scholarly journals The Impact of Renal Dysfunction in Mechanical Circulatory Support Device Patients on Post-Heart Transplant Outcomes

2021 ◽  
Vol 40 (4) ◽  
pp. S429-S430
Author(s):  
J. Patel ◽  
M. Kittleson ◽  
R. Cole ◽  
N. Patel ◽  
T. Singer-Englar ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Heart Transplant ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Transplant Outcomes ◽  
Support Device ◽  
Mechanical Circulatory Support Device ◽  
The Impact ◽  
Circulatory Support Device

scholarly journals 174. Temporizing Surgical Measures for Deep Mechanical Circulatory Support Device Infections: Case Series Report

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S110-S110
Author(s):  
Armita Kabirpour ◽  
Daniel G Tang ◽  
Oveimar De laCruz
Keyword(s):  
Heart Transplant ◽  
Mechanical Circulatory Support ◽  
Klebsiella Oxytoca ◽  
Case Series ◽  
Circulatory Support ◽  
Bridge To Transplant ◽  
Surgical Measures ◽  
Support Device ◽  
Mechanical Circulatory Support Device ◽  
Circulatory Support Device

Abstract Background Durable mechanical circulatory support device (MCSD) use continues to grow. MCSD deep-seated infections are a serious complication. Removal of the infected hardware is not always possible. Methods Single institution retrospective review of all culture-proven deep MCSD infection (pump and/or driveline) from 2009–2019. Patients were managed with intravenous (IV) and oral (PO) antibiotics; definitive surgical interventions included incision and drainage (I&D), device replacement, and heart transplant; and temporizing surgical measures were chronic chest tube (CCT) drainage for pump pocket and mediastinum and antibiotic impregnated bead implantation for driveline infection. Outcomes were analyzed. Results Total of 29 patients identified, 23 (79%) were male. Median age at device implantation was 44 years (20–68). MCSD were 18 (62%) destination therapy and 11 (38%) bridge to transplant. MCSD included 1 Heartmate I, 17 Heartmate II, 1 Heartmate III, 4 Heartware HVAD, and 6 Syncardia TAH. The median time to infection of 258 days (43–1551), affecting pump in 8 (28%), pump + driveline in 13 (44%), and driveline in 8 (28%). Microorganisms were S. aureus in 17 (60%, MRSA 11 and MSSA 6); coag-negative staphylococci in 3 (10%); Viridans streptococci in 1; Serratia marcescens in 3; P. aeruginosa in 2; Klebsiella oxytoca in 1; Mycobacterium abscessus in 1 and C. albicans in 1. Antibiotics are given to 28 patients, 23 (80%) with initial IV for a median of 6 weeks (1–14) and 5 (17%) with initial PO, for a median of 7 weeks (2–20). Nineteen patients (83%) on IV received PO antibiotics after. 17 patients (61%) remained on chronic suppression antibiotics (13 PO, 2 IV, 2 PO and IV). Twenty-six (90%) patients had I&D, 6 (21%) had device replacement and 11 (38%) had transplant. Of 21 patients with pump infection 16 (76%) had CCT drainage of pump pocket site or mediastinum for a median of 116 days (range 10–887 days). Of 21 patients with driveline infections, 6 (29%) had antibiotic impregnated bead implants. Overall survival at 90 days was 28/29 (95%) and 24/29 (83%) at 1 year. Infection-related mortality in Table 1. Conclusion Deep MCSD infection remains a challenging clinical problem. CCT drainage (for pump) and antibiotic-impregnated bead implant (for driveline) may be temporizing options for patients unable to undergo timely device replacement or heart transplant. Disclosures All authors: No reported disclosures.

scholarly journals Unusual Pathology in a Kidney from a Heart-Transplant Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Marie Larcher ◽  
Audey Delas ◽  
Clément Delmas ◽  
Olivier Cointault ◽  
Camille Dambrin ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
Mechanical Circulatory Support ◽  
Transplant Patient ◽  
Circulatory Support ◽  
Heart Transplant Patient ◽  
Tubular Necrosis ◽  
Support Device ◽  
Mechanical Circulatory Support Device ◽  
Circulatory Support Device

Acute kidney injury (AKI) is often observed after heart transplantation. In this setting, acute tubular necrosis is the main histological finding on kidneys. We report the unusual pathology found in a kidney from a heart-transplant patient. The patient experienced several hemodynamic insults, massive transfusion, and implantation of a mechanical circulatory-support device before heart transplantation: there was prolonged AKI after transplantation. A kidney biopsy revealed acute tubular necrosis and renal hemosiderosis, which was probably related to the transfusion and to mechanical circulatory-support device-induced intravascular hemolysis. Assessment of iron during resuscitation could have prevented, at least partly, AKI.

scholarly journals Inhaled nitric oxide preserves ventricular function during resuscitation using a percutaneous mechanical circulatory support device in a porcine cardiac arrest model: an echocardiographic myocardial work analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christoph Nix ◽  
Rashad Zayat ◽  
Andreas Ebeling ◽  
Andreas Goetzenich ◽  
Uma Chandrasekaran ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Cardiac Arrest ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Inhaled Nitric Oxide ◽  
Circulatory Support ◽  
Support Device ◽  
Mechanical Circulatory Support Device ◽  
Rv Function ◽  
Circulatory Support Device

Abstract Background Resuscitation using a percutaneous mechanical circulatory support device (iCPR) improves survival after cardiac arrest (CA). We hypothesized that the addition of inhaled nitric oxide (iNO) during iCPR might prove synergistic, leading to improved myocardial performance due to lowering of right ventricular (RV) afterload, left ventricular (LV) preload, and myocardial energetics. This study aimed to characterize the changes in LV and RV function and global myocardial work indices (GWI) following iCPR, both with and without iNO, using 2-D transesophageal echocardiography (TEE) and GWI evaluation as a novel non-invasive measurement. Methods In 10 pigs, iCPR was initiated following electrically-induced CA and 10 min of untreated ventricular fibrillation (VF). Pigs were randomized to either 20 ppm (20 ppm, n = 5) or 0 ppm (0 ppm, n = 5) of iNO in addition to therapeutic hypothermia for 5 h following ROSC. All animals received TEE at five pre-specified time-points and invasive hemodynamic monitoring. Results LV end-diastolic volume (LVEDV) increased significantly in both groups following CA. iCPR alone led to significant LV unloading at 5 h post-ROSC with LVEDV values reaching baseline values in both groups (20 ppm: 68.2 ± 2.7 vs. 70.8 ± 6.1 mL, p = 0.486; 0 ppm: 70.8 ± 1.3 vs. 72.3 ± 4.2 mL, p = 0.813, respectively). LV global longitudinal strain (GLS) increased in both groups following CA. LV-GLS recovered significantly better in the 20 ppm group at 5 h post-ROSC (20 ppm: − 18 ± 3% vs. 0 ppm: − 13 ± 2%, p = 0.025). LV-GWI decreased in both groups after CA with no difference between the groups. Within 0 ppm group, LV-GWI decreased significantly at 5 h post-ROSC compared to baseline (1,125 ± 214 vs. 1,835 ± 305 mmHg%, p = 0.011). RV-GWI was higher in the 20 ppm group at 3 h and 5 h post-ROSC (20 ppm: 189 ± 43 vs. 0 ppm: 108 ± 22 mmHg%, p = 0.049 and 20 ppm: 261 ± 54 vs. 0 ppm: 152 ± 42 mmHg%, p = 0.041). The blood flow calculated by the Impella controller following iCPR initiation correlated well with the pulsed-wave Doppler (PWD) derived pulmonary flow (PWD vs. controller: 1.8 ± 0.2 vs. 1.9 ± 0.2L/min, r = 0.85, p = 0.012). Conclusions iCPR after CA provided sufficient unloading and preservation of the LV systolic function by improving LV-GWI recovery. The addition of iNO to iCPR enabled better preservation of the RV-function as determined by better RV-GWI. Additionally, Impella-derived flow provided an accurate measure of total flow during iCPR.

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