Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 4 de 4
Filter
Add more filters










Database
Language
Publication year range
1.
J Thorac Cardiovasc Surg ; 153(2): 360-367.e1, 2017 02.
Article in English | MEDLINE | ID: mdl-27955912

ABSTRACT

OBJECTIVE: Right ventricular failure in patients treated using left ventricular assist devices is associated with poor outcomes. We assessed the strategy of preplanned biventricular assist device implantation in patients with a high risk for right ventricular failure. METHODS: Between 2010 and 2014, we assigned 20 patients to preplanned biventricular assist device and 21 patients to left ventricular assist device as a bridge to heart transplantation on the basis of the estimated risk of postimplant right ventricular failure. Preimplant characteristics and postimplant outcomes were compared between the 2 groups. RESULTS: Patients with a biventricular assist device were younger, more often female, and more frequently had nonischemic heart disease than left ventricular assist device recipients. At preoperative assessment, biventricular assist device recipients had poorer Interagency Registry for Mechanically Assisted Circulatory Support profiles, a lower cardiac index, and more compromised right ventricular function. Survival on device to heart transplantation/weaning/destination for biventricular assist device and left ventricular assist device recipients was 90% versus 86% (not significant), with shorter heart transplantation waiting times for biventricular assist device recipients (median days, 154 vs 302, P < .001). Overall survival at 1 year was 85% (95% confidence interval, 62-95) versus 86% (95% confidence interval, 64-95) (not significant). The majority of both biventricular assist device and left ventricular assist device recipients could be discharged to home during the heart transplantation waiting time (55% vs 71%, not significant), and complication rates on device were comparable between groups (major stroke 10% vs 10%, not significant). CONCLUSIONS: Planned in advance, the biventricular assist device seems to be a feasible option as bridge to heart transplantation for patients with a high risk of postimplant right ventricular failure. The outcomes for these patients were similar to those observed for contemporary left ventricular assist device recipients, despite those receiving biventricular assist devices being more severely ill.


Subject(s)
Heart Failure/etiology , Heart Transplantation , Heart-Assist Devices/adverse effects , Registries , Ventricular Dysfunction, Right/surgery , Ventricular Function, Right/physiology , Adult , Female , Follow-Up Studies , Heart Failure/epidemiology , Heart Failure/physiopathology , Heart-Assist Devices/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Rate/trends , Sweden/epidemiology , Time Factors , Ventricular Dysfunction, Right/physiopathology
2.
Vasc Health Risk Manag ; 6: 657-63, 2010 Sep 07.
Article in English | MEDLINE | ID: mdl-20859537

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the effect of levosimendan on mortality in cardiogenic shock (CS) after ST elevation myocardial infarction (STEMI). METHODS AND RESULTS: Data were obtained prospectively from the SCAAR (Swedish Coronary Angiography and Angioplasty Register) and the RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) about 94 consecutive patients with CS due to STEMI. Patients were classified into levosimendan-mandatory and levosimendan-contraindicated cohorts. Inotropic support with levosimendan was mandatory in all patients between January 2004 and December 2005 (n = 46). After the SURVIVE and REVIVE II studies were presented, levosimendan was considered contraindicated and was not used in consecutive patients between December 2005 and December 2006 (n = 48). The cohorts were similar with respect to pre-treatment characteristics and concomitant medications. There was no difference in the incidence of new-onset atrial fibrillation, in-hospital cardiac arrest and length of stay at the coronary care unit. There was no difference in adjusted mortality at 30 days and at one year. CONCLUSION: The use of levosimendan neither improves nor worsens mortality in patients with CS due to STEMI. Well-designed randomized clinical trials are needed to define the role of inotropic therapy in the treatment of CS.


Subject(s)
Cardiotonic Agents/therapeutic use , Hydrazones/therapeutic use , Myocardial Infarction/drug therapy , Pyridazines/therapeutic use , Shock, Cardiogenic/drug therapy , Age Factors , Aged , Atrial Fibrillation/etiology , Chi-Square Distribution , Cohort Studies , Electrocardiography , Female , Heart Arrest/etiology , Humans , Length of Stay , Male , Myocardial Infarction/complications , Myocardial Infarction/mortality , Myocardial Revascularization , Proportional Hazards Models , Sex Factors , Shock, Cardiogenic/etiology , Shock, Cardiogenic/mortality , Simendan , Statistics, Nonparametric
3.
Resuscitation ; 54(2): 133-8, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12161292

ABSTRACT

AIM: To describe the diurnal, weekly and seasonal rhythm among patients suffering from out of hospital cardiac arrest in Sweden. METHODS: All patients in Sweden between 1990 and 1999 participating in a National Registry covering 65% of all patients suffering from out of hospital cardiac arrest where cardiopulmonary resuscitation (CPR) was attempted. Only patients with a cardiac arrest of a cardiac aetiology and aged > 18 years were included in the survey. RESULTS: 10,868 patients fulfilled inclusion criteria. In terms of the diurnal rhythm, there was a progressive increase in the development of cardiac arrest from 06:00 h, reaching a peak at about 10:00 h. Thereafter, there was a progressive decline until 05:00 h. The diurnal rhythm was more marked among patients aged > 65 years and among patients in whom the arrest occurred outside home. There was a weekly rhythm with an increased incidence of cardiac arrest on Mondays. This was particularly evident among patients aged < 66 years and among men. A cardiac arrest occurred most frequently in January and December. This was particularly observed in the large cities. CONCLUSION: We found that out of hospital cardiac arrest of a cardiac etiology has a diurnal, weekly and seasonal rhythm occurring most frequently in the morning hours, on Mondays and in December and January. Age, sex and place of arrest influence these rhythms.


Subject(s)
Heart Arrest/epidemiology , Periodicity , Seasons , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Sweden/epidemiology , Time Factors
4.
Resuscitation ; 54(1): 37-45, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12104107

ABSTRACT

AIM: To relate the outcome of out-of-hospital cardiac arrest to whether medication with adrenaline (epinephrine) was given and whether patients were intubated. PATIENTS: A national survey in Sweden between 1990-1995 among patients suffering out-of-hospital cardiac arrest and in whom resuscitation was attempted. Sixty per cent of ambulance organisations in Sweden participated. DESIGN: Prospective evaluation. Survival was defined as survival 1 month after cardiac arrest. RESULTS: In all, 14065 patients were included in the evaluation. Of these, resuscitation was attempted in 10966 cases. Among these adrenaline (epinephrine) was given in 42.4 and 47.5% were intubated. In an univariate analysis treatment with adrenaline (epinephrine) and intubation was associated with a lower survival when all patients were evaluated. In a multivariate analysis including age, sex, place of arrest, bystander-CPR, initial arrhythmia, arrest being witnessed and aetiology, treatment with adrenaline (epinephrine) (OR 0.43, CI 0.27-0.66) and intubation (OR 0.71, CI 0.51-0.99) were both independent predictors of a lower chance of survival. When separately analysing patients with bystander witnessed cardiac arrest found in ventricular fibrillation and requiring more than 3 defibrillatory shocks neither treatment with adrenaline (epinephrine) nor intubation was associated with survival. Among patients with a non-shockable rhythm treatment with adrenaline (epinephrine) was a significant independent predictor for lower survival (OR 0.30, CI 0.07-0.82). CONCLUSION: In a national survey in Sweden including 10966 cases of out-of-hospital cardiac arrest the outcome was related to whether medication with adrenaline (epinephrine) was given and whether patients were intubated. Neither in total nor in any subgroup did we find results indicating beneficial effects of any of these two interventions. Whether treatment with adrenaline (epinephrine) or intubation will increase survival after out-of-hospital cardiac arrest needs to be confirmed in prospective randomised trials.


Subject(s)
Adrenergic Agonists/therapeutic use , Cardiopulmonary Resuscitation , Epinephrine/therapeutic use , Heart Arrest/therapy , Aged , Combined Modality Therapy , Emergency Medical Services , Female , Heart Arrest/mortality , Humans , Intubation , Male , Survival Analysis , Sweden/epidemiology , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL
...