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. · Jun 2012
Comparative StudyDifferent prognostic impact of the tissue Doppler-derived E/e' ratio on mortality in Chagas cardiomyopathy patients with heart failure.
Risk assessment of Chagas cardiomyopathy patients is essential for clinical decision making. The ratio of the ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/e') is a powerful predictor of adverse outcome in patients with heart failure. However, its prognostic value remains to be established in the setting of Chagas cardiomyopathy. This study investigated the effect of E/e' on mortality according to different degrees of left ventricular (LV) systolic function in patients with Chagas cardiomyopathy. ⋯ This study demonstrated the role of the interaction between LV ejection fraction and E/e' ratio in predicting prognosis in Chagas cardiomyopathy patients. The E/e' ratio had a stronger prognostic value in patients with mild and moderate LV dysfunction and was inversely associated with mortality in patients with advanced systolic heart failure.
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J. Heart Lung Transplant. · Jun 2012
Comparative StudyLong-term support with an ambulatory percutaneous paracorporeal artificial lung.
Conventional extracorporeal membrane oxygenation is bulky and non-ambulatory and requires multiple blood transfusions. We hypothesized that a percutaneous, paracorporeal artificial lung (PAL) could be established through a single venous cannulation to provide long-term ambulatory respiratory support. ⋯ We successfully established long-term ambulatory PAL for up to 24 days in 11 animals using our patented DLC through a single-site percutaneous venous cannulation. Critical bleeding/thrombosis formation and gas exchanger durability remain two major challenges for long-term-ambulatory PAL.
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J. Heart Lung Transplant. · Jun 2012
Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system.
Liver dysfunction increases post-surgical morbidity and mortality. The Model of End-stage Liver Disease (MELD) estimates liver function but can be inaccurate in patients receiving oral anti-coagulation. We evaluated the effect of liver dysfunction on outcomes after ventricular assist device (VAD) implantation and the dynamic changes in liver dysfunction that occur during VAD support. ⋯ MELD-XI is a viable alternative for assessing liver dysfunction in heart failure patients on oral anti-coagulation. Liver dysfunction is associated with worse survival. However, if MELD-XI improves during VAD support, post-transplant survival is similar to those without prior liver dysfunction, suggesting an important prognostic role. We also found evidence of a transient cholestatic state after LVAD implantation that deserves further examination.
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J. Heart Lung Transplant. · May 2012
Hospital charges for pediatric heart transplant hospitalizations in the United States from 1997 to 2006.
Heart transplantation remains a resource-intensive therapy for children. However, data regarding change in costs over time are scarce. We tested the hypothesis that hospital charges for pediatric heart transplant hospitalizations would increase from 1997 to 2006 and assessed factors associated with hospital charges. ⋯ From 1997 to 2006, mean charges for pediatric heart transplant hospitalizations increased by > $170,000 (160%). Although greater morbidities in the later years of the study potentially contributed to increased charges, later calendar year was independently associated with increased charges. The changes in charges for heart transplant are similar to the increases seen in other surgical procedures. Ongoing study of management strategies is needed to determine cost-effective therapies for this complex group of patients.
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J. Heart Lung Transplant. · May 2012
Cost-effectiveness of the implantable HeartMate II left ventricular assist device for patients awaiting heart transplantation.
Left ventricular assist devices (LVADs) are being proposed as a life-saving therapeutic alternative to conventional medical management for people with end-stage heart failure awaiting transplantation. However, cost-effectiveness assessments of first-generation LVADs have not been encouraging. The cost-effectiveness of the enhanced second-generation LVAD HeartMate II (Thoratec, Pleasanton, CA) is estimated here. ⋯ Although HeartMate II LVAD implantation significantly increases survival compared with conventional medical management, it does not provide good value for the money spent according to established thresholds of cost-effectiveness in the UK. HeartMate II is unlikely to become cost-effective unless the additional survival gained by its use raises and/or the device is given free of charge. Therefore, its implantation to transplant candidates lacks justification in terms of cost-effectiveness.