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Recipient Anemia during Cardiopulmonary Bypass is the Risk Factor of Primary Graft Failure in Heart Transplantation
S208 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 EP10-1
EP10-4
The Effect of Continuous Flow Left Ventricular Assist Device on Sleep Quality in Patients with Advanced Heart Failure Kei Nakamoto1, Tomohito Ohtani1, Yasumasa Tsukamoto1, Hidetaka Kioka1, Fusako Sera1, Kenji Nakamura1, Osamu Yamaguchi1, Koichi Toda2, Yoshiki Sawa2, Yasushi Sakata1; 1Department of Cardiovascular Medicine Osaka University Graduate School of Medicine, Suita, Japan; 2Department of Cardiovascular Surgery Osaka University Graduate School of Medicine, Suita, Japan
The Proportion and Outcome of Candidates for Heart Transplantation and Left Ventricular Assist Devices in Chronic Heart Failure Takamasa Sato, Akiomi Yoshihisa, Yasuchika Takeishi; The Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
Background: Although poor sleep quality as well as sleep-disordered breathing is sometimes observed in patients with advanced heart failure (HF), it has not been well investigated. The aims of this study are to examine sleep quality in HF patients and to analyze the association between sleep quality and the treatment with continuous flow left ventricular assist device (cf-LVAD) which can improve deteriorated circulation. Method: Of the hospitalized patients in Osaka University Hospital, 6 patients who were received cf-LVAD implantation and 41 HF patients (<65 year-old) without cf-LVAD treatment were studied. With polysomnography at stable HF condition, poor sleep quality was defined as sleep efficiency under average -1SD of Japanese healthy population. Results: Poor sleep quality was observed in 61% of patients without cf-LVAD and in a half of cf-LVAD patients before implantation. In cf-LVAD patients with poor sleep quality, their total sleep time and sleep efficiency were significantly improved after implantation (from 317 ± 45 min to 415p < 57 min P < .01, from 69 ± 7% to 90 ± 5%, P < .01, respectively), whereas these indices in cf-LVAD patients without poor sleep quality were preserved (from 410 ± 37 min to 442 ± 92 min P = .11, from 92 ± 4% to 92 ± 3%, P = .68, respectively). Conclusion: Poor sleep quality is present in about half of HF patients, and it was improved with cf-LVAD treatment.
Background: Implantable ventricular assist devices (iVADs) have been approved as a bridge to heart transplantation (HTx) in Japan. Methods: We retrospectively investigated the proportion and outcome of consecutive 1058 patients with chronic heart failure (CHF) who underwent cardiopulmonary exercise testing from July 2007 to March 2015 in our hospital. Results: Out of 522 CHF patients less than 65 years, 89 patients had peak VO2 < 14 ml/kg/min or % predicted peak VO2 < 50% in order to be listed for HTx. Of 89 cases, 38 had contraindication for HTx and 51 had nocontraindication. Kaplan- Meier Analysis demonstrated that they had 1, 3 and 5 years survival rates of 78.8%, 53.4% and 30.8%. Conclusion: Patients with lower exercise capacity had poor prognosis, and we should consider appropriate management for iVADs and HTx.
EP10-2 An Approach to Improve Prognosis after LVAD Implantation by Earlier Evaluation of Transplant Eligibility in Patients with Advanced Heart Failure Togo Iwahana1, Sho Okada1, Osamu Hashimoto1, Goro Matsumiya2, Yoshio Kobayashi1; 1 Department of Cardiovascular Medicine Chiba University Graduate School of Medicine, Chiba, Japan; 2Department of Cardiovascular Surgery Chiba University Graduate School of Medicine, Chiba, Japan In patients with advanced heart failure (HF), emergent introduction of extracorporeal Ventricular Assist Devices (VADs) against hemodynamic collapse was indicative of poor prognosis. To achieve safe introduction of implantable LVAD and improve clinical outcome, we established two systems since September 2014. First, we cooperated with the hospitals in Chiba Prefecture and recruited the potentially eligible patients with advanced HF as early as possible. This system, minimizing the delay in transfer and eligibility assessment, would avoid extracorporeal VADs and enable rapid and direct introduction of implantable LVAD. Second, the HF cardiologists took charge of almost all of these patients for evaluation and preoperative care. Since April 2008, we experienced 28 cases of VAD implantation, and 16 patients with implantable LVAD are now waiting for heart transplantation. After establishment of the system, more patients were introduced from the allied hospitals as compared to the pre-established period. The rate of direct introduction of implantable LVAD significantly increased (71% vs 21%, P = .008), and the mean length of stay markedly shortened (61 days vs 101 days, P = .031). Event-free survival also tended to improve. In conclusion, early recruitment and rapid assessment of potentially eligible HF patients, along with the improvement of postoperative care, rehabilitation and device training program, contributed to the favorable clinical outcome after implantable LVAD operation.
EP10-3 Recipient Anemia during Cardiopulmonary Bypass is the Risk Factor of Primary Graft Failure in Heart Transplantation Yuki Nakamura, Koichi Toda, Teruya Nakamura, Shigeru Miyagawa, Satsuki Fukushima, Shunsuke Saito, Keitaro Domae, Kaoru Kubota, Yoshiki Sawa; The Department of Cardiovascular Surgery, Osaka University, Osaka, Japan Purpose: Primary graft failure (PGF) is a devastating complication of heart transplantation (HTx). Although the systemic inflammatory response in recipient is one of the scenario of PGF, its mechanism is poorly understood. The aim of this study is to elucidate a recipient risk factor of PGF associated with systemic inflammation. Method: Fifty-seven consecutive patients undergoing adult HTx between 2007 and 2016 at our hospital were reviewed retrospectively. Perioperative Interleukin (IL)-6 was measured. We defined PGF according to the severity scale of PGF defined at The International Society of Heart Lung Transplantation consensus meeting in 2014. Cytokine levels and perioperative recipient factors were compared between patients with PGF and without PGF. ResultOf 58 patients, 14 (24.1%) developed moderate to severe PGF. Patients with PGF had significantly higher levels of IL-6 (1262 ± 3422 pg/ml vs. 177 ± 260 pg/ ml; P = .04) especially before the reperfusion of transplanted hearts. In patients with PGF, Hemoglobin (Hb) level at the time of reperfusion was significantly lower than that in patients without PGF (7.8 ± 1.2 mg/dl vs. 9.3 ± 1.1 mg/dl; P < .0001). Only Hb level had significant correlation with IL-6 level before reperfusion (r = -0.618, P = .0206). ConclusionRecipient anemia during the cardiopulmonary bypass, which might cause systemic inflammation, is one of RRFs of PGF.
EP10-6 Heart Transplantation in Korea: 20 Years of Experience Jin-Oh Choi1, Jin-Oh Choi1, Min-Seok Oh1, Ga Yeon Lee1, Seok-Min Kang2, Jae-Joong Kim3, Hyun-Jai Cho4, Eun Seok Jeon1; 1Sungkyunkwan University School of Medicine, Samsung Medical Center; 2Yonsei University College of Medicine; 3Asan Medical Center, University of Ulsan College of Medicine; 4Seoul National University Hospital, Seoul, Republic of Korea Background: Heart transplantation (HTx) has become the gold standard treatment option for end-stage heart failure. After first HTx in Korea in 1992, annual count of operation has been increasing. More than 100 patients pre year were salvaged with HTx in 2010’s in Korea. We sought to provide 20-year experiences of HTx in Korea. Methods: From January 1992 to December 2012, 742 patients were undergone orthotopic HTx. Patients with multiorgan transplantation were excluded. Medical records were reviewed retrospectively. Results: HTx had been performed in 10 institutes. Mean age of recipients was 42.9 ± 16.8 years and 72.6% were men. Gender-matched transplantation was proceded in 75.0%. Leading indication for HTx was dilated cardiomyopathy (60.6%). Short-term mortality (within 1 month) was 4.5% (n = 32) and infection was the most common cause of death (50% of all-cause death, n = 16). After 1-, 5-, 10years of follow-up, overall survival rates were 87.3%, 78.2%, and 74.8%, respectively. Rejection-free survival rates were 71.0%, 66.3%, and 65.2%, and malignancy-free survival rates were 99.1%, 97.7%, and 96.9%. Chronic allograft vasculopathy was occurred in 10 patients. After 2003, rejection rate was lower than that of before 2003 (P < .001), but all-cause mortality (P = .10) and malignancy-free survival rate (P = .58) was not statistically remarkable. High volume center (yearly 20 cases or more) showed better clinical outcome (P = .002). Conclusion: With upgrading of procedural techniques and postoperative care including immunosuppressant therapy, outcome of heart transplantation has been improving and actuarial survival after HTx were similar or even better than those reported by the International Society of Heart and Lung Transplantation.
EP10-4
The Effect of Continuous Flow Left Ventricular Assist Device on Sleep Quality in Patients with Advanced Heart Failure Kei Nakamoto1, Tomohito Ohtani1, Yasumasa Tsukamoto1, Hidetaka Kioka1, Fusako Sera1, Kenji Nakamura1, Osamu Yamaguchi1, Koichi Toda2, Yoshiki Sawa2, Yasushi Sakata1; 1Department of Cardiovascular Medicine Osaka University Graduate School of Medicine, Suita, Japan; 2Department of Cardiovascular Surgery Osaka University Graduate School of Medicine, Suita, Japan
The Proportion and Outcome of Candidates for Heart Transplantation and Left Ventricular Assist Devices in Chronic Heart Failure Takamasa Sato, Akiomi Yoshihisa, Yasuchika Takeishi; The Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
Background: Although poor sleep quality as well as sleep-disordered breathing is sometimes observed in patients with advanced heart failure (HF), it has not been well investigated. The aims of this study are to examine sleep quality in HF patients and to analyze the association between sleep quality and the treatment with continuous flow left ventricular assist device (cf-LVAD) which can improve deteriorated circulation. Method: Of the hospitalized patients in Osaka University Hospital, 6 patients who were received cf-LVAD implantation and 41 HF patients (<65 year-old) without cf-LVAD treatment were studied. With polysomnography at stable HF condition, poor sleep quality was defined as sleep efficiency under average -1SD of Japanese healthy population. Results: Poor sleep quality was observed in 61% of patients without cf-LVAD and in a half of cf-LVAD patients before implantation. In cf-LVAD patients with poor sleep quality, their total sleep time and sleep efficiency were significantly improved after implantation (from 317 ± 45 min to 415p < 57 min P < .01, from 69 ± 7% to 90 ± 5%, P < .01, respectively), whereas these indices in cf-LVAD patients without poor sleep quality were preserved (from 410 ± 37 min to 442 ± 92 min P = .11, from 92 ± 4% to 92 ± 3%, P = .68, respectively). Conclusion: Poor sleep quality is present in about half of HF patients, and it was improved with cf-LVAD treatment.
Background: Implantable ventricular assist devices (iVADs) have been approved as a bridge to heart transplantation (HTx) in Japan. Methods: We retrospectively investigated the proportion and outcome of consecutive 1058 patients with chronic heart failure (CHF) who underwent cardiopulmonary exercise testing from July 2007 to March 2015 in our hospital. Results: Out of 522 CHF patients less than 65 years, 89 patients had peak VO2 < 14 ml/kg/min or % predicted peak VO2 < 50% in order to be listed for HTx. Of 89 cases, 38 had contraindication for HTx and 51 had nocontraindication. Kaplan- Meier Analysis demonstrated that they had 1, 3 and 5 years survival rates of 78.8%, 53.4% and 30.8%. Conclusion: Patients with lower exercise capacity had poor prognosis, and we should consider appropriate management for iVADs and HTx.
EP10-2 An Approach to Improve Prognosis after LVAD Implantation by Earlier Evaluation of Transplant Eligibility in Patients with Advanced Heart Failure Togo Iwahana1, Sho Okada1, Osamu Hashimoto1, Goro Matsumiya2, Yoshio Kobayashi1; 1 Department of Cardiovascular Medicine Chiba University Graduate School of Medicine, Chiba, Japan; 2Department of Cardiovascular Surgery Chiba University Graduate School of Medicine, Chiba, Japan In patients with advanced heart failure (HF), emergent introduction of extracorporeal Ventricular Assist Devices (VADs) against hemodynamic collapse was indicative of poor prognosis. To achieve safe introduction of implantable LVAD and improve clinical outcome, we established two systems since September 2014. First, we cooperated with the hospitals in Chiba Prefecture and recruited the potentially eligible patients with advanced HF as early as possible. This system, minimizing the delay in transfer and eligibility assessment, would avoid extracorporeal VADs and enable rapid and direct introduction of implantable LVAD. Second, the HF cardiologists took charge of almost all of these patients for evaluation and preoperative care. Since April 2008, we experienced 28 cases of VAD implantation, and 16 patients with implantable LVAD are now waiting for heart transplantation. After establishment of the system, more patients were introduced from the allied hospitals as compared to the pre-established period. The rate of direct introduction of implantable LVAD significantly increased (71% vs 21%, P = .008), and the mean length of stay markedly shortened (61 days vs 101 days, P = .031). Event-free survival also tended to improve. In conclusion, early recruitment and rapid assessment of potentially eligible HF patients, along with the improvement of postoperative care, rehabilitation and device training program, contributed to the favorable clinical outcome after implantable LVAD operation.
EP10-3 Recipient Anemia during Cardiopulmonary Bypass is the Risk Factor of Primary Graft Failure in Heart Transplantation Yuki Nakamura, Koichi Toda, Teruya Nakamura, Shigeru Miyagawa, Satsuki Fukushima, Shunsuke Saito, Keitaro Domae, Kaoru Kubota, Yoshiki Sawa; The Department of Cardiovascular Surgery, Osaka University, Osaka, Japan Purpose: Primary graft failure (PGF) is a devastating complication of heart transplantation (HTx). Although the systemic inflammatory response in recipient is one of the scenario of PGF, its mechanism is poorly understood. The aim of this study is to elucidate a recipient risk factor of PGF associated with systemic inflammation. Method: Fifty-seven consecutive patients undergoing adult HTx between 2007 and 2016 at our hospital were reviewed retrospectively. Perioperative Interleukin (IL)-6 was measured. We defined PGF according to the severity scale of PGF defined at The International Society of Heart Lung Transplantation consensus meeting in 2014. Cytokine levels and perioperative recipient factors were compared between patients with PGF and without PGF. ResultOf 58 patients, 14 (24.1%) developed moderate to severe PGF. Patients with PGF had significantly higher levels of IL-6 (1262 ± 3422 pg/ml vs. 177 ± 260 pg/ ml; P = .04) especially before the reperfusion of transplanted hearts. In patients with PGF, Hemoglobin (Hb) level at the time of reperfusion was significantly lower than that in patients without PGF (7.8 ± 1.2 mg/dl vs. 9.3 ± 1.1 mg/dl; P < .0001). Only Hb level had significant correlation with IL-6 level before reperfusion (r = -0.618, P = .0206). ConclusionRecipient anemia during the cardiopulmonary bypass, which might cause systemic inflammation, is one of RRFs of PGF.
EP10-6 Heart Transplantation in Korea: 20 Years of Experience Jin-Oh Choi1, Jin-Oh Choi1, Min-Seok Oh1, Ga Yeon Lee1, Seok-Min Kang2, Jae-Joong Kim3, Hyun-Jai Cho4, Eun Seok Jeon1; 1Sungkyunkwan University School of Medicine, Samsung Medical Center; 2Yonsei University College of Medicine; 3Asan Medical Center, University of Ulsan College of Medicine; 4Seoul National University Hospital, Seoul, Republic of Korea Background: Heart transplantation (HTx) has become the gold standard treatment option for end-stage heart failure. After first HTx in Korea in 1992, annual count of operation has been increasing. More than 100 patients pre year were salvaged with HTx in 2010’s in Korea. We sought to provide 20-year experiences of HTx in Korea. Methods: From January 1992 to December 2012, 742 patients were undergone orthotopic HTx. Patients with multiorgan transplantation were excluded. Medical records were reviewed retrospectively. Results: HTx had been performed in 10 institutes. Mean age of recipients was 42.9 ± 16.8 years and 72.6% were men. Gender-matched transplantation was proceded in 75.0%. Leading indication for HTx was dilated cardiomyopathy (60.6%). Short-term mortality (within 1 month) was 4.5% (n = 32) and infection was the most common cause of death (50% of all-cause death, n = 16). After 1-, 5-, 10years of follow-up, overall survival rates were 87.3%, 78.2%, and 74.8%, respectively. Rejection-free survival rates were 71.0%, 66.3%, and 65.2%, and malignancy-free survival rates were 99.1%, 97.7%, and 96.9%. Chronic allograft vasculopathy was occurred in 10 patients. After 2003, rejection rate was lower than that of before 2003 (P < .001), but all-cause mortality (P = .10) and malignancy-free survival rate (P = .58) was not statistically remarkable. High volume center (yearly 20 cases or more) showed better clinical outcome (P = .002). Conclusion: With upgrading of procedural techniques and postoperative care including immunosuppressant therapy, outcome of heart transplantation has been improving and actuarial survival after HTx were similar or even better than those reported by the International Society of Heart and Lung Transplantation.