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 1994
Multicenter StudyPreoperative predictors of survival in patients with Thoratec ventricular assist devices as a bridge to heart transplantation. Thoratec Ventricular Assist Device Principal Investigators.
Approximately two-thirds of patients implanted with ventricular assist devices recover sufficiently to requalify for heart transplantation, and the other one-third die of complications that are often secondary to delayed ventricular assist device implantation and subsequent end-organ failure. To determine whether any preoperative predictors of survival exist, univariate statistics and multivariate stepwise logistic regression analysis were performed on pre-ventricular assist device demographics, hemodynamics, and blood chemistry in 186 patients receiving Thoratec ventricular assist devices (Thoratec Laboratories Corp., Berkeley, Calif.) while awaiting transplantation. The duration of circulatory support averaged 19.6 days (maximum, 226 days). ⋯ Pre-ventricular assist device creatinine levels (p = 0.24) and total bilirubin levels (p = 0.09) were not significant, but blood urea nitrogen level (p = 0.02) and previous operations (p = 0.05) were related to survival, using univariate techniques. Patients with cardiac operations more than 30 days previously had the lowest survival-to-transplantation (39%) compared with patients with no previous operations (67%) or operations within the previous 30 days (61%). Blood urea nitrogen level was the only parameter found to be significant (p = 0.016) in a multivariate model.(ABSTRACT TRUNCATED AT 250 WORDS)
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In selected cases with either acute or chronic graft failure after lung or heart-lung transplantation, retransplantation remains the only therapeutic option. Since December 1987, we have performed a total of 110 single lung, bilateral lung, and combined heart-lung transplantations in 102 patients including five early and four late retransplantations in eight patients. Early retransplantation was indicated for severe reperfusion injury after single lung transplantation (n = 2) or heart-lung transplantation (n = 1), for persistent pulmonary hypertension caused by an unrecognized aortopulmonary window (n = 1), for central airway necrosis, and for contralateral pulmonary artery bleeding after bilateral lung transplantation (n = 1). ⋯ Mortality was 22.2% in the retransplantation group versus 15.1% (11 of 73 patients) undergoing primary single lung transplantation or bilateral lung transplantation (not significant). Patient survival after retransplantation ranged between 159 and 993 days (median, 453 days). Duration of postoperative ventilation was markedly prolonged in patients who underwent retransplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Heart Lung Transplant. · Jan 1994
Case ReportsLung transplantation for mechanically ventilated patients.
As lung transplantation has become more successful, the selection criteria have broadened; however, some relative contraindications to lung transplantation are controversial. Some programs consider mechanical ventilation to be a major contraindication to lung transplantation because airway colonization with bacteria may lead to nosocomial infection and respiratory muscle deconditioning may necessitate prolonged postoperative ventilatory support. We report our experience of seven double lung transplant procedures on six patients requiring mechanical ventilation. ⋯ One patient died 3 months after transplantation from severe central nervous system complications with no evidence of pulmonary problems; and two patients died 17 months after transplantation, one of them receiving a second double lung transplant for obliterative bronchiolitis. Except for the patient who required prolonged preoperative ventilatory support, mechanical ventilation did not appear to play a role in the outcome of these patients. The posttransplantation hospital stay and hospital charges for patients requiring pretransplantation ventilatory support were not significantly different from those for other lung transplant recipients.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Heart Lung Transplant. · Nov 1993
Static left latissimus dorsi cardiomyoplasty: effect on left ventricular function.
When the latissimus dorsi is used for ventricular augmentation in cardiomyoplasty, a delay of several weeks occurs before the muscle revascularizes, adheres to the heart, and is transformed to fatigue-resistant status. This study analyzes the effect of static (unstimulated) cardiomyoplasty on left ventricular function. Four mongrel dogs underwent staged left latissimus dorsi cardiomyoplasty. ⋯ Results, expressed as mean +/- standard error of the mean, showed no significant differences in indexes of systolic function (stroke work, 1017 +/- 223 gm.cm to 984 +/- 403 gm.cm; preload recruitable stroke work, 110 +/- 13 gm.cm/cm3 to 115 +/- 19.8 gm.cm/cm3; maximum elastance, 10.38 +/- 5.6 mm Hg/ml to 13.59 +/- 6.5 mm Hg/ml; cardiac output 4.51 +/- 0.43 L/min to 4.21 +/- 0.34 L/min) or diastolic function (left ventricular end-diastolic volume, 21 +/- 5.2 ml to 20 +/- 5.3 ml; left ventricular end-diastolic pressure, 13 +/- 3.5 mm Hg to 15 +/- 3 mm Hg; diastolic relaxation constant 42.8 +/- 5.2 msec to 42.5 +/- 4.5 msec). Heart rate also remained unchanged (131 +/- 8.9 beats/min to 140 +/- 9.8 beats/min). The static (unstimulated) left latissimus dorsi cardioplasty can be done with little effect on left ventricular systolic or diastolic function in the normal canine heart.
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J. Heart Lung Transplant. · Nov 1993
Critical issues debates: intervention for infants with fatal heart disease, xenografting, and brain death criteria for anencephalic infants. Debate I. Resolved: a fetus or infant diagnosed with fatal heart disease should be referred for transplantation or palliative surgery.