17 research outputs found
Postcardiac transplant survival in the current era in patients receiving continuous-flow left ventricular assist devices
ObjectivesContinuous-flow left ventricular assist devices have become the standard of care for patients with heart failure requiring mechanical circulatory support as a bridge to transplant. However, data on long-term post-transplant survival for these patients are limited. We evaluated the effect of continuous-flow left ventricular assist devices on postcardiac transplant survival in the current era.MethodsAll patients who received a continuous-flow left ventricular assist device as a bridge to transplant at a single center from June 2005 to September 2011 were evaluated.ResultsOf the 167 patients who received a continuous-flow left ventricular assist device as a bridge to transplant, 77 (46%) underwent cardiac transplantation, 27 died before transplantation (16%), and 63 (38%) remain listed for transplantation and continued with left ventricular assist device support. The mean age of the transplanted patients was 54.5 ± 11.9 years, 57% had an ischemic etiology, and 20% were women. The overall mean duration of left ventricular assist device support before transplantation was 310 ± 227 days (range, 67-1230 days). The mean duration of left ventricular assist device support did not change in patients who had received a left ventricular assist device in the early period of the study (2005-2008, n = 62) compared with those who had received a left ventricular assist device later (2009-2011, n = 78, 373 vs 392 days, P = NS). In addition, no difference was seen in survival between those patients supported with a left ventricular assist device for fewer than 180 days or longer than 180 days before transplantation (P = NS). The actuarial survival after transplantation at 30 days and 1, 3, and 5 years by Kaplan-Meier analysis was 98.7%, 93.0%, 91.1%, and 88.0%, respectively.ConclusionsThe short- and long-term post-transplant survival for patients bridged with a continuous-flow left ventricular assist device in the current era has been excellent. Furthermore, the duration of left ventricular assist device support did not affect post-transplant survival. The hemodynamic benefits of ventricular unloading with continuous-flow left ventricular assist devices, in addition to their durability and reduced patient morbidity, have contributed to improved post-transplant survival
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Ventriculophasic sinus arrhythmia in the orthotopic transplanted heart: mechanism of disease revisited
Background: Several mechanisms have been proposed for ventriculophasic sinus arrhythmia: phasic changes in baroreceptor mediated vagal input to the sinus node, mechanical effects and pressure changes caused by ventricular systole, and increased blood flow to the sinus node. We attempt to elucidate the role of SA nodal blood flow in the generation of ventriculophasic sinus arrhythmia by measuring phasic changes in PP intervals from the atrial remnants of patients who have received cardiac transplant.
Methods: A total of 16 atrial electrogram recordings were obtained from the recipient atrial remnant in 12 patients who had undergone heart transplantation at the University of Miami/Jackson Memorial Hospital. Concomitant recordings of the donor surface ECG were also obtained. Recipient atrial PP intervals that contained a QRS were measured. The QP intervals were also measured and plotted against the associated PP interval to assess the relationship between varying QP intervals and the associated PP interval.
Results: A linear relationship between the PP intervals and the associated QP intervals was seen in all patients. Despite widely varying QP intervals, there was little change in the PP intervals suggesting absence of ventriculophasic arrhythmia. Our linear graphs are in contrast to the typical curves seen in ventriculophasic arrhythmia that have been described by Lepeschkin.
Conclusions: In our study, there appeared to be absence of ventriculophasic arrhythmia despite intact vagal innervation to the atrial remnant suggesting that the lack of pulsatile SA node blood flow may contribute to the absence of ventriculophasic arrhythmia. We conclude that the transplanted heart, when performed by the standard technique, may provide a model to study mechanisms of ventriculophasic arrhythmia