Extracorporeal Membrane Oxygenation Support as Treatment for Early Graft Failure After Heart Transplantation

Early graft failure (EGF) is a major risk factor for death after heart transplantation (Htx) accounting for >40% of deaths within 30 days postoperatively. According to the last International Society for Heart and Lung Transplantation (ISHLT) consensus statement, the graft dysfunction (GD) is to be classified into primary (PGD), in case of an unknown triggering factor or secondary (SGD) where there is a discernible cause such as acute rejection, pulmonary hypertension, or known surgical complications. The diagnosis of GD is to be made within 24 h after completion of Htx surgery and a severity scale for GD should include mild, moderate, or severe grades based on specified criteria. Mechanical circulatory support (MCS) for GD should be considered when medical management is not sufficient to support the newly transplanted graft. Currently, extra‐corporeal membrane oxygenation (ECMO) is widely accepted as treatment of severe EGF, given its easy and quick setup, the system versatility, the optimal end‐organ perfusion provided, and the possibility of both biventricular and lung assistance by usage of a low‐cost single pump

Planeamiento estratégico de la Provincia de Castrovirreyna

El Plan Estratégico de la provincia de Castrovirreyna se realizó con base en el Modelo Secuencial del Proceso Estratégico, el cual desarrolló el Dr. Fernando D’Alessio Ipinza, quien partió de un análisis de la situación actual, para llegar a una situación futura deseada, por medio del establecimiento de la visión, misión, valores, objetivos de largo plazo, corto plazo y estrategias asociadas al entorno y sus fortalezas, debilidades, oportunidades y amenazas. Castrovirreyna es una provincia que se conforma de 13 distritos, es predominantemente rural y tiene un alto grado de pobreza y pobreza extrema, posee abundantes recursos que podrían permitirle mejorar su posición, debido a que no tiene la promoción e inversión necesaria para capitalizar la riqueza de su patrimonio en actividades productivas que le permitan desarrollarse y crecer. La propuesta del Plan se basa en el desarrollo de la infraestructura (vial y de comunicaciones) y de los servicios básicos (salud, educación e internet) que sirva de soporte e incremente el nivel de vida y la competitividad de la provincia; el desarrollo de sectores económicos como agropecuario, acuícola y turismo, a través de la mejora de la tecnología de producción de especies propias de la provincia y los beneficios tributarios, otorgados desde el Estado y las capacitaciones e incentivos a la generación de clústeres, también la participación de la población en todos los procesos de la búsqueda del desarrollo provincial. Asimismo, se orienta a motivar a las nuevas generaciones al emprendimiento teniendo en cuenta las potencialidades de la provincia, y de esta manera poder reducir las brechas de pobreza y desigualdad existentesThe Strategic Plan of the province of Castrovirreyna has been made based on the sequential model of the Strategic Process developed by Dr. Fernando D’Alessio Ipinza, based on an analysis of the current situation, to reach a desired future situation, through the establishment of vision, mission, values, long-term goals, short-term and related to the environment and their strategies strengths, weaknesses, opportunities and threats. Castrovirreyna is a province that is composed of 13 districts, it’s predominantly rural and has a high degree of poverty and extreme poverty, it has abundant resources that could enable it to improve its position because it does not have the promotion and investment needed to capitalize on the wealth of its assets in activities productive that allow develop and grow. Plan’s proposal is based on the development of the infrastructure (roads and communications) and of the basic services (health, education and internet) to serve as a support and increase the standard of living and competitiveness of the province; the development of economic sectors such as agriculture, aquaculture and tourism through improved production technology of species native of the province and the tax benefits granted from the State and trainings and incentives to generate clusters, also participation of the population in all processes of the search for provincial development. Additional aims to encourage new generations to entrepreneurship taking into account the potential of the province, and thus to reduce the gaps existing poverty and inequalityTesi

488 Candidacy for heart transplantation in adult congenital heart disease patients: a single-centre, retrospective, cohort study

Abstract Aims End-stage heart failure (HF) is the leading cause of death in adult congenital heart disease (ACHD) population. Heart transplantation (HTx) improves prognosis in ACHD end-stage HF but candidacy evaluation, referral pattern, and correct listing timing are not fully elucidated in this population. To evaluate factors associated to refusal from Htx in ACHD patients with end-stage HF referred for HTx evaluation. Methods and results This retrospective cohort study enrolled consecutive ACHD patients considered for HTx in our institution between 2014 and 2020 and patients undergone HTx between 2000 and 2013. Refusal from HTx served as primary study endpoint. Between 2014 and 2020, 46 ACHD patients were evaluated for HTx, 14 ACHD patients underwent HTx between 2001 and 2013. The main indication to HTx in patients with single ventricle physiology was Fontan failure, while in patients with systemic left ventricle and systemic right ventricle physiology, it was systemic ventricular dysfunction. We compared clinical, anatomical and demographic data of 41 patients accepted for transplantation with 15 patients refused after screening. Risk factors for refusal were: coexistence of multiple high risk features [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.1–12.9; P 0.048]; anatomical factors (OR: 14.5; 95% CI: 3.1–68.4; P 0.001), out-of-centre ACHD/HTx program referral (OR: 5.3; 95% CI: 1.5 to 19.0; p 0.01). Survival in patients accepted for HTx was significantly higher than survival in patients declined from HTx with landmark comparison at 20, 40 and 60 months of 87%, 78%, and 72% vs. 70%, 59%, and 20%, respectively. HTx refusal identifies a high risk ACHD patient subgroup (hazard ratio for overall mortality: 3.1; 95% CI: 1.1–8.3; P 0.02). Conclusions In our study risk factors for refusal from HTx are adverse anatomical features, coexistence of multiple conventional HTx high risk factors and out-of-centre referral. ACHD patients refused from HTx present shorter time to death. Efforts to increase HTx candidacy and to reduce referral delay in tertiary centre are strongly necessary for this growing population

Combined pulmonary accessory blood flow and High-tech scaffold patch during bidirectional cavo-pulmonary anastomosis: the role of combined therapy on pulmonary artery growth.

I cuori funzionalmente univentricolari costituiscono un gruppo di cardiopatie congenite ad alto rischio e complessità chirurgica. Il trattamento attuale consiste nell’adottare un approccio chirurgico palliativo che prevede più stadi volti a separare gradualmente la circolazione venosa da quella arteriosa, con un ultimo stadio rappresentato dall’intervento di Fontan o anastomosi cavo-polmonare totale (TCPC). In questo stravolgimento della normale fisiologia che trasforma la circolazione da un sistema “in parallelo” ad uno “in serie”, l’intervento di anastomosi cavo-polmonare bidirezionale (BCPA) è diventato un gradino obbligatorio per la separazione delle due circolazioni. Nel realizzare questo studio retrospettivo abbiamo raccolto e analizzato i parametri clinici, ecocardiografici, emodinamici e della capacità funzionale di 98 pazienti sottoposti a BCPA presso il nostro centro; inoltre abbiamo valutato l’outcome a lungo termine. Andando ad analizzare il ruolo del flusso accessorio e della plastica delle polmonari con patch sulla crescita delle arterie polmonari a distanza non abbiamo visto differenze significiative. Una sotto analisi effettuata sui pazienti sottoposti a test da sforzo cardio-polmonare dopo TCPC non ha mostrato differenze di outcome a lungo termine in entrambi i gruppi a riprova che non vi è un sovraccarico di volume ventricolare con entrambe le tecniche applicate.Functionally univentricular hearts form a group of congenital heart disease at high risk and surgical complexity. The current treatment consists in adopting a palliative surgical approach that involves several stages aimed at gradually separating the venous and arterial circulation, with the last stage represented by the Fontan intervention or total hollow-pulmonary anastomosis (TCPC). In this distortion of the normal physiology that transforms the flow from a "parallel" to a "serial" system, the intervention of bidirectional hollow-pulmonary anastomosis (BCPA) has become a mandatory step for the separation of the two circulations. In carrying out this retrospective study, we collected and analyzed the clinical, echocardiographic, hemodynamic and functional capacity of 98 patients undergoing BCPA at our center; we also evaluated the long-term outcome. Looking at the role of accessory flow and lung plastic with patches on the growth of remote pulmonary arteries, we have not seen significant differences. A sub-analysis performed on patients undergoing cardiopulmonary stress testing after TCPC showed no long-term outcome differences in both groups, confirming that there is no ventricular volume overload with both applied techniques

Treatment solution by Careddu et al

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Aortic atresia with interrupted aortic arch: A combination incompatible with life?

Not Availabl

Angiographic aspect of longstanding Starr-Edwards valve for type C Ebstein anomaly

This is a rare report of a longstanding well-functioning Starr-Edwards valve in the tricuspid position

Atrio sinistro gigante con stenosi mitralica reumatica

non disponibil