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Fishman G, Ram E, Gorfil D, Kassif Y, David R, Hershko T, Malbrain MLNG, Singer P, Sessler DI. Early detection of oliguric events in critically ill patients in the ICU with a novel continuous urine flow measurement device: results of an initial validation study. J Clin Monit Comput 2023; 37:1341-1349. [PMID: 37027058 PMCID: PMC10080177 DOI: 10.1007/s10877-023-00991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/26/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Urine output is used to evaluate fluid status and is an important marker for acute kidney injury (AKI). Our primary aim was to validate a new automatic urine output monitoring device by comparison to the current practice - the standard urometer. METHODS We conducted a prospective observational study in three ICUs. Urine flow measurements by Serenno Medical Automatic urine output measuring device (Serenno Medical, Yokneam, Israel) were compared to standard urometer readings taken automatically at 5-minutes intervals by a camera, and to hourly urometer readings by the nurses, both over 1 to 7 days. Our primary outcome was the difference between urine flow assessed by the Serenno device and reference camera-derived measurements (Camera). Our secondary outcome was the difference between urine flow assessed by the Serenno device and hourly nursing assessments (Nurse), and detection of oliguria. RESULTS Thirty-seven patients completed the study, with 1,306 h of recording and a median of 25 measurement hours per patient. Bland and Altman analysis comparing the study device to camera measurements demonstrated good agreement, with a bias of -0.4 ml/h and 95% confidence intervals ranging from - 28 to 27ml/h. Concordance was 92%. The correlation between Camera and hourly nursing assessment of urine output was distinctly worse with a bias of 7.2 ml and limits of agreement extending from - 75 to + 107 ml. Severe oliguria (urine output < 0.3 ml/kg/h) lasting 2 h or more was common and observed in 8 (21%) of patients. Among the severe oliguric events lasting more than 3 consecutive hours, 6 (41%) were not detected or documented by the nursing staff. There were no device-related complications. CONCLUSION The Serenno Medical Automatic urine output measuring device required minimal supervision, little ICU nursing staff attention, and is sufficiently accurate and precise. In addition to providing continuous assessments of urine output, it was considerably more accurate than hourly nursing assessments.
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Affiliation(s)
- Guy Fishman
- Department of General Intensive Care, Rabin Medical Center, campus Beilinson, Petah, Tikva, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Leviev cardiothoracic and vascular center, Sackler School of Medicine, Sheba Medical Center at Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Dan Gorfil
- Cardiothoracic Surgery Department, Rabin Medical Center, campus Beilinson, Petah, Tikva, Israel
| | - Yigal Kassif
- Department of Cardiac Surgery, Leviev cardiothoracic and vascular center, Sackler School of Medicine, Sheba Medical Center at Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Rachel David
- Department of General Intensive Care, Rabin Medical Center, campus Beilinson, Petah, Tikva, Israel
| | - Tzlil Hershko
- Adelson School of Medicine at Ariel University, Samaria, Israel
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego street 8, Lublin, 20-954, Poland
- International Fluid Academy, Dreef 3, Lovenjoel, 3360, Belgium
| | - Pierre Singer
- Department of General Intensive Care, Rabin Medical Center, campus Beilinson, Petah, Tikva, Israel
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Ave L1-407, Cleveland, OH, 44195, USA
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Ram E, Kassif T, Peled Y, Kassif Y, Koren RP, Sternik L, Raanani E. Anatomical and clinical risk stratification tool for mortality risk assessment following revascularization for multivessel coronary artery disease. J Thorac Cardiovasc Surg 2023; 166:793-800.e5. [PMID: 35031136 DOI: 10.1016/j.jtcvs.2021.11.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/24/2021] [Accepted: 11/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to assess the prognostic ability of SYNTAX score II in left main and/or 3-vessel disease patients undergoing revascularization either by coronary artery bypass grafting or percutaneous coronary intervention in a national registry. METHODS This prospective registry included consecutive patients with multivessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography. Of the 1112 study patients, 368 patients (33%) had a low (<25), 372 (33%) had an intermediate (25-35) and 372 patients (33%) a high (≥35) SYNTAX score II. RESULTS Patients with a high SYNTAX score II had higher 30-day mortality compared with those with an intermediate or low SYNTAX score II (2.8% vs 0.6% vs 0% respectively, P = .001). Each 1-unit increment in SYNTAX score II increased the odds for death at 30 days by 11% (95% CI, 1.02-1.22; P = .026). Six-year mortality was higher among patients with a high compared with an intermediate or low SYNTAX score II (34.9% vs 11% vs 3.8%; log-rank P < .001). By adding a SYNTAX score II to standard prognostic factors, we showed a significant improvement of 40.1% (P < .001) for predicting 6-year mortality. The area under the curve of the SYNTAX score II (continuous) yielded 0.79 (95% CI, 0.75-0.82) in predicting 6-year mortality. CONCLUSIONS Our findings show that the admission SYNTAX score II is a powerful marker of short- and long-term mortality, and therefore may be used as a risk stratification tool in patients with multivessel coronary artery disease who are candidates for revascularization.
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Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel; The Sheba Talpiot Medical Leadership Program, Ramat Gan, Israel.
| | - Tohar Kassif
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Yael Peled
- Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Yigal Kassif
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Roni Postan Koren
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
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3
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Levy L, Deri O, Huszti E, Nachum E, Ledot S, Shimoni N, Saute M, Sternik L, Kremer R, Kassif Y, Zeitlin N, Frogel J, Lambrikov I, Matskovski I, Chatterji S, Seluk L, Furie N, Shafran I, Mass R, Onn A, Raanani E, Grinberg A, Levy Y, Afek A, Kreiss Y, Kogan A. Timing of Lung Transplant Referral in Patients with Severe COVID-19 Lung Injury Supported by ECMO. J Clin Med 2023; 12:4041. [PMID: 37373734 DOI: 10.3390/jcm12124041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Severe respiratory failure caused by COVID-19 often requires mechanical ventilation, including extracorporeal membrane oxygenation (ECMO). In rare cases, lung transplantation (LTx) may be considered as a last resort. However, uncertainties remain about patient selection and optimal timing for referral and listing. This retrospective study analyzed patients with severe COVID-19 who were supported by veno-venous ECMO and listed for LTx between July 2020 and June 2022. Out of the 20 patients in the study population, four who underwent LTx were excluded. The clinical characteristics of the remaining 16 patients were compared, including nine who recovered and seven who died while awaiting LTx. The median duration from hospitalization to listing was 85.5 days, and the median duration on the waitlist was 25.5 days. Younger age was significantly associated with a higher likelihood of recovery without LTx after a median of 59 days on ECMO, compared to those who died at a median of 99 days. In patients with severe COVID-19-induced lung damage supported by ECMO, referral to LTx should be delayed for 8-10 weeks after ECMO initiation, particularly for younger patients who have a higher probability of spontaneous recovery and may not require LTx.
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Affiliation(s)
- Liran Levy
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ofir Deri
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON M5G 1X6, Canada
| | - Eyal Nachum
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Stephane Ledot
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nir Shimoni
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Milton Saute
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Thoracic Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Leonid Sternik
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ran Kremer
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Thoracic Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yigal Kassif
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nona Zeitlin
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Thoracic Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Jonathan Frogel
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilya Lambrikov
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilia Matskovski
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Sumit Chatterji
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Lior Seluk
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nadav Furie
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Inbal Shafran
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ronen Mass
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amir Onn
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ehud Raanani
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amir Grinberg
- General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yuval Levy
- General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Arnon Afek
- General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yitshak Kreiss
- General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Alexander Kogan
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Sabbag A, Berkovich A, Raanani E, Volvovitch D, McIntyre WF, Kassif Y, Kogan A, Glikson M, Beinart R. Subclinical postoperative atrial fibrillation: a randomized trial. Front Cardiovasc Med 2023; 10:1153275. [PMID: 37304958 PMCID: PMC10248069 DOI: 10.3389/fcvm.2023.1153275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, requiring interventions and prolonging hospital stay. POAF is associated with increased mortality and a higher rate of systemic thrombo-embolism. The rates of recurrent AF, optimal follow-up and management remain unclear. We aimed to evaluate the incidence of recurrent atrial fibrillation (AF) events, during long term follow-up in patients with POAF following cardiac surgery. Methods Patients with POAF and a CHA2DS2-VASc score of ≥2 were randomized in a 2:1 ratio to either implantation of a loop recorder (ILR) or ECG monitoring using periodic Holters. Participants were followed prospectively for 2 years. The primary end point was the occurrence of AF longer than 5 min. Results The final cohort comprised of 22 patients, of whom 14 received an ILR. Over a median follow up of 25.7 (IQR of 24.7-44.4) months, 8 patients developed AF, representing a cumulative annualized risk of AF recurrence of 35.7%. There was no difference between ILR (6 participants, 40%) and ECG/Holter (2 participants, 25% p = 0.917). All 8 patients with AF recurrence were treated with oral anticoagulation. There were no cases of mortality, stroke or major bleeding. Two patients underwent ILR explantation due to pain at the implantation site. Conclusions The rate of recurrent AF in patients with POAF after cardiac surgery and a CHA2DS2-VASc score of ≥2 is approximately 1 in 3 when followed systematically. Further research is need to assess the role of ILRs in this population.
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Affiliation(s)
- Avi Sabbag
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Berkovich
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Raanani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - David Volvovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - William F. McIntyre
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Yigal Kassif
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Kogan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Roy Beinart
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Lorusso R, De Piero ME, Mariani S, Di Mauro M, Folliguet T, Taccone FS, Camporota L, Swol J, Wiedemann D, Belliato M, Broman LM, Vuylsteke A, Kassif Y, Scandroglio AM, Fanelli V, Gaudard P, Ledot S, Barker J, Boeken U, Maier S, Kersten A, Meyns B, Pozzi M, Pedersen FM, Schellongowski P, Kirali K, Barrett N, Riera J, Mueller T, Belohlavek J, Lorusso R, De Piero ME, Mariani S, Di Mauro M, Folliguet T, Taccone FS, Camporota L, Swol J, Wiedemann D, Belliato M, Broman LM, Vuylsteke A, Kassif Y, Scandroglio AM, Fanelli V, Gaudard P, Ledot S, Barker J, Boeken U, Maier S, Kersten A, Meyns B, Pozzi M, Pedersen FM, Schellongowski P, Kirali K, Barrett N, Riera J, Mueller T, Belohlavek J, Lo Coco V, Van der Horst ICC, Van Bussel BCT, Schnabel RM, Delnoij T, Bolotin G, Lorini L, Schmiady MO, Schibilsky D, Kowalewski M, Pinto LF, Silva PE, Kornilov I, Blandino Ortiz A, Vercaemst L, Finney S, Roeleveld PP, Di Nardo M, Hennig F, Antonini MV, Davidson M, Jones TJ, Staudinger T, Mair P, Kilo J, Krapf C, Erbert K, Peer A, Bonaros N, Kotheletner F, Krenner Mag N, Shestakova L, Hermans G, Dauwe D, Meersseman P, Stockman B, Nobile L, Lhereux O, Nrasseurs A, Creuter J, De Backer D, Giglioli S, Michiels G, Foulon P, Raes M, Rodrigus I, Allegaert M, Jorens P, Debeucklare G, Piagnarelli M, Biston P, Peperstraete H, Vandewiele K, Germay O, Vandeweghe D, Havrin S, Bourgeois M, Lagny MG, Alois G, Lavios N, Misset B, Courcelle R, Timmermans PJ, Yilmaz A, Vantomout M, Lehaen J, Jassen A, Guterman H, Strauven M, Lormans P, Verhamme B, Vandewaeter C, Bonte F, Vionne D, Balik M, Blàha J, Lips M, Othal M, Bursa F, Spacek R, Christensen S, Jorgensen V, Sorensen M, Madsen SA, Puss S, Beljantsev A, Saiydoun G, Fiore A, Colson P, Bazalgette F, Capdevila X, Kollen S, Muller L, Obadia JF, Dubien PY, Ajrhourh L, Guinot PG, Zarka J, Besserve P, Malfertheiner MV, Dreier E, Heinze B, Akhyari P, Lichtenberg A, Aubin H, Assman A, Saeed D, Thiele H, Baumgaertel M, Schmitto JD, Ruslan N, Haverich A, Thielmann M, Brenner T, Ruhpawar A, Benk C, Czerny M, Staudacher DL, Beyersdorf F, Kalbhenn J, Henn P, Popov AF, Iuliu T, Muellenbach R, Reyher C, Rolfes C, Lotz G, Sonntagbauer M, Winkels H, Fichte J, Stohr R, Kalverkamp S, Karagiannidis C, Schafer S, Svetlitchny A, Fichte J, Hopf HB, Jarczak D, Groesdonk H, Rommer M, Hirsch J, Kaehny C, Soufleris D, Gavriilidis G, Pontikis K, Kyriakopoulou M, Kyriakoudi A, O'Brien S, Conrick-Martin I, Carton E, Makhoul M, Ben-Ari J, Hadash A, Kogan A, Kassif Lerner R, Abu-Shakra A, Matan M, Balawona A, Kachel E, Altshuler R, Galante O, Fuchs L, Almog Y, Ishay YS, Lichter Y, Gal-oz A, Carmi U, Nini A, Soroksky A, Dekel H, Rozman Z, Tayem E, Ilgiyaev E, Hochman Y, Miltau D, Rapoport A, Eden A, Kompanietz D, Yousif M, Golos M, Grazioli L, Ghitti D, Loforte A, Di Luca D, Baiocchi M, Pacini D, Cappai A, Meani P, Mondino M, Russo CF, Ranucci M, Fina D, Cotza M, Ballotta A, Landoni G, Nardelli P, Fominski EV, Brazzi L, Montrucchio G, Sales G, Simonetti U, Livigni S, Silengo D, Arena G, Sovatzis SS, Degani A, Riccardi M, Milanesi E, Raffa G, Martucci G, Arcadipane A, Panarello G, Chiarini G, Cattaneo S, Puglia C, Benussi S, Foti G, Giani M, Bombino M, Costa MC, Rona R, Avalli L, Donati A, Carozza R, Gasparri F, Carsetti A, Picichè M, Marinello A, Danzi V, Zanin A, Condello I, Fiore F, Moscarelli M, Nasso G, Speziale G, Sandrelli L, Montalto A, Musumeci F, Circelli A, Russo E, Agnoletti V, Rociola R, Milano AD, Pilato E, Comentale G, Montisci A, Alessandri F, Tosi A, Pugliese F, Giordano G, Carelli S, Grieco DL, Dell'Anna AM, Antonelli M, Ramoni E, Zulueta J, Del Giglio M, Petracca S, Bertini P, Guarracino F, De Simone L, Angeletti PM, Forfori F, Taraschi F, Quintiliani VN, Samalavicius R, Jankuviene A, Scupakova N, Urbonas K, Kapturauskas J, Soerensen G, Suwalski P, Linhares Santos L, Marques A, Miranda M, Teixeira S, Salgueiro A, Pereira F, Ketskalo M, Tsarenko S, Shilova A, Afukov I, Popugaev K, Minin S, Shelukhin D, Malceva O, Gleb M, Skopets A, Kornelyuk R, Kulikov A, Okhrimchuk V, Turchaninov A, Shelukhin D, Petrushin M, Sheck A, Mekulov A, Ciryateva S, Urusov D, Gorjup V, Golicnik A, Goslar T, Ferrer R, Martinez-Martinez M, Argudo E, Palmer N, De Pablo Sanchez R, Juan Higuera L, Arnau Blasco L, Marquez JA, Sbraga F, Fuset MP, De Gopegui PR, Claraco LM, De Ayala JA, Peiro M, Ricart P, Martinez S, Chavez F, Fabra M, Sandoval E, Toapanta D, Carraminana A, Tellez A, Ososio J, Milan P, Rodriguez J, Andoni G, Gutierrez C, Perez de la Sota E, Eixeres-Esteve A, Garcia-Maellas MT, Gutierrez-Gutierrez J, Arboleda-Salazar R, Santa Teresa P, Jaspe A, Garrido A, Castaneda G, Alcantara S, Martinez N, Perez M, Villanueva H, Vidal Gonzalez A, Paez J, Santon A, Perez C, Lopez M, Rubio Lopez MI, Gordillo A, Naranjo-Izurieta J, Munoz J, Alcalde I, Onieva F, Gimeno Costa R, Perez F, Madrid I, Gordon M, Albacete Moreno CL, Perez D, Lopez N, Martinenz D, Blanco-Schweizer P, Diez C, Perez D, Prieto A, Renedo G, Bustamante E, Cicuendez R, Citores R, Boado V, Garcia K, Voces R, Domezain M, Nunez Martinez JM, Vicente R, Martin D, Andreu A, Gomez Casal V, Chico I, Menor EM, Vara S, Gamacho J, Perez-Chomon H, Javier Gonzales F, Barrero I, Martin-Villen L, Fernandez E, Mendoza M, Navarro J, Colomina Climent J, Gonzales-Perez A, Muniz-Albaceita G, Amado L, Rodriguez R, Ruiz E, Eiras M, Grins E, Magnus R, Kanetoft M, Eidevald M, Watson P, Vogt PR, Steiger P, Aigner T, Weber A, Grunefelder J, Kunz M, Grapow M, Aymard T, Reser D, Agus G, Consiglio J, Haenggi M, Hansjoerg J, Iten M, Doeble T, Zenklusen U, Bechtold X, Faedda G, Iafrate M, Rohjer A, Bergamaschi L, Maessen J, Reis Miranda D, Endeman H, Gommers D, Meuwese C, Maas J, Van Gijlswijk MJ, Van Berg RN, Candura D, Van der Linden M, Kant M, Van der Heijden JJ, Scholten E, Van Belle-van Haren N, Lagrand WK, Vlaar AP, De Jong S, Cander B, Sargin M, Ugur M, Kaygin MA, Daly K, Agnew N, Head L, Kelly L, Anoma G, Russell C, Aquino V, Scott I, Flemming L, Gillon S, Moore O, Gelandt E, Auzinger G, Patel S, Loveridge R. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study. Lancet Respir Med 2023; 11:151-162. [PMID: 36402148 PMCID: PMC9671669 DOI: 10.1016/s2213-2600(22)00403-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. METHODS EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. FINDINGS Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. INTERPRETATION Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. FUNDING None.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
| | - Maria Elena De Piero
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Silvia Mariani
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Thierry Folliguet
- Department of Cardiac Surgery, Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Justyna Swol
- Department of Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University Hospital of Vienna, Vienna, Austria
| | - Mirko Belliato
- Anestesia e Rianimazione II Cardiopolmonare, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Alain Vuylsteke
- ECMO Retrieval Service & Critical Care, Royal Papworth Hospital, NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Yigal Kassif
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Fanelli
- Department of Surgical Sciences, Anesthesia and Intensive Care Medicine, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, France,Le laboratoire de Physiologie et Médecine Expérimentale du Coeur et des Muscles (PhyMedExp), Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Stephane Ledot
- Intensive Care Unit, Royal Brompton & Harefield hospitals, London, UK
| | - Julian Barker
- Cardiothoracic Critical Care Unit, Whythenshawe Hospital, Manchester, UK
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Bad Krozingen, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Kersten
- Medizinische Klinik, Uniklinik Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, Universitair Ziekenhuis Leuven Gasthuisberg University Hospital, Leuven, Belgium
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Hospital, Lyon, France
| | - Finn M Pedersen
- Cardiothoracic Intensive Care Unit, University Hospital, Copenhagen, Denmark
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit, Comprehensive Cancer Center, Center of Excellence in Medical Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Kaan Kirali
- Cardiovascular Surgery Department, Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Nicholas Barrett
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Jordi Riera
- Critical Care Department, Val d'Hebron Research Institute, Barcelona, Spain
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital, Prague, Czech Republic,1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Makhoul M, Keizman E, Carmi U, Galante O, Ilgiyaev E, Matan M, Słomka A, Sviri S, Eden A, Soroksky A, Fink D, Sternik L, Bolotin G, Lorusso R, Kassif Y. Outcomes of Extracorporeal Membrane Oxygenation (ECMO) for COVID-19 Patients: A Multi-Institutional Analysis. Vaccines (Basel) 2023; 11:vaccines11010108. [PMID: 36679953 PMCID: PMC9865577 DOI: 10.3390/vaccines11010108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/18/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In March 2020, COVID-19 was announced as a global pandemic. The first COVID-19 patient was connected to an ECMO device in Israel during that time. Since then, over 200 patients have required ECMO support due to COVID-19 infection. The present study is a multi-institutional analysis of all COVID-19 patients requiring veno-venous (VV) ECMO in Israel. The aim was to characterize and compare the survivors and deceased patients as well as establish risk factors for mortality. METHODS This retrospective multi-institutional study was conducted from March 2020 to March 2021 in eleven of twelve ECMO centers operating in Israel. All COVID-19 patients on VV ECMO support were included in the cohort. The patients were analyzed based on their comorbidities, procedural data, adverse event on ECMO, and outcomes. Univariate and multivariate analyses were used to compare the deceased and the surviving patients. RESULTS The study included 197 patients, of which 150 (76%) were males, and the mean age was 50.7 ± 12 years. Overall mortality was 106 (54%). Compared with the deceased subjects, survivors were significantly younger (48 ± 11 vs. 53 ± 12 years), suffered less from ischemic heart disease (IHD) (3% vs. 12%), and were ventilated for a significantly shorter period (≤4 days) prior to cannulation (77% vs. 63%). Patients in the deceased group experienced more kidney failure and sepsis. Rates of other complications were comparable between groups. CONCLUSIONS Based on this study, we conclude that early cannulation (≤4 days) of younger patients (≤55 years) may improve overall survival and that a history of IHD might indicate a reduced prognosis.
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Affiliation(s)
- Maged Makhoul
- Department of Cardiac Surgery, Rambam Medical Center, Haifa 3525408, Israel
- Correspondence:
| | - Eitan Keizman
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
| | - Uri Carmi
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Faculty of Health Ben Gurion University, Soroka Medical Center, Beer-Sheva 8400711, Israel
| | - Eduard Ilgiyaev
- Intensive Care Unit, Shamir Medical Center, Zerifin 703301, Israel
| | - Moshe Matan
- Intensive Care Unit, The Baruch Padeh Medical Center, Poriya 1528001, Israel
| | - Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier CollegiumMedicum, 85-094 Bydgoszcz, Poland
| | - Sigal Sviri
- Medical Intensive Care, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Arieh Eden
- Department of Anesthesiology Critical Care and Pain Medicine, Carmel Lady Davis Medical Center, Haifa 3436212, Israel
| | - Arie Soroksky
- Intensive Care Unit, E. Wolfson Medical Center, Tel Aviv 6423906, Israel
| | - Danny Fink
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem 91120, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
| | - Gil Bolotin
- Department of Cardiac Surgery, Rambam Medical Center, Haifa 3525408, Israel
| | - Roberto Lorusso
- Cardiovascular Research Institute, Maastricht (CARIM), 6200 Maastricht, The Netherlands
| | - Yigal Kassif
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
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Ram E, Lavee J, Kassif Y, Peysakhovich Y, Sternik L, Segev A, Patel J, Peled Y. Primary heart dysfunction is greater with combined heart and lung compared with isolated heart procurement. J Thorac Cardiovasc Surg 2023; 165:186-195.e4. [PMID: 33691941 DOI: 10.1016/j.jtcvs.2021.01.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Combined heart and lungs (CHL) procurement differs from isolated heart (IH) procurement in several aspects, including lung recruitment, cannulation, and preservation requirements. We aimed to investigate whether CHL versus IH procurement contributes to the development of primary graft dysfunction (PGD) after heart transplantation (HT). METHODS Between 1999 and 2019, we assessed 175 patients undergoing HT at a single center. Patients were divided into IH (n = 61) or CHL (n = 114) procurement groups. End points included PGD (defined according to the International Society for Heart and Lung Transplantation consensus statement) and long-term survival. RESULTS The incidence of PGD was significantly greater in CHL recipients compared with IH recipients (53.5% vs 16.4%, P < .001). Multivariable analysis showed that CHL procurement was independently associated with a significant 4.6-fold increased risk for PGD (95% confidence interval, 2.1-11, P < .001). Univariable and multivariable analyses showed that the overall survival was not significantly affected by the procurement group (log-rank P = .150, hazard ratio, 1.13; 95% confidence interval, 0.68-1.88, P = .646). The simultaneous procurement of abdominal organs was not associated with an increased risk of PGD in HT recipients. These results remained consistent in a propensity-matched analysis. CONCLUSIONS Combined procurement of heart and lungs is independently associated with an increased risk of PGD. Further prospective studies are needed to validate this hypothesis-generating study.
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Affiliation(s)
- Eilon Ram
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jacob Lavee
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yury Peysakhovich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Leonid Sternik
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jignesh Patel
- Cedars-Sinai Heart Institute and David Geffen School of Medicine at the University of California, Los Angeles, Calif
| | - Yael Peled
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Segev A, Lavee J, Kassif Y, Shemesh Y, Kogan A, Freimark D, Morgan A, Lotan D, Itelman E, Grupper A. Effect of levosimendan infusion prior to left ventricular assist device implantation on right ventricular failure. J Cardiothorac Surg 2022; 17:158. [PMID: 35710438 PMCID: PMC9205013 DOI: 10.1186/s13019-022-01915-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Investigate the safety and efficacy of preoperative levosimendan in patients undergoing left ventricular assist device (LVAD) implantation.
Methods Consecutive patients who received LVADs (HeartMate-2, 3, HVAD) in a single tertiary medical center (2012–2018). INTERMACS profile 1 patients were excluded. The primary outcome was post-LVAD right ventricular failure (RVF) and inhospital mortality rates. The secondary outcomes included other clinical, echocardiographic and hemodynamic parameters at follow-up. Results Final cohort consisted of 62 patients (40[65%] in the levosimendan group and 22[35%] in the no-levosimendan group). Post-operative RVF rate and inotrope or ventilation support time were similar in the levosimendan and no-levosimendan groups (7.5% vs. 13.6%; P = 0.43, median of 51 vs. 72 h; P = 0.41 and 24 vs. 27 h; P = 0.19, respectively). Length of hospitalization, both total and in the intensive care unit, was not statistically significant (median days of 13 vs. 16; P = 0.34, and 3 vs. 4; P = 0.44, respectively). Post-operative laboratory and echocardiographic parameters and in-hospital complication rate did not differ between the groups, despite worse baseline clinical parameters in the Levosimendan group. There was no significant difference in the in-hospital and long term mortality rate (2.5% vs. 4.5%; P > 0.999 and 10% vs. 27.3% respectively; P = 0.64). Conclusions Levosimendan infusion prior to LVAD implantation was safe and associated with comparable results without significant improved post-operative outcomes, including RVF. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01915-6.
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Affiliation(s)
- Amitai Segev
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jacob Lavee
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Yedida Shemesh
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Alexander Kogan
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Dov Freimark
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Morgan
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Dor Lotan
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Itelman
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel
| | - Avishay Grupper
- Cardiovascular Division, Sheba Medical Center, Tel Hashomer, Sheba Rd. 2, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shalabi A, Kachel E, Kassif Y, Faqeeh M, Sergey P, Sternik L, Grosman-Rimon L, Kinany W, Amir O, Ram E, Lavee J, Grupper A. Correction to: Unusual complications following left ventricular assisted device implantation: case series. J Cardiothorac Surg 2021; 16:251. [PMID: 34488815 PMCID: PMC8422685 DOI: 10.1186/s13019-021-01633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amjad Shalabi
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel. .,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel. .,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Erez Kachel
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yigal Kassif
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muin Faqeeh
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Preisman Sergey
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Anesthesia, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liza Grosman-Rimon
- Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Wadi Kinany
- Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Offer Amir
- Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jacob Lavee
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishay Grupper
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Shalabi A, Kachel E, Kassif Y, Faqeeh M, Sergey P, Sternik L, Grosman-Rimon L, Kinany W, Amir O, Ram E, Lavee J, Grupper A. Unusual complications following left ventricular assisted device implantation: case series. J Cardiothorac Surg 2021; 16:70. [PMID: 33823878 PMCID: PMC8025327 DOI: 10.1186/s13019-021-01445-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background While left ventricular assisted devices (LVAD) have revolutionized the treatment of advanced heart failure, they are associated with a wide range of complications, including bleeding and infection which are the most common complications reported in the literature. Our case series report four unusual complications not related to gastrointestinal bleeding and infections and their management. Case presentation A 61 year old female after LVAD implantation with late onset of severe symptomatic aortic regurgitation treated by transfemoral transcatheter valve implantation (TAVI) with good long term results. A 75 year old male patient with acute pump failure secondary to cable damage, who underwent urgent pump replacement. A 49 year old female patient with a history of myoma who developed massive uterine bleeding which was treated with emergent open hysterectomy after failed gonadotropin-releasing hormone therapy replacement. A 57 year old male patient with device display failure 1 month after LVAD implantation without the ability to monitor speed, power consumption and blood flow. Conclusions LVAD patients can be presented with a great variety of complications. Physicians should be aware of their manifestations and the management options.
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Affiliation(s)
- Amjad Shalabi
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel. .,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel. .,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Erez Kachel
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yigal Kassif
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muin Faqeeh
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Preisman Sergey
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Anesthesia, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liza Grosman-Rimon
- Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Wadi Kinany
- Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Offer Amir
- Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eylon Ram
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jacob Lavee
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishay Grupper
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peled Y, Lavee J, Ram E, Kassif Y, Peysakhovich Y, Sternik L, Patel J, Raanani E. Combined Procurement of Heart and Lungs is Associated with an Increased Risk of Primary Graft Dysfunction after Heart Transplantation Compared to Isolated Heart Procurement. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Kogan A, Kassif Y, Frogel J, Levin S, Ram E, Peled Y, Raanani E, Sternik L. The Impact of Initiation of an Intensivist-Led Patient Management Protocol on Outcomes After Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 35:2370-2376. [PMID: 33483270 DOI: 10.1053/j.jvca.2020.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Prolonged intensive care unit stay after cardiac surgery is associated with high mortality. The aim of this study was to evaluate the impact of the introduction of a quality improvement program under the supervision of an intensivist on the long-term mortality of high-risk patients with prolonged intensive care unit (ICU) stay after cardiac surgery. DESIGN Retrospective study of prospectively collected data. SETTING Cardiac surgery ICU. PARTICIPANTS A total of 7,549 patients after cardiac surgery. INTERVENTIONS Patients were divided into two periods: 2004 to 2007, before introducing the quality improvement program (3,315 patients), and 2009 to 2014, after introduction of the program (4,234 patients). In the period from 2004 to 2007, patients were divided into group I (ICU stay ≥ seven days), which included 242 patients, and group III (ICU stay < seven days), which included 3,073 patients. Also, in the period from 2009 to 2014 patients, were divided into group II (ICU stay ≥seven days), which included 326 patients, and group IV (ICU stay < seven days), which included 3,908 patients. Patient outcomes were compared. Follow-up was five years for each group. MEASUREMENTS AND MAIN RESULTS The European System for Cardiac Operative Risk Evaluation did not differ significantly among the groups. When comparing between group I and group II, 30-day mortality decreased significantly from 24.8% to 16.6%, six-month mortality from 27.3% to 19.3%, one-year mortality from 42.1% to 32.2%, 3-year mortality from 54.5% to 43.3%, and 5-year mortality from 61.2% to 51.8%. In comparing between group III and group IV, the authors did not observe a statistically significant decrease of mortality. CONCLUSIONS Intensivist-led patient management protocol is associated with decreased long-term mortality in high-risk patients with a prolonged ICU stay.
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Affiliation(s)
- Alexander Kogan
- Department of Cardiac Surgery, Sheba Medical Center, Tel Aviv, Israel; Cardiac Surgery Intensive Care Unit, Sheba Medical Center, Tel Aviv, Israel.
| | - Yigal Kassif
- Department of Cardiac Surgery, Sheba Medical Center, Tel Aviv, Israel; Cardiac Surgery Intensive Care Unit, Sheba Medical Center, Tel Aviv, Israel
| | - Jonathan Frogel
- Department of Anesthesiology, Sheba Medical Center, Tel Aviv, Israel
| | - Shany Levin
- Department of Cardiac Surgery, Sheba Medical Center, Tel Aviv, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Sheba Medical Center, Tel Aviv, Israel
| | - Yael Peled
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Sheba Medical Center, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center, Tel Aviv, Israel
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Ram E, Klempfner R, Peled A, Kassif Y, Sternik L, Lavee J, Peled Y. Weight gain post-heart transplantation is associated with an increased risk for allograft vasculopathy and rejection. Clin Transplant 2020; 35:e14187. [PMID: 33314309 DOI: 10.1111/ctr.14187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Obesity and overweight are associated with an increased risk for cardiovascular disease. Since fat mass (FM) and fat-free mass (FFM) both contribute to total body weight (TBW), we characterized the post-heart transplantation (HT) change in TBW and its implications for outcomes. METHODS Post-HT changes in TBW, FM, and FFM were reviewed for 211 HT patients assessed during 1997-2017. Endpoints included cardiac allograft vasculopathy (CAV) and rejection. RESULTS Median TBW increased by 7.3% at 1 year, with a significant rise in the obese category (28% vs. 13%, p < 0.001) and with FM versus FFM making the main contribution (23% vs. 3%, p < 0.001). When patients were divided according to median TBW change ("high" vs. "low"), Kaplan-Meier analysis showed that 10-year freedom from CAV (log-rank p < 0.005) and rejection (log-rank p < 0.01) was significantly higher for the "low" TBW change group. Consistently, multivariable analyses showed that the "high" group was independently associated with significant 3.5-fold and 4.2-fold increased risks for CAV (95% CI 1.4-8.7, p = 0.01) and rejection (95% CI 1.2-15.4, p = 0.03), respectively. CONCLUSIONS Weight gain, contributed mostly by FM, is independently associated with an increased risk for CAV and rejection. Follow-up emphasis should be placed on weight gain and preventative measures.
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Affiliation(s)
- Eilon Ram
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israeli Association for Cardiovascular Trials, Ramat Gan, Israel
| | - Amir Peled
- Clalit Health Services, Central Region, Israel
| | - Yigal Kassif
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Peled Y, Klempfner R, Kassif Y, Kogan A, Maor E, Sternik L, Lavee J, Ram E. Preoperative Statin Therapy and Heart Transplantation Outcomes. Ann Thorac Surg 2020; 110:1280-1285. [DOI: 10.1016/j.athoracsur.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 01/06/2023]
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Peled Y, Lavee J, Kassif Y, Arad M, Kogan A, Peled A, Tirosh A, Sternik L, Ram E. Donor thyroid hormone therapy is associated with an increased risk of graft dysfunction after heart transplantation. Clin Transplant 2020; 34:e13887. [PMID: 32367594 DOI: 10.1111/ctr.13887] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Heart transplantation (HT) is uniquely associated with the potential impact of thyroid hormone therapy at three intersecting levels-donor, operation, and recipient. We aimed to study the effect of thyroid hormone therapy of the donor on primary graft dysfunction (PGD). METHODS A retrospective cohort study was conducted on 209 HT recipients assessed from 1997 to 2018; for 33 of the recipients, the donors had received T4 (DT4 group), and for 176, the donors had not (NoDT4 group). The primary endpoint was PGD defined according to the International Society for Heart and Lung consensus statement. RESULTS Both the incidence (58% vs 35%, P = .022) and the severity of PGD (42% vs 25% moderate/severe, P = .007) were significantly higher in the DT4 recipients. Multivariable analysis showed donor T4 therapy to be independently associated with a ~3.5-fold increased risk for PGD (OR = 3.44, 95% CI 1.26-9.86). These results remained consistent after propensity score analysis. CONCLUSIONS Donor thyroid hormone therapy is independently associated with an increased risk of PGD. Hypothesizing a "withdrawal effect" as the cause, we suggest that administration of thyroid hormone to the recipient at time of reperfusion could counter this negative effect. Prospective studies are needed to validate this hypothesis-generating study.
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Affiliation(s)
- Yael Peled
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Arad
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Kogan
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Peled
- Clalit Health Services, Tel Aviv, Israel
| | - Amir Tirosh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Leonid Sternik
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eilon Ram
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peled Y, Ram E, Kogan A, Rozenman J, Kassif Y, Sternik L, Lavee J. Explantation of Left Ventricular Assist Device as Bridge Therapy is Associated with Diaphragm Dysfunction after Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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17
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Peled Y, Lavee J, Ram E, Kassif Y, Sternik L, Schwammenthal E, Klempfner R, Tzur B. Left Atrial Volume after Heart Transplantation - A Predictor of Outcomes? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Peled Y, Ram E, Kogan A, Kassif Y, Sternik L, Lavee J. Spontaneous Restoration of Sinus Rhythm during Heart Transplantation is Associated with a Reduced Incidence of Primary Graft Dysfunction and Early Mortality. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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19
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Ram E, Lavee J, Freimark D, Maor E, Kassif Y, Sternik L, Kogan A, Peled Y. Improved long-term outcomes after heart transplantation utilizing donors with a traumatic mode of brain death. J Cardiothorac Surg 2019; 14:138. [PMID: 31331354 PMCID: PMC6647135 DOI: 10.1186/s13019-019-0963-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background The donor’s mode of brain death (BD), being associated with impairment of myocardial function and hemodynamic performance, impacts the prognosis of the heart transplantation (HTx) recipient. Methods All patients who underwent HTx between 1996 and 2017 were categorized according to donor’s BD mechanism: traumatic BD (TBD) versus non-traumatic BD (NTBD). Results The TBD group included 105 recipients, and the NTBD group, 85 recipients. Kaplan-Meier survival analysis showed that overall survival was significantly higher for recipients of TBD hearts (10-year survival 58.1 vs. 37.6%, p = 0.044). Consistently, multivariate analysis showed that TBD was independently associated with a significant 43% reduction in mortality [95% confidence interval (CI) 0.42–0.75, p = 0.033]. Rejection rate was lower in the TBD group (total rejection score 0.44 ± 0.32 vs. 0.51 ± 0.38, p = 0.04; any rejection score 0.38 ± 0.26 vs. 0.45 ± 0.31, p = 0.030), and freedom from cardiac allograft vasculopathy (CAV) was significantly higher in recipients of traumatic vs. non-traumatic donors (10 years: 82.9 vs. 62.4%, log-rank p-value = 0.024). Multivariate analysis showed a significant 42% reduction in CAV [hazard ratio (HR) = 0.58, 95% CI 0.51–0.85, p = 0.022). Conclusion Mode of brain death significantly impacts HTx outcomes, with TBD being associated with reduced mortality, rejections and CAV.
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Affiliation(s)
- Eilon Ram
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
| | - Jacob Lavee
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dov Freimark
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Kogan
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kogan A, Ram E, Nachum E, Kassif Y, Lavee J, Peled Y. Does duration of donor brain injury impact heart transplantation outcomes? Clin Transplant 2019; 33:e13660. [PMID: 31278764 DOI: 10.1111/ctr.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/19/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
Abstract
AIM We aimed to study the implications of pre-transplantation time intervals on HT outcomes. METHODS Brain injury time (BIT) was defined as the period from the donor brain injury to brain death declaration. Brain death interval (BDI) was defined as the period from brain death to application of an aortic cross-clamp during donor heart procurement. Allograft ischemia was defined as the time from donor aortic cross-clamp to aortic unclamping. End points included mortality and rejections. RESULTS Between 1997 and 2017, we assessed 173 patients. Kaplan-Meier analyses showed that prolonged donor BIT, BDI, allograft ischemia, and total injury time had no significant effect on mortality and rejections. Patients were subdivided into short BIT (<97 hours, n = 87) and long BIT (≥97 hours, n = 86) groups. No differences in rejection scores nor in time to first rejection were noted. Kaplan-Meier analysis showed a similar long-term survival in the two groups. Sub-analysis of both groups according to their median BDI (12 hours) revealed no differences in mortality or time to rejection. CONCLUSIONS Pre-transplantation time intervals do not affect mortality or rejection. Our findings have important clinical implications regarding HT allocation and organ availability.
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Affiliation(s)
- Alexander Kogan
- Heart Transplantation Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eilon Ram
- Heart Transplantation Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nachum
- Heart Transplantation Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- Heart Transplantation Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Heart Transplantation Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled
- Heart Transplantation Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ram E, Lavee J, Kogan A, Kassif Y, Elian D, Freimark D, Peled Y. Does donor‐recipient age difference matter in outcome of heart transplantation? Clin Transplant 2019; 33:e13593. [DOI: 10.1111/ctr.13593] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/05/2019] [Accepted: 05/08/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery and Cardiology Sheba Medical Center Tel Hashomer Israel
- Leviev Cardiovascular and Thoracic Surgery Center Sheba Medical Center Tel Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Jacob Lavee
- Department of Cardiac Surgery and Cardiology Sheba Medical Center Tel Hashomer Israel
- Leviev Cardiovascular and Thoracic Surgery Center Sheba Medical Center Tel Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Alexander Kogan
- Department of Cardiac Surgery and Cardiology Sheba Medical Center Tel Hashomer Israel
- Leviev Cardiovascular and Thoracic Surgery Center Sheba Medical Center Tel Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Yigal Kassif
- Department of Cardiac Surgery and Cardiology Sheba Medical Center Tel Hashomer Israel
- Leviev Cardiovascular and Thoracic Surgery Center Sheba Medical Center Tel Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Dan Elian
- Leviev Cardiovascular and Thoracic Surgery Center Sheba Medical Center Tel Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Dov Freimark
- Leviev Cardiovascular and Thoracic Surgery Center Sheba Medical Center Tel Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Yael Peled
- Leviev Cardiovascular and Thoracic Surgery Center Sheba Medical Center Tel Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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Ram E, Goldenberg I, Kassif Y, Segev A, Lavee J, Einhorn-Cohen M, Raanani E. Real-life characteristics and outcomes of patients who undergo percutaneous coronary intervention versus coronary artery bypass grafting for left main coronary artery disease: data from the prospective Multi-vessel Coronary Artery Disease (MULTICAD) Israeli Registry. Eur J Cardiothorac Surg 2019; 54:717-723. [PMID: 29554237 DOI: 10.1093/ejcts/ezy115] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/21/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Left main coronary artery involvement in patients with multivessel coronary artery disease provides a poor prognosis. Although the main strategy for revascularization is by coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) is being used with increased frequency. METHODS This prospective, 3-year follow-up study included 1063 consecutive patients with multivessel coronary artery disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and PCI. RESULTS Of the 1063 patients, 252 (24%) had left main coronary artery disease. Of them, 27% were treated by PCI and 73% by CABG. Factors associated with referral for PCI included older age [odds ratio (OR) 1.04; P = 0.021], renal impairment (OR 3.52; P = 0.006), prior PCI (OR 2.23; P = 0.041) and lower SYNTAX score (OR 1.05; P = 0.004). Kaplan-Meier survival analysis showed that after 3 years, all-cause mortality among left main coronary artery disease patients was significantly higher among those who underwent PCI versus CABG (26.9% vs 8.7%; P < 0.001). Multivariable analysis showed that PCI was associated with a >2-fold increased hazard for mortality compared with surgical revascularization (hazard ratio 2.13, 95% confidence interval 1.05-4.31; P = 0.036). CONCLUSIONS In real-life practice, clinical factors and a lower SYNTAX score affect the decision to perform PCI in left main coronary artery disease patients. Our findings suggest that CABG is associated with improved long-term survival compared to PCI in patients with left main coronary artery disease after adjustment for those factors.
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Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ilan Goldenberg
- Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yigal Kassif
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Amit Segev
- Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Jacob Lavee
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Michal Einhorn-Cohen
- Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Peled Y, Freimark D, Nachum E, Arad M, Elian D, Kassif Y, Shlomo N, Klempfner R, Lavee J. Weight Gain Post Heart Transplantation is Associated with an Increased Risk for Allograft Vasculopathy and Rejection. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Peled Y, Lavee J, Nachum E, Kassif Y, Arad M, Kogan A, Freimark D, Ram E. Donor Hormonal Thyroid Therapy is Associated with Increased Risk of Primary Graft Dysfunction after Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ram E, Lavee J, Kassif Y, Elian D, Katz M, Klempfner R, Freimark D, Peled Y. Does Donor-Recipient Age Difference Matter in the Outcome of Heart Transplantation? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Peled Y, Lavee J, Ram E, Kassif Y, Peled A, Freimark D, Ofek E, Kogan A. Recurrent acute cellular rejection graded ISHLT 1R early after heart transplantation negatively affects long-term outcomes: The prognostic significance of 1990 ISHLT grades 1B and 2. Transpl Immunol 2019; 55:101204. [PMID: 30904625 DOI: 10.1016/j.trim.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE We investigated the implications of early recurrent 1R rejections for long-term outcomes after heart transplantation (HT) and evaluated the prognostic significance of 1990 ISHLT grading 1B/2 versus 1A. METHODS Data on all patients who underwent HT between 1992 and 2017 were reviewed. Patients with ≥2 endomyocardial biopsies graded 1R in the first 3 months were classified as "recurrent 1R." Those patients were further categorized according to 1A vs. 1B/2. Outcomes (>3 months) were long-term rejections and the combined endpoint of cardiac allograft vasculopathy (CAV) and cardiovascular (CV) mortality. RESULTS Sixty-nine out of 228 patients were classified as recurrent grade 1R. In the recurrent 1R group, 2R rejection rate was significantly higher (2.6 ± 0.6 vs 1.2 ± 0.4, p = 0.03), while survival free of rejections was lower (5-year: 57.1% vs. 72.3%, p = 0.022). Multivariate analysis showed that early recurrent 1R rejection was associated with a 30% increased risk for subsequent major rejection. Among 28 patients classified as 1B/2 of the recurrent group, rejection scores were higher, while survival free of rejections was lower, compared to 37 patients of the recurrent group classified as 1A (5-year: 57.1% vs. 72.7%, p = 0.013). Kaplan-Meier analysis showed that CAV/CV mortality at 10 years of follow-up was significantly higher among the recurrent 1R group (38% vs. 18% p < 0.05). Multivariate analysis showed that early recurrent 1R rejections were associated with a 2.5-fold increased risk for CAV/CV mortality. CONCLUSION Early recurrent grade 1R rejections negatively affect long-term outcomes. The adverse outcomes are experienced mainly by 1R patients subcategorized as1B/2 and not 1A.
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Affiliation(s)
- Yael Peled
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jacob Lavee
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eilon Ram
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Peled
- Clalit Health Services, Central Region, Israel
| | - Dov Freimark
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Ofek
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Pathology, Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Kogan
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peled Y, Loewenthal R, Kassif Y, Raichlin E, Younis A, Younis A, Nachum E, Freimark D, Lavee J. Ethnic disparity in Israel impacts long-term results after heart transplantation. Isr J Health Policy Res 2019; 8:3. [PMID: 30636628 PMCID: PMC6330742 DOI: 10.1186/s13584-018-0271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethnicity may affect graft longevity and recipient mortality after heart transplantation (HTx). We hypothesized that differences in ethnic origin between Arabs and Jews undergoing HTx in Israel may contribute to differences in long-term outcomes. METHODS The study population comprised all 254 patients who underwent HTx between 1991 and 2017 in a tertiary medical center located in the center of Israel. Patients were categorized as either Jews (226 patients, 89%) or Arabs (28 patients, 11%). The primary end point was cardiac allograft vasculopathy (CAV), secondary end points were cardiovascular (CV) mortality and the combined end point of CAV/CV mortality. RESULTS In comparison with Jews, Arab patients were significantly younger (ave. age 42 vs. 50) and had shorter in-hospital stay (45 vs. 80 days). However, Kaplan-Meier survival analysis showed that at 10 years of follow-up CAV rates were significantly higher among Arabs (58%) compared with Jews (23%; log-rank P = 0.01) for the overall difference during follow-up. Similar results were shown for the separate end point of CV mortality and the combined end point of CAV/CV mortality. Multivariate analysis, which controlled for age, gender, statin treatment, and other potential confounders, showed that Arab recipient ethnic origin was associated with a significant > 2.5-fold (p = 0.01) increase in the risk for CAV; a > 4-fold increase in the risk for CV mortality (p = 0.001); and approximately 4-fold increase in the risk for the combined end point (p = 0.001). These findings were validated by propensity score analysis. CONCLUSIONS Our data suggest that Arab ethnic origin is associated with a significantly increased risk for CAV and mortality following HTx. Suggested explanations contributing to ethnic disparities in Israel include socioeconomic, environmental and genetic factors. Further studies are required to evaluate whether more aggressive risk factor management in the Israeli Arab population following HTx would reduce CAV and CV mortality in this high-risk population. Increased awareness and early intervention of the Israeli healthcare system and cooperation with the Arab community is of paramount importance.
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Affiliation(s)
- Yael Peled
- The Olga and Lev Leviev Heart Center, Sheba Medical Center Tel Hashomer, Heart Transplantation Unit, Heart Failure Institute, 52621, Ramat Gan, Israel. .,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ron Loewenthal
- Tissue Typing Laboratory Sheba Medical Center, Ramat Gan, Israel
| | - Yigal Kassif
- The Olga and Lev Leviev Heart Center, Sheba Medical Center Tel Hashomer, Heart Transplantation Unit, Heart Failure Institute, 52621, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eugenia Raichlin
- Cardiology Department, Loyola University Medical Center, Maywood, IL, USA
| | - Arwa Younis
- The Olga and Lev Leviev Heart Center, Sheba Medical Center Tel Hashomer, Heart Transplantation Unit, Heart Failure Institute, 52621, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anan Younis
- The Olga and Lev Leviev Heart Center, Sheba Medical Center Tel Hashomer, Heart Transplantation Unit, Heart Failure Institute, 52621, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nachum
- The Olga and Lev Leviev Heart Center, Sheba Medical Center Tel Hashomer, Heart Transplantation Unit, Heart Failure Institute, 52621, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dov Freimark
- The Olga and Lev Leviev Heart Center, Sheba Medical Center Tel Hashomer, Heart Transplantation Unit, Heart Failure Institute, 52621, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- The Olga and Lev Leviev Heart Center, Sheba Medical Center Tel Hashomer, Heart Transplantation Unit, Heart Failure Institute, 52621, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peled Y, Loewenthal R, Kassif Y, Raichlin E, Younis A, Younis A, Nachum E, Freimark D, Goldenberg I, Lavee J. Donor-recipient ethnic mismatching impacts short- and long-term results of heart transplantation. Clin Transplant 2018; 32:e13389. [DOI: 10.1111/ctr.13389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/28/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Yael Peled
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ron Loewenthal
- Tissue Typing Laboratory Sheba Medical Center; Tel Hashomer Israel
| | - Yigal Kassif
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eugenia Raichlin
- Cardiology Department; Loyola University Medical Center; Maywood Illinois
| | - Arwa Younis
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Anan Younis
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eyal Nachum
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Dov Freimark
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ilan Goldenberg
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Jacob Lavee
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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Fink N, Nikolsky E, Assali A, Shapira O, Kassif Y, Barac YD, Finkelstein A, Eitan A, Danenberg H, Zahger D, Sahar G, Atar S, Raanani E, Bolotin G, Goldenberg I, Segev A. Revascularization Strategies and Survival in Patients With Multivessel Coronary Artery Disease. Ann Thorac Surg 2018; 107:106-111. [PMID: 30267693 DOI: 10.1016/j.athoracsur.2018.07.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/23/2018] [Accepted: 07/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND We sought to assess real-world implementation of the guidelines in patients with multivessel coronary artery disease (CAD) using a prospective national registry in Israel. METHODS All consecutive patients with left main or 2- to 3-vessel CAD involving the proximal or mid left anterior descending artery were enrolled in a dedicated multicenter registry. Patients were managed at the discretion of the treating team at each hospital and were followed for 30 months. RESULTS This registry included 1,064 patients, 55% treated with percutaneous coronary intervention (PCI) and 45% with coronary artery bypass surgery (CABG). Multivariate logistic regression analysis showed that chronic renal failure (odds ratio [OR], 2.43; p = 0.001) and prior myocardial infarction (OR, 1.7; p = 0.024) were associated with referral to PCI versus CABG, whereas male gender (OR, 2.27; p < 0.001), prior aspirin treatment (OR, 1.72; p = 0.005), diabetes mellitus (OR, 1.51; p = 0.007), 3-vessel CAD (OR, 3.45; p < 0.001) and SYNTAX score (SS) greater than 32 (OR, 10.0; p < 0.001) were associated with referral to CABG versus PCI. Each point increment in the SS was independently associated with a 9% greater likelihood of referral to CABG (p < 0.001). Survival analysis showed that mortality risk was lower among PCI patients less than 8 months after the procedure, and CABG was associated with a significant survival benefit thereafter. CONCLUSIONS We found good agreement with current guidelines regarding revascularization strategies in real-world patients with multivessel CAD. The SS was the main independent predictor associated with the choice of revascularization strategy. The time-dependent association between revascularization strategy and long-term survival should be incorporated in the risk assessment of this population.
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Affiliation(s)
- Noam Fink
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | | | - Abid Assali
- Division of Cardiology, Rabin Medical Center, Petach-Tikva, Israel
| | - Oz Shapira
- Department of Cardiac Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Yigal Kassif
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaron D Barac
- Department of Cardiac Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | | | - Amnon Eitan
- Division of Cardiology, Rambam Healthcare Center, Haifa, Israel
| | - Haim Danenberg
- Division of Cardiology, Hadassah Medical Center, Jerusalem, Israel
| | - Doron Zahger
- Division of Cardiology, Soroka Medical Center, Beer-Sheva, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gideon Sahar
- Department of Cardiac Surgery, Soroka Medical Center, Beer-Sheva, Israel
| | - Shaul Atar
- Division of Cardiology, Galilee Medical Center, Naharyiah, Faculty of Medicine in the Galilee, Bar Ilan University, Ramat Gan, Israel
| | - Ehud Raanani
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Gil Bolotin
- Department of Cardiovascular Surgery, Rambam Healthcare Center, Haifa, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Peled Y, Freimark D, Har-Zahav Y, Nachum E, Kogan A, Kassif Y, Lavee J. Trends and Outcomes in Heart Transplantation over the Past Three Decades: A Single Tertiary Center Experience in Israel. Isr Med Assoc J 2018; 20:567-572. [PMID: 30221871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Heart transplantation (HT) is the treatment of choice for patients with end-stage heart failure. The HT unit at the Sheba Medical Center is the largest of its kind in Israel. OBJECTIVES To evaluate the experience of HT at a single center, assess trends over 3 decades, and correlate with worldwide data. METHODS Between 1990 and 2017, we reviewed all 285 adult HT patients. Patients were grouped by year of HT: 1990-1999 (decade 1), 2000-2009 (decade 2), and 2010-2017 (decade 3). RESULTS The percentage of women undergoing HT has increased and etiology has shifted from ischemic to non-ischemic cardiomyopathy (10% vs. 25%, P = 0.033; 70% vs. 40% ischemic, for decades 1 vs. 3, respectively). Implantation of left ventricular assist device as a bridge to HT has increased. Metabolic profile has improved over the years with lower low-density lipoprotein, diabetes, and hypertension after HT (101 mg/dl, 27%, and 41% at decade 3, respectively). There has been a prominent change in immunosuppressive treatments, currently more than 90% are treated with tacrolimus, compared with 2.7% and 30.9% in decades 1 and 2, respectively (P < 0.001). Cardiac allograft vasculopathy (CAV) rates have declined significantly (47% vs. 17.5% for decades 1 and 2, P < 0.001) as have the combined endpoint of CAV/death. Similarly, the current incidence of acute rejections is significantly lower. CONCLUSIONS Our analysis of over 25 years of a single-center experience with HT shows encouraging improved results, which are in line with worldwide standards and experience.
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Affiliation(s)
- Yael Peled
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dov Freimark
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yedael Har-Zahav
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Nachum
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Kogan
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nachum E, Sternik L, Kassif Y, Raanani E, Hay I, Shalabi A, Buber J. Surgical Pericardiectomy for Constrictive Pericarditis: A Single Tertiary Center Experience. Thorac Cardiovasc Surg 2018; 68:730-736. [PMID: 29804284 DOI: 10.1055/s-0038-1645869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Although surgery is the sole therapeutic option for patients with constrictive pericarditis (CP), reports on high postoperative mortality rates have led to hesitant surgery referral. The aim of this study was to report the short- and long-term outcomes of surgical pericardiectomy (SP) from a large tertiary center. METHODS Between January 2005 and January 2017, 55 consecutive patients underwent SP after comprehensive echocardiography, computed tomography, and hemodynamic studies. Detailed clinical, imaging, surgical techniques and follow-up outcomes were recorded. RESULTS The most common etiology was idiopathic (n = 27, 49%) and 33 patients (60%) were in functional class 3/4. Sixteen patients (29%) underwent concomitant interventions during SP, and cardiopulmonary bypass (CPB) was used in these, as well as in four additional cases. Complete resection, independent of CPB, was achieved in 96%. One patient died during the index hospitalization, and four (7%) needed re-explorations due to bleeding. While 12 patients (22%) died during a mean follow-up of 52 ± 39 months, only 1 death was due to right heart failure. Functional class significantly improved (with a p-value < 0.001), diuretics were discontinued in all, and significant reductions of right atrial pressures were recorded. None of these outcomes differed as a result of concomitant interventions at the time of SP. CONCLUSION Short- and long-term outcomes of SP, performed either alone or concomitantly with other procedures, indicate high safety and favorable clinical and hemodynamic efficacy for the treatment of CP.
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Affiliation(s)
- Eyal Nachum
- Department of Cardiac Surgery, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Yigal Kassif
- Department of Cardiac Surgery, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Ilan Hay
- Department of Cardiology, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Amjad Shalabi
- Department of Cardiac Surgery, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Jonathan Buber
- Department of Cardiology, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
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Peled Y, Raichlin E, Gueta I, Mazin I, Kassif Y, Har-Zahav Y, Nachum E, Freimark D, Goldenberg I, Lavee J. Recurrent Acute Cellular Rejection Graded ISHLT 1R Early After Heart Transplantation Negatively Affects Long-term Outcomes. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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33
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Peled Y, Loewenthal R, Raichlin E, Gueta I, Younis A, Kassif Y, Har-Zahav Y, Nachum E, Freimark D, Goldenberg I, Lavee J. Donor-recipient Ethnic Matching Impacts Short and Long-term Results of Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Peled Y, Lavee J, Arad M, Raichlin E, Shlomo N, Har-Zahav Y, Kassif Y, Nachum E, Freimark D, Goldenberg I, Mazin I. Relation of Age to Risk of Major Rejections, Allograft Vasculopathy, and Long-term Mortality in a Contemporary Cohort of Patients Undergoing Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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35
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Peled Y, Lavee J, Raichlin E, Katz M, Arad M, Kassif Y, Peled A, Asher E, Elian D, Har-Zahav Y, Shlomo N, Freimark D, Goldenberg I, Klempfner R. Early aspirin initiation following heart transplantation is associated with reduced risk of allograft vasculopathy during long-term follow-up. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13133] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Yael Peled
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Jacob Lavee
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eugenia Raichlin
- Cardiology Department; Loyola University Medical Center; Maywood IL USA
| | - Moshe Katz
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michael Arad
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yigal Kassif
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Amir Peled
- Clalit Health Services; Central Region; Tel Aviv Israel
| | - Elad Asher
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Dan Elian
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yedael Har-Zahav
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - Nir Shlomo
- Israeli Association for Cardiovascular Trials; Sheba Medical Center; Israel
| | - Dov Freimark
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ilan Goldenberg
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Israeli Association for Cardiovascular Trials; Sheba Medical Center; Israel
| | - Robert Klempfner
- The Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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Katz M, Freimark D, Raichlin E, Har-Zahav Y, Arad M, Kassif Y, Peled A, Asher E, Elian D, Kogan A, Shlomo N, Ofek E, Lavee J, Goldenberg I, Peled Y. Risk of early, intermediate, and late rejection following heart transplantation: Trends over the past 25 years and relation to changes in medical management. Tertiary center experience: The Sheba Heart Transplantation Registry. Clin Transplant 2017; 31. [PMID: 28753240 DOI: 10.1111/ctr.13063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 11/30/2022]
Abstract
AIM To explore the trends in the risk for rejection following heart transplantation (HT) over the past 25 years, and their relation to changes in medical management. METHODS The study population comprised 216 HT patients. Rejection periods were defined as follows: 0-3 months (early), 3-12 months (intermediate), and 12+ months (late). HT era was dichotomized as follows: 1991-1999 (remote era) and 2000-2016 (recent era). Medication combination was categorized as newer (TAC, MMF, and everolimus) vs older therapies (AZA, CSA). RESULTS Multivariate analysis showed that patients who underwent HT during the recent era experienced a significant reduction in the risk for major rejection. These findings were consistent for early (OR = 0.44 [95% CI 0.22-0.88]), intermediate (OR = 0.02 [95% CI 0.003-0.11]), and late rejections (OR = 0.18 [95% CI 0.05-0.52]). Using the year of HT as a continuous measure showed that each 1-year increment was independently associated with a significant reduction in the risk for early, intermediate, and late rejections (5%, 21%, 18%, respectively). In contrast, the risk reduction associated with newer types of immunosuppressive therapies was not statistically significant after adjustment for the treatment period. CONCLUSIONS Major rejection rates following HT have significantly declined over the past 2 decades even after adjustment for changes in immunosuppressive therapies, suggesting that other factors may also play a role in the improved outcomes of HT recipients.
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Affiliation(s)
- Moshe Katz
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dov Freimark
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eugenia Raichlin
- Cardiology Department, Loyola University Medical Center, Maywood, IL, USA
| | - Yedael Har-Zahav
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Michael Arad
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Peled
- Central Region, Clalit Health Services, Lod, Israel
| | - Elad Asher
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Elian
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Kogan
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Shlomo
- Israeli Association for Cardiovascular Trials, Sheba Medical Center, Israel
| | - Efrat Ofek
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel
| | - Jacob Lavee
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israeli Association for Cardiovascular Trials, Sheba Medical Center, Israel
| | - Yael Peled
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peled Y, Lavee J, Raichlin E, Katz M, Arad M, Kassif Y, Peled A, Asher E, Elian D, Har-Zahav Y, Shlomo N, Freimark D, Goldenberg I, Klempfner R. Metformin therapy reduces the risk of malignancy after heart transplantation. J Heart Lung Transplant 2017; 36:1350-1357. [PMID: 28736111 DOI: 10.1016/j.healun.2017.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/11/2017] [Accepted: 06/21/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Malignancy and diabetes mellitus (DM) cause significant morbidity and mortality after heart transplantation (HTx). Metformin, one of the most commonly used anti-diabetic drugs worldwide, has also been shown to exhibit anti-tumor activity. We therefore investigated the association between metformin therapy and malignancy after HTx. METHODS The study population comprised 237 patients who underwent HTx between 1991 and 2016 and were prospectively followed-up. Clinical data were recorded on prospectively designed forms. The primary outcome was any cancer recorded during 15 years of follow-up. Treatment with metformin and the development of DM after HTx were assessed as time-dependent factors in the analyses. RESULTS Of the 237 study patients, 85 (36%) had diabetes. Of the DM patients, 48 (56%) were treated with metformin. Kaplan-Meier survival analysis showed that, at 15 years after HTx, malignancy rate was 4% for DM patients treated with metformin, 62% for those who did not receive metformin and 27% for non-DM patients (log-rank test, p < 0.0001). Consistently, multivariate analysis showed that for DM patients, metformin therapy was independently associated with a significant 90% reduction (hazard ratio = 0.10; 95% confidence interval 0.02 to 0.40; p = 0.001) in the risk of the development of a malignancy. DM patients who were treated with metformin had a markedly lower risk (65%; p = 0.001) for the development of a malignancy or death after HTx as compared with non-DM patients. CONCLUSIONS Our findings suggest that metformin therapy is independently associated with a significant reduction in the risk of malignancy after HTx.
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Affiliation(s)
- Yael Peled
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jacob Lavee
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eugenia Raichlin
- Cardiology Department, Loyola University Medical Center, Maywood, Illinois, USA
| | - Moshe Katz
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Arad
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Kassif
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Peled
- Clalit Health Services, Central Region, Israel
| | - Elad Asher
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Elian
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yedael Har-Zahav
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Nir Shlomo
- Israeli Association for Cardiovascular Trials, The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Dov Freimark
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Israeli Association for Cardiovascular Trials, The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Robert Klempfner
- The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peled Y, Katz M, Arad M, Kassif Y, Shemesh Y, Asher E, Elian D, Har-Zahav Y, Shlomo N, Freimark D, Lavee J, Goldenberg I. Risk of Early, Intermediate, and Late Rejection Following Heart Transplantation (HT): Trends Over the Past 25 Years and Relation to Changes in Medical Management. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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39
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Peled Y, Har-Zahav Y, Kassif Y, Shemesh Y, Freimark D, Lavee J. Heart Transplantation in LVAD Patient Following Donor's Extracorporeal Membrane Oxygenation Support: Is It Safe? J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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40
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Peled Y, Lavee J, Arad M, Shemesh Y, Katz M, Kassif Y, Asher E, Elian D, Har-Zahav Y, Goldenberg I, Freimark D. The impact of gender mismatching on early and late outcomes following heart transplantation. ESC Heart Fail 2016; 4:31-39. [PMID: 28217310 PMCID: PMC5292637 DOI: 10.1002/ehf2.12107] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/11/2016] [Indexed: 11/22/2022] Open
Abstract
Aims The role of donor/recipient gender matching on the long‐term rejection process and clinical outcomes following heart transplantation (HT) outcomes is still controversial. We aim to investigate the impact of gender matching on early and long‐term outcome HT. Methods and results The study population comprised 166 patients who underwent HT between 1991 and 2013 and were prospectively followed up in a tertiary referral centre. Early and late outcomes were assessed by the type of donor–recipient gender match (primary analysis: female donor–male recipient [FD–MR, n = 36] vs. male donor–male recipient [MD–MR, n = 109]). Early mortality, need for inotropic support, length of hospital stay, and major perioperative adverse events did not differ between the FD–MR and MD–MR groups. However, the FD–MR group experienced significantly higher rates of early major rejections per patient as compared with the MD–MR group (1.2 ± 1.6 vs. 0.4 ± 0.8; P = 0.001), higher rates of overall major rejections (16 vs. 5.5 per 100 person years; P < 0.05), and higher rate of cardiac allograft vasculopathy (43% vs. 20%; P = 0.01). Kaplan–Meier survival analysis showed that the cumulative probabilities of survival free of rejections and major adverse events were significantly higher in MD–MR group (P = 0.002 and 0.001, respectively). Multivariate analysis showed that FD–MR status was associated with >2.5‐fold (P = 0.03) increase in the risk for rejections and with a >3‐fold (P = 0.01) increase in the risk for major adverse events during follow‐up. Conclusions Donor–recipient gender mismatch is a powerful independent predictor of early and late rejections and long‐term major adverse events following HT.
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Affiliation(s)
- Yael Peled
- Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael; Heart Failure Institute, Heart Center, Sheba Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Jacob Lavee
- Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael Arad
- Heart Failure Institute, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Yedida Shemesh
- Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Moshe Katz
- Heart Rehabilitation Center, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Yigal Kassif
- Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Elad Asher
- Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Dan Elian
- Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Yedael Har-Zahav
- Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Ilan Goldenberg
- Heart Rehabilitation Center, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Dov Freimark
- Heart Failure Institute, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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41
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Peled Y, Katz M, Har-Zahav Y, Shemesh Y, Arad M, Kassif Y, Shlomo N, Goldenberg I, Freimark D, Lavee J. Trends of Early and Late Rejection Rates Following Heart Transplantation Over the Past Two Decades: Real World Data from a National Tertiary Center Registry. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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42
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Peled Y, Lavee J, Arad M, Shemesh Y, Kassif Y, Har-Zahav Y, Goldenberg I, Freimark D. The Impact of Gender Mismatching on Early and Late Outcomes Following Heart Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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43
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Dechtman ID, Ben-Zvi I, Yael S, Cohen R, Nachum E, Lipey A, Sternik L, Kachel E, Kassif Y, Shinfeld A, Spigelstein D, Lavee J, Raanani E, Livneh A. MEFV mutation carriage as possible predisposition factor for the development of Post Pericardiotomy Syndrome (PPS). Pediatr Rheumatol Online J 2015. [PMCID: PMC4599978 DOI: 10.1186/1546-0096-13-s1-p76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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44
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Kassif Y, Zilbershlag M, Levy M, Schueler S. Effective Transcutaneous Energy Transfer Allows for More Than 6 Hours of Freedom From External Gear - The Future Is Here. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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45
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Kogan A, Preisman S, Berkenstadt H, Segal E, Kassif Y, Sternik L, Orlov B, Shalom E, Levin S, Malachy A, Lavee J, Raanani E. Evaluation of the Impact of a Quality Improvement Program and Intensivist-Directed ICU Team on Mortality After Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:1194-200. [DOI: 10.1053/j.jvca.2013.02.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Indexed: 11/11/2022]
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46
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Naftali-Shani N, Itzhaki-Alfia A, Landa-Rouben N, Kain D, Holbova R, Molotski N, Asher E, Grupper A, Millet E, Tessone A, Winkler E, Kastrup J, Feinberg MS, Kassif Y, Sternik L, Lavee J, Raanani E, Leor J. Abstract 009: Cardiac Human Mesenchymal Stromal Cells from Patients with Ischemic Heart Disease are Proinflammatory and Impair Recovery after Myocardial Infarction in Rat. Circ Res 2013. [DOI: 10.1161/res.113.suppl_1.a009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Human mesenchymal stromal cells (hMSCs) from adipose cardiac tissue have attracted considerable interest for cell-based therapies. However, the best source of hMSCs for infarct repair is still unknown.
Hypothesis:
We aimed to test the hypothesis that, because of their proximity to the heart, hMSCs from the heart and epicardial fat would be better cells for infarct repair.
Methods and Results:
We isolated and grew hMSCs from patients with ischemic heart disease (IHD) from four different sources: 1) epicardial fat 2) pericardial fat 3) subcutaneous fat and 4) the right atrium. hMSCs from the right atrium and epicardial fat secreted the highest amounts of trophic and inflammatory cytokines, while hMSCs from pericardial and subcutaneous fat secreted the lowest (p<0.05, n=5-6 per source). Subsequently, the greatest angiogenic effect was induced with conditioned medium from atrium and epicardial fat hMSCs, by tube formation assay. To determine the effect of hMSCs
in vivo
, we allocated rats to hMSC transplantation 7 days after myocardial infarction (MI) (n=8-10 per group). Atrial hMSCs induced the highest number of vessels in the infarct, together with the highest inflammation score and macrophage accumulation 27 days after their injection. However, left ventricular (LV) dysfunction was worst after therapy with atrium and epicardial fat hMSCs, and minimal after subcutaneous fat hMSC therapy. Notably, there was a correlation between levels of tumor necrosis factor-α and hepatocyte growth factor,
in vitro
, and post-transplantation LV systolic dilatation. These surprising findings were supported by gene expression analysis in hMSCs from different sources of a patient with IHD. We found that the relative expression of inflammation and fibrosis-related genes was considerably higher in hMSCs from the right atrium and epicardial fat than in subcutaneous fat hMSCs.
Conclusions:
The origin of hMSCs affects their reparative and immunomodulatory properties. Because of their pro-inflammatory properties, hMSCs from the right atrium and epicardial fat of IHD patients could impair heart function after MI. Our findings might be relevant to autologous MSC therapy and pathogenesis and progression of IHD.
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Affiliation(s)
| | | | | | - David Kain
- Cardiac Rsch Institute, Sheba Med Cntr, Tel-Aviv Univ, Israel
| | - Radka Holbova
- Cardiac Rsch Institute, Sheba Med Cntr, Tel-Aviv Univ, Israel
| | - Natali Molotski
- Cardiac Rsch Institute, Sheba Med Cntr, Tel-Aviv Univ, Israel
| | - Elad Asher
- Cardiac Rsch Institute, Sheba Med Cntr, Tel-Aviv Univ, Israel
| | - Avishay Grupper
- Cardiac Rsch Institute, Sheba Med Cntr, Tel-Aviv Univ, Israel
| | - Eran Millet
- Dept of Plastic and Reconstructive Surgery, Sheba Med Cntr, Tel-Hashomer, Israel
| | - Ariel Tessone
- Dept of Plastic and Reconstructive Surgery, Sheba Med Cntr, Tel-Hashomer, Israel
| | - Eyal Winkler
- Dept of Plastic and Reconstructive Surgery, Sheba Med Cntr, Tel-Hashomer, Israel
| | - Jens Kastrup
- Cardiology Stem Cell Laboratory and Cardiac Catheterization Laboratory, The Heart Cntr, Rigshospitalet Copenhagen Univ Hosp, Denmark
| | | | - Yigal Kassif
- Dept of Cardiothoracic Surgery, Sheba Med Cntr, Tel-Hashomer, Israel
| | - Leonid Sternik
- Dept of Cardiothoracic Surgery, Sheba Med Cntr, Tel-Hashomer, Israel
| | - Jacob Lavee
- Dept of Cardiothoracic Surgery, Sheba Med Cntr, Tel-Hashomer, Israel
| | - Ehud Raanani
- Dept of Cardiothoracic Surgery, Sheba Med Cntr, Tel-Hashomer, Israel
| | - Jonathan Leor
- Cardiac Rsch Institute, Sheba Med Cntr, Tel-Aviv Univ, Israel
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Berger Y, Har Zahav Y, Kassif Y, Kogan A, Kuperstein R, Freimark D, Lavee J. Tricuspid valve regurgitation after orthotopic heart transplantation: prevalence and etiology. J Transplant 2012; 2012:120702. [PMID: 23097690 PMCID: PMC3477771 DOI: 10.1155/2012/120702] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 07/13/2012] [Accepted: 07/27/2012] [Indexed: 01/22/2023] Open
Abstract
Background. Tricuspid valve regurgitation (TR) after orthotopic heart transplantation (OHT) is common. The aims of this study were to determine the prevalence of TR after OHT, to examine the correlation between its development and various variables, and to determine its outcomes. Methods. All 163 OHT patients who were followed up between 1988 and 2009 for a minimal period of 12 months were divided into those with no TR/mild TR and those with at least mild-moderate TR, as assessed by doppler echocardiography. These groups were compared regarding preoperative hemodynamic variables, surgical technique employed, number of endomyocardial biopsies, number of acute cellular rejections, incidence of graft vasculopathy, and clinical outcomes. Results. At the end of the followup (average 8.2 years) significant TR was evident in 14.1% of the patients. The development of late TR was found by univariate, but not multivariate, analysis to be significantly correlated with the biatrial surgical technique (P < 0.01) and the presence of graft vasculopathy (P < 0.001). TR development was found to be correlated with the need for tricuspid valve surgery but not with an increased mortality. Conclusions. The development of TR after OHT may be related to the biatrial anastomosis technique and to graft vasculopathy.
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Affiliation(s)
- Yaniv Berger
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Yedael Har Zahav
- Heart Institute, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Yigal Kassif
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Alexander Kogan
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Rafael Kuperstein
- Heart Institute, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Dov Freimark
- Heart Institute, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Jacob Lavee
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
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Kogan A, Kassif Y, Shadel M, Shwarz Y, Lavee J, Or J, Raanani E. Severe hypothermia in myxoedema coma: A rewarming by extracorporeal circulation. Emerg Med Australas 2011; 23:773-5. [DOI: 10.1111/j.1742-6723.2011.01460.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lavee J, Kassif Y, Freimark D, Har Zahav Y, Koman V, Preisman S, Smolinsky A, Raanani E. [Ventricular assist devices as bridge to heart transplantation in cardiogenic shock or terminal heart failure--12 years experience at the Sheba Medical Center]. Harefuah 2007; 146:833-911. [PMID: 18087826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Patients in cardiogenic shock (CS) or with terminal heart failure (THF) are at imminent risk of death while waiting for heart transplantation (HTx). Implantation of left or bi-ventricular assist device (LVAD/BiVAD) as a bridge to HTx may save many of these doomed patients' lives. PATIENTS AND METHODS Between March 1994 and December 2006, 29 terminally ill patients (age 2.5-65 years, mean 48 years) underwent VADs implantation as bridge to HTx. The HeartMate VE LVAD was used in 18 patients, Thoratec pneumatic BiVAD in 7, Berlin Heart Excor BiVAD in one, and HeartMate II axial flow, Thoratec pneumatic and Biomedicus centrifugal LVADs in one each. Indications for VADs implantation were CS in 16 patients (55%) and intractable THF in 13 pts (45%). Etiologies were ischemic in 20 patients, idiopathic dilated, myocarditis and congenital in 2 patients each, and valvular, post partum and HTx graft vasculopathy in one patient each. RESULTS Seventeen patients (59%) survived VADs implantation and underwent HTx or are ongoing. Mean survival on VADs was 72 days (range 1-353 days, total 5.2 patient years). Seven patients (24%) were discharged home while on LVAD support for a mean of 146 days. Nine of the transplanted patients (64%) were discharged home. In 4 LVAD patients the cause of death was RV failure necessitating later implantation of RVAD. CONCLUSIONS VADs implantation as bridge to HTx in CS or THF saves many of these doomed patients, sometimes providing quality out-of-hospital life while waiting for HTx. Early recognition of RV failure and liberal use of BiVAD is important.
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Affiliation(s)
- Jacob Lavee
- Heart Transplantation Unit, Department of Cardiothoracic Surgery, Sheba Medical Center, Tel Hashomer affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Kaplan B, Martin BM, Cohen HI, Manaster J, Kassif Y, Rehany U, Livneh A. Primary local orbital amyloidosis: biochemical identification of the immunoglobulin light chain kappaIII subtype in a small formalin fixed, paraffin wax embedded tissue sample. J Clin Pathol 2005; 58:539-42. [PMID: 15858128 PMCID: PMC1770653 DOI: 10.1136/jcp.2004.022517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Amyloidosis refers to a heterogeneous group of disorders associated with the deposition of chemically distinct amyloid fibril proteins. Precise determination of chemical amyloid type has diagnostic, therapeutic, and prognostic relevance. Although immunohistochemical techniques are used routinely to determine the amyloid type, the results can be negative or inconclusive, so that biochemical characterisation is often required. The development and application of new biochemical microtechniques suitable for examination of extremely small tissue samples is essential for precise identification of the deposited amyloid proteins. AIMS To investigate biochemically the amyloid proteins present in a formalin fixed paraffin wax embedded orbital tissue from a patient with localised orbital amyloidosis in whom immunohistochemistry was not helpful in the determination of amyloid type. METHODS Extraction of amyloid proteins from fixed tissue and their identification was carried out by a recently developed microtechnique. An extremely small tissue sample was dewaxed and extracted with formic acid. The extracted material was analysed using electrophoresis, western blotting, and amino acid sequencing. RESULTS Biochemical examination of the extracted proteins showed the presence of immunoglobulin (Ig) derived amyloid proteins, which were composed of the N-terminal fragments of the Ig light chain kappaIII subtype (AL-kappaIII) (16, 8, and 3 kDa). CONCLUSIONS This is the first chemically proved AL case reported in association with primary localised orbital amyloidosis. The biochemical microtechnique used was useful in achieving a precise diagnosis of amyloid disease, in a case where the results of routine immunohistochemical examination of amyloid were inconclusive.
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Affiliation(s)
- B Kaplan
- Heller Institute of Medical Research, Sheba Medical Centre, Tel-Hashomer, 52621, Israel.
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