The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
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J. Heart Lung Transplant. · Aug 1999
Multicenter Study Comparative Study Clinical TrialAre preoperative obesity and cachexia risk factors for post heart transplant morbidity and mortality: a multi-institutional study of preoperative weight-height indices. Cardiac Transplant Research Database (CTRD) Group.
The relationship between pre-transplant body weight and post-transplant outcome has only recently been identified using a single, indirect measure of weight (percent ideal body weight [PIBW]). The literature is equivocal regarding which index is the better indicator of body weight. The purpose of this study was to determine (1) if pre-heart transplant body weight, measured by body mass index (BMI) and PIBW, is associated with post-heart transplant morbidity and mortality and (2) if patient gender, age, and etiology of heart disease affect this association. ⋯ In conclusion, being cachectic or obese preoperatively is associated with decreased survival in all patients after heart transplantation. Being obese preoperatively is associated with increased infection after heart transplant in males and females <55 years and in patients with ischemic heart disease. Of the 2 indices of body weight used in this study, percent ideal body weight appears to be the better predictor of future morbidity and mortality following heart transplantation.
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J. Heart Lung Transplant. · Aug 1999
Comparative StudyArginine vasopressin in the management of vasodilatory hypotension after cardiac transplantation.
Vasodilatory hypotension requiring the administration of catecholamine pressors may occur following cardiopulmonary bypass. We investigated the hemodynamic response to arginine vasopressin (AVP) in 20 patients who developed vasodilatory hypotension after cardiac transplantation. In this cohort, AVP infusion (0.1 U/min) significantly increased mean arterial pressure and decreased norepinephrine requirements, allowing rapid discontinuation of norepinephrine infusions in 7 patients. Judicious use of this novel agent in appropriately selected patients may minimize end-organ sequelae of hypotension and high-dose catecholamine therapy.
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J. Heart Lung Transplant. · Aug 1999
Case ReportsValve-sparing repair after aortic root dissection following heart transplantation.
We describe the case of a 56-year-old male who presented with a Stanford type A dissection limited to the donor aorta 25 days after orthotopic heart transplantation. Transesophageal echocardiography revealed a newly developed aortic regurgitation grade III and a typical intimal tear 1 cm above the commissures. Surgical therapy included replacement of the ascending aorta with an aortic allograft and implantation of the native aortic valve inside the allograft as a modified David procedure.
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J. Heart Lung Transplant. · Aug 1999
Case ReportsSuccessful eradication of mucormycosis occurring in a pulmonary allograft.
The zygomycetes are saprophytic fungi that rarely cause disease in the normal human host. In immunocompromised individuals, these organisms can cause invasive infections, collectively called mucormycosis. ⋯ Treatment consisted of surgical excision of the affected lobe and chest wall and lipid-complex amphotericin B. The lipid complex formulation permitted a prolonged course of therapy that was likely critical to eradication of the infection.