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Inoue K, Fujita T, Yoshioka D, Tonai K, Yanagino Y, Kakuta T, Tadokoro N, Kawamoto N, Yamashita K, Kawamura A, Matsuura R, Kawamura T, Saito T, Kawamura M, Kainuma S, Fukushima S, Toda K, Miyagawa S. Short-Term Outcomes of Magnetically Levitated Left Ventricular Assist Device in Advanced Heart Failure ― The Japanese Cohort ―. Circ J 2022; 86:1961-1967. [DOI: 10.1253/circj.cj-22-0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koichi Inoue
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | | | - Kohei Tonai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yusuke Yanagino
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | | | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Ryohei Matsuura
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Tetsuya Saito
- Department of Cardiovascular Surgery, Osaka University Hospital
| | | | - Satoshi Kainuma
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital
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Matsumoto Y, Fukushima S, Shimahara Y, Tadokoro N, Kakuta T, Kobayashi J, Fujita T. Sex differences in continuous-flow ventricular assist device therapy for advanced heart failure. Gen Thorac Cardiovasc Surg 2020; 69:919-925. [PMID: 33136257 DOI: 10.1007/s11748-020-01538-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The effect of patient sex in continuous-flow ventricular assist device (c-VAD) therapy has not been well described. We investigated sex-specific differences in clinical outcomes related to c-VAD therapy for Japanese patients. METHODS We retrospectively analyzed 153 patients, including 41 (27%) female patients who underwent c-VAD implantation over the last 13 years in our institution for a mean follow-up of 766 ± 446 days. Clinical outcomes were compared between male and female patients RESULTS: There was no significant difference in mortality, cerebral vascular accidents, the severity of heart failure, or driveline infection in patients who underwent c-VAD implantation, regardless of sex. While male patients tended to have more bleeding at the time of surgery, female patients had significantly higher rates of non-surgical bleeding during subsequent c-VAD therapy, mainly from gynecological origins. CONCLUSIONS Female patients treated with c-VAD had a significantly higher incidence of non-surgical bleeding events. Careful attention to gynecological complications and sex-specific care is required in female patients with c-VAD.
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Affiliation(s)
- Yorihiko Matsumoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
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Papanastasiou CA, Kyriakoulis KG, Theochari CA, Kokkinidis DG, Karamitsos TD, Palaiodimos L. Comprehensive review of hemolysis in ventricular assist devices. World J Cardiol 2020; 12:334-341. [PMID: 32843935 PMCID: PMC7415236 DOI: 10.4330/wjc.v12.i7.334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/02/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
Ventricular assist devices (VADs) have played an important role in altering the natural history of end-stage heart failure. Low-grade hemolysis has been traditionally described in patients with VADs, indicating effective device functionality. However, clinically significant hemolysis could be crucial in terms of prognosis, calling for prompt therapeutic actions. The absence of solid and widely approved diagnostic criteria for clinically significant hemolysis, render the utilization of hemolysis laboratory markers challenging. Hemolysis incidence varies (5%-18%) depending on definition and among different VAD generations, being slightly higher in continuous-flow devices than in pulsatile devices. Increased shear stress of red blood cells and underlying device thrombosis appear to be the main pathogenetic pathways. No certain algorithm is available for the management of hemolysis in patients with VADs, while close clinical and laboratory monitoring remains the cornerstone of management. Imaging examinations such as echocardiography ramp test or computed tomography scan could play a role in revealing the underlying cause. Treatment should be strictly personalized, including either pharmacological (antithrombotic treatment) or surgical interventions.
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Affiliation(s)
- Christos A Papanastasiou
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54621, Greece
| | - Konstantinos G Kyriakoulis
- 3rd Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | | | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Theodoros D Karamitsos
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54621, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
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Yanase M, Iwasaki K, Watanabe T, Seguchi O, Nakajima S, Kuroda K, Mochizuki H, Matsuda S, Takenaka H, Ikura M, Tadokoro N, Fukushima S, Fujita T, Ishibashi-Ueda H, Nakatani T, Kitamura S, Kobayashi J, Tsujita K, Ogawa H, Fukushima N. Effect of Therapeutic Modification on Outcomes in Heart Transplantation Over the Past Two Decades - A Single-Center Experience in Japan. Circ J 2020; 84:965-974. [PMID: 32350231 DOI: 10.1253/circj.cj-19-1209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND During these 2 decades (1999-2019), many therapeutic strategies have been developed in the field of heart transplant (HTx) to improve post-HTx outcomes. In the present study, 116 consecutive HTx adults between 1999 and 2019 were retrospectively reviewed to evaluate the influences of a therapeutic modification on post HTx outcomes.Methods and Results:Patient survival, functional status and hemodynamics after HTx and modification of therapeutic strategies were reviewed. The overall cumulative survival rate at 10 and 20 years post-HTx was 96.4 and 76.7%, respectively. There were no significant differences in survival rate or exercise tolerance after HTx between extracorporeal and implantable continuous flow-LVAD. Post-HTx patient survival in patients, irrespective of the donor risk factors such as donor age, low LVEF, history of cardiac arrest, was equivalent across cohorts, while longer TIT and higher inotrope dosage prior to procurement surgery were significant risk factors for survival. In 21 patients given everolimus (EVL) due to renal dysfunction, serum creatinine significantly decreased 1 year after initiation. In 22 patients given EVL due to transplant coronary vasculopathy (TCAV), maximum intimal thickness significantly decreased 3 years after initiation. CONCLUSIONS The analysis of a 20-year single-center experience with HTx in Japan shows encouraging improved results when several therapeutic modifications were made; for example, proactive use of donor hearts declined by other centers and the use of EVL in patients with renal dysfunction and TCAV.
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Affiliation(s)
- Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center.,Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Keiichiro Iwasaki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Seiko Nakajima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Kensuke Kuroda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Hiroki Mochizuki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Sachi Matsuda
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Hiromi Takenaka
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Megumi Ikura
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | | | | | - Soichiro Kitamura
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center.,Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
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