The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
-
J. Heart Lung Transplant. · May 2013
Time-dependent changes in the risk of death in pure bronchiolitis obliterans syndrome (BOS).
The timing of disease onset may affect the prognosis in chronic lung allograft dysfunction (CLAD). The relationship between the timing of disease onset and the prognosis of CLAD and its sub-types, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), was examined. ⋯ Late-onset BOS showed a better prognosis than early-onset BOS. Studies that do not distinguish BOS from RAS may overestimate the mortality risk of BOS. Multicenter studies will be required to further elucidate risk factors toward the development of better management strategies for CLAD.
-
J. Heart Lung Transplant. · May 2013
Multicenter StudyChildren with pulmonary arterial hypertension and prostanoid therapy: long-term hemodynamics.
Pediatric patients with severe pulmonary arterial hypertension (PAH) are treated with intravenous epoprostenol or intravenous or subcutaneous treprostinil. Little is known about longitudinal hemodynamics and outcomes of epoprostenol, treprostinil, and transitions from epoprostenol to treprostinil. ⋯ There was improvement in Rp/Rs on both therapies at 1 to 2 years that was not sustained. The 5-year transplant-free survival was better than in similar adult studies.
-
J. Heart Lung Transplant. · May 2013
Elevated left ventricular filling pressures can be estimated with accuracy by a new mathematical model.
Although the clinical assessment of jugular venous pressure (JVP) provides accurate estimate of right atrial pressure (RAP), there is no reliable non-invasive method for assessing pulmonary capillary wedge pressure (PCWP). Our objective was to evaluate the sensitivity and specificity for detecting elevated left ventricular filling pressures using a model for PCWP estimation, based on the clinical assessment of RAP and association between RAP and PCWP, which is unique for each patient, identified in a recent right heart catheterization (RHC). ⋯ The current PCWP of a patient with heart failure can be estimated accurately by a simple equation based on measurements of a previous RHC and the current value of clinically assessed JVP.
-
J. Heart Lung Transplant. · May 2013
Validation of the United States-derived Index for Mortality Prediction After Cardiac Transplantation (IMPACT) using international registry data.
We previously derived and validated the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) using United Network for Organ Sharing (UNOS) data. This study aimed to validate the IMPACT score using international data. ⋯ This study validates the use of the IMPACT score as a predictor of short- and long-term mortality after OHT. Strong consideration should be given to broadly implementing and prospectively using the IMPACT score to predict mortality after OHT.
-
J. Heart Lung Transplant. · May 2013
Antithrombotic strategies in children receiving long-term Berlin Heart EXCOR ventricular assist device therapy.
Thromboembolic events while receiving ventricular assist device (VAD) support remain a significant cause of morbidity and mortality despite standard anti-coagulation and anti-platelet therapies. The use of bivalirudin and epoprostenol infusions as an alternate anti-thrombotic (AT) regimen in pediatric VAD patients was reviewed. ⋯ This report provides data on estimated safety and efficacy of bivalirudin and epoprostenol as an AT strategy in pediatric patients on extended VAD support. The short drug half-life and predictable AT response facilitated conversion to standard AT regimens at the time of transplantation (heparin-induced thrombocytopenia-negative patients). These agents should be considered for management of pediatric VAD patients when standard regimens fail.