Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032909.33237.F8
H. Hausmann, E. Potapov, A. Koster, T. Krabatsch, J. Stein, R. Yeter, M. Kukucka, R. Sodian, H. Kuppe, R. Hetzer
BackgroundOver the past decade, the use of a ventricular-assist device (VAD) in patients with postcardiotomy cardiogenic shock has resulted in hospital discharge rates of 25% to 40% and is improving. Nevertheless, indications for and timing of the implantation of a VAD in patients who have received an intra-aortic balloon pump (IABP) remain unclear. Methods and ResultsFrom July 1996 to March 2000, 391 patients with cardiac low-output syndrome who underwent open-heart surgery and had an IABP implanted were analyzed in a retrospective pilot study. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 &mgr;g · kg−1 · min−1, a left atrial pressure >15 mm Hg, urine output <100 mL/h, and mixed venous saturation (SvO2) <60% had poor outcomes. Using this data, we developed an IABP score (0 to 5 points) to predict survival early after IABP implantation in cardiac surgery. We evaluated our score by monitoring another 101 patients as a control group prospectively. Additionally, 210 patients who received coronary artery bypass grafting (CABG) exclusively were analyzed. All investigations confirmed the validity of the score. ConclusionsThe IABP score can predict survival early after IABP implantation. In patients with a high IABP score, implantation of a VAD should be considered.
{"title":"Prognosis After the Implantation of an Intra-Aortic Balloon Pump in Cardiac Surgery Calculated With a New Score","authors":"H. Hausmann, E. Potapov, A. Koster, T. Krabatsch, J. Stein, R. Yeter, M. Kukucka, R. Sodian, H. Kuppe, R. Hetzer","doi":"10.1161/01.CIR.0000032909.33237.F8","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032909.33237.F8","url":null,"abstract":"BackgroundOver the past decade, the use of a ventricular-assist device (VAD) in patients with postcardiotomy cardiogenic shock has resulted in hospital discharge rates of 25% to 40% and is improving. Nevertheless, indications for and timing of the implantation of a VAD in patients who have received an intra-aortic balloon pump (IABP) remain unclear. Methods and ResultsFrom July 1996 to March 2000, 391 patients with cardiac low-output syndrome who underwent open-heart surgery and had an IABP implanted were analyzed in a retrospective pilot study. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 &mgr;g · kg−1 · min−1, a left atrial pressure >15 mm Hg, urine output <100 mL/h, and mixed venous saturation (SvO2) <60% had poor outcomes. Using this data, we developed an IABP score (0 to 5 points) to predict survival early after IABP implantation in cardiac surgery. We evaluated our score by monitoring another 101 patients as a control group prospectively. Additionally, 210 patients who received coronary artery bypass grafting (CABG) exclusively were analyzed. All investigations confirmed the validity of the score. ConclusionsThe IABP score can predict survival early after IABP implantation. In patients with a high IABP score, implantation of a VAD should be considered.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"19 1","pages":"I-203-I-206"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74527091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032893.55215.FC
P. Akhyari, P. Fedak, R. Weisel, T. J. Lee, S. Verma, Donald A. G. Mickle, Ren-Ke Li
BackgroundSurgical repair of congenital and acquired cardiac defects may be enhanced by the use of autologous bioengineered muscle grafts. These tissue-engineered constructs are not optimal in their formation and function. We hypothesized that a mechanical stretch regimen applied to human heart cells that were seeded on a three-dimensional gelatin scaffold (Gelfoam) would improve tissue formation and enhance graft strength. Methods and ResultsHeart cells from children undergoing repair of Tetralogy of Fallot were isolated and cultured. Heart cells were seeded on gelatin-matrix scaffolds (Gelfoam) and subjected to cyclical mechanical stress (n=7) using the Bio-Stretch Apparatus (80 cycles/minute for 14 days). Control scaffolds (n=7) were maintained under identical conditions but without cyclical stretch. Cell counting, histology, and computerized image analysis determined cell proliferation and their spatial distribution within the tissue-engineered grafts. Collagen matrix formation and organization was determined with polarized light and laser confocal microscopy. Uniaxial tensile testing assessed tissue-engineered graft function. Human heart cells proliferated within the gelatin scaffold. Remarkably, grafts that were subjected to cyclical stretch demonstrated increased cell proliferation and a marked improvement of cell distribution. Collagen matrix formation and organization was enhanced by mechanical stretch. Both maximal tensile strength and resistance to stretch were improved by cyclical mechanical stretch. ConclusionThe cyclical mechanical stretch regimen enhanced the formation of a three-dimensional tissue-engineered cardiac graft by improving the proliferation and distribution of seeded human heart cells and by stimulating organized matrix formation resulting in an order of magnitude increase in the mechanical strength of the graft.
{"title":"Mechanical Stretch Regimen Enhances the Formation of Bioengineered Autologous Cardiac Muscle Grafts","authors":"P. Akhyari, P. Fedak, R. Weisel, T. J. Lee, S. Verma, Donald A. G. Mickle, Ren-Ke Li","doi":"10.1161/01.CIR.0000032893.55215.FC","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032893.55215.FC","url":null,"abstract":"BackgroundSurgical repair of congenital and acquired cardiac defects may be enhanced by the use of autologous bioengineered muscle grafts. These tissue-engineered constructs are not optimal in their formation and function. We hypothesized that a mechanical stretch regimen applied to human heart cells that were seeded on a three-dimensional gelatin scaffold (Gelfoam) would improve tissue formation and enhance graft strength. Methods and ResultsHeart cells from children undergoing repair of Tetralogy of Fallot were isolated and cultured. Heart cells were seeded on gelatin-matrix scaffolds (Gelfoam) and subjected to cyclical mechanical stress (n=7) using the Bio-Stretch Apparatus (80 cycles/minute for 14 days). Control scaffolds (n=7) were maintained under identical conditions but without cyclical stretch. Cell counting, histology, and computerized image analysis determined cell proliferation and their spatial distribution within the tissue-engineered grafts. Collagen matrix formation and organization was determined with polarized light and laser confocal microscopy. Uniaxial tensile testing assessed tissue-engineered graft function. Human heart cells proliferated within the gelatin scaffold. Remarkably, grafts that were subjected to cyclical stretch demonstrated increased cell proliferation and a marked improvement of cell distribution. Collagen matrix formation and organization was enhanced by mechanical stretch. Both maximal tensile strength and resistance to stretch were improved by cyclical mechanical stretch. ConclusionThe cyclical mechanical stretch regimen enhanced the formation of a three-dimensional tissue-engineered cardiac graft by improving the proliferation and distribution of seeded human heart cells and by stimulating organized matrix formation resulting in an order of magnitude increase in the mechanical strength of the graft.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"17 1","pages":"I-137-I-142"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78945660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032917.33237.E0
Heath U. Jones, J. Muhlestein, Kent W. Jones, T. Bair, F. Lavasani, Mahtab Sohrevardi, B. Horne, D. Doty, D. Lappé
BackgroundEnoxaparin has become an attractive therapy for use during acute coronary syndrome (ACS) because of its potential superior efficacy over unfractionated heparin (UFH), its longer activity, and its subcutaneous route of administration. However, because a significant number of patients presenting with ACS may be sent directly to open heart surgery while still on anticoagulation, it is important to understand any potential bleeding risks that may be associated with the use of enoxaparin under these circumstances. MethodsFrom 1998 to 2001, 1159 consecutive patients presenting with an acute coronary syndrome who received either UFH (n=1008) or enoxaparin (n=151) before proceeding to open heart surgery for urgent therapy during the same hospitalization were included in this study. Incidence of perioperative bleeding as evidenced by the units of blood products (packed red blood cells or platelets) transfused or the need for surgical re-exploration for postoperative bleeding was recorded. ResultsAverage age was 65±11 and 67±11 years for patients receiving UFH and enoxaparin, respectively (P= 0.005). Seventy-five percent of those receiving UFH and 64% of those receiving enoxaparin (P <0.005) were males. After discharge, the incidence of rehospitalization for hemorrhage requiring return to surgery for re-exploration was 7.9% in the enoxaparin group and 3.7% in the UFH group (adjusted hazard ratio=2.6, P =0.03). The use of blood products did not differ between groups (UFH=2.7±6.5 U and enoxaparin=2.3±4.5 U;P =NS). ConclusionThe preoperative use of enoxaparin compared with UFH in patients presenting with an ACS who undergo open-heart surgery during the same hospitalization is associated with a significantly increased incidence of re-exploration for postoperative bleeding. Further study is needed to understand the mechanism of this phenomenon and to develop appropriate guidelines to address this potentially important issue.
{"title":"Preoperative Use of Enoxaparin Compared With Unfractionated Heparin Increases the Incidence of Re-Exploration for Postoperative Bleeding After Open-Heart Surgery in Patients Who Present With an Acute Coronary Syndrome: Clinical Investigation and Reports","authors":"Heath U. Jones, J. Muhlestein, Kent W. Jones, T. Bair, F. Lavasani, Mahtab Sohrevardi, B. Horne, D. Doty, D. Lappé","doi":"10.1161/01.CIR.0000032917.33237.E0","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032917.33237.E0","url":null,"abstract":"BackgroundEnoxaparin has become an attractive therapy for use during acute coronary syndrome (ACS) because of its potential superior efficacy over unfractionated heparin (UFH), its longer activity, and its subcutaneous route of administration. However, because a significant number of patients presenting with ACS may be sent directly to open heart surgery while still on anticoagulation, it is important to understand any potential bleeding risks that may be associated with the use of enoxaparin under these circumstances. MethodsFrom 1998 to 2001, 1159 consecutive patients presenting with an acute coronary syndrome who received either UFH (n=1008) or enoxaparin (n=151) before proceeding to open heart surgery for urgent therapy during the same hospitalization were included in this study. Incidence of perioperative bleeding as evidenced by the units of blood products (packed red blood cells or platelets) transfused or the need for surgical re-exploration for postoperative bleeding was recorded. ResultsAverage age was 65±11 and 67±11 years for patients receiving UFH and enoxaparin, respectively (P= 0.005). Seventy-five percent of those receiving UFH and 64% of those receiving enoxaparin (P <0.005) were males. After discharge, the incidence of rehospitalization for hemorrhage requiring return to surgery for re-exploration was 7.9% in the enoxaparin group and 3.7% in the UFH group (adjusted hazard ratio=2.6, P =0.03). The use of blood products did not differ between groups (UFH=2.7±6.5 U and enoxaparin=2.3±4.5 U;P =NS). ConclusionThe preoperative use of enoxaparin compared with UFH in patients presenting with an ACS who undergo open-heart surgery during the same hospitalization is associated with a significantly increased incidence of re-exploration for postoperative bleeding. Further study is needed to understand the mechanism of this phenomenon and to develop appropriate guidelines to address this potentially important issue.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"86 1","pages":"I-19-I-22"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73194167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000039154.47029.A4
A. Bortone, S. Schena, Donato D Agostino, G. Dialetto, V. Paradiso, G. Mannatrizio, T. Fiore, M. Cotrufo, Luigi de Luca, T. Schinosa
BackgroundStent grafting has been reported as a viable therapeutic option for the delayed treatment of traumatic rupture of the aortic isthmus as well as reconstruction of thoracic aortic dissections. We tested the hypothesis of whether immediate endovascular management offers clinical and pathological advantages over a delayed approach in patients with post-traumatic aortic pseudoaneurysms (PAPs) and Stanford type-B dissections (TBDs). MethodsThirty-one consecutive patients who were admitted with diagnosis of either PAP (n=10; 33.4±8.7 years) or TBD (n=21; 58.2±8.4 years) were respectively divided into 2 groups according to the timing of diagnosis and endovascular treatment after the traumatic or pathologic event: immediate ([lteq]2 weeks; PAP=6 and TBD=7) and delayed (>2 weeks; PAP=4 and TBD=14). Excluder®-Gore (11 in PAP and 8 in TBD) and Talent™-Medtronic (1 in PAP and 7 in TBD) endovascular stent grafts were deployed. Follow-up was performed at 3 months, 6 months, and 1 year and based on laboratory tests; chest angio-computed tomography scans of chest, abdomen, and pelvis; and transesophageal echocardiography. ResultsThe endovascular procedure proved uneventful in all PAP patients who underwent either immediate or delayed treatment. In 1 PAP patient with delayed treatment, surgical removal of the pseudoaneurysm was still necessary because of further compression of the airway stem. All immediately treated TBD patients were also successful. However, in 8 of 13 TBD patients with delayed treatment (61.5%), a stent graft deployment was not possible because of complicated progression of the false lumen and multiple intimal entry tears: 1 patient benefited by fenestrations of the false lumen and 7 patients underwent medical therapy. One patient (8.3%) died because of retrograde dissection involving the aortic arch. All patients treated with endovascular stent grafts were discharged within 5 days. ConclusionsAn immediate endovascular management of PAP and TBD patients offers important advantages such as avoidance of high-risk surgical procedures and postoperative complications with short hospital stay. Moreover, it has been observed that an immediate endovascular treatment allows a safe management of all patients with complete healing of the aortic wall and regression of the pseudoaneurysm in the PAP group and thrombosis of the false lumen in TBD patients.
{"title":"Immediate Versus Delayed Endovascular Treatment of Post-Traumatic Aortic Pseudoaneurysms and Type B Dissections: Retrospective Analysis and Premises to the Upcoming European Trial","authors":"A. Bortone, S. Schena, Donato D Agostino, G. Dialetto, V. Paradiso, G. Mannatrizio, T. Fiore, M. Cotrufo, Luigi de Luca, T. Schinosa","doi":"10.1161/01.CIR.0000039154.47029.A4","DOIUrl":"https://doi.org/10.1161/01.CIR.0000039154.47029.A4","url":null,"abstract":"BackgroundStent grafting has been reported as a viable therapeutic option for the delayed treatment of traumatic rupture of the aortic isthmus as well as reconstruction of thoracic aortic dissections. We tested the hypothesis of whether immediate endovascular management offers clinical and pathological advantages over a delayed approach in patients with post-traumatic aortic pseudoaneurysms (PAPs) and Stanford type-B dissections (TBDs). MethodsThirty-one consecutive patients who were admitted with diagnosis of either PAP (n=10; 33.4±8.7 years) or TBD (n=21; 58.2±8.4 years) were respectively divided into 2 groups according to the timing of diagnosis and endovascular treatment after the traumatic or pathologic event: immediate ([lteq]2 weeks; PAP=6 and TBD=7) and delayed (>2 weeks; PAP=4 and TBD=14). Excluder®-Gore (11 in PAP and 8 in TBD) and Talent™-Medtronic (1 in PAP and 7 in TBD) endovascular stent grafts were deployed. Follow-up was performed at 3 months, 6 months, and 1 year and based on laboratory tests; chest angio-computed tomography scans of chest, abdomen, and pelvis; and transesophageal echocardiography. ResultsThe endovascular procedure proved uneventful in all PAP patients who underwent either immediate or delayed treatment. In 1 PAP patient with delayed treatment, surgical removal of the pseudoaneurysm was still necessary because of further compression of the airway stem. All immediately treated TBD patients were also successful. However, in 8 of 13 TBD patients with delayed treatment (61.5%), a stent graft deployment was not possible because of complicated progression of the false lumen and multiple intimal entry tears: 1 patient benefited by fenestrations of the false lumen and 7 patients underwent medical therapy. One patient (8.3%) died because of retrograde dissection involving the aortic arch. All patients treated with endovascular stent grafts were discharged within 5 days. ConclusionsAn immediate endovascular management of PAP and TBD patients offers important advantages such as avoidance of high-risk surgical procedures and postoperative complications with short hospital stay. Moreover, it has been observed that an immediate endovascular treatment allows a safe management of all patients with complete healing of the aortic wall and regression of the pseudoaneurysm in the PAP group and thrombosis of the false lumen in TBD patients.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"89 1","pages":"I-234-I-240"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75194695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032876.55215.10
W. Zimmermann, M. Didié, G. Wasmeier, U. Nixdorff, A. Hess, Ivan Melnychenko, Oliver Boy, W. Neuhuber, M. Weyand, T. Eschenhagen
BackgroundCell grafting has emerged as a novel approach to treat heart diseases refractory to conventional therapy. We hypothesize that survival and functional and electrical integration of grafts may be improved by engineering cardiac tissue constructs in vitro before grafting. Methods and ResultsEngineered heart tissue (EHT) was reconstituted by mixing cardiac myocytes from neonatal Fischer 344 rats with liquid collagen type I, matrigel, and serum-containing culture medium. EHTs were designed in circular shape (inner/outer diameter: 8/10 mm; thickness: 1 mm) to fit around the circumference of hearts from syngenic rats. After 12 days in culture and before implantation on uninjured hearts, contractile function of EHT was measured under isometric conditions. Baseline twitch tension amounted to 0.34±0.03 mN (n=33) and was stimulated by Ca2+ and isoprenaline to 200±12 and 185±10% of baseline values, respectively. Despite utilization of a syngenic model immunosuppression (mg/kg BW: azathioprine 2, cyclosporine A 5, methylprednisolone 2) was necessary for EHT survival in vivo. Echocardiography conducted 7, 14, and 28 days after implantation demonstrated no change in left ventricular function compared with pre-OP values (n=9). Fourteen days after implantation, EHTs were heavily vascularized and retained a well organized heart muscle structure as indicated by immunolabeling of actinin, connexin 43, and cadherins. Ultrastructural analysis demonstrated that implanted EHTs surpassed the degree of differentiation reached before implantation. Contractile function of EHT grafts was preserved in vivo. ConclusionsEHTs can be employed for tissue grafting approaches and might serve as graft material to repair diseased myocardium.
{"title":"Cardiac Grafting of Engineered Heart Tissue in Syngenic Rats","authors":"W. Zimmermann, M. Didié, G. Wasmeier, U. Nixdorff, A. Hess, Ivan Melnychenko, Oliver Boy, W. Neuhuber, M. Weyand, T. Eschenhagen","doi":"10.1161/01.CIR.0000032876.55215.10","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032876.55215.10","url":null,"abstract":"BackgroundCell grafting has emerged as a novel approach to treat heart diseases refractory to conventional therapy. We hypothesize that survival and functional and electrical integration of grafts may be improved by engineering cardiac tissue constructs in vitro before grafting. Methods and ResultsEngineered heart tissue (EHT) was reconstituted by mixing cardiac myocytes from neonatal Fischer 344 rats with liquid collagen type I, matrigel, and serum-containing culture medium. EHTs were designed in circular shape (inner/outer diameter: 8/10 mm; thickness: 1 mm) to fit around the circumference of hearts from syngenic rats. After 12 days in culture and before implantation on uninjured hearts, contractile function of EHT was measured under isometric conditions. Baseline twitch tension amounted to 0.34±0.03 mN (n=33) and was stimulated by Ca2+ and isoprenaline to 200±12 and 185±10% of baseline values, respectively. Despite utilization of a syngenic model immunosuppression (mg/kg BW: azathioprine 2, cyclosporine A 5, methylprednisolone 2) was necessary for EHT survival in vivo. Echocardiography conducted 7, 14, and 28 days after implantation demonstrated no change in left ventricular function compared with pre-OP values (n=9). Fourteen days after implantation, EHTs were heavily vascularized and retained a well organized heart muscle structure as indicated by immunolabeling of actinin, connexin 43, and cadherins. Ultrastructural analysis demonstrated that implanted EHTs surpassed the degree of differentiation reached before implantation. Contractile function of EHT grafts was preserved in vivo. ConclusionsEHTs can be employed for tissue grafting approaches and might serve as graft material to repair diseased myocardium.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"71 1","pages":"I-151-I-157"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80007529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032871.55215.DE
J. Pilla, A. S. Blom, D. Brockman, F. Bowen, Q. Yuan, J. Giammarco, V. Ferrari, J. Gorman, R. Gorman, M. Acker
BackgroundLeft ventricular remodeling secondary to acute myocardial infarction (AMI) is characterized by ventricular dilatation and regional akinesis. In this study, we investigated the effect of passive constraint on akinetic area development. Methods and ResultsThe effect of passive constraint on akinetic area was investigated in 10 sheep using tissue-tagging magnetic resonance imaging (MRI). A baseline MRI study was followed by the creation of an anterior infarct. After 1 week, the animals received a second MRI study. A cardiac support device (CSD) was then placed over the epicardium in 5 sheep whereas the remaining animals served as controls. A terminal study was performed at the 2-month postinfarct in both groups. The akinetic area at 1-week postinfarct was similar in both groups. At the terminal time-point, the akinetic area in the control group was similar to the 1-week time-point whereas in the CSD group, the area of akinesis decreased (P= 0.001). A comparison of the 2 groups at the terminal time-point demonstrates a significantly diminished area of akinesis in the CSD group (P= 0.004). The relative area of akinesis followed a similar pattern. End-systolic and end-diastolic wall thickness was significantly greater in the CSD group at terminal (P= 0.001). In addition, the minimum wall thickness was greater in the CSD group compared with the controls (P= 0.04). ConclusionsPassive constraint reduced akinetic area development secondary to AMI. The attenuation of regional wall stress may prevent the incorporation of the border zone into the infarct, decreasing infarct size and providing a promising new therapy for patients after an AMI.
{"title":"Ventricular Constraint Using the Acorn Cardiac Support Device Reduces Myocardial Akinetic Area in an Ovine Model of Acute Infarction","authors":"J. Pilla, A. S. Blom, D. Brockman, F. Bowen, Q. Yuan, J. Giammarco, V. Ferrari, J. Gorman, R. Gorman, M. Acker","doi":"10.1161/01.CIR.0000032871.55215.DE","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032871.55215.DE","url":null,"abstract":"BackgroundLeft ventricular remodeling secondary to acute myocardial infarction (AMI) is characterized by ventricular dilatation and regional akinesis. In this study, we investigated the effect of passive constraint on akinetic area development. Methods and ResultsThe effect of passive constraint on akinetic area was investigated in 10 sheep using tissue-tagging magnetic resonance imaging (MRI). A baseline MRI study was followed by the creation of an anterior infarct. After 1 week, the animals received a second MRI study. A cardiac support device (CSD) was then placed over the epicardium in 5 sheep whereas the remaining animals served as controls. A terminal study was performed at the 2-month postinfarct in both groups. The akinetic area at 1-week postinfarct was similar in both groups. At the terminal time-point, the akinetic area in the control group was similar to the 1-week time-point whereas in the CSD group, the area of akinesis decreased (P= 0.001). A comparison of the 2 groups at the terminal time-point demonstrates a significantly diminished area of akinesis in the CSD group (P= 0.004). The relative area of akinesis followed a similar pattern. End-systolic and end-diastolic wall thickness was significantly greater in the CSD group at terminal (P= 0.001). In addition, the minimum wall thickness was greater in the CSD group compared with the controls (P= 0.04). ConclusionsPassive constraint reduced akinetic area development secondary to AMI. The attenuation of regional wall stress may prevent the incorporation of the border zone into the infarct, decreasing infarct size and providing a promising new therapy for patients after an AMI.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"14 1","pages":"I-207-I-211"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91023054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032920.33237.C0
T. Timek, D. Lai, F. Tibayan, D. Liang, Filiberto Rodríguez, G. Daughters, P. Dagum, N. Ingels, Craig D. Miller
BackgroundIschemic mitral regurgitation (IMR) has been attributed to annular dilatation, papillary muscle (PM) displacement (“apical leaflet tenting”), or both. We compared the efficacy of reducing annular or subvalvular dimensions to gain more mechanistic insight into acute IMR. MethodsEight adult sheep underwent implantation of radiopaque markers on the LV, mitral annulus (MA), each leaflet edge, and each PM tip. Trans-annular septal-lateral (SL) and inter-PM tip sutures were placed and externalized. Biplane videofluoroscopy and transesophageal echocardiography were performed before and continuously during LCx occlusion-induced IMR with SL annular (SLAC) or inter-PM (PAPS) suture tightening (4 to 5 mm of cinching for 5 seconds during ischemia). MA SL dimension, inter-papillary distance (APM-PPM), and the distances between the anterior (APM) and posterior (PPM) PM tips and the mid-septal annulus (“saddle horn”) were calculated from 3-D marker coordinates at end-systole. ResultsSLAC reduced IMR (grade=2.1±0.6 versus 0.7±0.5, P.001), SL annular diameter (4.9±2.5 mm smaller versus pre-cinching;P.001), and PM-“saddle horn” distances (0.9±0.7 and 1.0±0.8 mm reduction for APM and PPM, respectively;P.005). PAPS reduced APM-PPM distance (3.7±1.8 mm reduction versus precinching;P.001), only slightly decreased the PPM-“saddle horn” distance (0.3±0.3 mm reduction;P.03), and had no effect on IMR. ConclusionsAcute IMR was abolished by annular SL reduction, which also repositioned both PM tips closer to the mid-septal annulus and paradoxically increased leaflet “apical tenting”; reducing inter-papillary dimension was not effective, even though it displaced the leaflets toward the annular plane (less “apical tenting”).
非化学性二尖瓣反流(IMR)被认为是由于环扩张，乳头肌(PM)移位(“根尖小叶支索”)，或两者兼而有之。我们比较了减少环形或瓣下尺寸的疗效，以获得更多的机制洞察急性IMR。方法8只成年羊在左室、二尖瓣环、每个小叶边缘和每个小叶尖端植入不透射线标记物。放置并外化跨环间隔外侧(SL)和pm间尖端缝合线。在LCx闭塞引起的IMR之前和期间连续进行双翼透视和经食管超声心动图检查，并进行SL环形(SLAC)或pm间(PAPS)缝合收紧(缺血期间收紧4 ~ 5mm，持续5秒)。根据收缩期末的三维标记坐标计算MA - SL尺寸、乳头间距离(APM-PPM)以及前(APM)和后(PPM) PM尖端与中隔环(“鞍角”)之间的距离。结果sslac降低了IMR(等级为2.1±0.6比0.7±0.5,P.001)、SL环径(比预扣环小4.9±2.5 mm, P.001)和PM-“鞍角”距离(APM和PPM分别减少0.9±0.7和1.0±0.8 mm, P.005)。PAPS降低了PPM- PPM的距离(与预夹相比减少了3.7±1.8 mm;P.001)，仅略微降低了PPM-“鞍角”的距离(减少了0.3±0.3 mm;P.03)，对IMR没有影响。结论环形SL复位可消除急性IMR，这也使两个PM尖端更靠近中隔环，并矛盾地增加了小叶的“根尖帐篷”;减少乳头间的尺寸是无效的，即使它使小叶向环形平面移动(减少“根尖帐篷”)。
{"title":"Annular Versus Subvalvular Approaches to Acute Ischemic Mitral Regurgitation","authors":"T. Timek, D. Lai, F. Tibayan, D. Liang, Filiberto Rodríguez, G. Daughters, P. Dagum, N. Ingels, Craig D. Miller","doi":"10.1161/01.CIR.0000032920.33237.C0","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032920.33237.C0","url":null,"abstract":"BackgroundIschemic mitral regurgitation (IMR) has been attributed to annular dilatation, papillary muscle (PM) displacement (“apical leaflet tenting”), or both. We compared the efficacy of reducing annular or subvalvular dimensions to gain more mechanistic insight into acute IMR. MethodsEight adult sheep underwent implantation of radiopaque markers on the LV, mitral annulus (MA), each leaflet edge, and each PM tip. Trans-annular septal-lateral (SL) and inter-PM tip sutures were placed and externalized. Biplane videofluoroscopy and transesophageal echocardiography were performed before and continuously during LCx occlusion-induced IMR with SL annular (SLAC) or inter-PM (PAPS) suture tightening (4 to 5 mm of cinching for 5 seconds during ischemia). MA SL dimension, inter-papillary distance (APM-PPM), and the distances between the anterior (APM) and posterior (PPM) PM tips and the mid-septal annulus (“saddle horn”) were calculated from 3-D marker coordinates at end-systole. ResultsSLAC reduced IMR (grade=2.1±0.6 versus 0.7±0.5, P.001), SL annular diameter (4.9±2.5 mm smaller versus pre-cinching;P.001), and PM-“saddle horn” distances (0.9±0.7 and 1.0±0.8 mm reduction for APM and PPM, respectively;P.005). PAPS reduced APM-PPM distance (3.7±1.8 mm reduction versus precinching;P.001), only slightly decreased the PPM-“saddle horn” distance (0.3±0.3 mm reduction;P.03), and had no effect on IMR. ConclusionsAcute IMR was abolished by annular SL reduction, which also repositioned both PM tips closer to the mid-septal annulus and paradoxically increased leaflet “apical tenting”; reducing inter-papillary dimension was not effective, even though it displaced the leaflets toward the annular plane (less “apical tenting”).","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"106 1","pages":"I-27-I-32"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81886465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032919.33237.4D
T. Walther, A. Schubert, V. Falk, C. Binner, C. Walther, N. Doll, A. Fabricius, S. Dhein, J. Gummert, F. Mohr
BackgroundSurgical therapy for aortic stenosis leads to reverse remodeling, with normalization of left ventricular hypertrophy (LVH). The aim of this study was to examine Renin-Angiotensin system (RAS) gene expression in this setting. MethodsGrowing sheep (n=44) underwent supracoronary aortic banding for controlled induction of LVH at the age of 6 to 8 months (A=baseline). Surgical revision to completely release the pressure gradient was performed 8.3±1 months later (B). The animals were sacrificed after another 10.1±2 months (C). Along with hemodynamic measurements, subtractive hybridization and competitive polymerase chain reaction were applied to quantify mRNA expression for angiotensin-converting enzyme (ACE) and angiotensin receptors 1 and 2 (AT1-R and AT2-R). ResultsLeft ventricular mass index was 82±21 g (A), 150±33 g (B), and 78±18 g (C), P <0.01. Left ventricular function and cardiac index remained stable. Myocardial fiber diameter was 11.3±0.8 (A), 15.9±1.2 (B), and 11.4±1 (C) &mgr;m, P <0.01. Gene expression was as follows: ACE 0.8±0.05 (A), 1.3±0.08 (B), and 0.9±0.06 (C), P <0.01; AT1-R 0.7±0.06 (A), 0.9±0.07 (B), and 0.3±0.04 (C), P <0.01; AT2-R 0.5±0.05 (A), 0.2±0.04 (B), and 0.5±0.05 (C), P <0.01. ConclusionLVH in aortic stenosis coincides with significant alterations of the RAS. Surgical therapy leads to reverse remodeling, which is paralleled by regression of RAS gene expression.
背景:主动脉瓣狭窄的手术治疗导致了左心室肥厚(LVH)的正常化，导致了反向重构。本研究的目的是检测肾素-血管紧张素系统(RAS)基因在这种情况下的表达。方法:生长中的绵羊(n=44)在6 ~ 8月龄时(A=基线)行冠状动脉上束带术以控制LVH诱导。8.3±1个月后进行手术翻修以完全释放压力梯度(B)。再过10.1±2个月后处死动物(C)。在进行血流动力学测量的同时，采用减法杂交和竞争性聚合酶链反应定量血管紧张素转换酶(ACE)和血管紧张素受体1和2 (AT1-R和AT2-R)的mRNA表达。结果左室质量指数分别为82±21 g (A)、150±33 g (B)和78±18 g (C)， P <0.01。左心室功能和心脏指数保持稳定。心肌纤维直径分别为11.3±0.8 (A)、15.9±1.2 (B)、11.4±1 (C)， P <0.01。基因表达:ACE 0.8±0.05 (A)、1.3±0.08 (B)、0.9±0.06 (C)， P <0.01;AT1-R 0.7±0.06 (A), 0.9±0.07 (B)和0.3±0.04 (C), P < 0.01;AT2-R 0.5±0.05 (A), 0.2±0.04 (B)和0.5±0.05 (C), P < 0.01。结论主动脉瓣狭窄患者lvh与RAS变化一致。手术治疗导致逆转重塑，这与RAS基因表达的回归是平行的。
{"title":"Left Ventricular Reverse Remodeling After Surgical Therapy for Aortic Stenosis: Correlation to Renin-Angiotensin System Gene Expression","authors":"T. Walther, A. Schubert, V. Falk, C. Binner, C. Walther, N. Doll, A. Fabricius, S. Dhein, J. Gummert, F. Mohr","doi":"10.1161/01.CIR.0000032919.33237.4D","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032919.33237.4D","url":null,"abstract":"BackgroundSurgical therapy for aortic stenosis leads to reverse remodeling, with normalization of left ventricular hypertrophy (LVH). The aim of this study was to examine Renin-Angiotensin system (RAS) gene expression in this setting. MethodsGrowing sheep (n=44) underwent supracoronary aortic banding for controlled induction of LVH at the age of 6 to 8 months (A=baseline). Surgical revision to completely release the pressure gradient was performed 8.3±1 months later (B). The animals were sacrificed after another 10.1±2 months (C). Along with hemodynamic measurements, subtractive hybridization and competitive polymerase chain reaction were applied to quantify mRNA expression for angiotensin-converting enzyme (ACE) and angiotensin receptors 1 and 2 (AT1-R and AT2-R). ResultsLeft ventricular mass index was 82±21 g (A), 150±33 g (B), and 78±18 g (C), P <0.01. Left ventricular function and cardiac index remained stable. Myocardial fiber diameter was 11.3±0.8 (A), 15.9±1.2 (B), and 11.4±1 (C) &mgr;m, P <0.01. Gene expression was as follows: ACE 0.8±0.05 (A), 1.3±0.08 (B), and 0.9±0.06 (C), P <0.01; AT1-R 0.7±0.06 (A), 0.9±0.07 (B), and 0.3±0.04 (C), P <0.01; AT2-R 0.5±0.05 (A), 0.2±0.04 (B), and 0.5±0.05 (C), P <0.01. ConclusionLVH in aortic stenosis coincides with significant alterations of the RAS. Surgical therapy leads to reverse remodeling, which is paralleled by regression of RAS gene expression.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"6 1","pages":"I-23-I-26"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72642714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032900.55215.85
S. Cebotari, H. Mertsching, K. Kallenbach, S. Kostin, O. Repin, Aurel Batrinac, C. Kleczka, A. Ciubotaru, A. Haverich
ObjectiveTissue engineered heart valves based on polymeric or xenogeneic matrices have several disadvantages, such as instability of biodegradable polymeric scaffolds, unknown transfer of animal related infectious diseases, and xenogeneic rejection patterns. To overcome these limitations we developed tissue engineered heart valves based on human matrices reseeded with autologous cells. Methods and ResultsAortic (n=5) and pulmonary (n=6) human allografts were harvested from cadavers (6.2±3.1 hours after death) under sterile conditions. Homografts stored in Earle’s Medium 199 enriched with 100 IU/mL Penicillin-Streptomycin for 2 to 28 days (mean 7.3±10.2 days) showed partially preserved cellular viability (MTT assay) and morphological integrity of the extracellular matrix (H-E staining). For decellularization, valves were treated with Trypsin/EDTA resulting in cell-free scaffolds (DNA-assay) with preserved extracellular matrix (confocal microscopy). Primary human venous endothelial cells (HEC) were cultivated and labeled with carboxy-fluorescein diacetate-succinimidyl ester in vitro. After recellularization under fluid conditions, EC were detected on the luminal surfaces of the matrix. They appeared as a monolayer of positively labeled cells for PECAM-1, VE-cadherin and Flk-1. Reseeded EC on the acellular allograft scaffold exhibited high metabolic activity (MTT assay). ConclusionsEarle’s Medium 199 enriched with low concentration of antibiotics represents an excellent medium for long time preservation of extracellular matrix. After complete acellularization with Trypsin/EDTA, recellularization under shear stress conditions of the allogeneic scaffold results in the formation of a viable confluent HEC monolayer. These results represent a promising step toward the construction of autologous heart valves based on acellular human allograft matrix.
基于聚合物或异种基质的组织工程心脏瓣膜存在一些缺点，如可生物降解聚合物支架的不稳定性、动物相关传染病的未知转移以及异种排斥模式。为了克服这些限制，我们开发了基于自体细胞再播种的人类基质的组织工程心脏瓣膜。方法与结果在无菌条件下(死亡后6.2±3.1 h)采集人体同种异体器官(n=5)和肺(n=6)。同种移植物在富含100 IU/mL青霉素-链霉素的Earle 's Medium 199中保存2至28天(平均7.3±10.2天)，显示部分保留细胞活力(MTT测定)和细胞外基质形态完整(H-E染色)。对于脱细胞，用胰蛋白酶/EDTA处理瓣膜，得到无细胞支架(dna测定)和保存的细胞外基质(共聚焦显微镜)。体外培养原代人静脉内皮细胞(HEC)，并用羧基荧光素二乙酸-琥珀酰亚胺酯进行标记。在流体条件下再细胞化后，在基质的腔面检测到EC。它们呈现为PECAM-1、VE-cadherin和Flk-1阳性标记的单层细胞。在脱细胞异体支架上重新播种EC表现出较高的代谢活性(MTT测定)。结论富含低浓度抗生素的searle 's Medium 199是一种长期保存细胞外基质的优良培养基。在胰蛋白酶/EDTA完全脱细胞化后，同种异体支架在剪切应力条件下的再细胞化导致形成一个可行的融合HEC单层。这些结果代表了基于脱细胞人类同种异体移植基质构建自体心脏瓣膜的有希望的一步。
{"title":"Construction of Autologous Human Heart Valves Based on an Acellular Allograft Matrix","authors":"S. Cebotari, H. Mertsching, K. Kallenbach, S. Kostin, O. Repin, Aurel Batrinac, C. Kleczka, A. Ciubotaru, A. Haverich","doi":"10.1161/01.CIR.0000032900.55215.85","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032900.55215.85","url":null,"abstract":"ObjectiveTissue engineered heart valves based on polymeric or xenogeneic matrices have several disadvantages, such as instability of biodegradable polymeric scaffolds, unknown transfer of animal related infectious diseases, and xenogeneic rejection patterns. To overcome these limitations we developed tissue engineered heart valves based on human matrices reseeded with autologous cells. Methods and ResultsAortic (n=5) and pulmonary (n=6) human allografts were harvested from cadavers (6.2±3.1 hours after death) under sterile conditions. Homografts stored in Earle’s Medium 199 enriched with 100 IU/mL Penicillin-Streptomycin for 2 to 28 days (mean 7.3±10.2 days) showed partially preserved cellular viability (MTT assay) and morphological integrity of the extracellular matrix (H-E staining). For decellularization, valves were treated with Trypsin/EDTA resulting in cell-free scaffolds (DNA-assay) with preserved extracellular matrix (confocal microscopy). Primary human venous endothelial cells (HEC) were cultivated and labeled with carboxy-fluorescein diacetate-succinimidyl ester in vitro. After recellularization under fluid conditions, EC were detected on the luminal surfaces of the matrix. They appeared as a monolayer of positively labeled cells for PECAM-1, VE-cadherin and Flk-1. Reseeded EC on the acellular allograft scaffold exhibited high metabolic activity (MTT assay). ConclusionsEarle’s Medium 199 enriched with low concentration of antibiotics represents an excellent medium for long time preservation of extracellular matrix. After complete acellularization with Trypsin/EDTA, recellularization under shear stress conditions of the allogeneic scaffold results in the formation of a viable confluent HEC monolayer. These results represent a promising step toward the construction of autologous heart valves based on acellular human allograft matrix.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"153 1","pages":"I-63-I-68"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79687940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032906.33237.1C
Y. Ochiai, P. McCarthy, N. Smedira, M. Banbury, J. Navia, Jingyuan Feng, A. Hsu, M. Yeager, T. Buda, K. Hoercher, M. Howard, M. Takagaki, K. Doi, K. Fukamachi
BackgroundInsertion of an implantable left ventricular assist device (LVAD) complicated by early right ventricular (RV) failure has a poor prognosis and is largely unpredictable. Prediction of RV failure after LVAD placement would lead to more precise patient selection and optimal device selection. Methods and ResultsWe reviewed data from 245 patients (mean age, 54±11 years; 85% male) with 189 HeartMate (77%) and 56 Novacor (23%) LVADs. Ischemic cardiomyopathy predominated (65%), and 29% had dilated cardiomyopathy. Overall, RV assist device (RVAD) support was required after LVAD insertion for 23 patients (9%). We compared clinical and hemodynamic parameters before LVAD insertion between RVAD (n=23) and No-RVAD patients (n=222) to determine preoperative risk factors for severe RV failure. By univariate analysis, female gender, small body surface area, nonischemic etiology, preoperative mechanical ventilation, circulatory support before LVAD insertion, low mean and diastolic pulmonary artery pressures (PAPs), low RV stroke work (RVSW), and low RVSW index (RVSWI) were significantly associated with RVAD use. Elevated PAP and pulmonary vascular resistance were not risk factors. Risk factors by multivariable logistic regression were preoperative circulatory support (odds ratio [OR], 5.3), female gender (OR, 4.5), and nonischemic etiology (OR, 3.3). ConclusionsThe need for circulatory support, female gender, and nonischemic etiology were the most significant predictors for RVAD use after LVAD insertion. Regarding hemodynamics, low PAP and low RVSWI, reflecting low RV contractility, were important parameters. This information may lead to better patient selection for isolated LVAD implantation.
{"title":"Predictors of Severe Right Ventricular Failure After Implantable Left Ventricular Assist Device Insertion: Analysis of 245 Patients","authors":"Y. Ochiai, P. McCarthy, N. Smedira, M. Banbury, J. Navia, Jingyuan Feng, A. Hsu, M. Yeager, T. Buda, K. Hoercher, M. Howard, M. Takagaki, K. Doi, K. Fukamachi","doi":"10.1161/01.CIR.0000032906.33237.1C","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032906.33237.1C","url":null,"abstract":"BackgroundInsertion of an implantable left ventricular assist device (LVAD) complicated by early right ventricular (RV) failure has a poor prognosis and is largely unpredictable. Prediction of RV failure after LVAD placement would lead to more precise patient selection and optimal device selection. Methods and ResultsWe reviewed data from 245 patients (mean age, 54±11 years; 85% male) with 189 HeartMate (77%) and 56 Novacor (23%) LVADs. Ischemic cardiomyopathy predominated (65%), and 29% had dilated cardiomyopathy. Overall, RV assist device (RVAD) support was required after LVAD insertion for 23 patients (9%). We compared clinical and hemodynamic parameters before LVAD insertion between RVAD (n=23) and No-RVAD patients (n=222) to determine preoperative risk factors for severe RV failure. By univariate analysis, female gender, small body surface area, nonischemic etiology, preoperative mechanical ventilation, circulatory support before LVAD insertion, low mean and diastolic pulmonary artery pressures (PAPs), low RV stroke work (RVSW), and low RVSW index (RVSWI) were significantly associated with RVAD use. Elevated PAP and pulmonary vascular resistance were not risk factors. Risk factors by multivariable logistic regression were preoperative circulatory support (odds ratio [OR], 5.3), female gender (OR, 4.5), and nonischemic etiology (OR, 3.3). ConclusionsThe need for circulatory support, female gender, and nonischemic etiology were the most significant predictors for RVAD use after LVAD insertion. Regarding hemodynamics, low PAP and low RVSWI, reflecting low RV contractility, were important parameters. This information may lead to better patient selection for isolated LVAD implantation.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"11 1","pages":"I-198-I-202"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75172470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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