Pub Date : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.7
Cecilia Chan
Prior to establishment of the heart failure (HF) nurse clinic at Queen Elizabeth Hospital (QEH), Hong Kong in 2003, high rates of hospital readmission were seen in HF patients. Despite shortage of manpower and resources in the Hong Kong public healthcare sector, the clinic has over the years improved patient outcomes including functional capacity and rates of hospital readmission. Initially, cardiac nurses contributed to promoting patients’ health seeking behaviour through education. By 2012, the clinic provided protocol-guided titration of medications to achieve optimal dosing of medications. The HF clinic nurses would individually titrate and maximise medical therapy according to the pre-set protocol endorsed by cardiologists.1 HF patients were closely followed, particularly for those referred from Outpatient Clinics or recently discharged from hospital requiring medication adjustment and education. On average, HF patients were followed up every 2–4 weeks, and sometimes even weekly for close monitoring. In contrast, follow-up at Outpatient Clinics occurred at 3- to 4 month intervals. Apart from education and medication titration, cardiac nurses of the HF clinic also helped to identify and refer difficult-to-manage patients for advanced treatment such as device therapy. Nurses at the HF clinic have a high degree of autonomy, not only in titrating medication according to protocol but also in customising care plan for patients. The QEH HF nurse clinic has been successful in reducing HF patients’ length of hospital stay and readmission rates (figures 1 and 2), as well as in improving patients’ left ventricular ejection fraction, 6 min walk distance, quality of life, and compliance to diet and medications. Abstract 7 Figure 1 Hospital readmission rates for patients attending the Queen Elizabeth Hospital HF nurse clinic in 2016 and outcome measurement in 2017 Abstract 7 Figure 2 Length of hospital stay (LOS) for patients attending the Queen Elizabeth Hospital HF nurse clinic in 2016 and outcome measurement in 2017 References Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005;112:e154–235.
{"title":"7 Nurse-led ambulatory heart failure clinic at queen elizabeth hospital, hong kong SAR","authors":"Cecilia Chan","doi":"10.1136/heartasia-2019-apahff.7","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.7","url":null,"abstract":"Prior to establishment of the heart failure (HF) nurse clinic at Queen Elizabeth Hospital (QEH), Hong Kong in 2003, high rates of hospital readmission were seen in HF patients. Despite shortage of manpower and resources in the Hong Kong public healthcare sector, the clinic has over the years improved patient outcomes including functional capacity and rates of hospital readmission. Initially, cardiac nurses contributed to promoting patients’ health seeking behaviour through education. By 2012, the clinic provided protocol-guided titration of medications to achieve optimal dosing of medications. The HF clinic nurses would individually titrate and maximise medical therapy according to the pre-set protocol endorsed by cardiologists.1 HF patients were closely followed, particularly for those referred from Outpatient Clinics or recently discharged from hospital requiring medication adjustment and education. On average, HF patients were followed up every 2–4 weeks, and sometimes even weekly for close monitoring. In contrast, follow-up at Outpatient Clinics occurred at 3- to 4 month intervals. Apart from education and medication titration, cardiac nurses of the HF clinic also helped to identify and refer difficult-to-manage patients for advanced treatment such as device therapy. Nurses at the HF clinic have a high degree of autonomy, not only in titrating medication according to protocol but also in customising care plan for patients. The QEH HF nurse clinic has been successful in reducing HF patients’ length of hospital stay and readmission rates (figures 1 and 2), as well as in improving patients’ left ventricular ejection fraction, 6 min walk distance, quality of life, and compliance to diet and medications. Abstract 7 Figure 1 Hospital readmission rates for patients attending the Queen Elizabeth Hospital HF nurse clinic in 2016 and outcome measurement in 2017 Abstract 7 Figure 2 Length of hospital stay (LOS) for patients attending the Queen Elizabeth Hospital HF nurse clinic in 2016 and outcome measurement in 2017 References Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005;112:e154–235.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A3 - A4"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42784470","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 : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.30
Y. Taniguchi
Pulmonary endarterectomy is the standard care for patients with chronic thromboembolic pulmonary hypertension (CTEPH), however, about 40% of them are inoperable. Several controlled and uncontrolled trials have shown that the use of pulmonary arterial hypertension (PAH)-specific drugs might be useful in inoperable CTEPH.1 2 Riociguat is currently the only PAH-specific drug also approved for inoperable CTEPH.3 Recently, balloon pulmonary angioplasty (BPA) has emerged as an alternative treatment option for patients with inoperable CTEPH or persistent PH after surgery. Several reports now support the efficacy and safety of BPA. The haemodynamic benefits were summarised in a recent review article, with an overall reduction in mean pulmonary arterial pressure of 12–21 mmHg from baseline, and a mortality rate of 0.0%–3.4% after 2–5 angioplasty sessions.4 Sustained haemodynamic improvements, almost to within the normal range, have been reported up to 3.5 years after BPA.5 Severe and fatal complications, including mostly pulmonary vessel injury, may be minimised with not only accumulation of experience but also refinements in technique. An old approach with targeting only one lobe during each session and full balloon sizing increased the incidence of complications. Approaching with undersized balloon may reduce or prevent vessel injury but is less effective in each individual segment, so several segments and lobes are targeted at one session. BPA has the potential to become a key treatment strategy for patients with inoperable CTEPH. However, the indications and limitations of BPA have not been fully established. An international registry contributed by specialised centres is needed for further investigations. References Jais X, D’Armini AM, Jansa P, Torbicki A, Delcroix M, Ghofrani HA, Hoeper MM, Lang IM, Mayer E, Pepke-Zaba J, Perchenet L, Morganti A, Simonneau G, Rubin LJ. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension), a randomized, placebo-controlled trial. J Am Coll Cardiol 2008;52:2127–2134. Ghofrani HA, Simonneau G, D’Armini AM, Fedullo P, Howard LS, Jais X, Jenkins DP, Jing ZC, Madani MM, Martin N, Mayer E, Papadakis K, Richard D, Kim NH. Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study. Lancet Respir Med 2017;5:785–794. Ghofrani HA, D’Armini AM, Grimminger F, Hoeper MM, Jansa P, Kim NH, Mayer E, Simonneau G, Wilkins MR, Fritsch A, Neuser D, Weimann G, Wang C. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med 2013;369:319–329. Satoh T, Kataoka M, Inami T, Ishiguro H, Yanagisawa R, Shimura N, Shigeta Y, Yoshino H. Endovascular treatment for chronic pulmonary hypertension: a focus on angioplasty for chronic thromboembolic pulmonary hyperte
肺动脉内膜切除术是慢性血栓栓塞性肺动脉高压(CTEPH)患者的标准治疗方法，但其中约40%不能手术治疗。一些对照和非对照试验表明，使用肺动脉高压(PAH)特异性药物可能对不能手术的CTEPH有用。2 Riociguat是目前唯一批准用于不能手术的CTEPH的PAH特异性药物。3最近，球囊肺血管成形术(BPA)已成为不能手术的CTEPH或术后持续PH患者的替代治疗选择。现在有几份报告支持BPA的有效性和安全性。最近的一篇综述文章总结了血流动力学方面的益处，平均肺动脉压从基线总体降低了12-21 mmHg, 2-5次血管成形术后的死亡率为0.0%-3.4%持续的血流动力学改善，几乎在正常范围内，已报道bpa后长达3.5年。5严重和致命的并发症，包括大多数肺血管损伤，不仅可以减少经验的积累，也可以减少技术的改进。旧的入路在每次手术中只针对一个肺叶和全球囊尺寸增加了并发症的发生率。使用小球囊可以减少或预防血管损伤，但对每个节段的效果较差，因此一次手术需要针对多个节段和叶。BPA有可能成为无法手术的CTEPH患者的关键治疗策略。然而，双酚a的适应症和局限性尚未完全确定。进一步调查需要由专门中心提供的国际登记册。参考文献Jais X, D 'Armini AM, Jansa P, Torbicki A, Delcroix M, Ghofrani HA, Hoeper MM, Lang IM, Mayer E, Pepke-Zaba J, Perchenet L, Morganti A, Simonneau G, Rubin LJ。波生坦治疗不可手术的慢性血栓栓塞性肺动脉高压:益处(波生坦对不可手术形式的慢性血栓栓塞性肺动脉高压的作用)，一项随机、安慰剂对照试验。[J]中国生物医学工程学报，2008;22(2):397 - 397。Ghofrani HA, Simonneau G, D 'Armini AM, Fedullo P, Howard LS, Jais X, Jenkins DP, Jing ZC, Madani MM, Martin N, Mayer E, Papadakis K, Richard D, Kim NH。马西坦用于治疗不能手术的慢性血栓栓塞性肺动脉高压(MERIT-1):来自多中心、随机、双盲、安慰剂对照研究的结果。柳叶刀呼吸医学2017;5:785-794。Ghofrani HA, D 'Armini AM, Grimminger F, Hoeper MM, Jansa P, Kim NH, Mayer E, Simonneau G, Wilkins MR, Fritsch A, Neuser D, Weimann G, Wang C. Riociguat治疗慢性血栓栓塞性肺动脉高压。中华医学杂志，2013;39(3):319 - 329。李晓明，李晓明，李晓明，李晓明，杨志泽，李晓明，李晓明。血管内成形术治疗慢性肺动脉高压的临床研究进展。中华心血管病杂志，2016;14:10 9 - 10。李建军，李建军，李建军，李建军，李建军，李建军，李建军，李建军，李建军。发行量2016;134:2030 - 2032。
{"title":"30 Advances in medical and interventional treatments for CTEPH","authors":"Y. Taniguchi","doi":"10.1136/heartasia-2019-apahff.30","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.30","url":null,"abstract":"Pulmonary endarterectomy is the standard care for patients with chronic thromboembolic pulmonary hypertension (CTEPH), however, about 40% of them are inoperable. Several controlled and uncontrolled trials have shown that the use of pulmonary arterial hypertension (PAH)-specific drugs might be useful in inoperable CTEPH.1 2 Riociguat is currently the only PAH-specific drug also approved for inoperable CTEPH.3 Recently, balloon pulmonary angioplasty (BPA) has emerged as an alternative treatment option for patients with inoperable CTEPH or persistent PH after surgery. Several reports now support the efficacy and safety of BPA. The haemodynamic benefits were summarised in a recent review article, with an overall reduction in mean pulmonary arterial pressure of 12–21 mmHg from baseline, and a mortality rate of 0.0%–3.4% after 2–5 angioplasty sessions.4 Sustained haemodynamic improvements, almost to within the normal range, have been reported up to 3.5 years after BPA.5 Severe and fatal complications, including mostly pulmonary vessel injury, may be minimised with not only accumulation of experience but also refinements in technique. An old approach with targeting only one lobe during each session and full balloon sizing increased the incidence of complications. Approaching with undersized balloon may reduce or prevent vessel injury but is less effective in each individual segment, so several segments and lobes are targeted at one session. BPA has the potential to become a key treatment strategy for patients with inoperable CTEPH. However, the indications and limitations of BPA have not been fully established. An international registry contributed by specialised centres is needed for further investigations. References Jais X, D’Armini AM, Jansa P, Torbicki A, Delcroix M, Ghofrani HA, Hoeper MM, Lang IM, Mayer E, Pepke-Zaba J, Perchenet L, Morganti A, Simonneau G, Rubin LJ. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension), a randomized, placebo-controlled trial. J Am Coll Cardiol 2008;52:2127–2134. Ghofrani HA, Simonneau G, D’Armini AM, Fedullo P, Howard LS, Jais X, Jenkins DP, Jing ZC, Madani MM, Martin N, Mayer E, Papadakis K, Richard D, Kim NH. Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study. Lancet Respir Med 2017;5:785–794. Ghofrani HA, D’Armini AM, Grimminger F, Hoeper MM, Jansa P, Kim NH, Mayer E, Simonneau G, Wilkins MR, Fritsch A, Neuser D, Weimann G, Wang C. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med 2013;369:319–329. Satoh T, Kataoka M, Inami T, Ishiguro H, Yanagisawa R, Shimura N, Shigeta Y, Yoshino H. Endovascular treatment for chronic pulmonary hypertension: a focus on angioplasty for chronic thromboembolic pulmonary hyperte","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A12 - A13"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44039077","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 : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.25
K. Fan
In the current era, approximately 50% of heart transplant (HTx) recipients survive more than 13 years, with an increasing population of patients surviving beyond 20 years. Previous studies have suggested that HTx recipients are at particularly high risk of developing de novo malignancies due to more intensive immunosuppression. The perception of higher risk for post-transplant lymphoproliferative disease (PTLD; e.g. lymphoma) associated with OKT3 led to a fall in the use of OKT3 during the 1990s. Main advances in post-HTx management with probable reduction of risk for neoplasia are introduction of (1) antiviral prophylaxis, (2) induction agents that are more specific in their actions and (3) the mammalian target-of-rapamycin inhibitors (mTORs). Reported incidence of post-transplant malignancy in HTx recipients ranged from 2.3% to 27% and skin malignancies represented up to 50% of post-transplant malignancies. The second most common cancer in HTx recipients was PTLD. A retrospective analysis included 17 587 adult HTx recipients who were followed for up to five years post-operation.1 The incidence of de novo malignancy was 10.7% one to five years after transplantation, with higher prevalence in the contemporary era. Considering the increased burden of de novo malignancy in HTx recipients, additional effort needs to be directed towards formulating evidence-based cancer screening recommendations and optimised immunosuppression protocols for these patients. It may be reasonable to consider the risk of de novo post transplant malignancy in older patients when making decisions regarding candidacy for HTx versus left ventricular assist device as destination. References Youn JC, Stehlik J, Wilk AR, Cherikh W, Kim IC, Park GH, Lund LH, Eisen HJ, Kim DY, Lee SK, Choi SW, Han S, Ryu KH, Kang SM, Kobashigawa JA. Temporal trends of de novo malignancy development after heart transplantation. J Am Coll Cardiol 2018;71:40–49.
{"title":"25 Malignancy after heart transplantation","authors":"K. Fan","doi":"10.1136/heartasia-2019-apahff.25","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.25","url":null,"abstract":"In the current era, approximately 50% of heart transplant (HTx) recipients survive more than 13 years, with an increasing population of patients surviving beyond 20 years. Previous studies have suggested that HTx recipients are at particularly high risk of developing de novo malignancies due to more intensive immunosuppression. The perception of higher risk for post-transplant lymphoproliferative disease (PTLD; e.g. lymphoma) associated with OKT3 led to a fall in the use of OKT3 during the 1990s. Main advances in post-HTx management with probable reduction of risk for neoplasia are introduction of (1) antiviral prophylaxis, (2) induction agents that are more specific in their actions and (3) the mammalian target-of-rapamycin inhibitors (mTORs). Reported incidence of post-transplant malignancy in HTx recipients ranged from 2.3% to 27% and skin malignancies represented up to 50% of post-transplant malignancies. The second most common cancer in HTx recipients was PTLD. A retrospective analysis included 17 587 adult HTx recipients who were followed for up to five years post-operation.1 The incidence of de novo malignancy was 10.7% one to five years after transplantation, with higher prevalence in the contemporary era. Considering the increased burden of de novo malignancy in HTx recipients, additional effort needs to be directed towards formulating evidence-based cancer screening recommendations and optimised immunosuppression protocols for these patients. It may be reasonable to consider the risk of de novo post transplant malignancy in older patients when making decisions regarding candidacy for HTx versus left ventricular assist device as destination. References Youn JC, Stehlik J, Wilk AR, Cherikh W, Kim IC, Park GH, Lund LH, Eisen HJ, Kim DY, Lee SK, Choi SW, Han S, Ryu KH, Kang SM, Kobashigawa JA. Temporal trends of de novo malignancy development after heart transplantation. J Am Coll Cardiol 2018;71:40–49.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A11 - A11"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.25","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42096650","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 : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.5
Kevin Kh Kam, Adam Yu, E. Fung, Alex P. W. Lee
According to the Hospital Authority’s Statistical Report 2015–2016, heart failure (HF) was the leading cause of admission in Cardiology. The total number of HF admissions have increased by 14% in 10 years. Moreover, increasing frequency of acute decompensated HF has resulted in higher rates of hospitalisation and mortality. It is recognised that the 30 day readmission rate can be 25%–50% following hospital discharge.1 Current guideline recommends that HF patients should be managed by a multi-disciplinary care team to reduce HF-related hospitalisation.2 In fact, the establishment of multi-disciplinary heart failure clinics have been associated with reduction in rates of readmission3–5 and all-cause mortality.5 In June 2017, we launched the Multi-disciplinary Heart Failure Clinic (MHFC) at Prince of Wales Hospital, Shatin, with two dedicated clinic sessions per week. Self-ambulatory patients in HF with reduced ejection fraction or HFREF (EF ≤40%) and New York Heart Association (NYHA) class II-IV who had recent HF-related hospitalisation were followed. Education on self-monitoring of symptoms, fluid restriction and medication adherence were done by a dedicated HF nurse. Subsequent optimisation of guideline-directed medical therapy was done by the cardiologist. At 6 month follow-up, NYHA class improved from I to II in the majority of patients (figure 1; p=0.029). In addition, the 30 day readmission rate decreased from 68% to 12% (figure 2; p<0.05). Abstract 5 Figure 1 Distribution of NYHA functional class in heart failure patients after 6 months of care and follow-up in the multidisciplinary heart failure clinic Abstract 5 Figure 2 Hospital admission rates 90 days before and 90 after starting care and follow-up at the multidisciplinary heart failure clinic In conclusion, the establishment of MHFC can improve HF-related hospitalisation and patients’ symptomatology. Our local study echoes the findings of a recent meta-analysis.5 References Adib-Hajbaghery M, Maghaminejad F, Abbasi A. The role of continuous care in reducing readmission for patients with heart failure. J Caring Sci 2013;2:255–267. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129–2200. Ducharme A, Doyon O, White M, Rouleau JL, Brophy JM. Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trial. CMAJ2005;173:40–45. Martineau P, Frenette M, Blais L, Sauvé C. Multidisciplinary outpatient congestive
{"title":"5 Optimising heart failure care by multi-disciplinary heart failure clinic (MHFC)","authors":"Kevin Kh Kam, Adam Yu, E. Fung, Alex P. W. Lee","doi":"10.1136/heartasia-2019-apahff.5","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.5","url":null,"abstract":"According to the Hospital Authority’s Statistical Report 2015–2016, heart failure (HF) was the leading cause of admission in Cardiology. The total number of HF admissions have increased by 14% in 10 years. Moreover, increasing frequency of acute decompensated HF has resulted in higher rates of hospitalisation and mortality. It is recognised that the 30 day readmission rate can be 25%–50% following hospital discharge.1 Current guideline recommends that HF patients should be managed by a multi-disciplinary care team to reduce HF-related hospitalisation.2 In fact, the establishment of multi-disciplinary heart failure clinics have been associated with reduction in rates of readmission3–5 and all-cause mortality.5 In June 2017, we launched the Multi-disciplinary Heart Failure Clinic (MHFC) at Prince of Wales Hospital, Shatin, with two dedicated clinic sessions per week. Self-ambulatory patients in HF with reduced ejection fraction or HFREF (EF ≤40%) and New York Heart Association (NYHA) class II-IV who had recent HF-related hospitalisation were followed. Education on self-monitoring of symptoms, fluid restriction and medication adherence were done by a dedicated HF nurse. Subsequent optimisation of guideline-directed medical therapy was done by the cardiologist. At 6 month follow-up, NYHA class improved from I to II in the majority of patients (figure 1; p=0.029). In addition, the 30 day readmission rate decreased from 68% to 12% (figure 2; p<0.05). Abstract 5 Figure 1 Distribution of NYHA functional class in heart failure patients after 6 months of care and follow-up in the multidisciplinary heart failure clinic Abstract 5 Figure 2 Hospital admission rates 90 days before and 90 after starting care and follow-up at the multidisciplinary heart failure clinic In conclusion, the establishment of MHFC can improve HF-related hospitalisation and patients’ symptomatology. Our local study echoes the findings of a recent meta-analysis.5 References Adib-Hajbaghery M, Maghaminejad F, Abbasi A. The role of continuous care in reducing readmission for patients with heart failure. J Caring Sci 2013;2:255–267. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129–2200. Ducharme A, Doyon O, White M, Rouleau JL, Brophy JM. Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trial. CMAJ2005;173:40–45. Martineau P, Frenette M, Blais L, Sauvé C. Multidisciplinary outpatient congestive","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A2 - A3"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49019113","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 : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.17
S. Tsui
Acute myocardial infarction and ischaemic cardiomyopathy are important causes of heart failure (HF). With ageing populations in developed nations, the incidences can be expected to rise in the coming decades. Stretch of a left ventricle (LV) scar results in detrimental ventricular remodelling, LV dilatation and a change in geometry from elliptical to spherical. These result in higher wall stress and less effective ventricular contractions. Surgical techniques to restore the shape of the remodelled ventricle were introduced in early 1980s.1 The RESTORE registry and others reported favourable outcomes in >5000 patients.2 However, the NHLBI and NIH-funded prospective randomised STICH Trial found no additional benefit of LV reconstruction in addition to coronary bypass grafting.3 The STICH Trial was well conducted. The neutral findings did curb enthusiasm for LV reconstruction surgery. However, the interpretation of STICH was not incontrovertible and had sparked heated debates.4 Subsequent re-analysis of STICH confirmed significant survival benefit when adequate LV volume reduction was achieved.5 New data from experienced centres continued to demonstrate efficacy of LV reconstruction surgery.6 7 The 2013 ACCF/AHA Guideline for the Management of Heart Failure recommended LV reconstruction for HF with reduce ejection fraction with a recommendation class IIb, level of evidence B.8 Unsurprisingly, the field remains confused about the role of this treatment. In order to facilitate appropriate sizing of the LV during reconstruction, graduated balloons are now available for use as templates. A new device has been developed for less invasive off-pump LV reconstruction and a Phase 2 clinical trial is now underway. References Dor V. Reconstructive left ventricular surgery for post-ischemic akinetic dilatation. Semin Thorac Cardiovasc Surg 1997;9:139–145. Athanasuleas CL, Buckberg GD, Stanley AW, Siler W, Dor V, Di Donato M, Menicanti L, Almeida de Oliveira S, Beyersdorf F, Kron IL, Suma H, Kouchoukos NT, Moore W, McCarthy PM, Oz MC, Fontan F, Scott ML, Accola KA; RESTORE group. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J Am Coll Cardiol 2004;44:1439–1445. Jones RH, Velazquez EJ, Michler RE, Sopko G, Oh JK, O’Connor CM, Hill JA, Menicanti L, Sadowski Z, Desvigne-Nickens P, Rouleau JL, Lee KL; STICH Hypothesis 2 Investigators. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med 2009;360:1705–1717. Buckberg GD, Athanasuleas CL. The STICH trial: misguided conclusions. J Thorac Cardiovasc Surg 2009;138:1060–1064. Michler RE, Rouleau JL, Al-Khalidi HR, Bonow RO, Pellikka PA, Pohost GM, Holly TA, Oh JK, Dagenais F, Milano C, Wrobel K, Pirk J, Ali IS, Jones RH, Velazquez EJ, Lee KL, Di Donato M; STICH Trial Investigators. Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical vent
{"title":"17 Left ventricular rconstruction surgery","authors":"S. Tsui","doi":"10.1136/heartasia-2019-apahff.17","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.17","url":null,"abstract":"Acute myocardial infarction and ischaemic cardiomyopathy are important causes of heart failure (HF). With ageing populations in developed nations, the incidences can be expected to rise in the coming decades. Stretch of a left ventricle (LV) scar results in detrimental ventricular remodelling, LV dilatation and a change in geometry from elliptical to spherical. These result in higher wall stress and less effective ventricular contractions. Surgical techniques to restore the shape of the remodelled ventricle were introduced in early 1980s.1 The RESTORE registry and others reported favourable outcomes in >5000 patients.2 However, the NHLBI and NIH-funded prospective randomised STICH Trial found no additional benefit of LV reconstruction in addition to coronary bypass grafting.3 The STICH Trial was well conducted. The neutral findings did curb enthusiasm for LV reconstruction surgery. However, the interpretation of STICH was not incontrovertible and had sparked heated debates.4 Subsequent re-analysis of STICH confirmed significant survival benefit when adequate LV volume reduction was achieved.5 New data from experienced centres continued to demonstrate efficacy of LV reconstruction surgery.6 7 The 2013 ACCF/AHA Guideline for the Management of Heart Failure recommended LV reconstruction for HF with reduce ejection fraction with a recommendation class IIb, level of evidence B.8 Unsurprisingly, the field remains confused about the role of this treatment. In order to facilitate appropriate sizing of the LV during reconstruction, graduated balloons are now available for use as templates. A new device has been developed for less invasive off-pump LV reconstruction and a Phase 2 clinical trial is now underway. References Dor V. Reconstructive left ventricular surgery for post-ischemic akinetic dilatation. Semin Thorac Cardiovasc Surg 1997;9:139–145. Athanasuleas CL, Buckberg GD, Stanley AW, Siler W, Dor V, Di Donato M, Menicanti L, Almeida de Oliveira S, Beyersdorf F, Kron IL, Suma H, Kouchoukos NT, Moore W, McCarthy PM, Oz MC, Fontan F, Scott ML, Accola KA; RESTORE group. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J Am Coll Cardiol 2004;44:1439–1445. Jones RH, Velazquez EJ, Michler RE, Sopko G, Oh JK, O’Connor CM, Hill JA, Menicanti L, Sadowski Z, Desvigne-Nickens P, Rouleau JL, Lee KL; STICH Hypothesis 2 Investigators. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med 2009;360:1705–1717. Buckberg GD, Athanasuleas CL. The STICH trial: misguided conclusions. J Thorac Cardiovasc Surg 2009;138:1060–1064. Michler RE, Rouleau JL, Al-Khalidi HR, Bonow RO, Pellikka PA, Pohost GM, Holly TA, Oh JK, Dagenais F, Milano C, Wrobel K, Pirk J, Ali IS, Jones RH, Velazquez EJ, Lee KL, Di Donato M; STICH Trial Investigators. Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical vent","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":"A8 - A8"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.17","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47508596","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 : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.23
Kl Wong, Ho Cally, T. Au, F. Katherine
Left ventricular assist device (LVAD) has been used for end-stage heart failure both as bridge to transplantation (BTT) and destination therapy (DT) for patients not suitable for heart transplantation. Stroke is a major cause of morbidity and mortality associated with LVAD therapy. We aimed to review the incidence and outcome of stroke during LVAD therapy in Hong Kong. Patients who had LVAD implantation from August 2010 to August 2018 for end-stage heart failure were reviewed. A total of 65 patients had LVAD implanted for end-stage heart failure (57 as BTT, 87.7%). The majority were male (n=55, 84.6%), with mean age of 49 years. Overall survival rates were 86.2% at 6 months and 79.2% at 12 months. There were 43 HeartMate IITM, 14 HeartWareTM HVADTM and 8 HeartMate 3TM implants. Twenty neurological events occurred in 18 patients with 10 cases of disabling stroke throughout the whole study period. There were 11 haemorrhagic strokes, 7 ischaemic strokes and 2 transient ischaemic attacks. Stroke and disabling stroke rates at 6 months were 20.7% and 12.1%, respectively. Disabling strokes were more common when haemorrhagic in origin (7 out of 10) and were the commonest cause of mortality in 9 out of 15 (60%) patients throughout the study period. In conclusion, stroke remains an important cause of morbidity and mortality among Hong Kong patients receiving LVAD therapy.
{"title":"23 Stroke outcomes in patients with left ventricular assist device","authors":"Kl Wong, Ho Cally, T. Au, F. Katherine","doi":"10.1136/heartasia-2019-apahff.23","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.23","url":null,"abstract":"Left ventricular assist device (LVAD) has been used for end-stage heart failure both as bridge to transplantation (BTT) and destination therapy (DT) for patients not suitable for heart transplantation. Stroke is a major cause of morbidity and mortality associated with LVAD therapy. We aimed to review the incidence and outcome of stroke during LVAD therapy in Hong Kong. Patients who had LVAD implantation from August 2010 to August 2018 for end-stage heart failure were reviewed. A total of 65 patients had LVAD implanted for end-stage heart failure (57 as BTT, 87.7%). The majority were male (n=55, 84.6%), with mean age of 49 years. Overall survival rates were 86.2% at 6 months and 79.2% at 12 months. There were 43 HeartMate IITM, 14 HeartWareTM HVADTM and 8 HeartMate 3TM implants. Twenty neurological events occurred in 18 patients with 10 cases of disabling stroke throughout the whole study period. There were 11 haemorrhagic strokes, 7 ischaemic strokes and 2 transient ischaemic attacks. Stroke and disabling stroke rates at 6 months were 20.7% and 12.1%, respectively. Disabling strokes were more common when haemorrhagic in origin (7 out of 10) and were the commonest cause of mortality in 9 out of 15 (60%) patients throughout the study period. In conclusion, stroke remains an important cause of morbidity and mortality among Hong Kong patients receiving LVAD therapy.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A10 - A10"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43279881","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 : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.33
P. Teekakirikul
Hypertrophic cardiomyopathy (HCM) is a prevalent heritable cardiac disorder, characterised by unexplained left ventricular hypertrophy (LVH) with the triad of myocyte hypertrophy, disarray, and interstitial fibrosis.1 Such pathological hallmarks impact diastolic function and contribute to adverse clinical outcomes: arrhythmias, progressive heart failure and sudden cardiac death.2 To date, none of the available armamentaria has been shown to fundamentally modify disease progression, or to benefit genotype-positive, phenotype-negative or preclinical HCM patients. Multiple genetic studies have identified considerable numbers of HCM-causing mutations in human sarcomere protein genes, and mice engineered to carry such human mutations recapitulated key phenotypes of HCM.1 3 This has provided remarkable opportunities to identify the novel therapeutics at the molecular levels, and allowed us to integrate gene-based diagnostics into clinical management of preclinical HCM.2 Studies in HCM mouse models have illustrated the importance of activated transforming growth factor beta (TGF-β) pathway in the early development of HCM. Treatment with either TGF-β neutralising antibodies or with angiotensin II type 1 receptor antagonist, losartan, was shown to retard and prevent HCM development in mouse models.4 Lately, MYK-461, the first allosteric inhibitor of the cardiac myosin adenosine triphosphate (ATPase), has been shown to reduce left ventricular contractility and attenuate HCM development in mouse models of HCM.5 Clinical trials are currently underway to evaluate and investigate these two promising disease-modifying therapies in HCM patients. References Teekakirikul P, Padera RF, Seidman JG, Seidman CE. Hypertrophic cardiomyopathy: Translating cellular cross talk into therapeutics. J Cell Biol 2012;199:417–421. Teekakirikul P, Kelly MA, Rehm HL, Lakdawala NK, Funke BH. Inherited cardiomyopathies: Molecular genetics and clinical genetic testing in the postgenomic era. J Mol Diagnostics 2013;15:158–170. Burke MA, Cook SA, Seidman JG, Seidman CE. Clinical and mechanistic insights into the genetics of cardiomyopathy. J Am Coll Cardiol 2016;68:2871–2886. Teekakirikul P, Eminaga S, Toka O, Alcalai R, Wang L, Wakimoto H, Nayor M, Konno T, Gorham JM, Wolf CM, Kim JB, Schmitt JP, Molkentin JD, Norris RA, Tager AM, Hoffman SR, Markwald RR, Seidman CE, Seidman JG. Cardiac fibrosis in mice with hypertrophic cardiomyopathy is mediated by non-myocyte proliferation and requires Tgf-β. J Clin Invest 2010;120:3520–3529. Green EM, Wakimoto H, Anderson RL, Evanchik MJ, Gorham JM, Harrison BC, Henze M, Kawas R, Oslob JD, Rodriguez HM, Song Y, Wan W, Leinwand LA, Spudich JA, McDowell RS, Seidman JG, Seidman CE. A small-molecule inhibitor of sarcomere contractility suppresses hypertrophic cardiomyopathy in mice. Science 2016;351:617–621.
{"title":"33 Hypertrophic cardiomyopathy: pathogenesis, therapies and disease modulation","authors":"P. Teekakirikul","doi":"10.1136/heartasia-2019-apahff.33","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.33","url":null,"abstract":"Hypertrophic cardiomyopathy (HCM) is a prevalent heritable cardiac disorder, characterised by unexplained left ventricular hypertrophy (LVH) with the triad of myocyte hypertrophy, disarray, and interstitial fibrosis.1 Such pathological hallmarks impact diastolic function and contribute to adverse clinical outcomes: arrhythmias, progressive heart failure and sudden cardiac death.2 To date, none of the available armamentaria has been shown to fundamentally modify disease progression, or to benefit genotype-positive, phenotype-negative or preclinical HCM patients. Multiple genetic studies have identified considerable numbers of HCM-causing mutations in human sarcomere protein genes, and mice engineered to carry such human mutations recapitulated key phenotypes of HCM.1 3 This has provided remarkable opportunities to identify the novel therapeutics at the molecular levels, and allowed us to integrate gene-based diagnostics into clinical management of preclinical HCM.2 Studies in HCM mouse models have illustrated the importance of activated transforming growth factor beta (TGF-β) pathway in the early development of HCM. Treatment with either TGF-β neutralising antibodies or with angiotensin II type 1 receptor antagonist, losartan, was shown to retard and prevent HCM development in mouse models.4 Lately, MYK-461, the first allosteric inhibitor of the cardiac myosin adenosine triphosphate (ATPase), has been shown to reduce left ventricular contractility and attenuate HCM development in mouse models of HCM.5 Clinical trials are currently underway to evaluate and investigate these two promising disease-modifying therapies in HCM patients. References Teekakirikul P, Padera RF, Seidman JG, Seidman CE. Hypertrophic cardiomyopathy: Translating cellular cross talk into therapeutics. J Cell Biol 2012;199:417–421. Teekakirikul P, Kelly MA, Rehm HL, Lakdawala NK, Funke BH. Inherited cardiomyopathies: Molecular genetics and clinical genetic testing in the postgenomic era. J Mol Diagnostics 2013;15:158–170. Burke MA, Cook SA, Seidman JG, Seidman CE. Clinical and mechanistic insights into the genetics of cardiomyopathy. J Am Coll Cardiol 2016;68:2871–2886. Teekakirikul P, Eminaga S, Toka O, Alcalai R, Wang L, Wakimoto H, Nayor M, Konno T, Gorham JM, Wolf CM, Kim JB, Schmitt JP, Molkentin JD, Norris RA, Tager AM, Hoffman SR, Markwald RR, Seidman CE, Seidman JG. Cardiac fibrosis in mice with hypertrophic cardiomyopathy is mediated by non-myocyte proliferation and requires Tgf-β. J Clin Invest 2010;120:3520–3529. Green EM, Wakimoto H, Anderson RL, Evanchik MJ, Gorham JM, Harrison BC, Henze M, Kawas R, Oslob JD, Rodriguez HM, Song Y, Wan W, Leinwand LA, Spudich JA, McDowell RS, Seidman JG, Seidman CE. A small-molecule inhibitor of sarcomere contractility suppresses hypertrophic cardiomyopathy in mice. Science 2016;351:617–621.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A14 - A14"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.33","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49420015","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 : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.24
K. Kerk
Although left ventricular assist devices (LVADs) have revolutionised the treatment of advanced heart failure, LVAD infection (LVADI) remains a significant cause of morbidity and mortality in LVAD patients. The International Society of Heart and Lung Transplantation defines LVADI in three categories: VAD-specific infections (pump/cannula, pocket, driveline); VAD-related infections (infective endocarditis, blood stream infection, mediastinitis); and non-VAD infections.1 Infection should be excluded or appropriately treated by an infectious disease physician before LVAD implantation when clinically feasible. Surgical techniques such as increasing intrafascial tunnelling and externalisation of the silicone portion of the driveline may help reduce infections.2 Besides culture tests, additional imaging, such as ultrasonography or computed tomography may be warranted if underlying abscess is suspected.3 The recommended treatment includes antimicrobial therapy, local debridement of the exit sites; surgical drainage, driveline repositioning and instalment of a wound VAC (or vacuum-assisted closure) system in patients with deep infection,4 surgical debridement and device exchange in the setting of persistent or relapsing blood stream infection (BSI) despite adequate antimicrobial and surgical therapy; pump exchange should be performed if feasible, in patients with persistent sepsis and instability due to device infection while heart transplant should be considered in haemodynamically stable transplant candidates with BSI.1 The clinical manifestations and management of LVADI vary based on the type and extent of infection, and the causative pathogens. Understanding these differences is critical in making timely diagnoses and providing appropriate management interventions for LVADI. References Kusne S, Mooney M, Danziger-Isakov L, Kaan A, Lund LH, Lyster H, Wieselthaler G, Aslam S, Cagliostro B, Chen J, Combs P, Cochrane A, Conway J, Cowger J, Frigerio M, Gellatly R, Grossi P, Gustafsson F, Hannan M, Lorts A, Martin S, Pinney S, Silveira FP, Schubert S, Schueler S, Strueber M, Uriel N, Wrightson N, Zabner R, Huprikar S. An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection. J Heart Lung Transplant 2017;36:1137–1153. Trachtenberg BH, Cordero-Reyes A, Elias B, Loebe M. A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management. Methodist Debakey Cardiovasc J 2015;11:28–32. Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, Starling RC, Chen L, Boyle AJ, Chillcott S, Adamson RM, Blood MS, Camacho MT, Idrissi KA, Petty M, Sobieski M, Wright S, Myers TJ, Farrar DJ; HeartMate II Clinical Investigators. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant 2010;29(4 Suppl):S1–39. Yarboro LT, Bergin JD, Kennedy JL, Ballew CC, Benton EM, Ailawadi G, Kern JA. Technique for minim
尽管左心室辅助装置(LVAD)已经彻底改变了晚期心力衰竭的治疗，但LVAD感染(LVADI)仍然是LVAD患者发病和死亡的重要原因。国际心肺移植学会将LVADI定义为三类:vad特异性感染(泵/插管、口袋、传动系统);vad相关感染(感染性心内膜炎、血流感染、纵隔炎);和非vad感染在临床上可行的情况下，在LVAD植入前应排除感染或由传染病医生进行适当治疗。外科技术，如增加筋膜内隧道和将传动系统的硅胶部分外化可能有助于减少感染除了培养检查外，如果怀疑有潜在的脓肿，可能需要额外的影像学检查，如超声检查或计算机断层扫描推荐的治疗方法包括抗菌药物治疗、出口部位局部清创;对于深部感染患者，外科引流、传动系统重新定位和伤口VAC(或真空辅助闭合)系统的安装，4对于持续或复发的血流感染(BSI)，尽管有足够的抗菌药物和手术治疗，但手术清创和器械更换;对于持续脓毒症和因器械感染而不稳定的患者，应在可行的情况下进行泵换血，而对于血流动力学稳定的bsi移植候选患者，应考虑进行心脏移植。1 LVADI的临床表现和处理因感染的类型和程度以及致病病原体而异。了解这些差异对于及时诊断和提供适当的LVADI管理干预至关重要。参考文献Kusne S, Mooney M, Danziger-Isakov L, Kaan A, Lund LH, Lyster H, Wieselthaler G, Aslam S, Cagliostro B, Chen J, Combs P, Cochrane A, Conway J, Cowger J, Frigerio M, gellly R, Grossi P, Gustafsson F, Hannan M, Lorts A, Martin S, Pinney S, Silveira FP, Schubert S, Schueler S, Strueber M, Uriel N, Wrightson N, Zabner R, Huprikar S. and ISHLT共识文件:机械循环支持感染的预防和管理策略。[J]中华肺脏移植杂志，2017;36(6):1137 - 1153。李建军，李建军，李建军，等。左心室辅助装置感染的临床研究进展。中华心血管病杂志，2015;11:28-32。Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, Starling RC, Chen L, Boyle AJ, Chillcott S, Adamson RM, Blood MS, Camacho MT, Idrissi KA, Petty M, Sobieski M, Wright S, Myers TJ, Farrar DJ;心脏伴侣II临床研究者。连续血流左心室辅助装置治疗晚期心力衰竭的临床管理。心肺移植杂志;2010;29(4增刊):S1-39。Yarboro LT, Bergin JD, Kennedy JL, Ballew CC, Benton EM, Ailawadi G, Kern JA。减少和治疗传动系统感染的技术。心外科杂志2014;3:557-562。
{"title":"24 Managing infections associated with LVADs","authors":"K. Kerk","doi":"10.1136/heartasia-2019-apahff.24","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.24","url":null,"abstract":"Although left ventricular assist devices (LVADs) have revolutionised the treatment of advanced heart failure, LVAD infection (LVADI) remains a significant cause of morbidity and mortality in LVAD patients. The International Society of Heart and Lung Transplantation defines LVADI in three categories: VAD-specific infections (pump/cannula, pocket, driveline); VAD-related infections (infective endocarditis, blood stream infection, mediastinitis); and non-VAD infections.1 Infection should be excluded or appropriately treated by an infectious disease physician before LVAD implantation when clinically feasible. Surgical techniques such as increasing intrafascial tunnelling and externalisation of the silicone portion of the driveline may help reduce infections.2 Besides culture tests, additional imaging, such as ultrasonography or computed tomography may be warranted if underlying abscess is suspected.3 The recommended treatment includes antimicrobial therapy, local debridement of the exit sites; surgical drainage, driveline repositioning and instalment of a wound VAC (or vacuum-assisted closure) system in patients with deep infection,4 surgical debridement and device exchange in the setting of persistent or relapsing blood stream infection (BSI) despite adequate antimicrobial and surgical therapy; pump exchange should be performed if feasible, in patients with persistent sepsis and instability due to device infection while heart transplant should be considered in haemodynamically stable transplant candidates with BSI.1 The clinical manifestations and management of LVADI vary based on the type and extent of infection, and the causative pathogens. Understanding these differences is critical in making timely diagnoses and providing appropriate management interventions for LVADI. References Kusne S, Mooney M, Danziger-Isakov L, Kaan A, Lund LH, Lyster H, Wieselthaler G, Aslam S, Cagliostro B, Chen J, Combs P, Cochrane A, Conway J, Cowger J, Frigerio M, Gellatly R, Grossi P, Gustafsson F, Hannan M, Lorts A, Martin S, Pinney S, Silveira FP, Schubert S, Schueler S, Strueber M, Uriel N, Wrightson N, Zabner R, Huprikar S. An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection. J Heart Lung Transplant 2017;36:1137–1153. Trachtenberg BH, Cordero-Reyes A, Elias B, Loebe M. A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management. Methodist Debakey Cardiovasc J 2015;11:28–32. Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, Starling RC, Chen L, Boyle AJ, Chillcott S, Adamson RM, Blood MS, Camacho MT, Idrissi KA, Petty M, Sobieski M, Wright S, Myers TJ, Farrar DJ; HeartMate II Clinical Investigators. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant 2010;29(4 Suppl):S1–39. Yarboro LT, Bergin JD, Kennedy JL, Ballew CC, Benton EM, Ailawadi G, Kern JA. Technique for minim","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":"A10 - A10"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.24","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46622059","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 : 2019-04-01DOI: 10.1136/HEARTASIA-2019-APAHFF.18
Jung-Hwan Kim
Since the first successful heart transplant in Korea in 1992, the case volume has been rapidly increasing. Compared with ISHLT registry data, the Korean KONOS registry data show similar post-transplant long-term survival rates. At Severance Cardiovascular Hospital (SCH) of Yonsei University, the number of heart transplants has been growing steadily since 2010. Between 1994 and 2018, 174 heart transplantations had been performed. Mean age of recipients and their follow-up duration were 42.9 and 3.2 years, respectively. Pre-operative CPR was performed in 18 (10.3%) patients, and extracorporeal membrane oxygenation (ECMO) was applied in 35 (20.1%) patients. In-hospital mortality was 19% and 10 year survival rate was 71.7%. By multivariate analysis, risk factors for in-hospital mortality were pre-operative elevated bilirubin and lactate levels. Risk factors for overall mortality were pre-operative dialysis, and high bilirubin and lactate levels. Gender and pre-operative body weight mismatch and ECMO bridging were not independent risk factors for mortality. The volume of LVAD implants had been low in Korea due to reimbursement limitations. However, from October 2018, a new national insurance policy was implemented to provide for 95% of total device cost. This change is projected to increase device implant rates and patient access. In conclusion, size-mismatch did not affect LVAD outcomes for the East Asian population. Organ protection remains an important factor for long-term survival. In the short term, MCS including ECMO may be used to reverse organ dysfunction as a bridge to recovery or decision. Finally, LVAD will be a main strategy for bridge-to-transplant (BTT) in Korea.
{"title":"18 Surgery for heart failure: experiences from severance cardiovascular hospital, seoul, korea","authors":"Jung-Hwan Kim","doi":"10.1136/HEARTASIA-2019-APAHFF.18","DOIUrl":"https://doi.org/10.1136/HEARTASIA-2019-APAHFF.18","url":null,"abstract":"Since the first successful heart transplant in Korea in 1992, the case volume has been rapidly increasing. Compared with ISHLT registry data, the Korean KONOS registry data show similar post-transplant long-term survival rates. At Severance Cardiovascular Hospital (SCH) of Yonsei University, the number of heart transplants has been growing steadily since 2010. Between 1994 and 2018, 174 heart transplantations had been performed. Mean age of recipients and their follow-up duration were 42.9 and 3.2 years, respectively. Pre-operative CPR was performed in 18 (10.3%) patients, and extracorporeal membrane oxygenation (ECMO) was applied in 35 (20.1%) patients. In-hospital mortality was 19% and 10 year survival rate was 71.7%. By multivariate analysis, risk factors for in-hospital mortality were pre-operative elevated bilirubin and lactate levels. Risk factors for overall mortality were pre-operative dialysis, and high bilirubin and lactate levels. Gender and pre-operative body weight mismatch and ECMO bridging were not independent risk factors for mortality. The volume of LVAD implants had been low in Korea due to reimbursement limitations. However, from October 2018, a new national insurance policy was implemented to provide for 95% of total device cost. This change is projected to increase device implant rates and patient access. In conclusion, size-mismatch did not affect LVAD outcomes for the East Asian population. Organ protection remains an important factor for long-term survival. In the short term, MCS including ECMO may be used to reverse organ dysfunction as a bridge to recovery or decision. Finally, LVAD will be a main strategy for bridge-to-transplant (BTT) in Korea.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A8 - A8"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/HEARTASIA-2019-APAHFF.18","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45656531","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 : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.4
Steven Tsui
Whilst there has recently been unprecedented growth in heart transplants (HTx) in North America, the number has been static or falling in most European countries. These have resulted in significant increases in the waiting times. In the UK, an Urgent Heart Allocation Scheme has been in existence since 2001. With a growing number of heart failure patients on temporary mechanical circulatory support (MCS) devices, a Super Urgent category was introduced in 2016. So far, ∼15% of HTx in the UK are performed under this new category and the median waiting time has been ≈7 days. Post-transplant 30 day survival has been reassuring. However, ongoing monitoring will be required to ensure effectiveness. The other major development has been donation after circulatory death (DCD) HTx. To date, ∼100 DCD HTx have been performed worldwide, with 70 of these being in the UK. Growing waiting lists have led to increased implantation of bridge-to-transplant left ventricular assist devices (LVAD). However, the extended waiting times for donor hearts in stable patients mean that patients being bridged are effectively having destination therapy by default. Whilst destination therapy is approved in some countries, the available evidence has not been accepted by other countries. The Swedish Evaluation of LVAD as Permanent Treatment in End-stage Heart Failure (SweVAD) is a prospective randomised study comparing LVAD therapy with optimal medical therapy. Recruitment commenced in 2016 with the aim of randomising 74 patients. Outcomes and adverse events associated with implantable MCS will further improve as new devices using novel pumping mechanisms with lower shear stress are in development to address inherent limitations of current devices.
{"title":"4 Updates on cardiac transplant and LVAD implants across the UK and europe","authors":"Steven Tsui","doi":"10.1136/heartasia-2019-apahff.4","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.4","url":null,"abstract":"Whilst there has recently been unprecedented growth in heart transplants (HTx) in North America, the number has been static or falling in most European countries. These have resulted in significant increases in the waiting times. In the UK, an Urgent Heart Allocation Scheme has been in existence since 2001. With a growing number of heart failure patients on temporary mechanical circulatory support (MCS) devices, a Super Urgent category was introduced in 2016. So far, ∼15% of HTx in the UK are performed under this new category and the median waiting time has been ≈7 days. Post-transplant 30 day survival has been reassuring. However, ongoing monitoring will be required to ensure effectiveness. The other major development has been donation after circulatory death (DCD) HTx. To date, ∼100 DCD HTx have been performed worldwide, with 70 of these being in the UK. Growing waiting lists have led to increased implantation of bridge-to-transplant left ventricular assist devices (LVAD). However, the extended waiting times for donor hearts in stable patients mean that patients being bridged are effectively having destination therapy by default. Whilst destination therapy is approved in some countries, the available evidence has not been accepted by other countries. The Swedish Evaluation of LVAD as Permanent Treatment in End-stage Heart Failure (SweVAD) is a prospective randomised study comparing LVAD therapy with optimal medical therapy. Recruitment commenced in 2016 with the aim of randomising 74 patients. Outcomes and adverse events associated with implantable MCS will further improve as new devices using novel pumping mechanisms with lower shear stress are in development to address inherent limitations of current devices.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A2 - A2"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45775953","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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