Long-term paracorporeal ventricular support systems: a single-center experience.

BACKGROUND: The Berlin Heart EXCOR is a first-generation paracorporeal, pneumatic ventricular assist device that creates pulsatile flow. It can be used for long-term support of the left and/or right ventricule during end-stage heart failure. The aim of this study was to share our clinical experience in 54 patients. METHODS: Between April 2007 and August 2012, 54 patients with end-stage heart failure underwent Berlin Heart EXCOR ventricular assist device implantation, including 5 females and 9 children. Twenty-four patients (44%) were in Intermacs level 1, 11 (21%) in level 2, and 19 (35%) in level 3. Biventricular support was applied to 13 patients. Device implantation was performed with an "on pump" beating heart technique while 6 other patients underwent intervention operations while the aortic valve has under cross-clamp. Tricuspid annuloplasty was performed in 6 patients. RESULTS: There was no peroperative death. Nine patients (17%) underwent re-exploration because of hemorrhage in the early postoperative period. Heart transplantation was performed in 32 patients (59%), while 10 (19%) are still under pump support with a mean follow-up of 13 months. Although 1 was successfully weaned from the system, 11 patients (20%) died during the support. Pump-head exchange was required 19 times in 17 patients because of visible thrombus or fibrin deposit in the pump head or due to membrane rupture. DISCUSSION: The use of long-term paracorporeal assist devices has decreased in recent years because of the increased popularity of implantable devices that permit longer survival and a better quality of life. We believe that the Berlin Heart EXCOR has a special role because it can be used in pediatric patients and especially in critical conditions like Intermacs levels 1 and 2.

Left ventricular assist device implantation in heart failure patients with a left ventricular thrombus.

BACKGROUND: In this report, we share our experience with left ventricular assist device (LVAD) implantation in cases with a left ventricular (LV) thrombus. METHOD: Over the 3 years, more than 100 end-stage heart failure cases have been treated with LVAD implantation in our center, including 6 patients with a LV thrombus. Three were detected using preoperative transthoracic echocardiography. Fifty percent of the patients had dilated cardiomyopathy and the remaining cases had an ischemic etiology. Double inotropic support with dopamine and dobutamine was used in all, with 3 drugs with the addition of adrenaline in 2 patients. In 4 cases we implanted the HeartWare Ventricular Assist System (HeartWare, Inc., Miramar, Fla, United States) and in the remaining 2 patients, the Berlin Heart EXCOR ventricular assist device (Berlin Heart AG, Berlin, Germany) for biventricular support. In 1 patient the apical ventriculotomy was extended to remove an intertrabecular thrombosis and ventricular septal surface covered with a dacron patch to minimize the thrombogenic potential. RESULTS: Two patients died due to sepsis and multiorgan failure. None of the patients experienced a neurological event, pump thrombosis, or pump malfunction. Two subjects underwent re-explorations due to hemorrhage. Two candidates underwent successfull transplantation without any evidence of thrombosis in the explanted heart or device. CONCLUSION: We believe that patients with a LV thrombus and preserved right ventricular function are good candidates for implantation of a LVAD after removing the intracavitary thrombus.

Effect of aortic valve movements on gastrointestinal bleeding that occured in continuous flow left ventricular assist device patients.

BACKGROUND: Gastrointestinal (GI) bleeding is one of the recently reported complications with continuous flow left ventricular assist devices (LVAD). The pathophysiology and etiology are unclear. We sought to describe the relationship between aortic valve movements and GI bleeding among patients with a new generation of LVAD. METHODS: We evaluated the data of 30 patients who underwent LVAD (HeartWare VAD) implantation from December 2010 to September 2012. The most common etiologic diagnosis was dilated cardiomyopathy. Patients were considered to show GI bleeding if they had hematemesis, melena, or hematochezia. RESULTS: Among 3 patients, 2 displayed upper GI bleeding and 1 had lower GI bleeding based on endoscopic and colononoscopic examinations. Pathological reports showed arteriovenous malformations in patients diagnosed with upper GI bleeding. The absence of aortic valve movements and a history of previous GI bleeding were significant risk factors (P = .021 and P = .007, respectively). CONCLUSION: In addition to aortic valve movements, we believe that a GI bleeding history was an equally important factor predisposing to this complication.

To bridge or not to bridge?

OBJECTIVE: Ventricular assist devices (VAD) are an important therapy that saves the lives of candidates a waiting heart transplantation (HTx). However, there are questions about posttransplantation effects of VADs. METHODS: Seventy-four patients with end-stage heart failure who underwent HTx in our clinic between February 2007 and July 2011 were divided into two groups; a bridge cohort (n = 28) and a nonbridge group comprising 46 who underwent HTx without mechanical circulatory support. There mean ages were 39.89 ± 15.66 and 38.33 ± 16.23 years respectively. Significantly more patients in the bridge group, were man displayed anemia, were treated with anticoagulation therapy, and underwent a resternotomy. In the nonbridge group, more patients needed preoperative inotropic support. RESULTS: Multiple logistic regression analysis revealed preoperative renal failure (P = .007, odds ratio [OR] 27) and inotropic support (P = .006, OR: 10,222) as well as longer cardiopulmonary bypasses (≥ 130 minutes, P = .001, OR: 11,24) to be risk factors for in-hospital mortality, which was 15.2% in nonbridge and 10.7% in bridge subjects, P = .733). Major adverse events, such as renal failure, pulmonary failure, right ventricular failure, neurological event, and reoperation due to bleeding, shown similar incidences between the groups. The amount of blood transfusion was significantly higher in the bridge group (2.34 U versus 3.56 U, P = .037). The preoperative incidence of human leukocyte antigen sensitization (panel reactive antibody ≥ 10%) and grade 2R were rejection episodes in the early period were similar. CONCLUSION: Early posttransplant results were not adversely or beneficially influenced by the use of VADs. Similar to other types of cardiac surgery, a patients preoperative condition seemed to be the major factor affecting mortality.

Gastric cancer and other organ cancer history in the parents of patients with gastric cancer.

A case-control study in a population from the Eastern Black Sea region of Turkey was performed to evaluate the risk of gastric cancer development in patients with gastric cancer reporting gastric cancer or other organ cancer history in their parents. Gastric cancer and/or other organ cancer history in the parents were found in 215 of 1240 patients with gastric cancer versus 73 of 1240 controls (odds ratio (OR) 3.35, P<0.001). The frequency of gastric cancer history among the parents was significantly different between the patients and the controls (148 versus 25, respectively; OR 6.59, P<0.001). The frequency of other organ cancer history was not significantly different between the patients and the controls (63 versus 48, respectively; OR 1.33, P>0.05). The frequency of gastric cancer history was significantly higher than the frequency of other organ cancer history in the parents of the patients (OR 4.51, P<0.001). Gastric cancer history was significantly higher in first- to third-degree relatives of the patients reporting gastric cancer and/or other organ cancer history in their parents than in the controls (OR 14.72, P<0.001). Familial clustering of gastric cancer defined by the presence of at least four cancer cases in family members, including parents, was reported by 12% of the patients. Overall, the result of this study of gastric cancer and other organ cancer history in the parents of patients with gastric cancer may suggest a genetic susceptibility for gastric carcinoma. A high risk of gastric cancer occurred in subjects reporting a gastric cancer history in their parents, and there was a higher predisposition to gastric cancer compared with other organ cancer in relatives and a familial clustering of the disease.

Stomach cancer history in the siblings of patients with gastric carcinoma.

A case-control study in the population of the Eastern Black Sea region of Turkey was conducted to learn the incidence of stomach cancer in the siblings of patients with gastric carcinoma. Among 1240 patients with gastric carcinoma, 168 had sibling(s) with a history of stomach cancer versus 19 cases in the control group matched according to age and gender (OR 10.07, P < 0.0001). The frequency of a history of stomach cancers and cancer of other organs in first- to third-degree relatives was 60.7% and 38.0%, respectively, of 168 sibling cases with gastric carcinoma (P < 0.0001). Fifty-two point three per cent of sibling cases having a history of cancer in other organs in their relatives also reported stomach cancer in the same-degree relatives. The number of stomach cancers in the first- to third-degree relatives of sibling cases was higher than the number of other organ cancers in the same-degree relatives (P < 0.01). Familial clustering of stomach cancer was reported in 12.5% of sibling cases. The study of stomach cancer history in the siblings suggests: the presence of a genetic susceptibility, high risk of the disease occurrence in the siblings of patients, higher predisposition to gastric than to other organ cancers in the relatives, and not infrequent familial clustering.

Effect of testicular torsion on the contralateral testis.

It has been previously shown that unilateral testicular torsion can cause disruptive anatomic changes in the contralateral testis in rats. In this experimental study plasma and urine prostaglandin E2 levels were studied correlatively with testicular histopathology in acute testicular torsion cases. As a result of this study, necrobiotic morphologic alterations causing testis necrosis and significant increase in plasma prostaglandin E2 levels were observed. Contralateral testicular histology was analyzed in all dogs. None of them showed abnormal tubular architecture.