6 research outputs found
Palliative Combined Percutaneous Balloon Aortic Valvuloplasty and Unprotected Left Main Stenting in End Stage Renal Disease
With the aging population and high prevalence of atherosclerosis, an increasing number of patients presenting with heart failure and angina are found to have severe coronary artery disease and severe valvular disease. These patients tend to have multiple co-morbidities such as end stage renal disease and are considered high-risk for surgery. In patients with severe coronary artery disease, severe aortic stenosis, and heart failure with depressed left ventricular systolic function, the options are limited as they are not usually offered surgery, but palliative percutaneous high-risk procedures might be a viable alternative
Hypertrophic obstructive cardiomyopathy in liver transplant patients
The optimal treatment strategy for patients with symptomatic hypertrophic obstructive cardiomyopathy
(HOCM) and end-stage liver disease (ESLD) is not well defined. Although medical
management is the accepted first line treatment, patients who are unresponsive to medication
require further interventions. Since ESLD patients have a high operative risk for surgical
myomectomy, alcohol septal ablation (ASA) emerges as a good alternative in these cases. The
timing of ASA in relation to liver transplantation is still unclear. We report here on the first
case of an orthotopic liver transplant-recipient undergoing ASA and the second of a cirrhotic
patient requiring ASA as a bridge to liver transplantation. Both patients had a good clinical
outcome and we argue that ASA in HOCM patients should be driven by symptom onset, and
that in the asymptomatic patient it can be safely deferred until after liver transplantation.
(Cardiol J 2008; 15: 74-79
The safety of bivalirudin during elective percutaneous coronary interventions in heart transplant patients
Background: Bivalirudin has been shown to be safe and effective during percutaneous
coronary interventions (PCI) of native coronary arteries in the REPLACE 2 trial. The safety of
bivalirudin during PCIs in heart transplant patients is not known.
Methods: Heart transplant patients who had undergone PCI of de novo lesions and received
bivalirudin during the procedure were included in the study. Medical records were reviewed for
the occurrence of death, myocardial infarction, target vessel revascularization or major bleeding
up to 30 days after discharge. The results were compared with the REPLACE 2 trial and with
a control group of heart transplant recipients who received heparin during their procedures.
Results: There were 51 separate PCIs performed in 30 patients in the study group. The mean
age was 56 ± 12 years and 6 (20%) were women. The control group consisted of 24 patients
who had undergone 35 PCIs. There were no deaths, myocardial infarctions or target vessel
revascularization during the follow-up period in the study group. The combined endpoint of
death, myocardial infarctions, target vessel revascularization and major bleeding requiring
two or more units of packed red blood cells occurred in 2 (3.9%) patients compared to
275 (9.2%) patients in the REPLACE 2 trial (p = 0.195) and 5 (14.3%) in the control group (p = 0.115).
Conclusion: Bivalirudin is a safe antithrombotic medication to use during elective PCI in
heart transplant patients with cardiac allograft vasculopathy. (Cardiol J 2007; 14: 458-462
Bezpiecze艅stwo stosowania biwalirudyny podczas elektywnych przezsk贸rnych interwencji wie艅cowych u pacjent贸w po przeszczepie serca
Wst臋p: W badaniu REPLACE 2 wykazano zar贸wno bezpiecze艅stwo, jak i skuteczno艣膰 stosowania
biwalirudyny podczas przezsk贸rnych interwencji wie艅cowych (PCI) dotycz膮cych natywnych
t臋tnic wie艅cowych. Nie istniej膮 natomiast doniesienia na temat bezpiecze艅stwa zastosowania
biwalirudyny w trakcie PCI u pacjent贸w po przeszczepie serca.
Metody: Do badania w艂膮czono chorych po zabiegu transplantacji serca, u kt贸rych wykrywane
de novo zmiany w naczyniach wie艅cowych zaopatrywano na drodze PCI. Za punkt ko艅cowy
badania uznano wyst膮pienie w ci膮gu 30 dni po zabiegu: zgonu pacjenta, zawa艂u serca, konieczno艣ci
wykonania rewaskularyzacji dotycz膮cej zaopatrywanego wcze艣niej na drodze PCI
naczynia oraz powa偶nego krwawienia. Wyniki badania por贸wnano zar贸wno z rezultatami
REPLACE 2, jak i z wynikami uzyskanymi w grupie kontrolnej (pacjenci po przeszczepie
serca otrzymuj膮cy podczas procedur PCI heparyn臋).
Wyniki: W grupie badawczej wykonano 51 zabieg贸w PCI u 30 chorych. 艢rednia wieku w tej grupie
wynosi艂a 56 ± 12 lat; kobiety stanowi艂y 20% og贸艂u grupy. Grupa kontrolna sk艂ada艂a si臋 z 24 chorych,
u kt贸rych wykonano 35 zabieg贸w PCI. W grupie badawczej podczas okresu obserwacji nie
stwierdzono wyst膮pienia: zgonu, zawa艂u serca lub konieczno艣ci rewaskularyzacji naczynia
wie艅cowego zaopatrywanego wcze艣niej za pomoc膮 PCI. Z艂o偶ony punkt ko艅cowy w postaci: zgonu,
zawa艂u serca, konieczno艣ci rewaskularyzacji naczynia wie艅cowego zaopatrywanego wcze艣niej za
pomoc膮 PCI oraz powa偶nego krwawienia wymagaj膮cego przetoczenia przynajmniej 2 j. koncentratu
krwinek czerwonych wyst膮pi艂 u 2 (3,9%) chorych w por贸wnaniu z 275 (9,2%) pacjentami
w badaniu REPLACE 2 (p = 0,195) oraz 5 (14,3%) osobami w grupie kontrolnej (p = 0,115).
Wnioski: Biwalirudyn臋, lek o dzia艂aniu przeciwzakrzepowym, mo偶na bezpiecznie stosowa膰
w przebiegu elektywnej PCI wykonywanej u pacjent贸w z waskulopati膮 w przeszczepionym
sercu. (Folia Cardiologica Excerpta 2008; 3: 29-34