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The registry of the International Society for heart transplantation: Sixth official report—1989
LITERATURE REVIEW
Skarphedinsson JO, Delle M, Hoffman P, Thoren P: The effects of naloxone on cerebral blood flow and cerebral function during relative cerebral ischemia. J Cereb Blood Flow Metab 9:515-522,1989. Twelve spontaneously hypertensive rats, bled into a reservoir to pressures sufficient to reduce the amplitude of somatosensory evoked potentials to 50% of the control value, were compared with 10 unhemorrhaged rats with respect to their response to naloxone, 5 rg/kg bolus and 25 mg/kg/h infusion for 30 minutes. Cerebral blood flow, measured by the laser Doppler technique, decreased to 77% of control during hemorrhage. The administration of naloxone under these conditions increased the amplitude of somatosensory evoked potentials but did not change cerebral blood flow. Such data suggest that sensory input is regulated by opioid systems and that increased opioid activity, by inhibiting ascending sensory pathways during cerebral ischemia, depresses somatosensory evoked responses. The conclusions from this study corroborate others suggesting that naloxone improves cerebral function independently from changes in cerebral blood flow.
Eidt JF, Ashton J, Golino P, et al: Treadmill exercise promotes cyclic alterations in coronary blood flow in dogs with coronary artery stenoses and endothelial injury. J Clin Invest 84:517-527, 1989. The effects of treadmill exercise, ventricular pacing, and thromboxane A, or serotonin-receptor antagonists on cyclic coronary flow variations were studied in chronically instrumented animals with coronary stenosis and vascular endothelial damage. The endothelial damage to the left anterior descending coronary artery was produced by gentle squeezing with a cushioned forceps. Coronary constriction was produced with a hard plastic cylindrical constrictor which reduced flow by 10% to 30%. The combination of constriction and endothelial damage results in a pattern of coronary blood flow characterized by severe, spontaneous reductions followed by abrupt spontaneous restoration of blood flow. This process is termed “cyclic flow variation.” In all animals, treadmill exercise at 1 mph for 30 minutes resulted in cyclic flow variation. However, ventricular pacing increased coronary blood flow but did not produce cyclic flow variation, except in one dog. Both serotoninreceptor antagonism and thromboxane A, abolished the cyclic flow variation (both frequency and severity) and increased coronary blood flow, except in one animal. Thus, both thromboxane and serotonin are important mediators of cyclic coronary flow variation.
Heck CF, Shumway SJ, Kaye MP: The Registry of the International Society for Heart Transplantation: Sixth Official Report-1989. J Heart Transplantation 8:271-276,1989. This summary from the data base of the International Society for Heart Transplantation provides current information on numbers of transplants, operative mortality, age
289
distribution, indications, and survival. However, some information may be incomplete since voluntary submission by society members forms the data base. The registry lists 9,139 orthotopic heart transplantations, 501 heart-lung transplantations, and 278 heterotopic heart transplantations since 1980. Both the numbers of transplants and the number of centers (from 78 in 1986 to 118 in 1989) has increased. Age ranges for transplant candidates have been extended from 15 to 50 years to newborn to 70 years, but most transplant patients are between 35 and 55 years. The most frequent indications for transplantation are cardiomyopathy and coronary artery disease, although congenital cardiac defects, Eisenmenger’s syndrome, and primary pulmonary hypertension are indications for combined heart-lung transplantation. The early mortality rate is 8.9%, with higher mortality rates in very young patients aged 0 to 9 years. Early mortality can be correlated with the ischemic interval. Actuarial survival rate is 73.9% for 5 years, but increases to 78% with cyclosporine and to 81.9% with triple immunosuppressive therapy with cyclosporine, azathioprine, and steroids.
Pae WE, Miller CA, Pierce WS: Combined registry for the clinical use of mechanical ventricular assist pumps and the total artificial heart: Third official report. J Heart Transplantation 8:277-280,1989. Safe and reliable circulatory support systems continue to be necessary as hemodynamic deterioration occurs before heart transplantation, or with acute rejection or acute donor organ failure after transplantation. Equipment including left ventricular assist devices, right ventricular assist devices, total artificial heart, and biventricular assist devices have been used in 219 patients from 44 centers worldwide. Electrical, pneumatic, and centrifugal pumps have been used with similar success rates of transplantation. Likewise, there is no difference in the incidence or type of complications with the type of circulatory support. However, complications precluding transplantation occurred in 0% to 55% of patients on assist devices. Shorter durations of support with these devices were associated with a more favorable outcome after cardiac transplantation.
Poulakos JJ, Gertner SB: Studies on the cardiovascular actions of central histamine H, and H, receptors. J Pharmacol Exp Ther 250:500507,1989. The cardiovascular effects of histamine, (H,) and histamine, (H,) agonists differ depending on route of administration. The cardiovascular effects mediated through central histamine receptors were evaluated in conscious rats with permanently implanted intracerebroventricular catheters. The H, agonist pyridylethylamine (PEA) produced dose-related bradycardia and increased mean arterial pressure when injected intraventricularly, while intravenously it increased heart rate and decreased mean arterial pressure. The cardiovascular effects of the H, agonist impromidine (IMP) were similar to those of PEA. Intraventricular administration of an H, antagonist produced bradycardia and a brief, dose-
Skarphedinsson JO, Delle M, Hoffman P, Thoren P: The effects of naloxone on cerebral blood flow and cerebral function during relative cerebral ischemia. J Cereb Blood Flow Metab 9:515-522,1989. Twelve spontaneously hypertensive rats, bled into a reservoir to pressures sufficient to reduce the amplitude of somatosensory evoked potentials to 50% of the control value, were compared with 10 unhemorrhaged rats with respect to their response to naloxone, 5 rg/kg bolus and 25 mg/kg/h infusion for 30 minutes. Cerebral blood flow, measured by the laser Doppler technique, decreased to 77% of control during hemorrhage. The administration of naloxone under these conditions increased the amplitude of somatosensory evoked potentials but did not change cerebral blood flow. Such data suggest that sensory input is regulated by opioid systems and that increased opioid activity, by inhibiting ascending sensory pathways during cerebral ischemia, depresses somatosensory evoked responses. The conclusions from this study corroborate others suggesting that naloxone improves cerebral function independently from changes in cerebral blood flow.
Eidt JF, Ashton J, Golino P, et al: Treadmill exercise promotes cyclic alterations in coronary blood flow in dogs with coronary artery stenoses and endothelial injury. J Clin Invest 84:517-527, 1989. The effects of treadmill exercise, ventricular pacing, and thromboxane A, or serotonin-receptor antagonists on cyclic coronary flow variations were studied in chronically instrumented animals with coronary stenosis and vascular endothelial damage. The endothelial damage to the left anterior descending coronary artery was produced by gentle squeezing with a cushioned forceps. Coronary constriction was produced with a hard plastic cylindrical constrictor which reduced flow by 10% to 30%. The combination of constriction and endothelial damage results in a pattern of coronary blood flow characterized by severe, spontaneous reductions followed by abrupt spontaneous restoration of blood flow. This process is termed “cyclic flow variation.” In all animals, treadmill exercise at 1 mph for 30 minutes resulted in cyclic flow variation. However, ventricular pacing increased coronary blood flow but did not produce cyclic flow variation, except in one dog. Both serotoninreceptor antagonism and thromboxane A, abolished the cyclic flow variation (both frequency and severity) and increased coronary blood flow, except in one animal. Thus, both thromboxane and serotonin are important mediators of cyclic coronary flow variation.
Heck CF, Shumway SJ, Kaye MP: The Registry of the International Society for Heart Transplantation: Sixth Official Report-1989. J Heart Transplantation 8:271-276,1989. This summary from the data base of the International Society for Heart Transplantation provides current information on numbers of transplants, operative mortality, age
289
distribution, indications, and survival. However, some information may be incomplete since voluntary submission by society members forms the data base. The registry lists 9,139 orthotopic heart transplantations, 501 heart-lung transplantations, and 278 heterotopic heart transplantations since 1980. Both the numbers of transplants and the number of centers (from 78 in 1986 to 118 in 1989) has increased. Age ranges for transplant candidates have been extended from 15 to 50 years to newborn to 70 years, but most transplant patients are between 35 and 55 years. The most frequent indications for transplantation are cardiomyopathy and coronary artery disease, although congenital cardiac defects, Eisenmenger’s syndrome, and primary pulmonary hypertension are indications for combined heart-lung transplantation. The early mortality rate is 8.9%, with higher mortality rates in very young patients aged 0 to 9 years. Early mortality can be correlated with the ischemic interval. Actuarial survival rate is 73.9% for 5 years, but increases to 78% with cyclosporine and to 81.9% with triple immunosuppressive therapy with cyclosporine, azathioprine, and steroids.
Pae WE, Miller CA, Pierce WS: Combined registry for the clinical use of mechanical ventricular assist pumps and the total artificial heart: Third official report. J Heart Transplantation 8:277-280,1989. Safe and reliable circulatory support systems continue to be necessary as hemodynamic deterioration occurs before heart transplantation, or with acute rejection or acute donor organ failure after transplantation. Equipment including left ventricular assist devices, right ventricular assist devices, total artificial heart, and biventricular assist devices have been used in 219 patients from 44 centers worldwide. Electrical, pneumatic, and centrifugal pumps have been used with similar success rates of transplantation. Likewise, there is no difference in the incidence or type of complications with the type of circulatory support. However, complications precluding transplantation occurred in 0% to 55% of patients on assist devices. Shorter durations of support with these devices were associated with a more favorable outcome after cardiac transplantation.
Poulakos JJ, Gertner SB: Studies on the cardiovascular actions of central histamine H, and H, receptors. J Pharmacol Exp Ther 250:500507,1989. The cardiovascular effects of histamine, (H,) and histamine, (H,) agonists differ depending on route of administration. The cardiovascular effects mediated through central histamine receptors were evaluated in conscious rats with permanently implanted intracerebroventricular catheters. The H, agonist pyridylethylamine (PEA) produced dose-related bradycardia and increased mean arterial pressure when injected intraventricularly, while intravenously it increased heart rate and decreased mean arterial pressure. The cardiovascular effects of the H, agonist impromidine (IMP) were similar to those of PEA. Intraventricular administration of an H, antagonist produced bradycardia and a brief, dose-