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Pritting C, Ahmad D, Patel K, Miyamoto T, Rajab TK, Rajapreyar IN, Massey HT, Tchantchaleishvili V. Microaxial mechanical circulatory support after orthotopic heart transplantation. Int J Artif Organs 2024; 47:173-180. [PMID: 38372215 DOI: 10.1177/03913988231213722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
AIM Use of microaxial mechanical circulatory support (MCS) has been reported for severe graft rejection or dysfunction after heart transplantation (HTx). We aimed to assess utilization patterns of microaxial MCS after HTx in adolescents (ages 18 and younger) and adults (ages 19 and older). METHODS Electronic search was performed to identify all relevant studies on post-HTx use of microaxial support in adults and adolescents. A total of 18 studies were selected and patient-level data were extracted for statistical analysis. RESULTS All patients (n=23), including adults (n=15) and adolescents (n=8), underwent Impella (Abiomed, Danvers, MA) microaxial MCS after HTx. Median age was 36 [IQR 18-56] years (Adults, 52 [37-59]; adolescents, 16 [15-17]). Primary right ventricular graft dysfunction was an indication exclusively seen in the adults 40% (6/15), while acute graft rejection was present in 46.7% (7/15) of adults. Median time after transplant was 9 [0-32] months (Adults, 4 [0-32]; adolescents, 11 [4.5, 45]). Duration of Impella support was comparable between adults and adolescents (5 [2.5-8] vs 6 [5-8] days, p = 0.38). Overall improvement was observed both in median LV ejection fraction (23.5% [11.3-28] to 42% [37.8-47.3], p < 0.01) and cardiac index (1.8 [1.2-2.6] to 3 [2.5-3.1], p < 0.01). Retransplantation was required in four adolescents (50%, 4/8). Survival to discharge was achieved by 60.0% (9/15) of adults and 87.5% (7/8) of adolescents respectively (p = 0.37). CONCLUSION Indications for microaxial MCS appear to vary between adult and adolescent patients. Overall improvement in LVEF and cardiac index was observed, however, with suboptimal survival to discharge.
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Affiliation(s)
| | - Danial Ahmad
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Keyur Patel
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Takuma Miyamoto
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Taufiek K Rajab
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - Howard T Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Weber MP, O'Malley TJ, Choi JH, Maynes EJ, Prochno KW, Austin MA, Wood CT, Patel S, Morris RJ, Massey HT, Tchantchaleishvili V. Outcomes of percutaneous temporary biventricular mechanical support: a systematic review. Heart Fail Rev 2020; 27:879-890. [PMID: 32458216 DOI: 10.1007/s10741-020-09971-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Percutaneous biventricular assist devices (BiVAD) are a recently developed treatment option for severe cardiogenic shock. This systematic review sought to identify indications and outcomes of patients placed on percutaneous BiVAD support. An electronic search was performed to identify all appropriate studies utilizing a percutaneous BiVAD configuration. Fifteen studies comprising of 20 patients were identified. Individual patient survival and outcomes data were combined for statistical analysis. All 20 patients were supported with a microaxial LVAD, 12/20 (60%) of those patients were supported with a microaxial (RMA) right ventricular assist device (RVAD), and the remaining 8/20 (40%) patients were supported with a centrifugal extracorporeal RVAD (RCF). All patients presented with cardiogenic shock, and of these, 12/20 (60%) presented with a non-ischemic etiology vs 8/20 (40%) with ischemic disease. For the RMA group, RVAD support was significantly longer [RMA 5 (IQR 4-7) days vs RCF 1 (IQR 1-2) days, p = 0.03]. Intravascular hemolysis post-BiVAD occurred in three patients (27.3%) [RMA 3 (33.3%) vs RCF 0 (0%), p = 0.94]. Five patients received a durable left ventricular assist device, one patient received a total artificial heart, and one patient underwent a heart transplantation. Estimated 30-day mortality was 15.0%, and 78.6% were discharged alive. Both strategies for percutaneous BiVAD support appear to be viable options for severe cardiogenic shock.
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Affiliation(s)
- Matthew P Weber
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Thomas J O'Malley
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Jae H Choi
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Kyle W Prochno
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Melissa A Austin
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Chelsey T Wood
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Sinal Patel
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - H Todd Massey
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA.
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Abstract
PURPOSE OF REVIEW Primary graft dysfunction (PGD) is common early postheart transplantation; however, use of standardized definitions remains inconsistent. This review focuses on understanding the incidence, classification, risk factors, and management of PGD. RECENT FINDINGS The incidence and mortality of PGD in heart transplant varies considerably in the published literature ranging from 1.0% to 31% and 3% to 75%, respectively. There is also considerable variation in management strategies with current data favoring early intervention. SUMMARY PGD in heart transplantation remains a challenging problem associated with significant mortality and morbidity. There is need for a consistent and accessible definition to better define associated risk factors and optimize management strategies.
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Utilization and Outcomes of Temporary Mechanical Circulatory Support for Graft Dysfunction After Heart Transplantation. ASAIO J 2018; 63:695-703. [PMID: 28906273 DOI: 10.1097/mat.0000000000000599] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Graft dysfunction is the main cause of early mortality after heart transplantation. In cases of severe graft dysfunction, temporary mechanical circulatory support (TMCS) may be necessary. The aim of this systematic review was to examine the utilization and outcomes of TMCS in patients with graft dysfunction after heart transplantation. Electronic search was performed to identify all studies in the English literature assessing the use of TMCS for graft dysfunction. All identified articles were systematically assessed for inclusion and exclusion criteria. Of the 5,462 studies identified, 41 studies were included. Among the 11,555 patients undergoing heart transplantation, 695 (6.0%) required TMCS with patients most often supported using venoarterial extracorporeal membrane oxygenation (79.4%) followed by right ventricular assist devices (11.1%), biventricular assist devices (BiVADs) (7.5%), and left ventricular assist devices (LVADs) (2.0%). Patients supported by LVADs were more likely to be supported longer (p = 0.003), have a higher death by cardiac event (p = 0.013) and retransplantation rate (p = 0.015). In contrast, patients supported with BiVAD and LVAD were more likely to be weaned off support (p = 0.020). Overall, no significant difference was found in pooled 30 day survival (p = 0.31), survival to discharge (p = 0.19), and overall survival (p = 0.51) between the subgroups. Temporary mechanical circulatory support is an effective modality to support patients with graft dysfunction after heart transplantation. Further studies are needed to establish the optimal threshold and strategy for TMCS and to augment cardiac recovery and long-term survival.
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Del Rio JM, Maerz D, Subramaniam K. Noteworthy Literature Published in 2017 for Thoracic Transplantation Anesthesiologists. Semin Cardiothorac Vasc Anesth 2018; 22:49-66. [DOI: 10.1177/1089253217749893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thoracic organ transplantation constitutes a significant proportion of all transplant procedures. Thoracic solid organ transplantation continues to be a burgeoning field of research. This article presents a review of remarkable literature published in 2017 regarding perioperative issues pertinent to the thoracic transplant anesthesiologists.
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Affiliation(s)
- J. Mauricio Del Rio
- Duke University, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - David Maerz
- University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kathirvel Subramaniam
- University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Tchantchaleishvili V, Luc JGY, Sagebin F, Wong JK, Massey HT. Pulmonary arteriovenous extracorporeal membrane oxygenation to avoid pulmonary overflow during total artificial heart implantation. Int J Artif Organs 2017; 41:0. [PMID: 29099541 DOI: 10.5301/ijao.5000655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 11/20/2022]
Abstract
Total artificial hearts (TAH) can be used as a bridge to transplant or, occasionally, as destination therapy for patients with severe biventricular dysfunction. Not infrequently TAHs are placed in patients with severe low flow states, in which the lungs of these patients are unable to adjust rapidly to the "normal" right ventricular output of a TAH. These patients may develop variable degrees of pulmonary edema secondary to stress failure of the pulmonary capillaries requiring increased respiratory support, which can occasionally be fatal. In this "how to do it" article, we describe the technique for a pulmonary arteriovenous extracorporeal membrane oxygenation with TAH to avoid sudden pulmonary overflow and gradually expose the lungs to increasing flow.
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Affiliation(s)
- Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York - USA
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota - USA
| | - Jessica G Y Luc
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta - Canada
| | - Fabio Sagebin
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York - USA
| | - Joshua K Wong
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York - USA
| | - Howard T Massey
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York - USA
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania - USA
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