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. · Jan 2010
Comparative StudyNoninvasive assessment of left ventricular assist devices with cardiovascular computed tomography and impact on management.
Left ventricular assist devices (LVADs) provide a bridge to recovery or heart transplantation but require serial assessment. Echocardiographic approaches may be limited by device artifact and acoustic window. Cardiovascular computed tomography (CCT) may provide improved non-invasive imaging of LVADs. We evaluated the diagnostic findings and clinical impact of CCT for non-invasive assessment of patients with LVADs. ⋯ This preliminary observational cohort study indicates that non-invasive imaging using CCT of LVADs is feasible and accurate. CCT warrants consideration in the initial evaluation of symptomatic patients with LVADs.
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J. Heart Lung Transplant. · Jan 2010
Case ReportsA novel percutaneous mechanical biventricular bridge to recovery in severe cardiac allograft rejection.
We describe the case of a 36-year-old man with acute cardiac transplant rejection bridged to recovery using simultaneous Impella 2.5 and TandemHeart percutaneous support devices. The patient underwent orthotopic cardiac transplantation 2 years earlier, and presented to our hospital with allograft failure 7 days after non-compliance with tacrolimus. ⋯ After a course of intravenous solumedrol and anti-thymocyte globulin, both the Impella and TandemHeart devices were successfully weaned and removed. Nine months later, his left ventricular ejection fraction had stabilized from 10% to 55%.
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J. Heart Lung Transplant. · Jan 2010
Initial experience with CentriMag extracorporal membrane oxygenation for support of critically ill patients with refractory cardiogenic shock.
Cardiogenic shock refractory to conventional therapy has very high mortality and limited support options. New technology with peripherally inserted CentriMag (Levitronix LLC, Waltham, MA) extracorporal membrane oxygenation (ECMO) may have the potential to significantly improve survival in these critically ill patients. Outcomes of the first 10 patients to receive this device at our institutions are presented. ⋯ The peripherally inserted CentriMag ECMO was easy to insert, functioned without mechanical error, and significantly reduced expected mortality in critically ill patients. Further research will be necessary to develop standardized algorithms and gain more experience, but this new technology has promising potential.
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J. Heart Lung Transplant. · Jan 2010
Short-term mechanical unloading and reverse remodeling of failing hearts in children.
Mechanical support using a left ventricular assist device (LVAD) can lead to functional recovery of the myocardium in patients with end-stage heart failure (HF). Molecular remodeling, cytoskeletal disruption, and apoptosis activation are associated with abnormal gene expression in the failing ventricular myocardium of HF subjects and can normalize in response to medium- and long-term mechanical unloading in adults. However, there is little knowledge of the changes in gene expression after short-term mechanical support in children with HF. ⋯ Our pilot study suggests that even short-term LVAD therapy in children with severe HF can reverse molecular remodeling. This favorable effect should be taken into consideration in eligible children with significant ventricular dysfunction.
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J. Heart Lung Transplant. · Jan 2010
Case ReportsFacilitated cardiac recovery in fulminant myocarditis: pediatric use of the Impella LP 5.0 pump.
We describe the successful use of the Impella LP 5.0 intracardiac microaxial pump (Abiomed, Danvers, MA) in a 13-year-old boy with fulminant biopsy-proven viral myocarditis. The patient, who previously was in refractory cardiogenic shock despite increasing inotropic and vasopressor support, immediately stabilized after Impella LP 5.0 implantation and was successfully bridged to a full recovery. Months later, he remains completely well, with no intracardiac or peripheral vascular sequelae of the procedure. In carefully selected pediatric patients the Impella may be a beneficial form of temporary mechanical circulatory support for fulminant cardiogenic shock.