Posttransplant survival is not diminished in heart transplant recipients bridged with implantable left ventricular assist devices

BackgroundThe purpose of this study was to compare posttransplantation morbidity and mortality in orthotopic heart transplant recipients bridged to transplant with a left ventricular assist device with nonbridged recipients. To account for potential differences across device types, we stratified bridge-to-transplant recipients by type of ventricular assist device: extracorporeal (EXTRA), paracorporeal (PARA), and intracorporeal (INTRA).MethodsThe United Network for Organ Sharing provided de-identified patient-level data. The study population included 10,668 orthotopic heart transplant recipients aged 18 years old or older and undergoing transplantation between January 1, 2001, and December 31, 2006. Follow-up data were provided through August 3, 2008, with a mean follow-up time of 3.17 ± 2.15 years (range, 0–8.11 years). The primary outcome was actuarial posttransplant graft survival. Other outcomes of interest included infection, stroke, and dialysis during the transplant hospitalization; primary graft failure at 30 days; transplant hospitalization length of stay; and long-term complications including diabetes mellitus, transplant coronary artery disease, and chronic dialysis. Multivariable Cox proportional hazards regression (backward, P < .15) was used to determine the relationship between groups and overall graft survival, and multivariable logistic regression analysis (backward, P < .15) was used to determine the relationship between groups and secondary outcome measures.ResultsIn multivariable Cox regression analysis, when compared with the nonbridged group, risk-adjusted greater than 90-day graft survival was diminished among the EXTRA group (hazard ratio = 3.54, 2.28–5.51, P < .001), but not the INTRA group (1.04, 0.719–1.51, P = .834) or the PARA group (1.06, 0.642–1.76, P = .809). There were no significant differences in risk-adjusted graft survival across the 4 groups during the 90-days to 1-year or 1- to 5-year intervals. However, at more than 5 years, risk-adjusted graft survival in the INTRA group (0.389, 0.205–0.738, P = .004) was better than in the nonbridged group. The EXTRA, PARA, and INTRA groups all experienced increased risks of infection. The EXTRA group had increased risks of dialysis, stroke, and primary graft failure at 30 days, whereas neither the PARA nor the INTRA group differed from the nonbridged group. Long-term complications did not differ by group.ConclusionThe use of implantable left ventricular assist devices as bridges to transplantation, including both intracorporeal and paracorporeal devices, is not associated with diminished posttransplant survival. However, 90-day survival was diminished in recipients bridged with extracorporeal devices

Del Nido Cardioplegia can be safely administered in high-risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison

Del Nido (DN) cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60 minutes, and the addition of lidocaine may limit intracellular calcium influx. Single-dose DN cardioplegia solution may offer an alternative myocardial protection strategy to multi-dose cold whole blood (WB) cardioplegia following acute myocardial infarction (AMI). We retrospectively reviewed 88 consecutive patients with AMI undergoing coronary artery bypass (CABG) surgery with cardioplegic arrest between June 2010 to June 2012. Patients exclusively received WB (n = 40, June 2010-July 2011) or DN (n = 48, August 2011-June 2012) cardioplegia. Preoperative and postoperative data were retrospectively reviewed and compared using propensity scoring. No significant difference in age, maximum preoperative serum troponin level, ejection fraction, and STS score was present between DN and WB. A single cardioplegia dose was given in 41 DN vs. 0 WB patients (p < 0.001), and retrograde cardioplegia was used 10 DN vs. 31 WB patients (p < 0.001). Mean cardiopulmonary bypass and cross clamp times were significantly shorter in the DN group versus WB group. Tranfusion rate, length of stay, intra-aortic balloon pump requirement, post-operative inotropic support, and 30-day mortality was no different between groups. One patient in the WB group required a mechanical support due to profound cardiogenic shock. DN cardioplegia may provide equivalent myocardial protection to existing cardioplegia without negative inotropic effects in the setting of acute myocardial infarction

Readjusting Our Sporting Sites/Sight: Sportification and the Theatricality of Social Life

This paper points out the potential of using sport for the analysis of society. Cultivated human movement is a specific social and cultural subsystem (involving sport, movement culture and physical culture), yet it becomes a part of wider social discourses by extending some of its characteristics into various other spheres. This process, theorised as sportification, provides as useful concept to examine the permeation of certain phenomena from the area of sport into the social reality outside of sport. In this paper, we investigate the phenomena of sportification which we parallel with visual culture and spectatorship practices in the Renaissance era. The emphasis in our investigation is on theatricality and performativity; particularly, the superficial spectator engagement with modern sport and sporting spectacles. Unlike the significance afforded to visualisation and deeper symbolic interpretation in Renaissance art, contemporary cultural shifts have changed and challenged the ways in which the active and interacting body is positioned, politicised, symbolised and ultimately understood. We suggest here that the ways in which we view sport and sporting bodies within a (post)modern context (particularly with the confounding amalgamations of signs and symbols and emphasis on hyper-realities) has invariably become detached from sports' profound metaphysical meanings and resonance. Subsequently, by emphasising the associations between social theatrics and the sporting complex, this paper aims to remind readers of ways that sport—as a nuanced phenomenon—can be operationalised to help us to contemplate questions about nature, society, ourselves and the complex worlds in which we live

False-positive Self-lensing Events: TESS Observing Asteroid-crossing Events in Disguise

We report observations of four asteroid-crossing events in Transiting Exoplanet Survey Satellite light curves masquerading as self-lensing pulses from binary systems containing main-sequence stars and black hole or neutron-star companions. The observed changes in flux and the durations of the events appear to be consistent with self-lensing pulses provided that (a) the compact-object mass is greater than 2 solar masses, and (b) the transit is not a perfect alignment, i.e., the center of the lens is not passing directly in front of the center of the source. We examine the relationship between the physical characteristics of these asteroid crossings and the derived parameters of our self-lensing model fits to the data sets. As the search for new self-lensing systems continues, we caution observers about such false-positive signals imitating real self-lensing pulses