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Role of left ventrcular assist device for patients in acute myocardial infarction complicated by cardiogenic shock
S130
Abstracts
diferences concerning any other clinical and laboratorial variables. Adverse symptoms were: headache (7%), sustained ventricular tachycardia (2%), dizziness(2%), fever (2%), thoracic pain (2%), unstable angina (2%), hemoptysis (2%), and phlebitis (4%). Conclusion: Our findings make LEVO an attractive option to treat CHF pts needing in inotropic drugs. The basal SSBP is associated with LEVO treatment efficacy. The lackness of response to LEVO is a marker of worse prognosis in CHF. 260 DECREASE OF WAITING LIST MORTALITY IN CARDIAC TRANSPLANTATION THOUGH TRANSPLANT NUMBERS ARE DROPPING. THE IMPACT OF OPTIMAL BRIDGING A. Mu ¨ hlbauer,1 A. Zuckermann,1 A. Bohdjalian,1 G. Wieselthaler,1 E. Wolner,1 M. Grimm,1 1Dept. of Cardio-Thoracic Surgery, University of Vienna, Vienna, Vienna, Austria Purpose: Transplant numbers have dropped markedly during the last years. Therefor the danger of increased waiting list mortality is obvious. The aim of the study was to examine incidence and cause of death on the waiting list and potential impact of different bridging therapies over the last decade. Procedures: Between 1992-2002 a total of 1065 patients (mean age 53.2 years, 15% females, 60% dil. CMP, 35% isch. CMP, 5% others) were put on the waiting list for cardiac transplantation. A total of 415 (39%) were bridged to transplantation (pharmacological: n ⫽ 199 (48%), AICD: n ⫽ 161 (39%) and mechanical: n ⫽ 55 (13%). Changes of waiting list mortality, causes of death, removal from the waiting list, transplant incidence and incidence of bridging amd bridging patterns were compared between two time periods: 1992-1997 and 1998-2002. Results: Waiting list mortality decreased significantly from 28% to 12% (p ⬍ 0.001) between the two time periods. While in the early time span 17% of listed patients died from SCD, these numbers dropped to 5% in the late period (p ⬍ 0.001). The risk of death from pump failure also decreased (8% to 2%; p ⫽ 0.002). Death from non cardiac reason has become the predominant cause of death (38%, p ⬍ 0.001). The number of bridged patients has markedly increased from 28% to 63% (p ⬍ 0.001). Within the group of bridged patients, assist devices underwent the biggest growth (7% vs. 19%, p ⬍ 0.01). Pharmacological bridging and AICD remained stable. The percentage of patients transplanted has remained stable (36% vs. 41%) while the total number of cardiac transplants (265 vs. 138) as well as patients put on the waiting list (732 vs. 333) and waiting time to transplantation (231 ⫾ 108 vs. 147 ⫾ 60, p ⬍ 0.01) has significantly decreased. Conclusion: Mortality on the waiting list for heart transplantation has decreased significantly although the total number of cardiac transplants has also dropped. Optimal bridging (pharmacological, mechanical and electrical) and heart failure therapy combined with a perfected local allocation system are responsible for this improvement. 261 ROLE OF LEFT VENTRCULAR ASSIST DEVICE FOR PATIENTS IN ACUTE MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK S.J. Park,1 M. Colvin-Adams,2 S. Ormaza,3 K.K. Liao,3 R. Segurola,3 A. Boyle,2 L.W. Miller,2 1Joint Cardiac Program, California Pacific Medical Center, San Francisco, CA; 2Medicine, University of Minnesota, Minneapolis, MN; 3Surgery, University of Minnesota, Minneapolis, MN Purpose: The overall survival rate of patients who present with acute myocardial infarction (AMI) has improved over the years. Yet some of
The Journal of Heart and Lung Transplantation February 2004
patients face exceedingly high mortality, in excess of 50%, when AMI is associated with cardiogenic shock. We hypothesize that left ventricular assist device (LVAD) implantation in this high risk population could improve their survival. Procedure: We treated 27 patients who presented in profound cardiogenic shock following AMI during the past 8 years. Their mean age was 55.3 years. Twenty-three patients were male. Majority of the patients required 2–3 inotropes or vasoactive drugs. Intra-aortic balloon pump support was required in 100% of patients and 5 patient were supported on extra-corporeal membrane oxygenator. Twentytwo patients were supported with mechanical ventilator. All patients had diagnostic coronary angiography and 16/27 (60%) underwent percutaneous transcatheter angioplasty without improvement in their condition. Their mean pulmonary capillary wedge pressure was 26, cardiac index of 2.1 l/min, their mean systolic blood pressure was 85, and mean heart rate was 110 beats/min. Results: The survival following LVAD implantation was 78% (21/26). The mean from the time of acute myocardial infarction to the LVAD implant was about 4 days. Except for one patient who is still being supported on LVAD, 20 out of 21 survivors underwent heart transplantation after mean of 180 days support. Seventeen out of 20 patients are long-term survivors following heart transplantation. Conclusion: Patients who present in cardiogenic shock with AMI have exceedingly high mortality with conventional treatment. LVAD can implanted with acceptable operative mortality, despite a fresh infarction. The use of an LVAD in this setting can translate into good long-term survival for patients who otherwise would have had dismal prognosis. 262 EXPANDING THE DONOR POOL: SUCCESSFUL USE OF MARGINAL DONOR LUNGS WITH A HISTORY OF SMOKING J.C. Mullen,1 D.C. Lien,1 M.J. Bentley,1 K.B. Jackson,1 K.C. Stewart,1 P.J. Brown,1 H.A. Taskinen,1 D.L. Modry,1 1Lung Transplant Program, University of Alberta, Edmonton, AB, Canada Purpose: The purpose of this study was to evaluate the effect of donor smoking history on outcomes in lung transplantation. Methods: We retrospectively reviewed the results of 111 consecutive single and double lung transplants performed between January 2000 and August 2003 for whom donor smoking history was available. Living donor lung transplants and heart/lung transplants were excluded. Patients were grouped by pack-year smoking history. All prospective donors were free from significant respiratory symptoms or known respiratory disease. They were deemed to have acceptable chest radiographic findings, bronchoscopy findings, and oxygen challenges (PO2 measured on FiO2 ⫽ 1.0). Some marginal donors also underwent chest CT scans. Results: Variable
0
0–10
N Intubation Time (h) Intensive Care Unit Stay (d) Hospital Stay (d) Follow-up (m) 1y FEV1 (L) 1y FVC (L) 1y FEV1/FVC Ratio Actuarial Survival (30d) Actuarial Survival (1y)
50 144 ⫾ 49 11 ⫾ 2
32 302 ⫾ 145 12 ⫾ 3
11–20 15 54 ⫾ 18 8⫾3
>20 14 91 ⫾ 35 8⫾2
45 ⫾ 7 35 ⫾ 7 30 ⫾ 5 34 ⫾ 5 17 ⫾ 2 15 ⫾ 2 18 ⫾ 3 14 ⫾ 3 2.13 ⫾ 0.17 2.63 ⫾ 0.15 2.27 ⫾ 0.20 2.09 ⫾ 0.21 3.29 ⫾ 0.24 3.27 ⫾ 0.20 3.36 ⫾ 0.22 3.07 ⫾ 0.33 0.66 ⫾ 0.03 0.81 ⫾ 0.03 0.68 ⫾ 0.05 0.69 ⫾ 0.02 96% 90% 93% 100% 82%
87%
Column headings are reported in pack-years.
86%
100%
p – 0.8 0.9 0.6 0.7 0.4 0.9 0.4 0.5 0.5
Abstracts
diferences concerning any other clinical and laboratorial variables. Adverse symptoms were: headache (7%), sustained ventricular tachycardia (2%), dizziness(2%), fever (2%), thoracic pain (2%), unstable angina (2%), hemoptysis (2%), and phlebitis (4%). Conclusion: Our findings make LEVO an attractive option to treat CHF pts needing in inotropic drugs. The basal SSBP is associated with LEVO treatment efficacy. The lackness of response to LEVO is a marker of worse prognosis in CHF. 260 DECREASE OF WAITING LIST MORTALITY IN CARDIAC TRANSPLANTATION THOUGH TRANSPLANT NUMBERS ARE DROPPING. THE IMPACT OF OPTIMAL BRIDGING A. Mu ¨ hlbauer,1 A. Zuckermann,1 A. Bohdjalian,1 G. Wieselthaler,1 E. Wolner,1 M. Grimm,1 1Dept. of Cardio-Thoracic Surgery, University of Vienna, Vienna, Vienna, Austria Purpose: Transplant numbers have dropped markedly during the last years. Therefor the danger of increased waiting list mortality is obvious. The aim of the study was to examine incidence and cause of death on the waiting list and potential impact of different bridging therapies over the last decade. Procedures: Between 1992-2002 a total of 1065 patients (mean age 53.2 years, 15% females, 60% dil. CMP, 35% isch. CMP, 5% others) were put on the waiting list for cardiac transplantation. A total of 415 (39%) were bridged to transplantation (pharmacological: n ⫽ 199 (48%), AICD: n ⫽ 161 (39%) and mechanical: n ⫽ 55 (13%). Changes of waiting list mortality, causes of death, removal from the waiting list, transplant incidence and incidence of bridging amd bridging patterns were compared between two time periods: 1992-1997 and 1998-2002. Results: Waiting list mortality decreased significantly from 28% to 12% (p ⬍ 0.001) between the two time periods. While in the early time span 17% of listed patients died from SCD, these numbers dropped to 5% in the late period (p ⬍ 0.001). The risk of death from pump failure also decreased (8% to 2%; p ⫽ 0.002). Death from non cardiac reason has become the predominant cause of death (38%, p ⬍ 0.001). The number of bridged patients has markedly increased from 28% to 63% (p ⬍ 0.001). Within the group of bridged patients, assist devices underwent the biggest growth (7% vs. 19%, p ⬍ 0.01). Pharmacological bridging and AICD remained stable. The percentage of patients transplanted has remained stable (36% vs. 41%) while the total number of cardiac transplants (265 vs. 138) as well as patients put on the waiting list (732 vs. 333) and waiting time to transplantation (231 ⫾ 108 vs. 147 ⫾ 60, p ⬍ 0.01) has significantly decreased. Conclusion: Mortality on the waiting list for heart transplantation has decreased significantly although the total number of cardiac transplants has also dropped. Optimal bridging (pharmacological, mechanical and electrical) and heart failure therapy combined with a perfected local allocation system are responsible for this improvement. 261 ROLE OF LEFT VENTRCULAR ASSIST DEVICE FOR PATIENTS IN ACUTE MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK S.J. Park,1 M. Colvin-Adams,2 S. Ormaza,3 K.K. Liao,3 R. Segurola,3 A. Boyle,2 L.W. Miller,2 1Joint Cardiac Program, California Pacific Medical Center, San Francisco, CA; 2Medicine, University of Minnesota, Minneapolis, MN; 3Surgery, University of Minnesota, Minneapolis, MN Purpose: The overall survival rate of patients who present with acute myocardial infarction (AMI) has improved over the years. Yet some of
The Journal of Heart and Lung Transplantation February 2004
patients face exceedingly high mortality, in excess of 50%, when AMI is associated with cardiogenic shock. We hypothesize that left ventricular assist device (LVAD) implantation in this high risk population could improve their survival. Procedure: We treated 27 patients who presented in profound cardiogenic shock following AMI during the past 8 years. Their mean age was 55.3 years. Twenty-three patients were male. Majority of the patients required 2–3 inotropes or vasoactive drugs. Intra-aortic balloon pump support was required in 100% of patients and 5 patient were supported on extra-corporeal membrane oxygenator. Twentytwo patients were supported with mechanical ventilator. All patients had diagnostic coronary angiography and 16/27 (60%) underwent percutaneous transcatheter angioplasty without improvement in their condition. Their mean pulmonary capillary wedge pressure was 26, cardiac index of 2.1 l/min, their mean systolic blood pressure was 85, and mean heart rate was 110 beats/min. Results: The survival following LVAD implantation was 78% (21/26). The mean from the time of acute myocardial infarction to the LVAD implant was about 4 days. Except for one patient who is still being supported on LVAD, 20 out of 21 survivors underwent heart transplantation after mean of 180 days support. Seventeen out of 20 patients are long-term survivors following heart transplantation. Conclusion: Patients who present in cardiogenic shock with AMI have exceedingly high mortality with conventional treatment. LVAD can implanted with acceptable operative mortality, despite a fresh infarction. The use of an LVAD in this setting can translate into good long-term survival for patients who otherwise would have had dismal prognosis. 262 EXPANDING THE DONOR POOL: SUCCESSFUL USE OF MARGINAL DONOR LUNGS WITH A HISTORY OF SMOKING J.C. Mullen,1 D.C. Lien,1 M.J. Bentley,1 K.B. Jackson,1 K.C. Stewart,1 P.J. Brown,1 H.A. Taskinen,1 D.L. Modry,1 1Lung Transplant Program, University of Alberta, Edmonton, AB, Canada Purpose: The purpose of this study was to evaluate the effect of donor smoking history on outcomes in lung transplantation. Methods: We retrospectively reviewed the results of 111 consecutive single and double lung transplants performed between January 2000 and August 2003 for whom donor smoking history was available. Living donor lung transplants and heart/lung transplants were excluded. Patients were grouped by pack-year smoking history. All prospective donors were free from significant respiratory symptoms or known respiratory disease. They were deemed to have acceptable chest radiographic findings, bronchoscopy findings, and oxygen challenges (PO2 measured on FiO2 ⫽ 1.0). Some marginal donors also underwent chest CT scans. Results: Variable
0
0–10
N Intubation Time (h) Intensive Care Unit Stay (d) Hospital Stay (d) Follow-up (m) 1y FEV1 (L) 1y FVC (L) 1y FEV1/FVC Ratio Actuarial Survival (30d) Actuarial Survival (1y)
50 144 ⫾ 49 11 ⫾ 2
32 302 ⫾ 145 12 ⫾ 3
11–20 15 54 ⫾ 18 8⫾3
>20 14 91 ⫾ 35 8⫾2
45 ⫾ 7 35 ⫾ 7 30 ⫾ 5 34 ⫾ 5 17 ⫾ 2 15 ⫾ 2 18 ⫾ 3 14 ⫾ 3 2.13 ⫾ 0.17 2.63 ⫾ 0.15 2.27 ⫾ 0.20 2.09 ⫾ 0.21 3.29 ⫾ 0.24 3.27 ⫾ 0.20 3.36 ⫾ 0.22 3.07 ⫾ 0.33 0.66 ⫾ 0.03 0.81 ⫾ 0.03 0.68 ⫾ 0.05 0.69 ⫾ 0.02 96% 90% 93% 100% 82%
87%
Column headings are reported in pack-years.
86%
100%
p – 0.8 0.9 0.6 0.7 0.4 0.9 0.4 0.5 0.5