Can heat therapy help patients with heart failure?

To review and analyze the clinical outcomes of thermal therapy (≤1.4°C increase in core body temperature) in patients with heart failure (HF). A systematic review and meta-analysis regarding the effects of thermal therapy on HF was done by searching PubMed, Ovid Medline, Ovid Embase, Scopus, and internal databases up to date (2019). Improvement in the New York Heart Association (NYHA) class: Ten studies with 310 patients showed significant improvement in NYHA class. Only 7 among 40 patients remained in Class IV and 99 patients in Class III from 155 patients. Increased patients in lower classes indicate that more patients showed improvement. Sixteen studies on 506 patients showed an overall improvement of 4.4% of left ventricular ejection fraction (LVEF). Four studies reported improved endothelial dysfunction by 1.7% increase in flow-mediated dilation (FMD) on 130 patients. Reduction in blood pressure: Thermal therapy reduced both systolic blood pressure (SBP) and diastolic blood pressure by 3.1% and 5.31%, respectively, in 431 patients of 15 studies. Decrease in cardiothoracic ratio (CTR): Eight studies reported an average of 5.55% reduction of CTR in a total of 347 patients. Improvement in oxidative stress markers: Plasma brain natriuretic peptide (BNP) levels significantly decreased (mean difference of 14.8 pg/dL) in 303 patients of 9 studies. Improvement of quality of life: Among 65 patients, thermal therapy reduced cardiac death and rehospitalization by 31.3%. A slight increase in core body temperature is a promising, noninvasive, effective, and complementary therapy for patients with HF. Further clinical studies are recommended.

Risk Factors and Outcome of Post Fallot Repair Junctional Ectopic Tachycardia (JET).

BACKGROUND: Junctional ectopic tachycardia (JET) is a common arrhythmia causing hemodynamic impairment following corrective cardiac surgery such as tetralogy of Fallot (TOF) repair. METHODS: We report our experience with postoperative JET following surgical repair of TOF. The retrospective study was done from 2003 to 2012 with a total of 105 patients who underwent TOF repair. These patients' clinical and electrocardiographic data (pre-, intra-, and postoperative) were monitored to identify risk factors for the occurrence of JET and to evaluate the outcome of the affected patients. RESULTS: Incidence-Fourteen patients developed JET, with only four patients going directly from sinus rhythm to JET. In all others, either a transient atrioventricular (AV) block or a junctional rhythm preceded JET, mostly intraoperatively, showing a significant relation ( P = .010). Age-Patients with JET were of younger age ( P = .025) and had longer cardiopulmonary bypass ( P = .044) and aortic cross-clamping times ( P = .038). Increased cost and care-The occurrence of JET was associated with a longer stay in the intensive care unit (ICU) and a prolonged need for inotropic support and mechanical ventilation. Time to rate control correlated with length of ICU and hospital stay. MORTALITY: All JET patients converted into sinus rhythm, one of them died shortly after cessation of JET and two patients subsequently developed a first-degree AV block. CONCLUSION: The occurrence of JET remains an important complication during the initial postoperative period by increasing mechanical ventilation time, the need for inotropic support, and prolonging the length of ICU and hospital stay. Risk factors are younger age, longer aortic cross-clamping/bypass times, and intraoperative arrhythmias.

Surgical Atrioventricular Valve Replacement With Melody Valve in Infants and Children.

Background Pediatric patients with atrioventricular valve disease have limited options for prosthetic valve replacement in sizes <15 mm. Based on successful experience with the stented bovine jugular vein graft (Melody valve) in the right ventricular outflow tract, the prosthesis has been modified for surgical valve replacement in pediatric patients with atrioventricular dysfunction with the intention of subsequent valve expansion in the catheterization laboratory as the child grows. Methods and Results A multicenter, retrospective cohort study was performed among patients who underwent atrioventricular valve replacement with Melody valve at 17 participating sites from North America and Europe, including 68 patients with either mitral (n=59) or tricuspid (n=9) replacement at a median age of 8 months (range, 3 days to 13 years). The median size at implantation was 14 mm (range, 9-24 mm). Immediately postoperatively, the valve was competent with low gradients in all patients. Fifteen patients died; 3 patients underwent transplantation. Nineteen patients required reoperation for adverse outcomes, including valve explantation (n=16), left ventricular outflow tract obstruction (n=1), permanent pacemaker implantation (n=1), and paravalvular leak repair (n=1). Twenty-five patients underwent 41 episodes of catheter-based balloon expansion, exhibiting a significant decrease in median gradient ( P<0.001) with no significant increase in grade of regurgitation. Twelve months after implantation, cumulative incidence analysis indicated that 55% of the patients would be expected to be free from death, heart transplantation, structural valve deterioration, or valve replacement. Conclusions The Melody valve is a feasible option for surgical atrioventricular valve replacement in patients with hypoplastic annuli. The prosthesis shows acceptable short-term function and is amenable to catheter-based enlargement as the child grows. However, patients remain at risk for mortality and structural valve deterioration, despite adequate early valvular function. Device design and implantation techniques must be refined to reduce complications and extend durability. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02505074.

Safety of optical coherence tomography in pediatric heart transplant patients.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a crucial problem after heart transplantation, in adults as well as in children. CAV is the main risk factor for a reduced long-term graft survival. The early diagnosis and treatment of CAV is essential for a successful long-term preservation of the donor heart. However, asymptomatic progression of CAV and concentric hyperplasia of the coronary arteries may complicate the early diagnosis by conventional measures. Intravascular imaging, such as intravascular ultrasound and optical coherence tomography (OCT), enables the diagnosis of early stage CAV. To date, there is little known about OCT in children. We present our single center experience with OCT after pediatric heart transplantation. METHODS: Retrospective analysis of OCT (n=50) after pediatric heart transplantation between June 2013 and March 2016 and comparison between angiographic appearance and OCT. RESULTS: 37 patients underwent optical coherence tomography, nine patients were examined twice and two patients tree times. The youngest patient at time of examination was 4years with a weight of 15kg (mean 50.86kg, range 15 to 88kg). There were no complications, especially no bleeding, no arrhythmias or myocardial ischemic events. Early CAV (Stanford I or II) was detected by OCT in 26 cases. Only in four of these cases, also the coronary angiography showed mild changes. CONCLUSION: OCT is a safe intravascular imaging method that can also be used in children after pediatric heart transplantation up to a minimum weight of 15kg without an increasing risk of a catheterization procedure.

Older age at the time of the Norwood procedure is a risk factor for early postoperative mortality†.

OBJECTIVES: The Norwood procedure is commonly used as first-step palliation in children with hypoplastic left heart syndrome or related congenital malformations. In most cases, the operation is carried out during the first week of life. Excessive pulmonary blood flow in univentricular physiology can soon lead to compromised cardiac function and pulmonary hypertension and could have an influence on postoperative outcomes. METHODS: Between 1997 and 2011, 257 Norwood procedures were performed at the Kinderherz-Zentrum Linz. Twenty-seven patients were older than 20 days at the time of the Norwood operation without previous pulmonary artery banding. A retrospective analysis of the two age groups was carried out concerning early mortality, interstage mortality and major events until the bidirectional Glenn operation. RESULTS: Patients older than 20 days had a significantly higher mortality rate before the bidirectional Glenn operation than younger patients (44.4 vs 20.3%; P = 0.002). They also showed a significantly higher need for postoperative inhalative nitric oxide therapy (40.7 vs 14.5%, P = 0.002). Summarized risk for either successful postoperative cardiopulmonary resuscitation (CPR), extracorporeal membrane oxygenation therapy or mortality before the bidirectional Glenn operation was 59.3% in the older age group vs 23.8% in the younger age group (P < 0.001). CONCLUSIONS: Age older than 20 days seems to be an independent risk factor for early postoperative mortality and fatal events after the Norwood procedure. Long-persisting excessive pulmonary blood flow and preoperative cardiac decompensation can be the reason for postoperative lethal pulmonary hypertensive crisis and compromised ventricular function.

Noninvasive control of adequate cerebral oxygenation during low-flow antegrade selective cerebral perfusion on adults and infants in the aortic arch surgery.

UNLABELLED: Real-time readings of the regional oxygen saturation (rSO(2)) using near-infrared spectroscopy (NIRS) during the aortic arch surgery can provide an early detection of perfusion or oxygenation abnormalities. BACKGROUND: Aortic arch repair techniques using low-flow antegrade selective cerebral perfusion have been standardized to a certain degree. However, some of the often-stated beneficial effects have never been proven. Especially, the existence of an adequate continuous flow in both cerebral hemispheres during the surgical procedure still remains unclear as the monitoring of an effective perfusion remains a nonstandardized technique. METHODS: Seventeen patients underwent surgical reconstruction of the aortic arch due to aortic aneurysm surgery (adult group n = 8 patients) or of the hypoplastic aortic arch due to hypoplastic left heart syndrome (HLHS) or aortic coarctation (infant group n = 9 patients) under general anesthesia and mild hypothermia (adult group 28 degrees C; infant group 25 degrees C). Mean weights were 92.75 +/- 14.00 kg and 4.29 +/- 1.32 kg, and mean ages were 58.25 +/- 10.19 years and 55.67 +/- 51.11 days in the adult group and the infant group, respectively. The cerebral O(2) saturation measurement was performed by continuous plotting of the somatic reflectance oximetry of the frontal regional tissue on both cerebral hemispheres (rSO(2), INVOS; Somanetics Corporation, Troy, MI, USA). RESULTS: During low-flow antegrade perfusion via innominate artery, continuous plots with similar values of O(2) saturation (rSO(2)) in both cerebral hemispheres were observed, whereas a decrease in the rSO(2) values below the desaturation threshold correlated with a displacement or an incorrect positioning of the arterial cannula in the right subclavian artery. CONCLUSIONS: Continuous monitorization of the cerebral O(2) saturation during aortic arch surgery in adults and infants is a feasible technique to control an adequate cannula positioning and to optimize clinical outcomes avoiding neurological complications related to cerebral malperfusion.