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. · May 2008
Case ReportsOff-pump exchange of short-term percutaneous ventricular assist device (VAD) to long-term implantable VAD in severe coagulopathy and multi-organ failure.
Ventricular support in patients with end-stage heart failure can be achieved using intracorporeal left ventricular assist device (LVAD) or percutaneous ventricular assist device (pVAD) systems. Multiple efforts have been made to minimize procedure-associated complications. We present a case report of an off-pump insertion of a MicroMed DeBakey VAD after Tandem Heart support using a previous sternotomy incision. ⋯ To avoid the need for heparinization in the light of HIT and severe coagulopathy, the LVAD implantation was performed under Tandem Heart support without cardiopulmonary bypass. The patient has been anti-coagulated with angiomax ever since. Critically ill patients with end-stage heart disease, multi-organ failure, severe coagulopathy and a previous median sternotomy can be bridged from a Tandem Heart to MicroMed DeBakey VAD without cardiopulmonary bypass using the previous incision, provided there are few adhesions and stable hemodynamic conditions.
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J. Heart Lung Transplant. · Mar 2008
Review Case ReportsUse of extracorporeal membrane oxygenation as a bridge to primary lung transplant: 3 consecutive, successful cases and a review of the literature.
Many transplant centers have considered extracorporeal membrane oxygenation (ECMO) to be a contraindication to lung transplantation, due to historically poor outcomes. However, recent advances in the technical aspects of ECMO have enabled patients to be supported with relative safety for several weeks until a donor lung becomes available. We present 3 young patients with acute (in 1 case, acute on chronic), severe respiratory failure that was refractory to conventional ventilation, who were placed on venovenous ECMO. In each case, a clinical decision was made that the patient's respiratory failure was irreversible and they were successfully managed with urgent lung transplantation.
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J. Heart Lung Transplant. · Mar 2008
Comparative StudyEffects of pulsatile- and continuous-flow left ventricular assist devices on left ventricular unloading.
In patients with end-stage heart failure, the use of left ventricular assist devices (LVADs) has improved clinical outcomes. Although newer continuous-flow devices have significant advantages, the effect of continuous flow on left ventricular unloading and hemodynamics is less well established. The aim of this investigation was to compare the effects of pulsatile- vs continuous-flow LVADs on left ventricular reverse remodeling and hemodynamic indices. ⋯ Substantial left ventricular unloading and hemodynamic improvement is achieved with the HeartMate XVE and the HeartMate II. We conclude that continuous-flow LVADs are as effective as pulsatile-flow LVADs with regard to degree of left ventricular unloading and cardiac hemodynamics.
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J. Heart Lung Transplant. · Mar 2008
Case ReportsSuccessful radiofrequency ablation therapy for intractable ventricular tachycardia with a ventricular assist device.
Refractory ventricular tachycardia (VT) can be a potentially life-threatening rhythm in the presence of non-ischemic dilated cardiomyopathy, particularly when it results in hemodynamic compromise. A 65-year-old man with non-ischemic cardiomyopathy was referred for multiple episodes of VT. A HeartMate left ventricular assist device (LVAD) was implanted to stabilize and control the VT. ⋯ On Day 41 post-operatively, radiofrequency ablation was performed. Two significant areas of scarring were identified and were successfully ablated. After ablation, he did not have significant sustained VT episodes and was discharged.
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J. Heart Lung Transplant. · Feb 2008
Comparative StudyOutcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database.
Patients 60 years and older have traditionally not been considered candidates for orthotopic heart transplantation (OHT). Recent studies have shown equivalent survival between older and younger patients, leading many to question this traditional ethos. As these studies may lack significant power to draw meaningful conclusions, the United Network for Organ Sharing (UNOS) database provides a unique opportunity to examine the effects of age on OHT. ⋯ The UNOS database has provided a large multi-institutional sample examining OHT in the elderly. Although our analysis shows lower survival in patients >or=60 years of age, the cumulative 5-year survival in these patients of close to 70% is acceptable. OHT should not be restricted based on age, as encouraging long-term results exist.