the number of patients who require a transplant exceeds the number of donor lungs available. One of the contributing factors to this is the conservative mindset of physicians who are concerned about transplanting marginal lungs due to the potential risk of primary graft dysfunction. Ex vivo lung perfusion (EVLP) technology has allowed for the expansion of donor pool of organs by enabling assessment and reconditioning of these marginal grafts before transplant. Ongoing efforts to optimize the therapeutic potential of EVLP are underway. Researchers have adopted the use of different large and small animal models to generate translational preclinical data. This includes the use of rejected human lungs, pig lungs, and rat lungs. In this review, we summarize some of the key current literature studies relevant to each of the major EVLP model platforms and identify the advantages and disadvantages of each platform. The review aims to guide investigators in choosing an appropriate species model to suit their specific goals of study, and ultimately aid in translation of therapy to meet the growing needs of the patient population.

scholarly journals Outcomes of temporary mechanical circulatory support in cardiogenic shock due to end-stage heart failure

2021 ◽  
pp. 175114372098870
Author(s):  
Hoong Sern Lim ◽  
Aaron Ranasinghe ◽  
David Quinn ◽  
Colin Chue ◽  
Jorge Mascaro
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Organ Dysfunction ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Number Of Patients ◽  
Significant Difference ◽  
End Stage Heart Failure ◽  
Baseline Characteristics ◽  
End Stage

Background There are few reports of mechanical circulatory support (MCS) in patients with cardiogenic shock (CS) due to end-stage heart failure (ESHF). We evaluated our institutional MCS strategy and compared the outcomes of INTERMACS 1 and 2 patients with CS due to ESHF. Methods Retrospective analysis of prospectively collected data (November 2014 to July 2019) from a single centre. ESHF was defined by a diagnosis of HF prior to presentation with CS. Other causes of CS (eg: acute myocardial infarction) were excluded. We compared the clinical course, complications and 90-day survival of patients with CS due to ESHF in INTERMACS profile 1 and 2. Results We included 60 consecutive patients with CS due to ESHF Differences in baseline characteristics were consistent with the INTERMACS profiles. The duration of MCS was similar between INTERMACS 1 and 2 patients (14 (10–33) vs 15 (7–23) days, p = 0.439). There was no significant difference in the number of patients with complications that required intervention. Compared to INTERMACS 2, INTERMACS 1 patients had more organ dysfunction on support and significant lower 90-day survival (66% vs 34%, p = 0.016). Conclusion Our temporary MCS strategy, including earlier intervention in patients with CS due to ESHF at INTERMACS 2 was associated with less organ dysfunction and better 90-day survival compared to INTERMACS 1 patients.

scholarly journals Mechanical Circulatory Support and the Role of LVADs in Heart Failure Therapy

2015 ◽  
Vol 9s2 ◽  
pp. CMC.S19694 ◽  
Author(s):  
Allison McLarty
Keyword(s):  
United States ◽  
Heart Failure ◽  
The United States ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Final Destination ◽  
End Stage Heart Failure ◽  
Maximal Medical Therapy ◽  
End Stage

Heart failure is epidemic in the United States with a prevalence of over 5 million. The diagnosis carries a mortality risk of 50% at 5 years rivaling many diagnoses of cancer. Heart transplantation, long the “gold standard” treatment for end stage heart failure unresponsive to maximal medical therapy falls way short of meeting the need with only about 2,000 transplants performed annually in the United States due to donor limitation. Left ventricular devices have emerged as a viable option for patients as both a “bridge to transplantation” and as a final “destination therapy”.

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