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. · Jul 1992
Case ReportsSuccessful heart transplantation with cardiac allografts exposed to carbon monoxide poisoning.
The procurement of cardiac allografts from brain-dead donors who have suffered acute carbon monoxide poisoning has, in the past, been considered inadvisable. Two patients have recently undergone successful transplantation at our institution with cardiac allografts from donors who had suffered acute carbon monoxide poisoning. Carbon monoxide poisoning is not a contraindication to cardiac allograft procurement in the setting of clinical and objective evidence of satisfactory cardiac function.
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J. Heart Lung Transplant. · Jul 1992
Long-term preservation of the heart: the effect of infusion pressure during continuous hypothermic cardioplegia.
Continuous hypothermic low-flow infusion of cardioplegic or other preservation solutions has been advocated for extending the maximum duration of storage of donor hearts for transplantation. We report the effect of varying the pressure during continuous infusion of St. Thomas' Hospital cardioplegic solution on functional recovery after long-term storage. ⋯ In hearts that had been subjected to continuous infusion at 6, 10, 20, 30, 40, and 60 cm H2O, the recoveries of aortic flow were 0% (p less than 0.05), 38.6% +/- 5.1% (p less than 0.05), 36.2% +/- 3.6% (p less than 0.05), 14.0% +/- 8.0%, 5.8% +/- 2.9%, and 9.9% +/- 4.7%, respectively, and the postischemic leakage of creatine kinase was 98.7 +/- 19.5 (p less than 0.05), 26.2 +/- 4.2, 15.5 +/- 3.4, 30.4 +/- 11.1, 109.8 +/- 21.8 (p less than 0.05), and 136.0 +/- 14.1 (p less than 0.05) IU/30 min/gm dry weight, respectively. In contrast, in noninfused control hearts the recovery of aortic flow was 11.1% +/- 7.5%, and creatine kinase leakage was 58.9 +/- 8.7 IU/30 min/gm dry weight. In conclusion, maximum myocardial preservation was obtained with continuous low-flow hypothermic cardioplegic infusion at pressures between 10 and 20 cm H2O.
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J. Heart Lung Transplant. · May 1992
Angiopeptin: a treatment for accelerated myointimal hyperplasia?
Extensive smooth muscle cell proliferation is the major event leading to the narrowing or occlusion of the lumen of the coronary arteries of patients undergoing heart transplantation or percutaneous transluminal coronary angioplasty. The smooth muscle cell proliferation in transplant atherosclerosis may be initiated by immunologic events, allowing the vascular smooth muscle cells to respond with migration and proliferation to circulating growth factors as well as chemoattractants and growth factors released by inflammatory cells and smooth muscle cells themselves. The somatostatin analog angiopeptin is a cyclic octapeptide that has different binding affinities for different somatostatin receptors compared with the parent compound itself. ⋯ Further, angiopeptin inhibits thymidine uptake in vitro in pig coronary arteries. Angiopeptin also exerts its inhibitory effect at a very early stage after injury: an 8-hour delay of treatment abolishes the inhibitory effect of angiopeptin on smooth muscle cell proliferation (intimal hyperplasia). On the basis of the experimental data, clinical studies of the inhibitory effect of angiopeptin on prevention of transplant atherosclerosis in heart transplant patients and prevention of restenosis after coronary artery angioplasty are ongoing, as well as are studies in patients undergoing saphenous vein coronary artery bypass surgery.
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J. Heart Lung Transplant. · Mar 1992
Heart transplantation after mechanical circulatory support: four years' experience.
To determine the effect of mechanical circulatory support before heart transplantation, we conducted a retrospective analysis of 207 men who underwent staged orthotopic transplantations. Of these patients, 185 (group I) required pharmacologic support before transplantation; 14 (group II) required mechanical circulatory support with an intraaortic balloon pump (duration of support, 1 to 26 days); and eight (group III) required advanced mechanical circulatory support with an implantable left ventricular assist device (duration of support, 19 to 132 days). A comparison of complications after transplantation (infection and rejection), hospitalization, and survival showed that no significant differences existed among the three groups. ⋯ In fact, such support can help to improve their end-organ perfusion, and, thus, their status as heart transplantation candidates. Furthermore, this study shows that advanced mechanical circulatory support is possible even for prolonged periods, with low risk of sudden death. This finding is an important step toward development of a permanent assist device.