Are 18F-fluorodeoxyglucose positron emission tomography results reliable in patients with ascending aortic grafts? A prospective study in non-infected patients.

OBJECTIVES: Our goal was to define characteristic patterns of 18F-fluorodeoxyglucose in non-infected patients with ascending aortic prosthetic grafts during the first year after surgery. METHODS: 18F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) was performed at 3, 6 and 12 months postoperatively in 26 uninfected patients. Clinical, analytical and microbiological (blood culture) assessments were performed to confirm the absence of infection. FDG uptake intensity [measured through maximum standardized uptake values (SUVmax) and the target-to-background ratio] and distribution patterns were obtained. Models of generalized estimating equations were used to assess the evolution of the SUVmax over time. The results were compared to those in our endocarditis-over-ascending-aortic-graft series database. The receiver operating characteristic curves of the control group and the 12-month group were assessed. RESULTS: All patients showed increased uptake in all areas. The uptake pattern was heterogeneous in 47.4%, 43.5% and 42.3% at 3, 6 and 12 months. The means and standard deviations of the SUVmax in the graft were 4.80 (±0.99), 4.28 (±0.88) and 4.14 (±0.87) at 3, 6 and 12 months after surgery. A comparison of all values obtained in the 6th and 12th months compared to those from the 3rd month revealed a slow decrease that may persist after the first year. The cut-off value of SUVmax of 4.24 had an overall sensitivity of 84.6% and specificity of 57.7% for patients seen at 12 months. CONCLUSIONS: Non-infected ascending aortic grafts showed no predominant uptake pattern; they also showed increased 18F-fluorodeoxyglucose activity that could persist beyond the first year. Caution is therefore recommended when interpreting PET/CT images obtained during the first year after surgery.

Experiencia con una asistencia ventricular pulsátil de larga duración como puente al trasplante cardiaco en adultos / Experience with a long-term pulsatile ventricular assist device as a bridge to heart transplant in adults

Introducción y objetivos: La mayoría de los dispositivos de asistencia ventricular (DAV) de larga duración utilizados actualmente son intracorpóreos y de flujo continuo. Sus principales inconvenientes son el coste elevado y la imposibilidad de ofrecer soporte biventricular. El objetivo de este estudio es describir los resultados de una estrategia de implante de un DAV paracorpóreo de flujo pulsátil como puente al trasplante (PAT) en pacientes adultos. Métodos: Análisis retrospectivo de las características, complicaciones y resultados de una serie unicéntrica de pacientes consecutivos tratados con el DAV EXCOR como PAT entre 2009 y 2015. Resultados: En este periodo se implantaron 25 DAV, 6 de ellos biventriculares. En 12 pacientes la indicación fue directamente PAT y en 13 puente a la decisión debido a la presencia de contraindicaciones potencialmente reversibles o posibilidad de recuperación. Veinte pacientes (80%) alcanzaron el objetivo del trasplante cardiaco tras una mediana de soporte de 112 días (rango 8-239). Las principales complicaciones fueron: infecciosas (52% de los pacientes), neurológicas (32%, la mitad de ellas mortales), hemorrágicas (28%) y fallo del DAV que obligó a cambiar algún componente de este (28%). Conclusiones: El 80% de los pacientes tratados con el DAV EXCOR como PAT alcanzaron el objetivo tras una mediana de soporte de casi 4 meses. Las complicaciones más frecuentes fueron las infecciosas y las más graves las neurológicas. El empleo de estos DAV de flujo pulsátil como PAT, en nuestro medio, es una estrategia factible que consigue resultados similares a los DAV de flujo continuo (AU)

Introduction and objectives: Most long-term ventricular assist devices (VADs) that are currently implanted are intracorporeal continuous-flow devices. Their main limitations include their high cost and inability to provide biventricular support. The aim of this study was to describe the results of using paracorporeal pulsatile-flow VADs as a bridge to transplant (BTT) in adult patients. Methods: Retrospective analysis of the characteristics, complications, and outcomes of a single-center case series of consecutive patients treated with the EXCOR VAD as BTT between 2009 and 2015. Results: During the study period, 25 VADs were implanted, 6 of them biventricular. Ventricular assist devices were indicated directly as a BTT in 12 patients and as a bridge to decision in 13 due to the presence of potentially reversible contraindications or chance of heart function recovery. Twenty patients (80%) were successfully bridged to heart transplant after a median of 112 days (range, 8-239). The main complications included infectious (52% of patients), neurological events (32%, half of them fatal), bleeding (28%), and VAD malfunction requiring component replacement (28%). Conclusions: Eighty percent of patients with the EXCOR VAD as BTT achieved the goal after an average of almost 4 months of support. The most frequent complications were infectious, and the most severe were neurological. In our enivonment, the use of these pulsatile-flow VAD as BTT is a feasible strategy that obtains similar outcomes to those of intracorporeal continuous-flow devices (AU)

Experience With a Long-term Pulsatile Ventricular Assist Device as a Bridge to Heart Transplant in Adults.

INTRODUCTION AND OBJECTIVES: Most long-term ventricular assist devices (VADs) that are currently implanted are intracorporeal continuous-flow devices. Their main limitations include their high cost and inability to provide biventricular support. The aim of this study was to describe the results of using paracorporeal pulsatile-flow VADs as a bridge to transplant (BTT) in adult patients. METHODS: Retrospective analysis of the characteristics, complications, and outcomes of a single-center case series of consecutive patients treated with the EXCOR VAD as BTT between 2009 and 2015. RESULTS: During the study period, 25 VADs were implanted, 6 of them biventricular. Ventricular assist devices were indicated directly as a BTT in 12 patients and as a bridge to decision in 13 due to the presence of potentially reversible contraindications or chance of heart function recovery. Twenty patients (80%) were successfully bridged to heart transplant after a median of 112 days (range, 8-239). The main complications included infectious (52% of patients), neurological events (32%, half of them fatal), bleeding (28%), and VAD malfunction requiring component replacement (28%). CONCLUSIONS: Eighty percent of patients with the EXCOR VAD as BTT achieved the goal after an average of almost 4 months of support. The most frequent complications were infectious, and the most severe were neurological. In our enivonment, the use of these pulsatile-flow VAD as BTT is a feasible strategy that obtains similar outcomes to those of intracorporeal continuous-flow devices.

Una complicación grave en paciente con asistencia ventricular / A Serious Complication in a Patient With a Ventricular Assist Device

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