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A unique linkage of administrative and clinical registry databases to expand analytic possibilities in pediatric heart transplantation research.

Mon, 12/11/2017 - 11:05

A unique linkage of administrative and clinical registry databases to expand analytic possibilities in pediatric heart transplantation research.

Am Heart J. 2017 Dec;194:9-15

Authors: Godown J, Thurm C, Dodd DA, Soslow JH, Feingold B, Smith AH, Mettler BA, Thompson B, Hall M

Abstract
BACKGROUND: Large clinical, research, and administrative databases are increasingly utilized to facilitate pediatric heart transplant (HTx) research. Linking databases has proven to be a robust strategy across multiple disciplines to expand the possible analyses that can be performed while leveraging the strengths of each dataset. We describe a unique linkage of the Scientific Registry of Transplant Recipients (SRTR) database and the Pediatric Health Information System (PHIS) administrative database to provide a platform to assess resource utilization in pediatric HTx.
METHODS: All pediatric patients (1999-2016) who underwent HTx at a hospital enrolled in the PHIS database were identified. A linkage was performed between the SRTR and PHIS databases in a stepwise approach using indirect identifiers. To determine the feasibility of using these linked data to assess resource utilization, total and post-HTx hospital costs were assessed.
RESULTS: A total of 3188 unique transplants were identified as being present in both databases and amenable to linkage. Linkage of SRTR and PHIS data was successful in 3057 (95.9%) patients, of whom 2896 (90.8%) had complete cost data. Median total and post-HTx hospital costs were $518,906 (IQR $324,199-$889,738), and $334,490 (IQR $235,506-$498,803) respectively with significant differences based on patient demographics and clinical characteristics at HTx.
CONCLUSIONS: Linkage of the SRTR and PHIS databases is feasible and provides an invaluable tool to assess resource utilization. Our analysis provides contemporary cost data for pediatric HTx from the largest US sample reported to date. It also provides a platform for expanded analyses in the pediatric HTx population.

PMID: 29223439 [PubMed - in process]

A Prospective Multi-Institutional Cohort Study of Mediastinal Infections After Cardiac Operations.

Mon, 12/11/2017 - 11:05

A Prospective Multi-Institutional Cohort Study of Mediastinal Infections After Cardiac Operations.

Ann Thorac Surg. 2017 Dec 06;:

Authors: Perrault LP, Kirkwood KA, Chang HL, Mullen JC, Gulack BC, Argenziano M, Gelijns AC, Ghanta RK, Whitson BA, Williams DL, Sledz-Joyce NM, Lima B, Greco G, Fumakia N, Rose EA, Puskas JD, Blackstone EH, Weisel RD, Bowdish ME

Abstract
BACKGROUND: Mediastinal infections are a potentially devastating complication of cardiac operations. This study analyzed the frequency, risk factors, and perioperative outcomes of mediastinal infections after cardiac operations.
METHODS: In 2010, 5,158 patients enrolled in a prospective study evaluating infections after cardiac operations and their effect on readmissions and mortality for up to 65 days after the procedure. Clinical and demographic characteristics, operative variables, management practices, and outcomes were compared for patients with and without mediastinal infections, defined as deep sternal wound infection, myocarditis, pericarditis, or mediastinitis.
RESULTS: There were 43 mediastinal infections in 41 patients (cumulative incidence, 0.79%; 95% confidence interval [CI] 0.60% to 1.06%). Median time to infection was 20.0 days, with 65% of infections occurring after the index hospitalization discharge. Higher body mass index (hazard ratio [HR] 1.06; 95% CI, 1.01 to 1.10), higher creatinine (HR, 1.25; 95% CI, 1.13 to 1.38), peripheral vascular disease (HR, 2.47; 95% CI, 1.21 to 5.05), preoperative corticosteroid use (HR, 3.33; 95% CI, 1.27 to 8.76), and ventricular assist device or transplant surgery (HR, 5.81; 95% CI, 2.36 to 14.33) were associated with increased risk of mediastinal infection. Postoperative hyperglycemia (HR, 3.15; 95% CI, 1.32 to 7.51) was associated with increased risk of infection in nondiabetic patients. Additional length of stay attributable to mediastinal infection was 11.5 days (bootstrap 95% CI, 1.88 to 21.11). Readmission rates and mortality were five times higher in patients with mediastinal infection than in patients without mediastinal infection.
CONCLUSIONS: Mediastinal infection after a cardiac operation is associated with substantial increases in length of stay, readmissions, and death. Reducing these infections remains a high priority, and improving post-operative glycemic management may reduce their risk in patients without diabetes.

PMID: 29223421 [PubMed - as supplied by publisher]

Left-Ventricular Assist Device Impact on Aortic Valve Mechanics, Proteomics and Ultrastructure.

Mon, 12/11/2017 - 11:05

Left-Ventricular Assist Device Impact on Aortic Valve Mechanics, Proteomics and Ultrastructure.

Ann Thorac Surg. 2017 Dec 06;:

Authors: Stephens EH, Han J, Trawick EA, Di Martino ES, Akkiraju H, Brown LM, Connell JP, Grande-Allen KJ, Vunjak-Novakovic G, Takayama H

Abstract
BACKGROUND: Aortic regurgitation is a prevalent, detrimental complication of left ventricular assist devices (LVADs). The altered hemodynamics of LVADs results in aortic valves (AVs) having distinct mechanical stimulation. Our hypothesis was that the altered AV hemodynamics modulates the valve cells and matrix, resulting in changes in valvular mechanical properties that then can lead to regurgitation.
METHODS: AVs were collected from 16 LVAD and 6 non-LVAD patients at time of heart transplant. Standard demographic and preoperative data were collected and comparisons between the two groups were calculated using standard statistical methods. Samples were analyzed using biaxial mechanical tensile testing, mass spectrometry-based proteomics, and transmission electron microscopy to assess ultrastructure.
RESULTS: The maximum circumferential leaflet strain in LVAD patients was less than in non-LVAD patients (0.35 ± 0.10MPa versus 0.52 ± 0.18 MPa, p = 0.03) with a trend of reduced radial strain (p = 0.06) and a tendency for the radial strain to decrease with increasing LVAD duration (p = 0.063). Numerous proteins associated with actin and myosin, immune signaling and oxidative stress, and transforming growth factor β were increased in LVAD patients. Ultrastructural analysis showed a trend of increased fiber diameter in LVAD patients (46.2 ± 7.2 nm versus 45.1 ± 6.9 nm, p = 0.10), but no difference in fiber density.
CONCLUSIONS: AVs in LVAD patients showed decreased compliance and increased expression of numerous proteins related to valve activation and injury compared to non-LVAD patients. Further knowledge of AV changes leading to regurgitation in LVAD patients and the pathways by which they occur may provide an opportunity for interventions to prevent and/or reverse this detrimental complication.

PMID: 29223417 [PubMed - as supplied by publisher]

Cost Variation Across Centers for the Norwood Operation.

Mon, 12/11/2017 - 11:05

Cost Variation Across Centers for the Norwood Operation.

Ann Thorac Surg. 2017 Dec 06;:

Authors: McHugh KE, Pasquali SK, Hall MA, Scheurer MA

Abstract
BACKGROUND: The Norwood operation is associated with high health care utilization, and prior studies reported substantial variability in Norwood costs across centers. However, specific factors driving this cost variation are unclear. We assessed center variability in Norwood costs and underlying mechanisms in a multicenter cohort.
METHODS: Clinical data from the Pediatric Heart Network Single Ventricle Reconstruction trial were linked with cost data from the Children's Hospital Association Inpatient Essentials database. Center variation was assessed by modeling Norwood costs adjusted for baseline patient characteristics, and the relationship with complications, length of stay (LOS), and specific cost categories was examined. Patients undergoing transplantation or stage 2 palliation during the Norwood admission were excluded.
RESULTS: Nine centers (332 patients) were included. Adjusted mean cost/case varied 4.6-fold across centers (range: $50,559 to $230,851, p < 0.001). In addition, variation was found across centers in the adjusted mean number of complications/case (2.6-fold variation) and adjusted mean LOS/case (1.9-fold variation). Differences in complications explained 63% of the cost variation across centers. After accounting for complications, differences in LOS explained 66% of the remaining cost variation. Seven specific complications were found to occur more frequently at high-cost centers: pleural effusion, seizures, wound infection, thrombus, liver dysfunction, sepsis, necrotizing enterocolitis (all p < 0.001). With regard to types of cost, room and board/supplies and laboratory costs were the primary drivers of cost variation across centers.
CONCLUSIONS: This study identified several factors associated with center variation in Norwood costs, which may be targeted in subsequent initiatives aimed at both improving quality of care and reducing costs.

PMID: 29223416 [PubMed - as supplied by publisher]

Frequency and Consequences of Right-Sided Heart Failure After Continuous-Flow Left Ventricular Assist Device Implantation.

Mon, 12/11/2017 - 11:05

Frequency and Consequences of Right-Sided Heart Failure After Continuous-Flow Left Ventricular Assist Device Implantation.

Am J Cardiol. 2017 Oct 31;:

Authors: Kurihara C, Critsinelis AC, Kawabori M, Sugiura T, Loor G, Civitello AB, Morgan JA

Abstract
Postoperative right-sided heart failure (RHF) is a common complication after continuous-flow left ventricular assist device implantation. Studies have examined RHF in the perioperative period, but few have assessed late-onset RHF. We analyzed the incidence of early and late RHF in patients with HeartMate II and HeartWare left ventricular assist devices and associated morbidity, mortality, and independent predictors of RHF. We retrospectively analyzed records of 526 patients with chronic heart failure who underwent continuous-flow left ventricular assist device implantation; 147 (27.9%) developed RHF (early RHF, n = 87, 16.5%; late RHF, n = 74, 14.4%). We examined demographics, postoperative complications, and long-term survival rate. Patients with RHF or late RHF had higher mortality (p <0.001) than those without RHF. Patients with RHF had a higher incidence of acute kidney injury (20.4% vs 11.9%, p = 0.01). Device type did not affect the incidence of early, late, or overall RHF. Patients with severe RHF requiring right ventricular assist device support had a low success of bridge to transplantation (11.1% vs 33.3%, p = 0.02). In Cox regression models, RHF was an independent predictor of mortality (hazard ratio = 1.69, 95% confidence interval = 1.28 to 2.22, p <0.001), but no predictive variables of RHF were identified. RHF was significantly associated with increased mortality and a higher incidence of postoperative acute kidney injury. RHF decreased the success rate of bridging patients to transplantation when a right ventricular assist device was required.

PMID: 29223289 [PubMed - as supplied by publisher]

Outcome of antibody-mediated rejection compared to acute cellular rejection after pediatric heart transplantation.

Sun, 12/10/2017 - 13:45

Outcome of antibody-mediated rejection compared to acute cellular rejection after pediatric heart transplantation.

Pediatr Transplant. 2017 Dec 09;:

Authors: Vaughn GR, Jorgensen NW, Law YM, Albers EL, Hong BJ, Friedland-Little JM, Kemna MS

Abstract
Outcomes of ACR after pediatric HTx have been well described, but less has been reported on outcomes of AMR. We compared the clinical characteristics and cardiovascular outcomes (composite end-point of death, retransplantation, or allograft vasculopathy) of pediatric HTx recipients with AMR, ACR, and no rejection in a retrospective single-center study of 104 recipients. Twenty were treated for AMR; 15 were treated for ACR. Recipients with AMR had an increased frequency of congenital heart disease (90% vs ACR 67% vs no rejection 59%, P = .03), homograft (68% vs 7% vs 18%, P < .001), HLA sensitization (45% vs 13% vs 13%, P = .008), and positive cross-match (30% vs 7% vs 9%, P = .046). AMR caused hemodynamic compromise more often than ACR (39% vs 4%, P = .02). AMR recipients had worse cardiovascular outcome than recipients with ACR or no rejection (40% vs 20% vs 8.6%, P = .003). In bivariate Cox analysis, AMR (HR 4.1, CI 1.4-12.0, P = .009) and ischemic time (HR 1.6, CI 1.1-2.3, P = .02) were associated with worse cardiovascular outcome; ACR was not. In summary, pediatric HTx recipients who develop AMR have worse cardiovascular outcome than recipients who develop only ACR or experience no rejection at all.

PMID: 29222866 [PubMed - as supplied by publisher]

Obesity, lipid profiles and oxidative stress in children after liver transplantation.

Sun, 12/10/2017 - 13:45

Obesity, lipid profiles and oxidative stress in children after liver transplantation.

Acta Biochim Pol. 2017 Dec 10;:

Authors: Czubkowski P, Wierzbicka A, Pawłowska J, Jankowska I, Socha P

Abstract
PURPOSE: In adult liver transplant recipients, coronary artery disease and congestive heart failure are significant cause of morbidity and mortality. This may be attributed to the long-term immunosuppressive treatment, mostly with calcineurin inhibitors and steroids, which in long-term may be associated with hyperlipidemia, oxidative stress and cardiovascular complications. Since such data for children is sparse, the aim of this study was to assess the lipid and oxidative stress markers after pediatric liver transplantation (LTx).
METHOD: We performed prospective analysis of 74 children, at the median age of 7.9 (2.8-11.6) years, 3.2 (1.2-4.3) years after LTx. We assessed the BMI Z-scores, cholesterol fractions (LDLc, HDLc, VLDLc), triglicerides, apolipoproteins (ApoAI, ApoB, ApoE), LCAT, insulin resistance by HOMA-IR and markers of oxidative stress and atherosclerosis: glutathione (GSH), glutathione peroxidase (GPx), asymmetrical dimethyl arginine (ADMA) and oxidized low-density lipoprotein (oxyLDL). At baseline, the results were compared with a healthy age-and-sex matched control group. After 3.1±0.3 year follow-up we repeated all investigations and compared them with the baseline results.
RESULTS: At the baseline, we investigated 74 patients 3.2 (1.2-4.3) years after LTx, at the median age of 7.9 (2.8-11.6) years. The prevalence of overweight or obesity (BMI >85th percentile) was 23% and was more common in girls (24% vs 20%). Fourteen patients had TCH >200 mg%, 9 patients had LDLc >130 mg% and TG were at normal levels in all patients. Compared to the controls, there were no significant differences in lipid profiles but we found decreased GSH (p<0.001) and GPx (p<0.001) which play role as an antioxidant defense. OS markers were higher in the study group: ADMA (p<0.001), and oxyLDL (p<0.0001). Insulin resistance by HOMA-IR was increased in the study group (p=0.0002) but fasting glucose remained within normal ranges in all patients. After 3.1-year follow-up, the BMI >95th and >85Th percentile was present in 8% and 14% respectively. ADMA and oxyLDL decreased, whilst GSH and GPx increased when compared to the baseline. There was also significant decrease in apoB and Lp(a).
CONCLUSION: Children after LTx had normal lipid profiles when compared to controls, however there is a tendency for hypercholesterolemia and obesity, which may play a role in cardiovascular complications in the future. Some markers of oxidative stress were increased after LTx, however further investigations are required to establish its clinical significance.

PMID: 29222858 [PubMed - as supplied by publisher]

Indoxyl Sulfate Upregulates Liver P-Glycoprotein Expression and Activity through Aryl Hydrocarbon Receptor Signaling.

Sun, 12/10/2017 - 13:45
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Indoxyl Sulfate Upregulates Liver P-Glycoprotein Expression and Activity through Aryl Hydrocarbon Receptor Signaling.

J Am Soc Nephrol. 2017 Dec 08;:

Authors: Santana Machado T, Poitevin S, Paul P, McKay N, Jourde-Chiche N, Legris T, Mouly-Bandini A, Dignat-George F, Brunet P, Masereeuw R, Burtey S, Cerini C

Abstract
In patients with CKD, not only renal but also, nonrenal clearance of drugs is altered. Uremic toxins could modify the expression and/or activity of drug transporters in the liver. We tested whether the uremic toxin indoxyl sulfate (IS), an endogenous ligand of the transcription factor aryl hydrocarbon receptor, could change the expression of the following liver transporters involved in drug clearance: SLC10A1, SLC22A1, SLC22A7, SLC47A1, SLCO1B1, SLCO1B3, SLCO2B1, ABCB1, ABCB11, ABCC2, ABCC3, ABCC4, ABCC6, and ABCG2 We showed that IS increases the expression and activity of the efflux transporter P-glycoprotein (P-gp) encoded by ABCB1 in human hepatoma cells (HepG2) without modifying the expression of the other transporters. This effect depended on the aryl hydrocarbon receptor pathway. Presence of human albumin at physiologic concentration in the culture medium did not abolish the effect of IS. In two mouse models of CKD, the decline in renal function associated with the accumulation of IS in serum and the specific upregulation of Abcb1a in the liver. Additionally, among 109 heart or kidney transplant recipients with CKD, those with higher serum levels of IS needed higher doses of cyclosporin, a P-gp substrate, to obtain the cyclosporin target blood concentration. This need associated with serum levels of IS independent of renal function. These findings suggest that increased activity of P-gp could be responsible for increased hepatic cyclosporin clearance. Altogether, these results suggest that uremic toxins, such as IS, through effects on drug transporters, may modify the nonrenal clearance of drugs in patients with CKD.

PMID: 29222397 [PubMed - as supplied by publisher]

Invasive Assessment of the Coronary Microvasculature: The Index of Microcirculatory Resistance.

Sun, 12/10/2017 - 13:45
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Invasive Assessment of the Coronary Microvasculature: The Index of Microcirculatory Resistance.

Circ Cardiovasc Interv. 2017 Dec;10(12):

Authors: Fearon WF, Kobayashi Y

Abstract
Traditionally, invasive coronary physiological assessment has focused on the epicardial coronary artery. More recently, appreciation of the importance of the coronary microvasculature in determining patient outcomes has grown. Several invasive modalities for interrogating microvascular function have been proposed. Angiographic techniques have been limited by their qualitative and subjective nature. Doppler wire-derived coronary flow reserve has been applied in research studies, but its clinical role has been limited by its lack of reproducibility, its lack of a clear normal value, and the fact that it is not specific for the microvasculature but interrogates the entire coronary circulation. The index of microcirculatory resistance-a thermodilution-derived measure of the minimum achievable microvascular resistance-is relatively easy to measure, more reproducible, has a clearer normal value, and is independent of epicardial coronary artery stenosis. The index of microcirculatory resistance has been shown to have prognostic value in patients with ST-segment-elevation myocardial infarction and cardiac allograft vasculopathy after heart transplantation. Emerging data demonstrate its role in evaluating patients with chest pain and nonobstructive coronary artery disease. Increasingly, the index of microcirculatory resistance is used as a reference standard for invasively assessing the microvasculature in clinical trials.

PMID: 29222132 [PubMed - in process]

Re-examining Factors Associated With Mortality After Heart Transplantation: A Focus on Recipient Age and Relative Pulmonary Hypertension.

Sun, 12/10/2017 - 13:45
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Re-examining Factors Associated With Mortality After Heart Transplantation: A Focus on Recipient Age and Relative Pulmonary Hypertension.

J Cardiothorac Vasc Anesth. 2017 Nov 04;:

Authors: Bolliger D, Bouchez S, Mauermann E

PMID: 29221977 [PubMed - as supplied by publisher]

The distal airway microbiome after lung transplantation: A driver of immune regulation?

Sun, 12/10/2017 - 13:45
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The distal airway microbiome after lung transplantation: A driver of immune regulation?

J Heart Lung Transplant. 2017 Nov 22;:

Authors: Mitchell AB, Glanville AR

PMID: 29221917 [PubMed - as supplied by publisher]

Extracorporeal membrane oxygenation system as a bridge to reparative surgery in ventricular septal defect complicating acute inferoposterior myocardial infarction.

Sun, 12/10/2017 - 13:45
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Extracorporeal membrane oxygenation system as a bridge to reparative surgery in ventricular septal defect complicating acute inferoposterior myocardial infarction.

J Thorac Dis. 2017 Sep;9(9):E827-E830

Authors: Rozado J, Pascual I, Avanzas P, Hernandez-Vaquero D, Alvarez R, Díaz R, Díaz B, Martín M, Carro A, Muñiz G, Silva J, Moris C

Abstract
Post-infarction ventricular septal defect (VSD) is a rare but potentially lethal complication of acute myocardial infarction. Medical management is usually futile, so definitive surgery remains the treatment of choice but the risk surgery is very high and the optimal timing for surgery is still under debate. A 55-year-old man with no previous medical history attended the emergency-room for 12 h evolution of oppressive chest pain and strong anginal pain 7 days ago. On physical examination, blood pressure was 96/70 mmHg, pansystolic murmur over left sternal border without pulmonary crackles. An electrocardiogram revealed sinus rhythm 110 bpm, elevation ST and Q in inferior-posterior leads. Transthoracic echocardiogram showed inferoposterior akinesia, posterior-basal septal rupture (2 cm × 2 cm) with left-right shunt. Suspecting VSD in inferior-posterior acute myocardial infarction evolved, we performed emergency coronarography with 3-vessels disease and complete subacute occlusion of the mid segment of the right coronary artery. Left ventriculography demonstrated shunting of contrast from the left ventricule to the right ventricule. He was rejected for heart transplantation because of his age. Considering the high surgical risk to early surgery and his hemodynamic and clinical stability, delayed surgical treatment is decided, and 4 days after admission the patient suffered hemodynamic instability so venoarterial extracorporeal membrane oxygenation system (ECMO) is implanted as a bridge to reparative surgery. The 9th day after admission double bypass, interventricular defect repair with pericardial two-patch exclusion technique, and ECMO decannulation were performed. The patient's postoperative course was free of complications and was discharged 10 days post VSD repair surgery. Follow-up 3-month later revealed the patient to be in good functional status and good image outcome with intact interventricular septal patch without shunt. ECMO as a bridge to reparative surgery in postinfarction VSD is an adequate option to stabilize patients until surgery.

PMID: 29221351 [PubMed]

Bridging to lung transplantation with extracorporeal circulatory support: when or when not?

Sun, 12/10/2017 - 13:45
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Bridging to lung transplantation with extracorporeal circulatory support: when or when not?

J Thorac Dis. 2017 Sep;9(9):3352-3361

Authors: Loor G, Simpson L, Parulekar A

Abstract
Patients with end-stage lung disease who are candidates for lung transplantation may acutely decompensate before a donor organ becomes available. In this scenario, extracorporeal life support (ECLS) may be considered as a bridge to transplant or as a bridge to decision. In the current chapter, we review the indications, techniques, and outcomes for bridging to lung transplantation with ECLS.

PMID: 29221320 [PubMed]

Bioengineered Cardiac Tissue Based on Human Stem Cells for Clinical Application.

Sat, 12/09/2017 - 13:45
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Bioengineered Cardiac Tissue Based on Human Stem Cells for Clinical Application.

Adv Biochem Eng Biotechnol. 2017 Dec 08;:

Authors: Jara Avaca M, Gruh I

Abstract
Engineered cardiac tissue might enable novel therapeutic strategies for the human heart in a number of acquired and congenital diseases. With recent advances in stem cell technologies, namely the availability of pluripotent stem cells, the generation of potentially autologous tissue grafts has become a realistic option. Nevertheless, a number of limitations still have to be addressed before clinical application of engineered cardiac tissue based on human stem cells can be realized. We summarize current progress and pending challenges regarding the optimal cell source, cardiomyogenic lineage specification, purification, safety of genetic cell engineering, and genomic stability. Cardiac cells should be combined with clinical grade scaffold materials for generation of functional myocardial tissue in vitro. Scale-up to clinically relevant dimensions is mandatory, and tissue vascularization is most probably required both for preclinical in vivo testing in suitable large animal models and for clinical application.

PMID: 29218360 [PubMed - as supplied by publisher]

Endolymphatic Balloon-Occluded Retrograde Abdominal Lymphangiography (BORAL) and Embolization (BORALE) For the Diagnosis and Treatment of Chylous Ascites: Technique and Experience in Three Patients.

Sat, 12/09/2017 - 13:45
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Endolymphatic Balloon-Occluded Retrograde Abdominal Lymphangiography (BORAL) and Embolization (BORALE) For the Diagnosis and Treatment of Chylous Ascites: Technique and Experience in Three Patients.

Ann Vasc Surg. 2017 Dec 04;:

Authors: Srinivasa RN, Gemmete JJ, Osher ML, Beecham Chick JF

Abstract
PURPOSE: To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization.
MATERIALS AND METHODS: Two (66%) men and one (33%) woman with mean age of 52 years (range: range: 14-79 years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017. Patients presented with renal cell carcinoma status post left nephrectomy and lymph node dissection (n=1), metastatic Merkel cell carcinoma status post left nephrectomy and adrenalectomy (n=1), and heart transplantation after failed Fontan procedure (n=1). Pelvic lymphangiography technical success, BORAL and BORALE technical successes, complications, clinical response, and follow-up were recorded.
RESULTS: Pelvic lymphangiography and BORAL was technically successful in 3 (100%) patients. BORALE was attempted in 2 (65%) patients and was technically successful in both patients (100%). No minor or major complications occurred. Mean radiation dose was 1,037 mGy (range: 391-2,264 mGy). Mean contrast was 83 mL (range: 25-150 mL). Mean blood loss was 15 mL (range: 5-30 mL). Chylous ascites resolved in all 3 (100%) patients.
CONCLUSION: BORAL and BORALE provide a rational and effective approach for the diagnosis and treatment of patients with chylous ascites and previously unidentifiable leakage site or failed lymphatic embolization.

PMID: 29217440 [PubMed - as supplied by publisher]

Endolymphatic Thoracic Duct Stent-Graft Reconstruction for Chylothorax:Approach, Technical Success, Safety, and Short-Term Outcomes.

Sat, 12/09/2017 - 13:45
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Endolymphatic Thoracic Duct Stent-Graft Reconstruction for Chylothorax:Approach, Technical Success, Safety, and Short-Term Outcomes.

Ann Vasc Surg. 2017 Dec 04;:

Authors: Srinivasa R, Chick JFB, Hage A, Gemmete JJ, Murrey DC, Srinivasa RN

Abstract
PURPOSE: To report approach, technical success, safety, and short-term outcomes of thoracic duct stent-graft reconstruction for the treatment of chylothorax.
MATERIALS AND METHODS: Two patients, one (50%) male and one (50%) female, with mean age of 38 years (range: 16-59 years) underwent endolymphatic thoracic duct stent-grafting between September 2016 and July 2017. Patients had radiographic left-sided chylothoraces (n=2) from idiopathic causes (n=1) and heart transplantation (n=1). In both (100%) patients, anterograde lymphatic access was used to opacify the thoracic duct after which retrograde access was used for thoracic duct stent-graft placement. Pelvic lymphangiography technical success, anterograde cisterna chyli cannulation technical success, thoracic duct opacification technical success, retrograde thoracic duct access technical success, thoracic duct stent-graft reconstruction technical success, ethiodized oil volume, contrast volume, estimated blood loss, procedure time, fluoroscopy time, radiation dose, clinical success, complications, deaths, and follow-up were recorded.
RESULTS: Pelvic lymphangiography, anterograde cisterna chyli cannulation, thoracic duct opacification, retrograde thoracic duct access, and thoracic duct stent-graft reconstruction were technically successful in both (100%) patients. Mean ethiodized oil volume was 8 mL (range: 5-10 mL). Mean contrast volume was 13 mL (range: 5-20 mL). Mean estimated blood loss was 13 mL (range: 10-15 mL). Mean fluoroscopy time was 50.4 minutes (range: 31.2-69.7 minutes). Mean dose area product and reference air kerma were 954.4 uGmy2 (range: 701-1208 uGmy2) and 83.5 mGy (range: 59-108 mGy), respectively. Chylothorax resolved in both (100%) patients. There were no minor or major complications directly related to the procedure.
CONCLUSION: Thoracic duct stent-graft reconstruction may be a technically successful and safe alternative to thoracic duct embolization, disruption, and surgical ligation for the treatment of chylothorax. Additional studies are warranted.

PMID: 29217436 [PubMed - as supplied by publisher]

Transaxillary Implantation of the Impella CP Mechanical Circulatory Support Device as a Bridge to Heart Transplant. First Experience in Spain.

Sat, 12/09/2017 - 13:45
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Transaxillary Implantation of the Impella CP Mechanical Circulatory Support Device as a Bridge to Heart Transplant. First Experience in Spain.

Rev Esp Cardiol (Engl Ed). 2017 Dec 04;:

Authors: Couto-Mallón D, Estévez-Cid F, Solla-Buceta M, García-Velasco C, Crespo-Leiro MG, Cuenca-Castillo JJ

PMID: 29217220 [PubMed - as supplied by publisher]

End-stage renal disease after pediatric heart transplantation: A 25-year national cohort study.

Sat, 12/09/2017 - 13:45
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End-stage renal disease after pediatric heart transplantation: A 25-year national cohort study.

J Heart Lung Transplant. 2017 Nov 15;:

Authors: Azeka E

PMID: 29217110 [PubMed - as supplied by publisher]

High prevalence of skin cancers and actinic keratoses in lung transplant recipients.

Sat, 12/09/2017 - 13:45
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High prevalence of skin cancers and actinic keratoses in lung transplant recipients.

J Heart Lung Transplant. 2017 Nov 15;:

Authors: Sahebian A, Pandeya N, Chambers DC, Soyer HP, Green AC

PMID: 29217109 [PubMed - as supplied by publisher]

Improved outcomes after heart transplantation for cardiac amyloidosis in the modern era.

Sat, 12/09/2017 - 13:45
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Improved outcomes after heart transplantation for cardiac amyloidosis in the modern era.

J Heart Lung Transplant. 2017 Nov 15;:

Authors: Kristen AV, Kreusser MM, Blum P, Schönland SO, Frankenstein L, Dösch AO, Knop B, Helmschrott M, Schmack B, Ruhparwar A, Hegenbart U, Katus HA, Raake PWJ

Abstract
BACKGROUND: Cardiac amyloidosis, caused most commonly by deposition of light chain (AL) or transthyretin (ATTR) type fibrils, has an extremely poor prognosis. In this retrospective single-center study, we evaluated temporal trends in survival after heart transplantation for cardiac amyloidosis.
METHODS: We analyzed 48 patients with cardiac amyloidosis (AL, n = 32; familial ATTR, n = 16) who underwent heart transplantation from May 2002 to March 2017. Patients were analysed in 2 periods, Era 1 (2002- 2007) and Era 2 (2008- 2017), separated by altered patient selection in both, AL and ATTR amyloidosis, and changed chemotherapy regimens for AL amyloidosis.
RESULTS: The modern era was characterized by a lower number of extracardiac organ involvement for AL (94% isolated cardiac amyloidosis in Era 2 vs 56% in Era 1; p = 0.0221), and more frequent treatment for AL with the proteasome inhibitor bortezomib (94% in Era 2 vs 6% in Era 1; p < 0.0001). AL patients had significantly lower survival than patients with non-amyloid cardiomyopathy after heart transplantation in Era 1, and ATTR patients had numerically lower survival. However, survival in the modern era was comparable to non-amyloid transplants in both cohorts, possibly reflecting a shift in chemotherapy strategies and patient selection, respectively.
CONCLUSIONS: In the current era, use of enhanced chemotherapy regimens for isolated advanced AL cardiac amyloidosis was associated with outcomes comparable to non-amyloid cardiomyopathy. We conclude that heart transplantation in highly selected patients with isolated non-systemic advanced cardiac amyloidosis may be a feasible approach.

PMID: 29217108 [PubMed - as supplied by publisher]

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