scholarly journals Intraventricular placement of a spring expander does not attenuate cardiac atrophy of the healthy heart induced by unloading via heterotopic heart transplantation

2019 ◽  
pp. 567-580 ◽  
Author(s):  
J. Pokorný ◽  
I. Mrázová ◽  
H. Kubátová ◽  
J. Piťha ◽  
J. Malý ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Heart Weight ◽  
Assist Device ◽  
Therapeutic Measure ◽  
Time Points ◽  
Cardiac Atrophy ◽  
Heterotopic Heart Transplantation ◽  
Important Complication ◽  
Patients With Heart Failure

An important complication of the prolonged left ventricle assist device support in patients with heart failure is unloading-induced cardiac atrophy which proved resistant to various treatments. Heterotopic heart transplantation (HTx) is the usual experimental model to study this process. We showed previously that implantation of the newly designed intraventricular spring expander can attenuate the atrophy when examined after HTx in the failing heart (derived from animals with established heart failure). The present study aimed to examine if enhanced isovolumic loading achieved by implantation of the expander would attenuate cardiac post-HTx atrophy also in the healthy heart. Cardiac atrophy was assessed as the ratio of the transplanted-to-native heart weight (HW) and its degree was determined on days 7, 14, 21 and 28 after HTx. The transplantation resulted in 32±3, 46±2, 48±3 and 46±3 % HW loss when measured at the four time points; implantation of the expander had no significant effect on these decreases. We conclude that enhanced isovolumic loading achieved by intraventricular implantation of the expander does not attenuate the development of cardiac atrophy after HTx in the healthy heart. This indicates that such an approach does not represent a useful therapeutic measure to attenuate the development of unloading-induced cardiac atrophy.

scholarly journals Isovolumic loading of the failing heart by intraventricular placement of a spring expander attenuates cardiac atrophy after heterotopic heart transplantation

2018 ◽  
Vol 38 (3) ◽  
Author(s):  
Martin Pokorný ◽  
Iveta Mrázová ◽  
Jan Šochman ◽  
Vojtěch Melenovský ◽  
Jiří Malý ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Weight Ratio ◽  
Volume Overload ◽  
Advanced Heart Failure ◽  
Common Complication ◽  
Assist Device ◽  
Time Points ◽  
Cardiac Atrophy ◽  
Heterotopic Heart Transplantation ◽  
Control Heart

Cardiac atrophy is the most common complication of prolonged application of the left ventricle (LV) assist device (LVAD) in patients with advanced heart failure (HF). Our aim was to evaluate the course of unloading-induced cardiac atrophy in rats with failing hearts, and to examine if increased isovolumic loading obtained by intraventricular implantation of an especially designed spring expander would attenuate this process. Heterotopic abdominal heart transplantation (HTx) was used as a rat model of heart unloading. HF was induced by volume overload achieved by creation of the aorto-caval fistula (ACF). The degree of cardiac atrophy was assessed as the weight ratio of the heterotopically transplanted heart (HW) to the control heart. Isovolumic loading was increased by intraventricular implantation of a stainless steel three-branch spring expander. The course of cardiac atrophy was evaluated on days 7, 14, 21, and 28 after HTx. Seven days unloading by HTx in failing hearts sufficed to substantially decrease the HW (−59 ± 3%), the decrease progressed when measured on days 14, 21, and 28 after HTx. Implantation of the spring expander significantly reduced the decreases in whole HW at all the time points (−39 ± 3 compared with −59 ± 3, −52 ± 2 compared with −69 ± 3, −51 ± 2 compared with –71 ± 2, and −44 ± 2 compared with −71 ± 3%, respectively; P<0.05 in each case). We conclude that the enhanced isovolumic heart loading obtained by implantation of the spring expander attenuates the development of unloading-induced cardiac atrophy in the failing rat heart.

scholarly journals Pediatric Palliative Care in the Heart Failure, Ventricular Assist Device and Transplant Populations: Supporting Patients, Families and Their Clinical Teams

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 468
Author(s):  
Kyle D. Hope ◽  
Priya N. Bhat ◽  
William J. Dreyer ◽  
Barbara A. Elias ◽  
Jaime L. Jump ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Heart Transplantation ◽  
Ventricular Assist Device ◽  
Mechanical Circulatory Support ◽  
Pediatric Palliative Care ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Patients With Heart Failure

Heart failure is a life-changing diagnosis for a child and their family. Pediatric patients with heart failure experience significant morbidity and frequent hospitalizations, and many require advanced therapies such as mechanical circulatory support and/or heart transplantation. Pediatric palliative care is an integral resource for the care of patients with heart failure along its continuum. This includes support during the grief of a new diagnosis in a child critically ill with decompensated heart failure, discussion of goals of care and the complexities of mechanical circulatory support, the pensive wait for heart transplantation, and symptom management and psychosocial support throughout the journey. In this article, we discuss the scope of pediatric palliative care in the realm of pediatric heart failure, ventricular assist device (VAD) support, and heart transplantation. We review the limited, albeit growing, literature in this field, with an added focus on difficult conversation and decision support surrounding re-transplantation, HF in young adults with congenital heart disease, the possibility of destination therapy VAD, and the grimmest decision of VAD de-activation.

scholarly journals Value of SERCA2a as a Biomarker for the Identification of Patients with Heart Failure Requiring Circulatory Support

2021 ◽  
Vol 11 (11) ◽  
pp. 1122
Author(s):  
Meryem Ezzitouny ◽  
Esther Roselló-Lletí ◽  
Manuel Portolés ◽  
Ignacio Sánchez-Lázaro ◽  
Miguel Ángel Arnau-Vives ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sarcoplasmic Reticulum ◽  
Heart Transplantation ◽  
Predictive Value ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Bridge To Recovery ◽  
Blood Samples ◽  
Cytoplasmic Transport ◽  
Patients With Heart Failure

Background: Heart failure (HF) alters the nucleo-cytoplasmic transport of cardiomyocytes and reduces SERCA2a levels, essential for intracellular calcium homeostasis. We consider in this study whether the molecules involved in these processes can differentiate those patients with advanced HF and the need for mechanical circulatory support (MCS) as a bridge to recovery or urgent heart transplantation from those who are clinically stable and who are transplanted in an elective code. Material and method: Blood samples from 29 patients with advanced HF were analysed by ELISA, and the plasma levels of Importin5, Nucleoporin153 kDa, RanGTPase-Activating Protein 1 and sarcoplasmic reticulum Ca2+ ATPase were compared between patients requiring MCS and those patients without a MCS need prior to heart transplantation. Results: SERCA2a showed significantly lower levels in patients who had MCS compared to those who did not require it (0.501 ± 0.530 ng/mL vs. 1.123 ± 0.661 ng/mL; p = 0.01). A SERCA2a cut-off point of 0.84 ng/mL (AUC 0.812 ± 0.085, 95% CI: 0.646–0.979; p = 0.004) provided a 92% sensitivity, 62% specificity, 91% negative predictive value and 67% positive predictive value. Conclusions: In this cohort, patients with advanced HF and a need for MCS have shown significantly lower levels of SERCA2a as compared to stable patients without a need for MCS prior to heart transplantation. This is a small study with preliminary findings, and larger-powered dedicated studies are required to confirm and validate these results.

Risk Factors Associated With Peripheral Neuropathy in Heart Failure Patients Candidates for Transplantation

2018 ◽  
Vol 28 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Chiara Minà ◽  
Sergio Bagnato ◽  
Antonino Sant’Angelo ◽  
Calogero Falletta ◽  
Gabriele Di Gesaro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peripheral Neuropathy ◽  
Heart Transplantation ◽  
Clinical History ◽  
Cardiac Care ◽  
Factors Associated ◽  
Needle Electromyography ◽  
Patients With Heart Failure ◽  
Rehabilitation Strategy

Introduction: Peripheral neuropathy can affect patients with heart failure, though its prevalence is unknown. After heart transplantation, it can influence the postoperative course and quality of life, but screening for neuromuscular disease is not routinely performed. Objective: The aim of this study was to identify the factors associated with neuropathy in a population of patients with heart failure who are candidates for heart transplantation. Study Design: Data regarding patients’ clinical history, including recent hospitalizations, were collected. All patients underwent a complete neurological examination and a neurophysiological protocol including nerve conduction studies and concentric needle electromyography. Results: Thirty-two patients were included in the study, and neuropathy was diagnosed in 10 (31.3%). Neuropathy was associated with the number of admissions ( P = .023; odds ratio [OR]: 1.96) and the total number of days of hospitalization in the year prior to inclusion in the study ( P = .010; OR: 1.03). The majority of hospitalizations occurred in the step-down unit (85%), with acute heart failure the leading cause of admission (42%). Conclusions: This study shows that neuropathy is frequent in patients with advanced heart failure and that hospitalization for cardiac care, also in the absence of intensive care, is a marker of high risk of neurologic damage. These data can help physicians in selecting and managing candidates for transplantation and can guide decisions on the best immunosuppressive regimen or rehabilitation strategy.

scholarly journals Left ventricular assist device: which emotional impact on the patient?

2015 ◽  
Vol 82 (2) ◽  
Author(s):  
Gianluigi Balestroni ◽  
Giovanna Omarini ◽  
Pierangela Omarini ◽  
Massimo Pistono ◽  
Ugo Corrà ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Emotional Impact ◽  
Published Data ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background: Advanced heart failure is a challenging disease; the implantable Left Ventricular Assist Device (L-VAD) is becoming a good chance for relieving symptoms and prolong survival in most CHF patients. The emotional impact of L-VAD implantation is thought to be high but, at present, published data are scant about that. Aim of this study was to evaluate the modifications of perceived quality of life (QoL) in a group of patients recently treated with L-VAD implantation, admitted to a residential cardiac rehabilitation program, and to compare the results to those obtained in patients awaiting heart transplantation and recently transplanted. Material and Method: We enrolled 66 patients (pts) with a recent implant of L-VAD, 51 with refractory heart failure awaiting heart transplantation (HT) and 55 recently treated with HT. On day two after admission, all patients underwent a complete psychometric assessment consisting in the compilation of: – Minnesota Living with Heart Failure Questionnaire (MLHFQ) – Beck Anxiety Inventory (BAI) – Beck Depression Inventory-II (BDI - II) Results: L-VAD recipients had significantly higher scores at MLHFQ. Both the total score and the 2 subscales scores (respectively physical and emotional disturbances) were statistically significant when compared with posttransplant patients. Post- transplant pts had the lowest scores regarding anxiety symptoms, while the bearers of device had the highest ones. The same results were obtained for depression scores (BDI - II), both in total score and in the subscales (somatic symptoms and affective symptoms). Conclusions: With an opening scoring, this study showed the development of more relevant psychological troubles in patients treated with L-VAD when compared to those awaiting for heart transplantation and those transplanted.

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