Pub Date : 2019-04-01DOI: 10.1136/heartasia-2019-apahff.2
P. Macdonald
2018 marks the 50th anniversary of heart transplantation at St Vincent’s Hospital in Sydney. The modern era of heart transplantation for our institution commenced in 1984 and since then the programme has performed >1000 heart transplants (HTx), >1000 lung transplants and almost 100 combined heart-lung transplants. Bridge-to-transplant ventricular assist device (VAD) support began in 1994 with the pulsatile Heartmate 1 device with a transition to continuous flow VADs in the mid 2000s. Current activity is 20–25 VADs, 40–50 HTx and 50–60 lung transplants per year. Over the last 3 decades, there has been an increased utilisation of marginal donors including older DBD donors and more recently DCD donors.1 The latter has been facilitated by utilisation of normothermic machine perfusion (NMP) for donor heart retrieval and transport.2 Donor hearts retrieved using NMP now account for 20% of all HTx. This proportion is expected to increase in the future. There have also been major changes in recipient characteristics with increased referral of older patients with advanced heart failure. Assessment of physical frailty together with cognition and depression are now routine for all patients referred for HTx assessment.3 4 There has also been an increased reliance on bridge-to-transplant VAD to support patients to transplantation. Despite these changing donor and recipient characteristics, post-transplant survival remains excellent with a median survival of almost 15 years. HTx remains the most effective therapy for advanced heart failure but is limited by availability of suitable donors. Improvements in donor heart preservation are expected to further increase the availability of this life-saving therapy. References Dhital K, Iyer A, Connellan M, et al. Distant procurement orthotopic heart transplant from donation after circulatory death. Lancet 2015;385:2585–2591. Macdonald PS, Chew HC, Connellan M, Dhital K. Extracorporeal heart perfusion before heart transplantation: The heart in a box. Curr Opin Organ Transplant 2016;21:336–342. Jha S, Carter D, Hannu MK, et al. Frailty as a predictor of outcomes in transplant eligible patients with advanced heart failure. Transplantation 2016;100:429–436. Jha S, Carter D, Hannu MK, et al. Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. J Heart Lung Transplant 2016;35:1092–1100.
{"title":"2 The heart transplant and VAD program at St Vincent’s hospital, sydney","authors":"P. Macdonald","doi":"10.1136/heartasia-2019-apahff.2","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.2","url":null,"abstract":"2018 marks the 50th anniversary of heart transplantation at St Vincent’s Hospital in Sydney. The modern era of heart transplantation for our institution commenced in 1984 and since then the programme has performed >1000 heart transplants (HTx), >1000 lung transplants and almost 100 combined heart-lung transplants. Bridge-to-transplant ventricular assist device (VAD) support began in 1994 with the pulsatile Heartmate 1 device with a transition to continuous flow VADs in the mid 2000s. Current activity is 20–25 VADs, 40–50 HTx and 50–60 lung transplants per year. Over the last 3 decades, there has been an increased utilisation of marginal donors including older DBD donors and more recently DCD donors.1 The latter has been facilitated by utilisation of normothermic machine perfusion (NMP) for donor heart retrieval and transport.2 Donor hearts retrieved using NMP now account for 20% of all HTx. This proportion is expected to increase in the future. There have also been major changes in recipient characteristics with increased referral of older patients with advanced heart failure. Assessment of physical frailty together with cognition and depression are now routine for all patients referred for HTx assessment.3 4 There has also been an increased reliance on bridge-to-transplant VAD to support patients to transplantation. Despite these changing donor and recipient characteristics, post-transplant survival remains excellent with a median survival of almost 15 years. HTx remains the most effective therapy for advanced heart failure but is limited by availability of suitable donors. Improvements in donor heart preservation are expected to further increase the availability of this life-saving therapy. References Dhital K, Iyer A, Connellan M, et al. Distant procurement orthotopic heart transplant from donation after circulatory death. Lancet 2015;385:2585–2591. Macdonald PS, Chew HC, Connellan M, Dhital K. Extracorporeal heart perfusion before heart transplantation: The heart in a box. Curr Opin Organ Transplant 2016;21:336–342. Jha S, Carter D, Hannu MK, et al. Frailty as a predictor of outcomes in transplant eligible patients with advanced heart failure. Transplantation 2016;100:429–436. Jha S, Carter D, Hannu MK, et al. Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. J Heart Lung Transplant 2016;35:1092–1100.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":"A1 - A1"},"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.2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43993042","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.14
Wei-Ting Wang
Intra-aortic balloon pump (IABP), which simultaneously augments coronary blood flow and decreases myocardial oxygen demand, usually provides haemodynamic support in patients with impaired left ventricular function undergoing percutaneous coronary intervention (PCI)1 2 or for patients with established cardiogenic shock.3 Several observational studies have reported that prophylactic IABP insertion could reduce major adverse cardiovascular events (MACE) compared with a provisional counterpulsation strategy during high-risk PCI.4 However, meta-analysis did not reveal a benefit of routine elective use of IABP or percutaneous ventricular assisted device.5 Due to a lack of national data from Taiwan, this presentation therefore summarises the experience at Taipei Veterans General Hospital, and the patients’ clinical characteristics and long-term outcomes including cardiac mortality and MACE associated with high-risk PCI and/or acute myocardial infarction. References Kern MJ, Aguirre F, Bach R, Donohue T, Siegel R, Segal J. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation 1993;87:500–511. Cohen M, Urban P, Christenson JT, Joseph DL, Freedman RJ Jr, Miller MF, Ohman EM, Reddy RC, Stone GW, Ferguson JJ 3rd; Benchmark Registry Collaborators. Intra-aortic balloon counterpulsation in US and non-US centres: results of the Benchmark Registry. Eur Heart J 2003;24:1763–1770. Sjauw KD, Engstrom AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?Eur Heart J 2009;30:459–468. Mishra S, Chu WW, Torguson R, Wolfram R, Deible R, Suddath WO, Pichard AD, Satler LF, Kent KM, Waksman R. Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention. Am J Cardiol 2006;98:608–612. Lee JM, Park J, Kang J, Jeon KH, Jung JH, Lee SE, Han JK, Kim HL, Yang HM, Park KW, Kang HJ, Koo BK, Kim SH, Kim HS. The efficacy and safety of mechanical hemodynamic support in patients undergoing high-risk percutaneous coronary intervention with or without cardiogenic shock: Bayesian approach network meta-analysis of 13 randomized controlled trials. Int J Cardiol2015;184:36–46.
主动脉内球囊泵(IABP)在增加冠状动脉血流量的同时降低心肌需氧量，通常为接受经皮冠状动脉介入治疗(PCI)的左心室功能受损患者或心源性休克患者提供血流动力学支持一些观察性研究报道，与临时反搏策略相比，预防性插入IABP可以减少高危pci期间的主要不良心血管事件(MACE)。然而，荟萃分析并未显示常规选择性使用IABP或经皮心室辅助装置的益处由于缺乏台湾的全国性数据，本报告总结了台北荣民总医院的经验，以及患者的临床特征和长期预后，包括与高危PCI和/或急性心肌梗死相关的心脏死亡率和MACE。引用文献Kern MJ, Aguirre F, Bach R, Donohue T, Siegel R, Segal J.主动脉内球囊泵送对冠状动脉成形术后冠状动脉血流量的影响。发行量1993;87:500 - 511。科恩M，厄本P，克里斯滕森JT，约瑟夫DL，弗里德曼RJ Jr，米勒MF，欧曼EM，雷迪RC，斯通GW，弗格森JJ第三;基准注册表协作者。美国和非美国中心的主动脉内球囊反搏:基准登记的结果。[J] .中华医学杂志，2003;24(1):663 - 670。Sjauw KD, Engstrom AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP。st段抬高型心肌梗死主动脉内球囊泵治疗的系统回顾和荟萃分析:我们应该改变指南吗?[J] .中华医学杂志，2009;30(3):459 - 468。Mishra S, Chu WW, Torguson R, Wolfram R, Deible R, sudth WO, Pichard AD, Satler LF, Kent KM, Waksman R.经皮冠状动脉介入治疗高危患者预防性主动脉内球囊泵的作用。[J]中国生物医学工程学报，2006;22(3):391 - 391。李建民，朴健，姜健，全健，郑建辉，李世世，韩建军，金海龙，杨海明，朴光光，姜海杰，具宝康，金善，金洪生。机械血流动力学支持在高危经皮冠状动脉介入治疗伴或不伴心源性休克患者中的疗效和安全性:13项随机对照试验的贝叶斯方法网络meta分析中华心血管病杂志，2015;19(4):391 - 391。
{"title":"16 ECMO and MCS for patients undergoing PCI: experience from taipei veterans general hospital","authors":"Wei-Ting Wang","doi":"10.1136/heartasia-2019-apahff.14","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.14","url":null,"abstract":"Intra-aortic balloon pump (IABP), which simultaneously augments coronary blood flow and decreases myocardial oxygen demand, usually provides haemodynamic support in patients with impaired left ventricular function undergoing percutaneous coronary intervention (PCI)1 2 or for patients with established cardiogenic shock.3 Several observational studies have reported that prophylactic IABP insertion could reduce major adverse cardiovascular events (MACE) compared with a provisional counterpulsation strategy during high-risk PCI.4 However, meta-analysis did not reveal a benefit of routine elective use of IABP or percutaneous ventricular assisted device.5 Due to a lack of national data from Taiwan, this presentation therefore summarises the experience at Taipei Veterans General Hospital, and the patients’ clinical characteristics and long-term outcomes including cardiac mortality and MACE associated with high-risk PCI and/or acute myocardial infarction. References Kern MJ, Aguirre F, Bach R, Donohue T, Siegel R, Segal J. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation 1993;87:500–511. Cohen M, Urban P, Christenson JT, Joseph DL, Freedman RJ Jr, Miller MF, Ohman EM, Reddy RC, Stone GW, Ferguson JJ 3rd; Benchmark Registry Collaborators. Intra-aortic balloon counterpulsation in US and non-US centres: results of the Benchmark Registry. Eur Heart J 2003;24:1763–1770. Sjauw KD, Engstrom AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?Eur Heart J 2009;30:459–468. Mishra S, Chu WW, Torguson R, Wolfram R, Deible R, Suddath WO, Pichard AD, Satler LF, Kent KM, Waksman R. Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention. Am J Cardiol 2006;98:608–612. Lee JM, Park J, Kang J, Jeon KH, Jung JH, Lee SE, Han JK, Kim HL, Yang HM, Park KW, Kang HJ, Koo BK, Kim SH, Kim HS. The efficacy and safety of mechanical hemodynamic support in patients undergoing high-risk percutaneous coronary intervention with or without cardiogenic shock: Bayesian approach network meta-analysis of 13 randomized controlled trials. Int J Cardiol2015;184:36–46.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A7 - A7"},"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.14","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43296633","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.6
J. Casida
Self-management (SM) of a left ventricular assist device (LVAD) is a complex process and arduous to many patients. Thus, support from a family caregiver and a nurse is required to achieve the ultimate treatment goal for implanting an LVAD – to increase quantity and quality of life.1 A mobile phone application (VAD Care App version 1.0®) was invented to simplify the LVAD SM process and empower patient’s engagement in SM.2 The purposes of this presentation are the following: (1) illustrate the main components of the app; (2) describe the app-directed and nurse-supported LVAD SM intervention; and (3) present the results of the feasibility study as well as preliminary results of an ongoing pilot clinical trial. Future studies, app designs (versions 2.0 and 3.0), and implications for advancing the LVAD SM science will be discussed.3 Conference participants are encouraged to engage in a dialogue about the applicability of the app to other implantable devices (e.g. cardiac resynchronisation therapy) and complex conditions (e.g. pulmonary hypertension) within the context of healthcare delivery and culture in Asia. References Casida JM, Wu HS, Abshire M, Ghosh B, Yang JJ. Cognition and adherence are self-management factors predicting the quality of life of adults with a left ventricular assist device. J Heart Lung Transplant 2017;36:325–330. Casida JM, Aikens JE, Craddock H, Aldrich MW, Pagani FD. Development and feasibility of self-management application in left-ventricular assist devices. ASAIO J 2018;64:159–167. Casida J, Aikens J, Pagani F, et al. Advancing the science of self-management in adults with long-term left ventricular assist devices. Artif Organs 2018. doi:10.1111/aor.13113 [Epub ahead of print].
{"title":"6 Using mobile app to empower care and self-management in LVAD patients","authors":"J. Casida","doi":"10.1136/heartasia-2019-apahff.6","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.6","url":null,"abstract":"Self-management (SM) of a left ventricular assist device (LVAD) is a complex process and arduous to many patients. Thus, support from a family caregiver and a nurse is required to achieve the ultimate treatment goal for implanting an LVAD – to increase quantity and quality of life.1 A mobile phone application (VAD Care App version 1.0®) was invented to simplify the LVAD SM process and empower patient’s engagement in SM.2 The purposes of this presentation are the following: (1) illustrate the main components of the app; (2) describe the app-directed and nurse-supported LVAD SM intervention; and (3) present the results of the feasibility study as well as preliminary results of an ongoing pilot clinical trial. Future studies, app designs (versions 2.0 and 3.0), and implications for advancing the LVAD SM science will be discussed.3 Conference participants are encouraged to engage in a dialogue about the applicability of the app to other implantable devices (e.g. cardiac resynchronisation therapy) and complex conditions (e.g. pulmonary hypertension) within the context of healthcare delivery and culture in Asia. References Casida JM, Wu HS, Abshire M, Ghosh B, Yang JJ. Cognition and adherence are self-management factors predicting the quality of life of adults with a left ventricular assist device. J Heart Lung Transplant 2017;36:325–330. Casida JM, Aikens JE, Craddock H, Aldrich MW, Pagani FD. Development and feasibility of self-management application in left-ventricular assist devices. ASAIO J 2018;64:159–167. Casida J, Aikens J, Pagani F, et al. Advancing the science of self-management in adults with long-term left ventricular assist devices. Artif Organs 2018. doi:10.1111/aor.13113 [Epub ahead of print].","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A3 - 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.6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44894088","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.12
C. Graham
The diagnosis and emergency management of patients with shock (poor end organ perfusion with reduced tissue oxygen delivery, usually associated with systolic hypotension) is difficult even in optimum circumstances. The challenge is multiplied when patients have to be managed in overcrowded and poorly resourced emergency departments (ED). In Hong Kong, public hospital EDs manage over two million patient attendances annually, equivalent to 30% of Hong Kong’s population. Around 30% of ED patients require emergency hospital admission, with the majority being more than 80 years old. Hong Kong’s ageing population, with its associated comorbidities and polypharmacy, has inevitably contributed to rising numbers of critically ill ED patients in recent years. Shock is a major cause (and consequence) of critical illness in ED patients. Hypovolaemic shock is frequently secondary to gastrointestinal bleeding and trauma; septic shock is increasingly common due to better recognition in the ED and more patients with chronic immunosuppression. Cardiogenic shock is common, usually due to acute myocardial infarction. Optimum treatment for these patients is undoubtedly emergency revascularisation by primary percutaneous coronary intervention (PCI). Hong Kong currently does not have a regionalised or coordinated PCI service and this may contribute to the poor outcomes seen in elderly patients with cardiogenic shock. Increasingly, patients with acute on chronic heart failure often present with shock and require a coordinated specialist approach at the earliest opportunity to improve outcomes. Comprehensive collaboration between emergency medicine physicians, cardiologists, cardiothoracic surgeons and critical care services and shared clinical management are vital to optimise patient outcomes.
{"title":"12 Challenges in shock management in the emergency department","authors":"C. Graham","doi":"10.1136/HEARTASIA-2019-APAHFF.12","DOIUrl":"https://doi.org/10.1136/HEARTASIA-2019-APAHFF.12","url":null,"abstract":"The diagnosis and emergency management of patients with shock (poor end organ perfusion with reduced tissue oxygen delivery, usually associated with systolic hypotension) is difficult even in optimum circumstances. The challenge is multiplied when patients have to be managed in overcrowded and poorly resourced emergency departments (ED). In Hong Kong, public hospital EDs manage over two million patient attendances annually, equivalent to 30% of Hong Kong’s population. Around 30% of ED patients require emergency hospital admission, with the majority being more than 80 years old. Hong Kong’s ageing population, with its associated comorbidities and polypharmacy, has inevitably contributed to rising numbers of critically ill ED patients in recent years. Shock is a major cause (and consequence) of critical illness in ED patients. Hypovolaemic shock is frequently secondary to gastrointestinal bleeding and trauma; septic shock is increasingly common due to better recognition in the ED and more patients with chronic immunosuppression. Cardiogenic shock is common, usually due to acute myocardial infarction. Optimum treatment for these patients is undoubtedly emergency revascularisation by primary percutaneous coronary intervention (PCI). Hong Kong currently does not have a regionalised or coordinated PCI service and this may contribute to the poor outcomes seen in elderly patients with cardiogenic shock. Increasingly, patients with acute on chronic heart failure often present with shock and require a coordinated specialist approach at the earliest opportunity to improve outcomes. Comprehensive collaboration between emergency medicine physicians, cardiologists, cardiothoracic surgeons and critical care services and shared clinical management are vital to optimise patient outcomes.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A6 - A6"},"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.12","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48869247","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.19
G. Matsumiya
Left ventricular assist device (LVAD) has been increasingly utilised for the treatment of advanced (ACC/AHA stage D) heart failure. Three types of implantable device (HeartMate IITM, Jarvik 2000®, and EVAHEARTTM) are currently available as a bridge-to-transplant in Japan. J-MACS (Japanese registry for mechanically assisted circulatory support) has listed a total of 722 patients between December 2010 and October 2017. Mean age was 43.2 years and mean body surface area was 1.63 m2. Aetiology of heart failure was dilated cardiomyopathy in 77% and ischaemic cardiomyopathy in 11%. Pre-operative INTERMACS profile was level 1 in 10%, level 2 in 39%, level 3 in 48%, and level 4 or 5 in 4%. One hundred forty-nine (21%) patients received extracorporeal life support device first for cardiogenic shock or bridge-to-candidacy, and then underwent switch to implantable devices (bridge-to-bridge). Overall survival rate after LVAD implantation was 90% at 1 year and 86% at 2 years. Competing outcome analyses demonstrated that only 10% of patients reached heart transplantation and 60% were still on device therapy at 3 years. Causes of death were cerebrovascular accident in 44%, infection in 18%, bleeding in 6%, and device failure in 6%. Sixty-six per cent of patients required at least 1 hospital admission during an initial 1 year after device implantation. In conclusion, continuous flow LVAD was effective for bridge-to-transplant. Although the collected data indicate that the improved survival rate is acceptable, there remains potential for major complications which precludes wider application of LVAD.
{"title":"19 Update of LVAD therapy in japan","authors":"G. Matsumiya","doi":"10.1136/heartasia-2019-apahff.19","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.19","url":null,"abstract":"Left ventricular assist device (LVAD) has been increasingly utilised for the treatment of advanced (ACC/AHA stage D) heart failure. Three types of implantable device (HeartMate IITM, Jarvik 2000®, and EVAHEARTTM) are currently available as a bridge-to-transplant in Japan. J-MACS (Japanese registry for mechanically assisted circulatory support) has listed a total of 722 patients between December 2010 and October 2017. Mean age was 43.2 years and mean body surface area was 1.63 m2. Aetiology of heart failure was dilated cardiomyopathy in 77% and ischaemic cardiomyopathy in 11%. Pre-operative INTERMACS profile was level 1 in 10%, level 2 in 39%, level 3 in 48%, and level 4 or 5 in 4%. One hundred forty-nine (21%) patients received extracorporeal life support device first for cardiogenic shock or bridge-to-candidacy, and then underwent switch to implantable devices (bridge-to-bridge). Overall survival rate after LVAD implantation was 90% at 1 year and 86% at 2 years. Competing outcome analyses demonstrated that only 10% of patients reached heart transplantation and 60% were still on device therapy at 3 years. Causes of death were cerebrovascular accident in 44%, infection in 18%, bleeding in 6%, and device failure in 6%. Sixty-six per cent of patients required at least 1 hospital admission during an initial 1 year after device implantation. In conclusion, continuous flow LVAD was effective for bridge-to-transplant. Although the collected data indicate that the improved survival rate is acceptable, there remains potential for major complications which precludes wider application of LVAD.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A8 - A9"},"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.19","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46593296","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.15
C. K. Lung
Intra-aortic balloon pump (IABP) has been used for many years in high-risk PCI or cardiogenic shock. However, the support provided by IABP is limited and a major randomised controlled trial failed to demonstrate a beneficial effect.1 Impella® is a family of percutaneous mechanical circulatory support (MCS) devices that are used in protected PCI and cardiogenic shock.2 Depending on the device model, they provide a blood flow ranging from 2.5 to 5 L/min. The resulting augmented support increases mean arterial blood pressure, cardiac output and coronary flow while unloading left ventricular filling pressure to reduce myocardial oxygen demand.2 3 This is an ideal form of temporary support device for the patient. Moreover, the device is easy to set up and can be inserted very quickly to stabilise the patient. This presentation provides a review on the current data regarding the use of Impella MCS devices. References Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K; IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012;367:1287–1296. O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavík V, Popma J, Douglas PS, Ohman M. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012;126:1717–1727. O’Neill WW, Grines C, Schreiber T, Moses J, Maini B, Dixon SR, Ohman EM. Analysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device. Am Heart J 2018;202:33–38.
{"title":"15 Impella® use in protected PCI and cardiogenic shock","authors":"C. K. Lung","doi":"10.1136/heartasia-2019-apahff.15","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.15","url":null,"abstract":"Intra-aortic balloon pump (IABP) has been used for many years in high-risk PCI or cardiogenic shock. However, the support provided by IABP is limited and a major randomised controlled trial failed to demonstrate a beneficial effect.1 Impella® is a family of percutaneous mechanical circulatory support (MCS) devices that are used in protected PCI and cardiogenic shock.2 Depending on the device model, they provide a blood flow ranging from 2.5 to 5 L/min. The resulting augmented support increases mean arterial blood pressure, cardiac output and coronary flow while unloading left ventricular filling pressure to reduce myocardial oxygen demand.2 3 This is an ideal form of temporary support device for the patient. Moreover, the device is easy to set up and can be inserted very quickly to stabilise the patient. This presentation provides a review on the current data regarding the use of Impella MCS devices. References Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K; IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012;367:1287–1296. O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavík V, Popma J, Douglas PS, Ohman M. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012;126:1717–1727. O’Neill WW, Grines C, Schreiber T, Moses J, Maini B, Dixon SR, Ohman EM. Analysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device. Am Heart J 2018;202:33–38.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":"A7 - A7"},"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.15","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44677684","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.29
P. Wong
Pulmonary arterial hypertension (PAH) is a complex and devastating disease. According to a longitudinal United States-based registry, connective tissue disease (CTD) accounted for more than 50% of all patients with PAH, in which systemic sclerosis comprised the largest CTD-related PAH.1 In contrast to Western countries, systemic lupus erythematosus (SLE) is a more common CTD than systemic sclerosis in the Asia-Pacific region.2 A cohort study from China has shown that SLE, instead of systemic sclerosis, comprised the largest proportion of all CTD-related PAH.3 The prevalence of PAH in SLE is estimated at 0.5%–17.5%.4 The pathogenesis of PAH involves multiple mechanisms including vasculitis, in situ thrombosis to interstitial lung disease which may all increase pulmonary vascular resistance and lead to right heart failure. The leading risk factors for the development of PAH in SLE patients include Raynaud’s phenomenon, anti-U1 RNP antibody and anti-cardiolipin antibodies positivity. Since PAH is potentially life-threatening, early detection is crucial to improve the outcomes of this condition. Currently, the diagnostic algorithm for PAH in SLE patients follows that of international guidelines. Diagnosis is confirmed by right heart catheterisation. Treatments are similar to the therapeutic interventions for patients with idiopathic PAH. Since inflammatory and dysregulated immune components may play a major role in the pathogenesis of PAH in SLE, glucocorticoids and immunosuppressive therapies including cyclophosphamide are used, although the immunosuppressive therapy trials were small, uncontrolled studies only. Regular follow-up with prognostic evaluation and risk assessment should be performed and the treatment should be individualised accordingly. References McGoon MD, Miller DP. REVEAL: a contemporary US pulmonary arterial hypertension registry. Eur Respir Rev 2012;21:8–18. Jakes RW, Bae SC, Louthrenoo W, Mok CC, Navarra SV, Kwon N. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care Res (Hoboken) 2012;64:159–168. Zhao J, Wang Q, Liu Y, Tian Z, Guo X, Wang H, Lai J, Huang C, Yang X, Li M, Zeng X. Clinical characteristics and survival of pulmonary arterial hypertension associated with three major connective tissue diseases: A cohort study in China. Int J Cardiol 2017;236:432–437. Condliffe R, Kiely DG, Peacock AJ, Corris PA, Gibbs JS, Vrapi F, Das C, Elliot CA, Johnson M, DeSoyza J, Torpy C, Goldsmith K, Hodgkins D, Hughes RJ, Pepke-Zaba J, Coghlan JG. Connective tissue disease-associated pulmonary arterial hypertension in the modern treatment era. Am J Respir Crit Care Med 2009;179:151–157.
{"title":"29 Management of pulmonary hypertension in systemic lupus erythematosus patients","authors":"P. Wong","doi":"10.1136/heartasia-2019-apahff.29","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.29","url":null,"abstract":"Pulmonary arterial hypertension (PAH) is a complex and devastating disease. According to a longitudinal United States-based registry, connective tissue disease (CTD) accounted for more than 50% of all patients with PAH, in which systemic sclerosis comprised the largest CTD-related PAH.1 In contrast to Western countries, systemic lupus erythematosus (SLE) is a more common CTD than systemic sclerosis in the Asia-Pacific region.2 A cohort study from China has shown that SLE, instead of systemic sclerosis, comprised the largest proportion of all CTD-related PAH.3 The prevalence of PAH in SLE is estimated at 0.5%–17.5%.4 The pathogenesis of PAH involves multiple mechanisms including vasculitis, in situ thrombosis to interstitial lung disease which may all increase pulmonary vascular resistance and lead to right heart failure. The leading risk factors for the development of PAH in SLE patients include Raynaud’s phenomenon, anti-U1 RNP antibody and anti-cardiolipin antibodies positivity. Since PAH is potentially life-threatening, early detection is crucial to improve the outcomes of this condition. Currently, the diagnostic algorithm for PAH in SLE patients follows that of international guidelines. Diagnosis is confirmed by right heart catheterisation. Treatments are similar to the therapeutic interventions for patients with idiopathic PAH. Since inflammatory and dysregulated immune components may play a major role in the pathogenesis of PAH in SLE, glucocorticoids and immunosuppressive therapies including cyclophosphamide are used, although the immunosuppressive therapy trials were small, uncontrolled studies only. Regular follow-up with prognostic evaluation and risk assessment should be performed and the treatment should be individualised accordingly. References McGoon MD, Miller DP. REVEAL: a contemporary US pulmonary arterial hypertension registry. Eur Respir Rev 2012;21:8–18. Jakes RW, Bae SC, Louthrenoo W, Mok CC, Navarra SV, Kwon N. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care Res (Hoboken) 2012;64:159–168. Zhao J, Wang Q, Liu Y, Tian Z, Guo X, Wang H, Lai J, Huang C, Yang X, Li M, Zeng X. Clinical characteristics and survival of pulmonary arterial hypertension associated with three major connective tissue diseases: A cohort study in China. Int J Cardiol 2017;236:432–437. Condliffe R, Kiely DG, Peacock AJ, Corris PA, Gibbs JS, Vrapi F, Das C, Elliot CA, Johnson M, DeSoyza J, Torpy C, Goldsmith K, Hodgkins D, Hughes RJ, Pepke-Zaba J, Coghlan JG. Connective tissue disease-associated pulmonary arterial hypertension in the modern treatment era. Am J Respir Crit Care Med 2009;179:151–157.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A12 - A12"},"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.29","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43237993","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.20
C. Sivathasan
Heart transplantation was initiated in Singapore in 1990. Three to six heart transplants are performed annually. The waiting list mortality was about 30%. Hence, mechanical circulatory support was initiated with HeartMate I in 2001. Extracorporeal membrane oxygenation (ECMO) for acute life support became available by 2003. Durable implantable rotary left ventricular assist device (LVAD) with HeartMate IITM (HMII) was introduced in 2007, followed by HeartWareTM HVADTM in 2012 and HeartMate 3TM (HM3) in 2015. 90 consecutive durable implantable devices (58 HMII, 21 HVAD and 11 HM3), were placed from May 2009 to December 2017. Of these, 65 were placed as bridge-to-transplant. Overall perioperative mortality was 7 (7.7%). 26 were INTERMACS level 1 patients, bridged with ECMO without perioperative mortality. Median ICU stay and hospital stay were 8 and 31 days, respectively. Mean duration of support was 907 days. The longest support was 8.6 years. 45 had been on ongoing support, and 23 were transplanted. Late mortality occurred in 13 patients, 5 due to stroke. Driveline infection developed in 28.7%. 57.1% were associated with driveline trauma. Pocket infection developed in 5 patients. In the initial 78 patients, 17 (21.7%) experienced gastrointestinal bleeding (GIB); 11 with recurrent GIB were successfully treated with thalidomide. 6 developed aortic regurgitation, 5 underwent modified Park stitch. Implantable cardioverter defibrillator placement pre-LVAD did not confer mortality benefit. Issues with hardware occurred in 60%. Cardiac recovery occurred in 2 and their LVADs were decommissioned. Overall survival at 5 years was 84.4%, compared with INTERMACS registry data of 48%.
{"title":"20 Developing comprehensive mechanical circulatory support in singapore","authors":"C. Sivathasan","doi":"10.1136/heartasia-2019-apahff.20","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.20","url":null,"abstract":"Heart transplantation was initiated in Singapore in 1990. Three to six heart transplants are performed annually. The waiting list mortality was about 30%. Hence, mechanical circulatory support was initiated with HeartMate I in 2001. Extracorporeal membrane oxygenation (ECMO) for acute life support became available by 2003. Durable implantable rotary left ventricular assist device (LVAD) with HeartMate IITM (HMII) was introduced in 2007, followed by HeartWareTM HVADTM in 2012 and HeartMate 3TM (HM3) in 2015. 90 consecutive durable implantable devices (58 HMII, 21 HVAD and 11 HM3), were placed from May 2009 to December 2017. Of these, 65 were placed as bridge-to-transplant. Overall perioperative mortality was 7 (7.7%). 26 were INTERMACS level 1 patients, bridged with ECMO without perioperative mortality. Median ICU stay and hospital stay were 8 and 31 days, respectively. Mean duration of support was 907 days. The longest support was 8.6 years. 45 had been on ongoing support, and 23 were transplanted. Late mortality occurred in 13 patients, 5 due to stroke. Driveline infection developed in 28.7%. 57.1% were associated with driveline trauma. Pocket infection developed in 5 patients. In the initial 78 patients, 17 (21.7%) experienced gastrointestinal bleeding (GIB); 11 with recurrent GIB were successfully treated with thalidomide. 6 developed aortic regurgitation, 5 underwent modified Park stitch. Implantable cardioverter defibrillator placement pre-LVAD did not confer mortality benefit. Issues with hardware occurred in 60%. Cardiac recovery occurred in 2 and their LVADs were decommissioned. Overall survival at 5 years was 84.4%, compared with INTERMACS registry data of 48%.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":"A9 - A9"},"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.20","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48464818","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}
Objective: To investigate the effects of antithrombotic therapy on target lesion revascularisation (TLR) and major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months after femoropopliteal intervention with second-generation bare metal nitinol stents.
Methods: A total of 277 lesions in 258 limbs of 248 patients with de novo atherosclerosis in the above-the-knee femoropopliteal segment were analysed from the Japan multicentre postmarketing surveillance.
Results: At discharge, dual antiplatelet therapy (DAPT) was prescribed in 68.5% and cilostazol in 30.2% of patients. At 12 months of follow-up, prescriptions of DAPT significantly (p=0.0001) decreased to 51.2% and prescription of cilostazol remained unchanged (p=0.592) at 28.0%. Prescription of warfarin also remained unchanged (14.5% at discharge, 13.3% at 12 months, p=0.70). At 12 months, freedoms from TLR and MACCE were 89.4% and 89.7%, respectively. In a multivariate Cox proportional hazards model, neither DAPT nor cilostazol at discharge was associated with both TLR and MACCE at 12 months. However, warfarin at discharge was only independently associated with TLR at 12 months. Kaplan-Meier estimates demonstrated that warfarin at discharge yielded a significantly (p=0.013) lower freedom from TLR at 12 months than no warfarin at discharge. Freedom from TLR at 12 months by the Kaplan-Meier estimates was 77.8% (95% CI 59.0% to 88.8%) in patients with warfarin at discharge and 91.2% (95% CI 86.3% to 94.3%) in those without warfarin at discharge.
Conclusions: Clinical benefits of DAPT or cilostazol might be small in terms of TLR and MACCE at 12 months. Anticoagulation with warfarin at discharge might increase TLR at 12 months.
{"title":"Antithrombotic therapy after femoropopliteal artery stenting: 12-month results from Japan Postmarketing Surveillance.","authors":"Osami Kawarada, Michikazu Nakai, Kunihiro Nishimura, Hideki Miwa, Yusuke Iwasaki, Daitaro Kanno, Tatsuya Nakama, Yoshito Yamamoto, Nobuhiko Ogata, Masato Nakamura, Satoshi Yasuda","doi":"10.1136/heartasia-2018-011114","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011114","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of antithrombotic therapy on target lesion revascularisation (TLR) and major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months after femoropopliteal intervention with second-generation bare metal nitinol stents.</p><p><strong>Methods: </strong>A total of 277 lesions in 258 limbs of 248 patients with de novo atherosclerosis in the above-the-knee femoropopliteal segment were analysed from the Japan multicentre postmarketing surveillance.</p><p><strong>Results: </strong>At discharge, dual antiplatelet therapy (DAPT) was prescribed in 68.5% and cilostazol in 30.2% of patients. At 12 months of follow-up, prescriptions of DAPT significantly (p=0.0001) decreased to 51.2% and prescription of cilostazol remained unchanged (p=0.592) at 28.0%. Prescription of warfarin also remained unchanged (14.5% at discharge, 13.3% at 12 months, p=0.70). At 12 months, freedoms from TLR and MACCE were 89.4% and 89.7%, respectively. In a multivariate Cox proportional hazards model, neither DAPT nor cilostazol at discharge was associated with both TLR and MACCE at 12 months. However, warfarin at discharge was only independently associated with TLR at 12 months. Kaplan-Meier estimates demonstrated that warfarin at discharge yielded a significantly (p=0.013) lower freedom from TLR at 12 months than no warfarin at discharge. Freedom from TLR at 12 months by the Kaplan-Meier estimates was 77.8% (95% CI 59.0% to 88.8%) in patients with warfarin at discharge and 91.2% (95% CI 86.3% to 94.3%) in those without warfarin at discharge.</p><p><strong>Conclusions: </strong>Clinical benefits of DAPT or cilostazol might be small in terms of TLR and MACCE at 12 months. Anticoagulation with warfarin at discharge might increase TLR at 12 months.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011114"},"PeriodicalIF":0.0,"publicationDate":"2019-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37190104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：