The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
-
J. Heart Lung Transplant. · Feb 2008
Case ReportsExtracorporeal membrane oxygenation in pulmonary crisis and primary graft dysfunction.
This report describes the clinical use of an extracorporeal membrane oxygenation system in a 23-year-old woman with severe pulmonary arterial hypertension due to end-stage systemic lupus erythematosus. The system was also used to provide a direct bridge from resuscitation to transplantation after acute onset of pulmonary crisis and maintenance of stable hemodynamics during the bilateral lung transplant, and also to provide optimal oxygenation until the transplanted lung recovered from severe primary graft dysfunction.
-
J. Heart Lung Transplant. · Feb 2008
Pneumatic paracorporeal ventricular assist device in infants and children: initial Stanford experience.
Mechanical circulatory support with the Berlin Heart EXCOR pediatric ventricular assist device (VAD) has been used successfully in Europe for children with cardiac failure. Eighty-seven devices have been placed in North America through February 2007. We describe our single-center experience in 8 children. ⋯ In selected children, the Berlin Heart VAD can be used as a bridge to transplantation. In contrast to the published European experience, neurologic events occur frequently. Anti-coagulation and platelet inhibition strategies continue to evolve. Device exchange is technically feasible at the bedside and should be considered at the earliest visualization of thrombus formation.
-
J. Heart Lung Transplant. · Feb 2008
The Papworth experience with the Levitronix CentriMag ventricular assist device.
The Levitronix CentriMag ventricular assist device (VAD) is a centrifugal pump designed for short-term extracorporeal support in cardiogenic shock. The aim of this study is to report our clinical experience with the Levitronix CentriMag for uni- and biventricular support. ⋯ The Levitronix CentriMag system is a reliable and facile temporary circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock.
-
J. Heart Lung Transplant. · Jan 2008
Comparative StudyUse of the percutaneous left ventricular assist device in patients with severe refractory cardiogenic shock as a bridge to long-term left ventricular assist device implantation.
For patients with persistent cardiogenic shock refractory to intraaortic balloon pump (IABP) support, there are only limited means of resuscitation and bridging to surgical left ventricular assist device (LVAD) implantation. Extracorporeal membrane oxygenation and emergency surgical approaches have been attempted but are associated with significant morbidity and mortality. We evaluated the efficacy of a percutaneous left ventricular assist device (PVAD) as a bridge to LVAD implantation in patients in cardiogenic shock refractory to IABP and pressor support. ⋯ In patients with terminal hemodynamic collapse, PVAD support is an effective bridging therapy to LVAD and appears to be a viable alternative to other invasive methods of support.
-
J. Heart Lung Transplant. · Jan 2008
Relationship of immunosuppression to Epstein-Barr viral load and lymphoproliferative disease in pediatric heart transplant patients.
Post-transplant lymphoproliferative disease (PTLD) is a severe complication in transplant recipients. Detection of increased Epstein-Barr viral (EBV) load in the peripheral blood acts as a surrogate marker for increased risk of PTLD development. We prospectively monitored EBV load, immunosuppression and PTLD in pediatric heart transplant (HTx) patients to determine risk factors for an increased EBV load and risk of PTLD. ⋯ Frequent EBV load monitoring identifies patients at high risk for PTLD development. Azathioprine and ATG are major risk factors for increased EBV load and PTLD and patients may benefit from a change of immunosuppression in addition to pre-emptive anti-viral or anti-tumor strategies.