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 2009
Effects of centrifugal, axial, and pulsatile left ventricular assist device support on end-organ function in heart failure patients.
Newer continuous-flow left ventricular assist devices (LVAD) have the advantage of smaller size and increased durability. Questions remain regarding the safety and effects of long-term nonpulsatile flow, despite some animal and human studies showing that end-organ function is well maintained with pulsatile or axial-flow devices. This study investigated whether centrifugal devices have similar effects on end-organ function. ⋯ Centrifugal, axial, and pulsatile LVADs all provide adequate circulatory support to maintain appropriate end-organ function in patients with end-stage heart failure. The advantages of the newer continuous-flow devices can be safely applied to an increasing number of patients. Long-term studies (>1 year) are needed to assess effects on end-organ function with continuous-flow devices, which may have important implications for use as destination therapy.
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J. Heart Lung Transplant. · Apr 2009
The 15-step oximetry test: a reliable tool to identify candidates for lung transplantation among patients with idiopathic pulmonary fibrosis.
Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive disease with a median survival of approximately 3 years. Measurements of lung volumes and diffusion capacity at rest are generally used to monitor the clinical course of IPF. Due to its high mortality, identification of patients at high risk is crucial for treatment strategies such as lung transplantation. This study was design to determine whether the simple 15-step climbing exercise oximetry test accurately characterizes disease severity and survival in patients with IPF. ⋯ The lowest saturation and desaturation areas on the 15-step oximetry test are significantly associated with long-term outcome in patients with IPF. We suggest that the 15-step test be used as a simple and reliable tool to predict severity and prognosis in IPF and to identify candidates for lung transplantation.
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J. Heart Lung Transplant. · Apr 2009
Lung transplantation for ventilator-dependent respiratory failure.
Lung transplantation of patients on mechanical ventilation is controversial, but successful transplantation of these patients has been reported. This report describes our institutional experience with lung transplantation of mechanically ventilated patients since 2003. ⋯ The survival rate and post-operative clinical course of patients undergoing transplantation while receiving mechanical ventilation for respiratory failure suggest that these patients can be considered for lung transplantation. Despite a longer time on post-operative mechanical ventilation and length of ICU stay, outcome is similar to that of other lung transplant candidates.
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J. Heart Lung Transplant. · Mar 2009
Case ReportsRecognition and management of complex rhythm disorders in heterotopic heart transplantation.
Managing arrhythmias is challenging in patients who have undergone heterotopic heart transplantation because of the superimposed rhythms of the native and donor hearts. We present the case of a 43-year-old man with a previously placed biventricular pacemaker who underwent heterotopic heart transplantation and later developed acute rejection of the donor heart, which led to bradycardia and pause-dependent ventricular fibrillation. The patient remained clinically stable in the short term, likely because of partial recovery of myocardial function in the native heart. He later underwent placement of a pacing lead in the donor heart, allowing linking of the two hearts via a biventricular pacemaker.
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J. Heart Lung Transplant. · Feb 2009
Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome.
Among the many potential risk factors influencing the development of bronchiolitis obliterans syndrome (BOS), acute cellular rejection is the most frequently identified. Despite the unique susceptibility of the lung allograft to pathogens, the association with respiratory tract infections remains unclear. In this study we analyze the role respiratory tract infections have on the development of BOS after lung transplantation. ⋯ In addition to acute rejection, pneumonias with GP, GN and fungal pathogens occurring prior to BOS are independent determinants of chronic allograft dysfunction. Early recognition and treatment of these pathogens in lung transplant recipients may improve long-term outcomes after transplantation.