The hemodynamic effects of aortic arch vessel (AAV) clamping during normothermic regional perfusion (NRP) in donation after circulatory death is unknown. We investigated effects of AAV clamping ...during NRP compared with no clamping in a porcine model.
In 16 pigs, hemodynamic parameters were recorded including biventricular pressure-volume measurements and invasive blood pressure. Additionally, blood gas parameters and inflammatory cytokines were used to assess the effect of AAV clamping. The animals were centrally cannulated for NRP, and baseline measurements were obtained before hypoxic circulatory arrest was induced by halting mechanical ventilation. During an 8-min asystole period, the animals were randomized to clamp (n = 8) or no-clamp (n = 8) of the AAV before commencement of NRP. During NRP, circulation was supported with norepinephrine (NE) and dobutamine. After 30 min of NRP, animals were weaned and observed for 180 min post-NRP.
All hearts were successfully reanimated and weaned from NRP. The nonclamp groups received significantly more NE to maintain a mean arterial pressure >60 mm Hg during and after NRP compared with the clamp group. There were no between group differences in blood pressure or cardiac output. Pressure-volume measurements demonstrated preserved cardiac function' including ejection fraction and diastolic and systolic function. No between group differences in inflammatory markers were observed.
AAV clamping did not negatively affect donor cardiac function or inflammation after circulatory death and NRP. Significantly less NE was used to support in the clamp group than in the nonclamp group.
Heart transplantation in donation after circulatory death (DCD) relies on warm perfusion using either in situ normothermic regional perfusion (NRP) or ex situ normothermic machine perfusion. In this ...study, we explore an alternative: oxygenated hypothermic machine perfusion (HMP) using a novel clinically applicable perfusion system, which is compared to NRP with static cold storage (SCS).
In a porcine model, a DCD setting was simulated, followed by either (1) NRP and SCS (2) NRP and HMP with the XVIVO Heart preservation system or (3) direct procurement (DPP) and HMP. After preservation, heart transplantation (HTX) was performed. After weaning from cardiopulmonary bypass (CPB), biventricular function was assessed by admittance and Swan-Ganz catheters.
Only transplanted hearts in the HMP groups showed significantly increased biventricular contractility (end-systole elastance) 2 hour post-CPB (left ventricle absolute change: NRP HMP: +1.8 ± 0.56, p = 0.047, DPP HMP: +1.5 ± 0.43, p = 0.045 and NRP SCS: +0.97 ± 0.47 mmHg/ml, p = 0.21; right ventricle absolute change: NRP HMP: +0.50 ± 0.12, p = 0.025, DPP HMP: +0.82 ± 0.23, p = 0.039 and NRP SCS: +0.28 ± 0.26, p = 0.52) while receiving significantly less dobutamine to maintain a cardiac output >4l/min compared to SCS. Diastolic function was preserved in all groups. Post-HTX, both HMP groups showed significantly less increments in plasma troponin T compared to SCS.
In DCD HTX, increased biventricular contractility post-HTX was only observed in hearts preserved with HMP. In addition, the need for inotropic support and signs of myocardial damage were lower in the HMP groups. DCD HTX can be successfully performed using DPP followed by preservation with HMP in a preclinical setting.
We present the successful treatment of a large solid right atrial thrombus by the catheter-based suction embolectomy system AngioVac® (AngioDynamics, NY, USA). A previously healthy 60-year-old male ...was referred with acute pulmonary embolism, a large deep vein thrombus and a large right atrial thrombus. After one week of anticoagulation, the size of the atrial thrombus was unaltered, and the patient was treated by catheter-directed embolectomy using the AngioVac system. The solid thrombus occluded the catheter during the procedure. With the vacuum maintained, the occluded catheter was removed from the patient and the thrombus mass was removed. The remaining atrial thrombus was successfully removed by suction after the reinsertion of the catheter. The patient recovered well and was discharged 7 days after the procedure. The therapy was safe and minimally invasive.
Abstract
Objectives. The Heart Transplantation Center, Aarhus University Hospital, Skejby, now has 20 years' experience with heart transplantation (HTX). This study aims to evaluate long-term outcome ...after HTX including incidences of cancer and severe renal dysfunction. Design. Outcomes were reviewed using the transplant database of our department, the Scandiatransplant database, hospital medical records, and national database of biopsies. Results. From December 31, 1992 to February 27, 2013, a total of 258 patients underwent index HTX. Survival for the whole patient cohort at 1 month and 1 year was 95% and 88%. Long-term survival estimates of 5, 10, 15, and 20 years were 80%, 70%, 55%, and 40%, respectively. Median survival time was 15.6 years. Significant improvement in survival was observed from the 1992-1998 vs. 1999-2005 era and the 1992-1998 vs. the 2006-2012 era. Three patients (1%) underwent renal transplantation, and 29 patients (11%) developed severe renal dysfunction requiring dialysis. Sixty-four (25%) patients developed cancer, with skin cancer being most common. Conclusion. HTX is an excellent treatment for selected patients with end-stage heart failure. The prognosis has improved in the latest transplantation eras. With balanced immunosuppressive treatment, severe renal dysfunction and cancer can be limited to an acceptable level.
Chronic thromboembolic pulmonary hypertension (CTEPH) is an important differential diagnosis in patients with unexplained dyspnoea. CTEPH is under-recognized and carries a poor prognosis without ...treatment. Surgical pulmonary endarterectomy is the preferred treatment for the majority of patients. Advances in surgical and anaesthetic techniques and post-operative intensive treatment have reduced perioperative morbidity and mortality. Pulmonary endarterectomy results in major improvement of haemodynamics and clinical status and offers excellent long-term survival. It is most often a curative treatment. The surgical treatment of CTEPH in Denmark is centralized at Aarhus University Hospital. Pulmonary vasodilators and pulmonary balloon angioplasty are supplementary treatment options in this patient group.
A 46-year-old, healthy woman with sudden hemiplegia and nausea suffered cardiac arrest during transport to the hospital. This was treated en route with LUCAS-2. A computed tomography ruled out ...cerebral haemorrhage, and an electricardiogramme showed inferior myocardial infarction. During percutaneous intervention the patient had another cardiac arrest. Despite revascularization she was very unstable and received more than 20 cardioversions of ventricular fibrillation. In the catheterization laboratory, the patient was connected to a heart lung machine (extracorporeal membrane oxygenation) while treated with LUCAS-2. After two months of hospitalization, the patient was able to walk and had minor cognitive impairment.
On 1st March 1994, a passenger train with a speed of 85 km/h ran into the rear end of a stopped passenger train north of Aarhus, Denmark. No fatalities occurred. Questionnaires were sent to ...passengers and crew and 113 of 128 (88%) answered. In the stopped train 32% (9/28) of the sitting passengers compared with 12% (9/76) in the moving train had symptons corresponding to a whiplash lesion. Only the chairs in the moving train had head rests which might explain the observed difference. In the rest section of the moving train with all seats facing the same direction 81% (13/16) of the sitting passengers had face injuries compared to 13% (8/60) in the rest of the train. The higher incidence in the rest section was caused by folding tables at the back of the seats. Serious thoraco-abdominal injuries were only seen in one patient despite the fact that 37 passengers were thrown againsts tables between the seats in the second class section of the moving train. The tables were fragile and usually gave way. In conclusion, carriage interior has a major influence on personal injuries at railway accidents.
Two-hundred-and-twenty-nine men aged between 80 and 97 years (mean 83 years) underwent transurethral prostatectomy (TUR-P) for lower urinary tract symptoms (LUTS). All case records were reviewed. The ...follow-up period was 6-16 years. One-hundred-and-seven patients underwent operation because of acute urinary retention, and 122 because of chronic retention. The mean weight of tissue removed was 20 g (1-200 g). The perioperative mortality (< 1 month) was 2% (5 patients). Postoperative complications occurred in 21% (49 patients). Reoperation was performed in 11% (26 cases). The result was considered satisfactory in 196 patients (86%). The present data demonstrate that transurethral resection of the prostate in men over 80 years has a good outcome with an acceptable urological complication rate and mortality, and we therefore advocate surgery instead of watchful waiting in the fit patient.
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