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 2000
ReviewSudden death in heart failure patients: effects of optimized medical therapy.
Although medical therapy, particularly with angiotensin-converting enzyme (ACE) inhibitors, has been demonstrated to prolong life in patients with chronic heart failure, the effect of standard medical therapy on sudden unexpected death in patients with heart failure is less well understood. Recent clinical trials have provided new insights into this growing problem. The impact of modern medical therapy for heart failure, including ACE inhibitors, beta-adrenergic antagonists, digoxin, calcium channel antagonists, and antiarrhythmic interventions will be discussed.
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J. Heart Lung Transplant. · Aug 2000
ReviewLeft ventricular assist device implantation: short and long-term surgical complications.
Long-term implanted left ventricular assist devices (LVADs) have significantly improved the care of patients awaiting heart transplantation and will provide an alternative therapy to select patients with heart failure. However, although the technology and clinical results continue to improve, LVAD implantation is still associated with a significant level of complications. ⋯ Beyond the perioperative period, late complications consist primarily of infection, thromboembolism, and primary device failure. An improved understanding of the mechanisms involved should aid the clinician in further reducing the incidence of these occurrences.
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J. Heart Lung Transplant. · Jul 2000
Comparative StudyCardiac troponin I as diagnostic and prognostic marker in severe heart failure.
Cardiac cell death has been shown to occur in heart failure and has been implicated as one of the mechanisms responsible for progression of the disease. Cardiac Troponin I (cTnI) represents a highly sensitive marker for myocardial cell death. Based on previous studies reporting that cTnI may be detected in patients with heart failure, we evaluated the clinical correlates and prognostic implications of detectable cTnI in a consecutive series of patients with severe heart failure. ⋯ These observations suggest that cTnI is detected in the blood of 25% to 33% of patients with severe heart failure; its presence may help to identify a high-risk sub-group who faces very poor short-term prognosis.
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J. Heart Lung Transplant. · Jul 2000
Case ReportsBalloon-expandable stent placement for superior vena cava-right atrial stenosis after heart transplantation.
Anastomotic Stenoses are well known as a complication of vascular and cardiovascular surgical procedures; such a lesion was encountered at the superior vena cava-right atrial anastomosis after cardiac transplantation. A balloon expandable stent was used to relieve this anastomotic constriction, employing a 16 mm diameter balloon to deliver a P304 stent. Stent placement resulted in complete relief of the patient's symptoms and facilitated the passage of bioptomes through the superior vena cava for subsequent biopsy procedures following cardiac transplantation.
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J. Heart Lung Transplant. · May 2000
Comparative StudyDoes human leukocyte antigen matching influence the outcome of lung transplantation? An analysis of 3,549 lung transplantations.
Human leukocyte antigen (HLA) compatibility has been shown to improve the outcome of renal and cardiac transplantation. However, its impact on outcome following lung transplantation is not clear, with several single-center studies reporting inconsistent results. We studied the influence of HLA matching on survival and the development of rejection and obliterative bronchiolitis after lung transplantation, using data from the United Network for Organ Sharing/International Society for Heart and Lung Transplantation registry. ⋯ Although the number of HLA mismatches at the HLA-A and HLA-DR loci predicted 1-year mortality and the total number of mismatches predicted 3- and 5-year mortality following lung transplantation, the effect of each covariate was small in this multicenter study of 3,549 patients. Further close follow-up of registry patients is necessary to determine the effect of HLA matching on long-term survival and freedom from obliterative bronchiolitis and rejection following lung transplantation. A prospective study of HLA matching for lung transplantation should not yet be considered in view of the small number of grafts with 2 or fewer mismatches and the modest effect of HLA matching on outcome.