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 2014
Assessment of myocardial viability and left ventricular function in patients supported by a left ventricular assist device.
Chronically supported left ventricular assist device (LVAD) patients may be candidates for novel therapies aimed at promoting reverse remodeling and myocardial recovery. However, the effect of hemodynamic unloading with a LVAD on myocardial viability and LV function in chronically supported LVAD patients has not been fully characterized. We aimed to develop a non-invasive imaging protocol to serially quantify native cardiac structure, function, and myocardial viability while at reduced LVAD support. ⋯ In clinically stable chronically supported LVAD patients, intrinsic cardiac structure, function, and myocardial viability did not significantly change over the pre-specified time frame. Echocardiographic circumferential strain and (99m)Tc-sestamibi SPECT myocardial viability imaging may provide useful non-invasive end points for the assessment of cardiac structure and function, particularly for phase II studies of novel therapies aimed at promoting reverse remodeling and myocardial recovery in LVAD patients.
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J. Heart Lung Transplant. · Apr 2014
Extended in vivo evaluation of a miniaturized axial flow pump with a novel inflow cannula for a minimal invasive implantation procedure.
Minimally invasive techniques are desirable to minimize surgical trauma during left ventricular assist device (LVAD) implantation. This is particularly challenging for full-flow support. In this study, a minimally invasive implantation technique was developed for a microaxial rotary pump. The system was evaluated in a chronic sheep model. ⋯ The minimally invasive implantation technique using the HeartWare MVAD pump, together with a new cannula, provided excellent results in a chronic animal model.
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J. Heart Lung Transplant. · Apr 2014
EditorialBiomarkers for the prognosis of pulmonary arterial hypertension: Holy Grail or flying circus?
Despite recent and major progresses in the field of pulmonary vascular diseases pulmonary arterial hypertension (PAH) outcome still needs improvement. In parallel, several changes are observed in a disease that is no longer described as typically affecting young women. This is outlined in the most recent reports from PAH registries, where increasing age at the time of diagnosis is constantly described. ⋯ Yet, even if there are probably few chances, if any, to discover the "Holy Grail", researcher's efforts must continue. The combination of pertinent parameters in composite scores is indeed promising and emphasized in the most recent PAH guidelines. Clinicians would probably need to use a subtle combination of several biomarkers and clinical, functional, hemodynamic and right ventricular parameter criteria to drive the most ambitious treatment goals in a complex and life threatening disease.
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J. Heart Lung Transplant. · Apr 2014
Frailty and outcomes after implantation of left ventricular assist device as destination therapy.
Frailty is recognized as a major prognostic indicator in heart failure. There has been interest in understanding whether pre-operative frailty is associated with worse outcomes after implantation of a left ventricular assist device (LVAD) as destination therapy. ⋯ Frailty before destination LVAD implantation is associated with increased risk of death and may represent a significant patient selection consideration.