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 2006
Case ReportsManagement of aortic insufficiency with continuous flow left ventricular assist devices: bioprosthetic valve replacement.
There are several methods for surgical management of aortic insufficiency in patients with end-stage congestive heart failure who are undergoing implantation of a left ventricular assist device (LVAD). To date, little is known about the long-term outcome of bioprosthetic valves for aortic insufficiency in patients with continuous flow LVADs. We report on two patients with bioprosthetic aortic valve replacement for aortic insufficiency at the time of HeartMate II LVAD insertion.
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J. Heart Lung Transplant. · Dec 2006
Attenuation of lung reperfusion injury by modified ventilation and reperfusion techniques.
High ventilation and perfusion pressures after lung transplantation may have deleterious effects. We hypothesized that using combined protective approaches for ventilation and perfusion would be optimal for reducing injury and improving function after ischemia-reperfusion. ⋯ This protective approach of ventilation and perfusion after ischemia may improve lung function after transplantation, a simple method that could easily be applied clinically.
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J. Heart Lung Transplant. · Dec 2006
A quantitative gene expression profile of matrix metalloproteinases (MMPS) and their inhibitors (TIMPS) in the myocardium of patients with deteriorating heart failure requiring left ventricular assist device support.
Mechanisms underlying the rapid deterioration of heart failure patients who subsequently require left ventricular assist device (LVAD) support are poorly understood. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs) play a key role in myocardial remodelling and heart failure. We hypothesized that MMP and TIMP expression would be altered in these patients. ⋯ The data show that high myocardial collagenase (MMP1 and MMP8) expression without compensatory changes in collagen or TIMP expression is a feature of patients requiring LVAD support. This may be linked in part to elevated cytokine expression and suggests collagenase activity may be an important therapeutic target in deteriorating heart failure.
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J. Heart Lung Transplant. · Nov 2006
Hemodilution modulates the time of onset and rate of fibrinolysis in human and rabbit plasma.
Fibrinolysis has a critical role in the development of bleeding after insertion of a ventricular assist device (VAD). However, chronically, VAD-mediated fibrinolysis may also diminish thromboembolic events. Management of VADs involves fluid administration. It was hypothesized that the fluid administered could modulate fibrinolysis. ⋯ Compared with crystalloid or albumin, HES solutions enhance fibrinolysis by decreasing clot strength and decreasing the time of onset of fibrinolysis. Further studies are warranted to determine whether the fluid administered to patients with VADs can impact hemorrhagic and thrombotic morbidity.
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J. Heart Lung Transplant. · Nov 2006
Clinical TrialEfficacy of sildenafil as a rescue therapy for patients with severe pulmonary arterial hypertension and given long-term treatment with prostanoids: 2-year experience.
Both prostanoids and sildenafil are effective treatments for severe pulmonary arterial hypertension (PAH). The combined use of these drugs to maximize the clinical benefit is an emerging treatment option. This study describes a 2-year experience with adjunct sildenafil as a rescue therapy for patients with severe PAH treated long term with prostanoids and who showed clinical deterioration or onset of heart failure. ⋯ Adjunct sildenafil to long-term prostacyclin therapy in patients with severe PAH provided sustained clinical stabilization and an improved clinical situation, exercise capacity and echocardiographic parameters of right ventricular function. The beneficial effects were strong and lasted >24 months.