Joint Arthroplasties other than the Hip in Solid Organ Transplant Recipients

Transplantation Surgery has undergone a great development during the last thirty years and the survival of solid organ recipients has increased dramatically. Osteo-articular diseases such as osteoporosis, fractures, avascular bone necrosis and osteoarthritis are relatively common in these patients and joint arthroplasty may be required. The outcome of hip arthroplasty in patients with osteonecrosis of the femoral head after renal transplantation has been studied and documented by many researchers. However, the results of joint arthroplasties other than the hip in solid organs recipients were only infrequently reported in the literature. A systematic review of the English literature was conducted in order to investigate the outcome of joint arthroplasties other than the hip in kidney, liver or heart transplant recipients. Nine pertinent articles including 51 knee arthroplasties, 8 shoulder arthroplasties and 1 ankle arthroplasty were found. These articles reported well to excellent results with a complication rate and spectrum comparable with those reported in nontransplant patients

Continuous aortic flow augmentation - A pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure

Background - Diminished aortic flow may induce adverse downstream vascular and renal signals. Investigations in a heart failure animal model have shown that continuous aortic flow augmentation ( CAFA) achieves hemodynamic improvement and ventricular unloading, which suggests a novel therapeutic approach to patients with heart failure exacerbation that is inadequately responsive to medical therapy. Methods and Results - We studied 24 patients ( 12 in Europe and 12 in the United States) with heart failure exacerbation and persistent hemodynamic derangement despite intravenous diuretic and inotropic and/or vasodilator treatment. CAFA ( mean +/- SD 1.34 +/- 0.12 L/min) was achieved through percutaneous ( n = 19) or surgical ( n = 5) insertion of the Cancion system, which consists of inflow and outflow cannulas and a magnetically levitated and driven centrifugal pump. Hemodynamic improvement was observed within 1 hour. Systemic vascular resistance decreased from 1413 +/- 453 to 1136 +/- 381 dyne (.) s (.) cm(-5) at 72 hours ( P = 0.0008). Pulmonary capillary wedge pressure decreased from 28.5 +/- 4.9 to 19.8 +/- 7.0 mm Hg ( P < 0.0001), and cardiac index ( excluding augmented aortic flow) increased from 1.97 +/- 0.44 to 2.27 +/- 0.43 L (.) min(-1) (.) m(-2) ( P = 0.0013). Serum creatinine trended downward during treatment ( overall P = 0.095). There were 8 complications during treatment, 7 of which were self-limited. Hemodynamics remained improved 24 hours after CAFA discontinuation. Conclusions - In patients with heart failure and persistent hemodynamic derangement despite intravenous inotropic and/or vasodilator therapy, CAFA improved hemodynamics, with a reduction in serum creatinine. CAFA represents a promising, novel mode of treatment for patients who are inadequately responsive to medical therapy. The clinical impact of the observed hemodynamic improvement is currently being explored in a prospective, randomized, controlled trial

Diastolic Dysfunction Persists After Unloading by Left Ventricular Assist Device (LVAD) Support

Left Atrium (LA) size has prognostic importance in a variety of cardiac conditions [1] and is known to be enlarged with decreased contractile function in patients with congestive heart failure (CHF) [2]. Nearly 5 million Americans have CHF [3] and a majority of these patients display diastolic dysfunction, which is an abnormality in the left ventricle (LV) myocardial relaxation and/or compliance that alters the ease with which the blood is accepted into the LV from the LA during diastole [4]. Due to abnormal LV filling, the LA experiences intense stress and elevated pressures. In fact, the left atrium is exposed directly to the LV diastolic pressure through the open mitral valve (MV) and because of its thin wall structure it tends to dilate with increasing pressure [5]. This augmented LA size and increased contractility and booster function are some of the mechanisms compensating for decreased early filling in patients with reduced LV compliance [6]. Over time, the LA compensatory contribution decreases, this may lead to intrinsic left atrium dysfunction [7]. This in turn results in a progressive decline in health unless the hearts’ inadequate blood flow is augmented by a left ventricular assist device (LVAD). Although LVAD implantation rest the heart, restores function to the ventricle [8], and improve overall function [9], its effects on the left atrium remain unclear. The purpose of the present study was to use 2D and Doppler echocardiography to define the parameters for assessing LVAD unloading and determine its effect on LA diameter, area, volume, and pressure in patients prior to and following LVAD implantation.</jats:p