Humoral Rejection in Cardiac Transplantation: Management of Antibody-Mediated Rejection

After a successful heart transplantation, fundamental keys to achieve good results in the long term are to establish immunosuppressive therapy in the postoperative period in an appropriate manner and to ensure continuity of follow-ups. Despite the fact that these stages are maintained perfectly, patients may face one or more rejection episodes. T-cell-mediated acute cellular rejection of the cardiac allograft has well-established treatment algorithms, whereas antibody-mediated rejection (AMR) is challenging to diagnose, and its treatment varies between centers. Investigators reported that AMR is among the most important factors to improving long-term outcomes. Improved understanding of the roles of acute and chronic AMR has evolved in recent years following a major progress in the technical ability to detect and quantify recipient antihuman leukocyte antigen (HLA) antibody production. Recently, a study of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. There are some questions regarding the classification of AMR, the diagnostic approaches, and the treatment strategies for managing. In this chapter, we are discuss the effector mechanisms that are used by antibodies to eliminate antigens and clinical experience about AMR and its treatment with a discussion about the latest articles

Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries

Aims Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. Methods and results A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Conclusion Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encourage

The measurement of thermal conductivity variation with temperature for lead− free ternary eutectic solders

The goal of this paper is to measure the electrical and thermal conductivity variations with temperature in the unidirectional solidified quaternary Sn–Bi–In–Zn lead-free solder alloys for nine different compositions to determine the phonon thermal conductivity variation with temperature. The measurements of electrical and thermal conductivity variations with temperature were put into practice with the methods of four-point probe and longitudinal heat flow, respectively, and the electron and phonon thermal conductivity variations with temperature for the alloys were plotted. In addition, the temperature coefficient values for electrical and thermal conductivity were calculated

Neurocognitive functions after beating heart mitral valve replacement without cross-clamping the aorta

Background and aim of the study: Although neurologic outcome after cardiac surgery is well-established, neurocognitive functions after beating heart mitral valve replacement still needs to be elucidated. The aim of this study was to compare preoperative and postoperative neurocognitive functions in patients who underwent beating heart mitral valve replacement on cardiopulmonary bypass without cross-clamping the aorta. Methods: The prospective study included 25 consecutive patients who underwent mitral valve replacement. The operations were carried out on a beating heart method using normothermic cardiopulmonary bypass without cross-clamping the aorta. All patients were evaluated preoperatively (E1) and postoperatively (at sixth day [E2] and second month [E3]) for neurocognitive functions. Results: Neurologic deficit was not observed in the postoperative period. Comparison of the neurocognitive test results, between the preoperative and postoperative assessment for both hemispheric cognitive functions, demonstrated that no deterioration occurred. In the three subsets of left hemispheric cognitive function test evaluation, total verbal learning, delayed recall, and recognition, significant improvements were detected at the postoperative second month (E3) compared to the preoperative results (p = 0.005, 0.01, and 0.047, respectively). Immediate recall and retention were significantly improved within the first postoperative week (E2) when compared to the preoperative results (p = 0.05 and 0.05, respectively). Conclusions: The technique of mitral valve replacement with normothermic cardiopulmonary bypass without cross-clamping of the aorta may be safely used for majority of patients requiring mitral valve replacement without causing deterioration in neurocognitive functions

Intraoperative left atrium inversion after implantation of HeartMate III ventricular assist device

<p>We report here a case of left atrium inversion after implanting HeartMate III LVAD, which is known to be the first in literature. LVAD can be functional only if there is adequate inflow to the device. Parameters and filling of left ventricle can be assessed by TEE. In our case, initial examination with TEE showed thrombus like images. HeartMate III has a reliable algorithm that automatically reduces pump speed if ‘suction effect’ is detected. HeartMate III demonstrates clean flow properties and good surface wash. Despite these positive features of the HeartMate III, left atrium inversion can still be seen with it, so users should be alert in this regard.</p

A new heart surgery clinic: Open Heart Surgery Outcomes at Karabuk Training and Research Hospital: Assessment of the first year

This study aims to assess the one-year outcomes of open heart surgeries performed at the recently established Cardiovascular Surgery Clinic of Karabuk Training and Research Hospital. A total of 71 consecutive patients (60 males, 11 females; mean age 63.7±9.3 years; range 42 to 84 years) who underwent open heart surgery were evaluated retrospectively from 21 January 2016 to 21 January 2017. The most common comorbidity was hypertension (64.8%), followed by smoking (61.9%), chronic obstructive pulmonary disease (54.9%), and diabetes mellitus (40.6%). Mean length of stay at the intensive care unit was 3.4±2.9 days, and mean length of stay at the hospital was 10.4±6.9 days. In-hospital mortality occurred in a total of seven patients (9.9%). Early mortality (within the first 30 days) was seen in four (5.6%) patients. We believe our mortality and morbidity rates are acceptable despite the disadvantages of being a recently established center and the presence of multiple comorbid factors of patients. Although our clinic is a new center founded in Karabuk province, it is planned to become an important center in the future in terms of heart surgery through the increasing number and variety of surgeries. [Med-Science 2018; 7(1.000): 145-150

Driveline exit-site care protocols in patients with left ventricular assist devices

Objectives: Driveline infections continue to be a significant complication following left ventricular assist device (LVAD) implantation. Driveline exit-site care i