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. · Dec 2014
Effect of pulsatile and nonpulsatile flow on cerebral perfusion in patients with left ventricular assist devices.
Insertion of a left ventricular assist device (LVAD) is an accepted therapy for advanced heart failure patients. However, the effects on end-organ perfusion, including cerebral autoregulation, are unclear in the presence of reduced pulsatility. Therefore, the objective of this study was to determine whether cerebral autoregulation is impaired in patients with continuous-flow (CF) LVADs. ⋯ Cerebral blood flow in patients with CF-LVADs is comparable to that of healthy controls across a range of blood pressures. Patients with pulsatile devices have greater oscillations in MAP and CBFV. However, dynamic cerebral autoregulation is preserved among subjects with either type of device. Thus, the reduction in pulsatility afforded by CF-LVADs does not impair normal autoregulatory processes.
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J. Heart Lung Transplant. · Nov 2014
Centers for Disease Control "high-risk" donor status does not significantly affect recipient outcome after heart transplantation in children.
In 2004, the United Network for Organ Sharing (UNOS) added the label "high-risk donor" (HRD) for any organ donor who met the Centers for Disease Control (CDC) criteria for high-risk behavior for infection. The aim of this study was to calculate the rate of HRD graft use in heart transplantation in children and determine the differences in outcome from those who received standard-risk donor (SRD) grafts. ⋯ CDC HRD graft status does not appear to significantly affect recipient outcome after heart transplantation in children.
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J. Heart Lung Transplant. · Oct 2014
Comparative StudyFactors determining post-operative readmissions after left ventricular assist device implantation.
In the current era of extensive healthcare reform, there has been a heightened focus on the frequency and cause for readmissions within 30 days of discharge given that readmissions are not reimbursed by most providers. The aim of our study was to determine the frequency, etiology and patterns of 30-day readmissions among recipients of continuous-flow left ventricular assist devices (LVADs) at our institution as well to determine whether there were any significant predictors of readmission. ⋯ Our experience indicates that 30-day readmission rates after LVAD implantation remain relatively high, with most occurring within 10 days of discharge. Recurrent heart failure and GIB were the most common causes of post-operative rehospitalization. In addition, GIB during the index hospitalization was a significant predictor of 30-day readmission.
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J. Heart Lung Transplant. · Oct 2014
The physician becomes the patient: how my breast cancer journey taught me to be a better doctor.
On April 1, 2013, I received the shocking news that I had Stage II breast cancer. Despite my medical knowledge, at the time of my diagnosis, I was unable to grasp the magnitude of the ordeal I would experience. However I also received an unexpected gift: being a patient made me a better person and a better doctor.