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Orthotopic Heart Transplant

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https://www.readbyqxmd.com/read/28801074/rational-heart-transplant-from-hepatitis-c-donor-new-antiviral-weapons-conquer-the-trojan
#1
Robert L Gottlieb, Teena Sam, Suzanne Y Wada, James F Trotter, Sumeet K Asrani, Brian Lima, Susan M Joseph, Gonzalo Gonzalez-Stawinski, Shelley A Hall
BACKGROUND: Donors with hepatitis C (HCV) viremia are rarely utilized for orthotopic heart transplantation (OHTx) due to post-transplant risks. New, highly effective HCV antivirals may alter the landscape. METHODS: An adult patient unsuitable for bridging mechanical support therapy accepted a heart transplant offer from a donor with HCV viremia. Upon daily logarithmic rise in HCV viral load and adequate titers to ensure successful genotyping, once daily sofosbuvir 400 mg / velpatasvir 100 mg (Epclusa) was initiated empirically pending HCV genotype (genotype 3a confirmed after initiation of therapy)...
August 8, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28781013/early-aspirin-use-and-the-development-of-cardiac-allograft-vasculopathy
#2
Miae Kim, Brian A Bergmark, Thomas A Zelniker, Mandeep R Mehra, Garrick C Stewart, Deborah S Page, Erica L Woodcome, Jennifer A Smallwood, Steven Gabardi, Michael M Givertz
BACKGROUND: Cardiac allograft vasculopathy (CAV) remains a leading cause of morbidity and mortality after orthotopic heart transplantation (OHT). Little is known about the influence of aspirin on clinical expression of CAV. METHODS: We followed 120 patients with OHT at a single center for a median of 7 years and categorized them by the presence or absence of early aspirin therapy post-transplant (aspirin treatment ≥6 months in the first year). The association between aspirin use and time to the primary end-point of angiographic moderate or severe CAV (International Society for Heart and Lung Transplantation grade ≥2) was investigated...
July 3, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28772029/ace-inhibitor-associated-intestinal-angioedema-in-orthotopic-heart-transplantation
#3
Dushyanth Srinivasan, Garth W Strohbehn, Thomas Cascino
Angiotensin-converting enzyme inhibitor induced angioedema commonly involves the head and neck area. We report a case of angiotensin-converting enzyme inhibitor induced intestinal angioedema in a heart transplant recipient on mTOR immunosuppression. A 36-year-old Caucasian woman with history of heart transplantation on sirolimus, tacrolimus and prednisone presented to the Emergency Department with abdominal pain, one day following lisinopril initiation. A computer tomography scan demonstrated diffuse bowel wall thickening consistent with pancolitis and edema...
August 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/28761402/posterior-reversible-encephalopathy-syndrome-after-heart-transplantation-diagnosis-and-immunosuppressive-therapy
#4
Aniruddh Kapoor, Emma Birks, Andrew Lenneman, Kelly McCants
Posterior reversible encephalopathy syndrome, an infrequent neurotoxicity associated with the use of tacrolimus, was first described in 1996, as a reversible syndrome manifested by headache, altered mental function, seizures, and visual disturbances. We describe the case of a 37-year-old woman who developed neurologic symptoms consistent with encephalopathy after treatment with tacrolimus, which was prescribed to maintain immunosuppression after orthotopic heart transplantation. This report also discusses the imaging methods used in the diagnosis of posterior reversible encephalopathy and highlights the difficulty of maintaining immunosuppression and managing medication-related adverse effects, while taking into account the risk of acute rejection after transplantation...
June 2017: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/28760213/retained-cardiac-implantable-electronic-device-fragments-are-not-associated-with-magnetic-resonance-imaging-safety-issues-morbidity-or-mortality-after-orthotopic-heart-transplant
#5
Christopher O Austin, Kevin Landolfo, Pragnesh P Parikh, Parag C Patel, K L Venkatachalam, Fred M Kusumoto
BACKGROUND: Cardiac implantable electronic device therapy (CIED) has revolutionized treatment for advanced heart failure. Most patients considered for orthotopic heart transplantation (OHT) are treated with implantable cardioverter defibrillators, cardiac resynchronization therapy, or both. These CIEDs are surgically extracted at the time of transplant. Occasionally, CIEDs are incompletely removed. Little is known about the outcomes of post-OHT patients with retained CIED fragments. METHODS: We identified 200 consecutive patients that underwent OHT at our institution between April 2006 and December 2014 and performed a retrospective analysis of available radiographic images and clinical records...
August 2017: American Heart Journal
https://www.readbyqxmd.com/read/28743270/pre-transplant-depression-as-a-predictor-of-adherence-and-morbidities-after-orthotopic-heart-transplantation
#6
Maja Delibasic, Burhan Mohamedali, Nikola Dobrilovic, Jaishankar Raman
BACKGROUND: Psychosocial factors are useful predictors of adverse outcomes after solid organ transplantation. Although depression is a known predictor of poor outcomes in patients who undergo orthotopic heart transplantation (OHT) and is actively screened for during pre-transplant evaluation, the effects of early identification of this entity on post-transplant outcomes are not clearly understood. The purpose of this study was to evaluate the impact of pre-transplant depression on outcomes after OHT...
July 25, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28710785/effect-of-thyroid-hormone-on-cardiac-function-following-orthotopic-heart-transplantation-in-piglets
#7
T K Susheel Kumar, Craig Mathis, Shyam Sathanandam, David Zurakowski, Saradha Subramanian, Jerry Allen, Michael Solimine, Lindsay Berrios, Scott Jackson, Mark Landers, Ryan Sullivan, Stacey Barnett, Mark Rayburn, Christopher Loftis, Lauren Price, James B Tansey, Deepthi Hoskoppal, Christopher Knott-Craig
Studies in adult HT have demonstrated improved cardiac function in the recipient following administration of T3 to the donor. The purpose of this experiment was to assess the effects of T3 on the function of the immature donor heart following HT in a piglet model. A total of 32 piglets were divided into 16 donors and 16 recipients. Following creation of brain death, half of the donor piglets were randomized to receive three doses of T3 (0.2 μg/kg) along with hydrocortisone (1 mg/kg). The donor hearts were then transplanted into the recipient piglets on CPB...
July 14, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28706871/tricuspid-valve-regurgitation-after-heart-transplantation
#8
Murray H Kwon, Richard J Shemin
Tricuspid valve regurgitation (TVR) in the orthotopic heart transplant (OHT) recipient is quite common and has varied clinical sequelae. In its severest forms, it can lead to right-sided failure symptoms indistinguishable from that seen in native heart TVR disease. While certain implantation techniques are widely recognized to reduce the risk of TVR in the cardiac allograft, concomitant tricuspid annuloplasty, while having advocates, is not currently accepted as a routinely established adjunct. Decisions to surgically correct TVR in the OHT recipient must be made carefully, as certain clinical scenarios have high risk of failure...
May 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28706864/surgical-outcomes-of-isolated-tricuspid-valve-procedures-repair-versus-replacement
#9
Julius I Ejiofor, Robert C Neely, Maroun Yammine, Siobhan McGurk, Tsuyoshi Kaneko, Marzia Leacche, Lawrence H Cohn, Prem S Shekar
BACKGROUND: Isolated tricuspid valve (ITV) operations are infrequent and the decision to operate is controversial. We report a series of ITV operations to outline the current disease status requiring this uncommon procedure with an emphasis on the results of tricuspid valve repair (TVr) versus replacement (TVR). METHODS: Using our prospective cardiac surgery database, 57 patients who underwent ITV operations between 01/02-03/14 were identified. Median follow up time was 3...
May 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28703300/a-point-based-prediction-model-for-cardiovascular-risk-in-orthotopic-liver-transplantation-the-car-olt-score
#10
Lisa B VanWagner, Hongyan Ning, Maureen Whitsett, Josh Levitsky, Sarah Uttal, John T Wilkins, Michael M Abecassis, Daniela P Ladner, Anton I Skaro, Donald M Lloyd-Jones
Cardiovascular disease (CVD) complications are important causes of morbidity and mortality after orthotopic liver transplantation (OLT). There is currently no preoperative risk assessment tool that allows physicians to estimate the risk for CVD events following OLT. We sought to develop a point-based prediction model (risk score) for CVD complications after OLT, the CAR-OLT risk score, among a cohort of 1024 consecutive patients aged 18-75 years who underwent first OLT in a tertiary-care teaching hospital (2002-2011)...
July 13, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28672061/thalidomide-treatment-prevents-chronic-graft-rejection-after-aortic-transplantation-in-rats
#11
Katharine K Miller, Dong Wang, Xiaomeng Hu, Xiaoqin Hua, Tobias Deuse, Evgenios Neofytou, Thomas Renne, Joachim Velden, Hermann Reichenspurner, Sonja Schrepfer, Daniel Bernstein
BACKGROUND: Cardiac allograft vasculopathy (CAV) affects approximately 30% of cardiac transplant patients at five years post-transplantation. To date there are few CAV treatment or prevention options, none of which are highly effective. The aim of the study was to investigate the effect of thalidomide on the development of CAV. METHODS: The effect of thalidomide treatment on chronic rejection was assessed in rat orthotopic aortic transplants in allogeneic F344 or syngeneic Lew rats (n=6/group)...
July 3, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28671171/early-onset-de-novo-invasive-pulmonary-aspergillosis-in-an-orthotopic-heart-transplant-recipient
#12
Zaw Min, Manik Veer, Parth Rali, Anil Singh, Nitin Bhanot
Invasive aspergillosis generally occurs during the first 1-6 months after heart transplantation. It has been rarely seen in the first 2 weeks postcardiac transplant. We herein describe a unique case of invasive pulmonary aspergillosis (IPA) diagnosed on day 9 postorthotopic heart transplantation. The known risk factors for IPA in cardiac transplant recipients were not identified in our case. The organ recipients from the same donor did not report Aspergillus infection. Hospital environmental samplings failed to demonstrate Aspergillus spores in the patient's room and his adjacent rooms...
July 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/28670701/diarrhea-an-uncommon-presentation-of-tertiary-adrenal-insufficiency-following-heart-transplantation
#13
Saad Sikanderkhel, M Waqas Choudhry, Vincent Valentine, Ghannam Al-Dossari, Wissam I Khalife
Diarrhea following organ transplantation is usually associated with infection and immunosuppression therapy. We describe two patients with diarrhea following orthotopic heart transplantation due to tertiary adrenal insufficiency.
July 2, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28651907/tumor-necrosis-factor-%C3%AE-levels-and-non-surgical-bleeding-in-continuous-flow-left-ventricular-assist-devices
#14
Corey E Tabit, Mitchell J Coplan, Phetcharat Chen, Valluvan Jeevanandam, Nir Uriel, James K Liao
BACKGROUND: Non-surgical bleeding (NSB) due to angiodysplasia is common in left ventricular assist device (LVAD) patients. Thrombin-induced angiopoietin-2 (Ang-2) expression in LVAD patients leads to altered angiogenesis and is associated with lower angiopoietin-1 (Ang-1) and increased NSB. However, the mechanism for decreased Ang-1, made by pericytes, is unknown and the origin of thrombin in LVAD patients is unclear. We hypothesized that high tumor necrosis factor-α (TNF-α) levels in LVAD patients induce pericyte apoptosis, tissue factor (TF) expression and vascular instability...
June 8, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28643428/mechanical-circulatory-support-in-the-treatment-of-advanced-heart-failure
#15
Amanda W Cai, Sabrina Islam, Shelley R Hankins, Wade Fischer, Howard J Eisen
According to the Centers for Disease Control (CDC), heart failure (HF) remains a pervasive condition with high morbidity and mortality, affecting 5.8 million people in the United States (US) and 23 million worldwide. For patients with refractory end-stage HF, heart transplantation is the gold standard for definitive treatment. However, the demand for heart transplantation has consistently exceeded the availability of donor hearts, with approximately 2,331 orthotopic heart transplantations performed in the US in 2015 despite an estimated 100,000 to 250,000 patients with New York Heart Association (NYHA) class IIIB or IV symptoms that are refractory to medical treatment and potential transplant candidates...
June 22, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28631410/coronary-artery-bypass-grafting-to-treat-coronary-arterial-occlusion-incurred-during-orthotopic-heart-transplantation
#16
Keshava Rajagopal, Indranee Rajapreyar, Biswajit Kar, Pranav Loyalka, Igor D Gregoric
We report a case of left circumflex coronary artery occlusion sustained during orthotopic heart transplantation. Emergent coronary artery bypass grafting was performed, with recovery of cardiac function. The etiology and management of this complication are reviewed.
July 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28627403/accepting-hearts-from-hepatitis-c-positive-donor-can-we-expand-the-donor-pool
#17
Jonathan Grinstein, Laura M Lourenco, Helen S Te, John F Renz, Valluvan Jeevanandam, Nir Uriel
BACKGROUND: Until recently, transplantation from hepatitis C-positive donors was relatively contraindicated as eradication of active hepatitis C previously required an interferon-based regimen that has been associated with rejection in solid organ transplantation. New interferon-free treatment regimens for hepatitis C have fewer adverse events and higher cure rates than interferon-based regimens. Interferon-free regimens have been shown to be safe in the liver transplantation literature, but little is known about the safety and efficacy of treatment in heart transplantation...
June 13, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28583372/dose-dependent-association-between-amiodarone-and-severe-primary-graft-dysfunction-in-orthotopic-heart-transplantation
#18
Matthew Wright, Koji Takeda, Christine Mauro, Douglas Jennings, Paul Kurlansky, Jiho Han, Lauren Truby, Samantha Stein, Veli Topkara, Arthur R Garan, Melana Yuzefpolskaya, Paolo Colombo, Yoshifumi Naka, Maryjane Farr, Hiroo Takayama
BACKGROUND: There is growing concern regarding the association between pre-transplant amiodarone exposure and post-transplant adverse outcomes. We hypothesized that amiodarone use would be associated with the development of severe primary graft dysfunction (PGD) in a dose-dependent manner. METHODS: This was a retrospective review of 269 adult orthotopic heart transplantation (OHT) recipients at our institution between 2010 and 2014. At the time of OHT, 100 were receiving amiodarone therapy (Group 1) and 169 were not (Group 2)...
May 20, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28570244/transcatheter-tricuspid-valve-replacement-in-orthotopic-heart-transplant
#19
Abdul Moiz Hafiz, Jeffrey Shih, Nikolaos Kakouros
A patient with history of orthotopic heart transplant (OHT) followed by tricuspid valve replacement and two subsequent balloon valvuloplasties was offered transcatheter tricuspid valve replacement (TTVR) to avoid what would have been his fourth sternotomy. TTVR in patients with OHT can be a valuable approach to prevent further open-heart surgeries, which carry added morbidity and mortality.
June 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28545281/-pre-and-post-orthotopic-heart-transplantation-electrocardiogram-characteristics-of-998-patients
#20
H Q Guan, Z J Chen, Y Zhou, J Liu, W X Sun, J Yuan, Y H Liao, N G Dong, J P Liu, K G Feng, Q Zhang, X Zhao, C Qian, F Hu
Objective: To analyze pre- and post-operation electrocardiograms (ECGs) features of patients underwent orthotopic heart transplantation (OHT), and provide evidences for identifying and analyzing post OHT ECGs. Methods: Nine hundreds and ninty-eight pre- and post- OHT standard 12-leads ECGs from 110 consecutive patients, who underwent OHT in our hospital from May 2008 to May 2014, were analyzed. Results: The mean heart rate(HR)was (86.9±16.4) beats per minute before OHT, and (100.0±0.4) beats per minute after OHT...
April 24, 2017: Zhonghua Xin Xue Guan Bing za Zhi
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