The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
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J. Heart Lung Transplant. · Aug 2008
Case ReportsSuccessful treatment of rotary pump thrombus with the glycoprotein IIb/IIIa inhibitor tirofiban.
Despite advances in blood pump technology, thrombus formation within left ventricular assist devices (LVADs) is a life-threatening complication with few therapeutic options. A 38-year-old woman who underwent rotary LVAD implantation as a bridge to cardiac transplant developed labile flows (4 to >10 liters), associated with power spikes (4 to 12 watts) and an increase in plasma free hemoglobin (0.86 g/liter), consistent with pump thrombus at Day 140 post-LVAD implantation, despite thromboprophylaxis with aspirin and warfarin. Within 12 hours of commencing an intravenous infusion of tirofiban at a rate of 0.1 mug/kg/min, there were signs of improvement of pump dysfunction, and complete resolution was evident at Day 4 with, stable flows, power consumption and normalization of plasma free hemoglobin. Tirofiban may be considered as an alternative thrombolytic treatment strategy in rotary pump thrombus to avoid the need for LVAD replacement.
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J. Heart Lung Transplant. · Aug 2008
Pre-arrest administration of the cell-permeable free radical scavenger tempol reduces warm ischemic damage of lung function in non-heart-beating donors.
Lungs retrieved from non-heart-beating donors (NHBDs) may alleviate the shortage of suitable organs for transplantation. The critical point is the preservation of lungs during warm ischemia, when severe damage is caused by free radicals. We investigated the effect of ventilation, pre-arrest administration of heparin, and the cell-permeable free radical scavenger, tempol, on the function of NHBD grafts. ⋯ The free radical scavenger tempol, which has a very good ability to permeate biologic membranes, contributes to better preservation of lungs retrieved from NHBDs.
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J. Heart Lung Transplant. · Jun 2008
Multicenter Study Clinical TrialA prospective, multicenter trial of the VentrAssist left ventricular assist device for bridge to transplant: safety and efficacy.
The increasing prevalence of chronic heart failure has stimulated the ongoing development of left ventricular assist devices (LVADs) for both bridge-to-transplant (BTT) and destination therapy (DT). The aim of this prospective, multicenter clinical trial was to determine the efficacy and safety of a third-generation LVAD, the VentrAssist, in a BTT cohort. ⋯ This trial demonstrated a favorable efficacy and safety profile for use of the VentrAssist LVAD in BTT patients.
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J. Heart Lung Transplant. · Jun 2008
Pre-transplant quality of life does not predict survival after lung transplantation.
Currently, the goal of lung transplantation is not only to improve survival but also includes improvement of health-related quality of life (HRQL). Limited knowledge is available about the value of HRQL before lung transplantation with regard to predicting survival after lung transplantation. To maximize the benefits of transplantation, it is essential to gain knowledge about variables that predict both length and quality of survival. In this study we sought to determine whether HRQL before transplantation predicts survival after lung transplantation. ⋯ Results suggest that scores on the various HRQL measures before transplantation did not predict survival after lung transplantation. The present results do not support the usefulness of pre-transplant HRQL measures for the selection of lung transplant candidates or their urgency for transplantation.