The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
-
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.
-
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.
-
J. Heart Lung Transplant. · Sep 2014
Efficacy and durability of central oversewing for treatment of aortic insufficiency in patients with continuous-flow left ventricular assist devices.
Aortic insufficiency (AI) in patients supported with continuous-flow left ventricular assist devices (CF-LVAD) results in regurgitant volume returning from the aorta to the left ventricle, increased LVAD pump volume and reduced systemic cardiac output. One common strategy to address AI during CF-LVAD support is central oversewing of the aortic valve, which allows some opening between the valve leaflets laterally. However, the long-term durability of this technique has not been extensively described. ⋯ Central oversewing of the aortic valve is an effective and durable means of addressing greater than mild AI in patients with CF-LVAD.
-
J. Heart Lung Transplant. · Sep 2014
Institutional volume of heart transplantation with left ventricular assist device explantation influences graft survival.
There are increasing numbers of patients undergoing orthotopic heart transplantation (OHT) with left ventricular assist device (LVAD) explantation (LVAD explant-OHT). We hypothesized that LVAD explant-OHT is a more challenging surgical procedure compared to OHT without LVAD explantation and that institutional LVAD explant-OHT procedural volume would be associated with post-transplant graft survival. We sought to assess the impact of institutional volume of LVAD explant-OHT on post-transplant graft survival. ⋯ Graft survival is decreased when performed at centers falling in the lowest quartile of LVAD explant-OHT for a given year. This volume-survival relationship should be considered in the context of limited donor organ availability and the rapidly growing number of LVAD centers.
-
J. Heart Lung Transplant. · Aug 2014
A minimally invasive off-pump implantation technique for continuous-flow left ventricular assist devices: early experience.
The HeartWare (HeartWare International, Inc. Framingham, MA) ventricular assist device (HVAD) is approved for implantation through a sternotomy with cardiopulmonary bypass. We report on our initial experience with this device implanted off-pump via thoracotomy. ⋯ Our experience was favorable in respect to outcome, safety, and use of blood products. Our technique can be used as an alternative approach for left ventricular assist device implantation using the HVAD.