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. · Apr 1997
Delayed reversal of impaired metabolic vasodilation in patients with end-stage heart failure during long-term circulatory support with a left ventricular assist device.
Whether increased cardiac output during chronic circulatory support with a left ventricular assist device (LVAD) is associated with improved metabolic vasodilation in the peripheral circulation of patients with congestive heart failure is unknown. ⋯ In spite of early normalization of cardiac output, mean arterial pressure, and resting forearm blood flow during chronic circulatory support with the LVAD, peak forearm blood flow, and peak vascular conductance did not increase to values similar to those observed in normal subjects until the late postoperative recovery period. The delayed effect of the LVAD on metabolic vasodilation may be related to flow-dependent changes in the peripheral vasculature of patients with heart failure.
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J. Heart Lung Transplant. · Apr 1997
Effects of mechanical left ventricular support on right ventricular diastolic function.
Previous studies have shown that left ventricular (LV) unloading alters right ventricular (RV) systolic mechanics, but the effects of LV assist device (LVAD) support on RV diastolic function have not been examined in intact subjects. ⋯ In intact animals, RV ischemia impaired RV relaxation and decreased chamber stiffness, but there was no change in RV filling rates. Mechanical LV support, during the control state and with RV ischemia, did not affect RV diastolic performance.
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J. Heart Lung Transplant. · Feb 1997
Comparative StudyHemodynamics and gas exchange after single lung transplantation and unilateral thoracoscopic lung reduction.
Single lung transplantation and recently thoracoscopic lung reduction (TLR) have become surgical alternatives to manage emphysema. We report here early outcomes of 10 single lung transplant (SLT) recipients with severe emphysema compared with 10 patients treated with unilateral TLR. ⋯ Early results show TLR as an acceptable alternative to SLT in carefully selected patients with the same severity of obstructive lung disease. Long-term follow-up studies are needed to establish long-term differences in functional outcome and development of complications. TLR may be an option for patients with severe dyspnea related to emphysema who do not meet criteria for transplantation.
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J. Heart Lung Transplant. · Feb 1997
Restrictive criteria for heart transplantation candidacy maximize survival of patients with advanced heart failure.
The shortage of organ donors and the amelioration of medical management of advanced heart failure mandate strict selection of heart transplant candidates on the basis of the need and probability of success of transplantation, with the aim of maximizing survival of patients with advanced heart failure, both with and without transplantation. This study analyzes the impact of restricting the criteria for heart transplantation candidacy on the outcome of patients with advanced heart failure referred for transplantation. ⋯ Restricting the admissions to the waiting list to patients with refractory/progressive heart failure improved survival rates after listing by increasing the probability to undergo transplantation in a short time. Selection of most severely ill candidates did not affect postoperative survival. Survival and freedom from cardiac events were good in patients with advanced but stable heart failure, in spite of their severe functional limitation. Thus restrictive criteria for heart transplantation candidacy allows maximal survival benefit from both medical therapy and transplantation.
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J. Heart Lung Transplant. · Dec 1996
Ischemic preconditioning enhances donor lung preservation in the rat.
Ischemic preconditioning achieved by brief periods of ischemia and reperfusion before a prolonged period of ischemia can significantly reduce the extent of cardiac damage in many mammalian species and human beings. In this study we used a rat model of single lung transplantation to show that ischemic preconditioning also occurs in the lung. ⋯ These results show that the phenomenon of ischemic preconditioning occurs in the lung and that it may reduce injury to the donor lung during prolonged cold ischemic storage.