Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 80
Filtrar
5.
Annu Rev Med ; 70: 33-44, 2019 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-30296900

RESUMO

The number of patients with end-stage heart failure (HF) continues to increase over time, but there has been little change in the availability of organs for cardiac transplantation, intensifying the demand for left ventricular assist devices (LVADs) as a bridge to transplantation. There is also a growing number of patients with end-stage HF who are not transplant candidates but may be eligible for long-term support with an LVAD, known as destination therapy. Due to this increasing demand, LVAD technology has evolved, resulting in transformative improvements in outcomes. Additionally, with growing clinical experience patient management continues to be refined, leading to iterative improvements in outcomes. With outcomes continuing to improve, the potential benefit from LVAD therapy is being considered for patients earlier in their course of advanced HF. We review recent changes in technology, patient management, and implant decision making in LVAD therapy.


Assuntos
Desenho de Equipamento/tendências , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/estatística & dados numéricos , Qualidade de Vida , Adulto , Idoso , Desenho de Equipamento/métodos , Segurança de Equipamentos , Feminino , Previsões , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Análise de Sobrevida
6.
Circulation ; 137(1): 71-87, 2018 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-29279339

RESUMO

Heart transplantation has become a standard therapy option for advanced heart failure. The translation of heart transplantation from innovative experiments to long-term clinical success has married prescient insights with discipline and organization in the domains of surgical techniques, organ preservation, immunosuppression, organ donation and transplantation logistics, infection control, and long-term graft surveillance. This review explores the key milestones of the past 50 years of heart transplantation and discusses current challenges and promising innovations on the clinical horizon.


Assuntos
Insuficiência Cardíaca/história , Transplante de Coração/história , Animais , Difusão de Inovações , Rejeição de Enxerto/história , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Transplante de Coração/mortalidade , História do Século XX , História do Século XXI , Humanos , Imunossupressores/história , Imunossupressores/uso terapêutico , Preservação de Órgãos/história , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Risco , Coleta de Tecidos e Órgãos/história , Resultado do Tratamento
8.
J Heart Lung Transplant ; 35(5): 547-9, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27197770

RESUMO

The proposed new United States allocation system incorporates extensive research into an elegant plan designed to reduce wait list mortality while preserving post-transplant outcomes. All architects are to be congratulated. However, the future cannot be reliably modeled from the past as listing practices will evolve in response to new criteria. The new system should provide a major advance if and only if it is combined with a commitment to limit the number of listed patients overall and within each high priority status to the number that could reasonably undergo timely transplantation.


Assuntos
Coração , Cardiopatias , Transplante de Coração , Humanos , Obtenção de Tecidos e Órgãos , Estados Unidos , Listas de Espera
9.
J Heart Lung Transplant ; 35(3): 352-361, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26970472

RESUMO

BACKGROUND: With increasing age, human ventricular myocardium exhibits selective downregulation of ß1-adrenergic receptors (ß1-ARs). We tested the hypothesis that sex differences exist in age-related changes in ß1-ARs. METHODS: Left (LV) and right (RV) ventricular tissue was obtained from 61 unplaceable potential organ donor hearts ages 1 to 71 years with no known cardiac history and from LVs removed from 56 transplant recipients with idiopathic dilated cardiomyopathy. ß1-AR and ß2-AR densities, the frequency of ß1-AR389 gene variants, and ß-AR function were determined. RESULTS: Sex had a marked effect on the age-related decrease in ß1-ARs. Female LVs had more pronounced downregulation (by 42% [p < 0.001] vs 22% [p = 0.21] in 31 male LVs) comparing the youngest (average age, 15.3 ± 5.5 years) to the oldest (average age, 50.8 ± 9.1 years) sub-groups. On regression analyses, female LVs exhibited a closer relationship between ß1-AR density and age (r = -0.78, p <0.001 vs r = -0.46, p = 0.009 in males), with a second-degree polynomial yielding the best fit. There was no statistically significant relationship of ß1-ARs to age in female or male idiopathic dilated cardiomyopathy LVs. CONCLUSIONS: Sex affects age-related ß-AR downregulation in normal human ventricles, with females exhibiting more profound decreases with increasing age. The curvilinear relationship between age and receptor density that plateaus around age 40 in women suggests an effect of sex hormones on ß1-AR expression in the human heart.


Assuntos
Cardiomiopatia Dilatada/metabolismo , Regulação para Baixo , Ventrículos do Coração/metabolismo , Receptores Adrenérgicos beta 1/biossíntese , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
11.
Pediatr Transplant ; 19(1): 76-81, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25388808

RESUMO

Many children who undergo heart transplantation will survive into adulthood. We sought to examine the QOL and capacity for achievement in long-term adult survivors of pediatric heart transplantation. Adults >18 yr of age who received transplants as children (≤18 yr old) and had survived for at least 10 yr post-transplant completed two self-report questionnaires: (i) Ferrans & Powers QLI, in which life satisfaction is reported as an overall score and in four subscale domains and is then indexed from 0 (very dissatisfied) to 1 (very satisfied); and (ii) a "Metrics of Life Achievement" questionnaire regarding income, education, relationships, housing status, and access to health care. A total of 20 subjects completed the survey. The overall mean QLI score was 0.77 ± 0.16. Subjects were most satisfied in the family domain (0.84 ± 0.21) and least satisfied in the psychological/spiritual domain (0.7 ± 0.28). Satisfaction in the domains of health/functioning and socioeconomic were intermediate at 0.78 and 0.76, respectively. Most respondents had graduated from high school, reported a median annual income >$50 000/yr, and lived independently. Adult survivors of pediatric heart transplant report a good QOL and demonstrate the ability to obtain an education, work, and live independently.


Assuntos
Logro , Transplante de Coração , Qualidade de Vida , Sobreviventes , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
12.
Trends Cardiovasc Med ; 24(8): 341-9, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25258115

RESUMO

Recent advances in the management of heart transplant recipients have resulted in improved survival, particularly in the early post-transplant period. Although graft rejection, infection, malignancy, and allograft vasculopathy remain important challenges to the long-term management of heart transplant recipients, active research in these fields continues to advance our understanding and improve outcomes. This review will provide an overview of modern heart transplantation, summarize our current understanding of best practices for the management of heart transplant recipients, and describe recent advances in the field and areas of active research.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração , Rejeição de Enxerto/prevenção & controle , Insuficiência Cardíaca/epidemiologia , Transplante de Coração/métodos , Transplante de Coração/tendências , Humanos , Imunossupressores/administração & dosagem , Doadores de Tecidos , Transplantados
13.
J Heart Lung Transplant ; 33(10): 1103, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25242127
14.
Circ Heart Fail ; 5(6): 759-68, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22933526

RESUMO

BACKGROUND: Microvascular dysfunction is emerging as a strong predictor of outcome in heart transplant recipients. At this time, the determinants and consequences of early microvascular dysfunction are not well established. The objective of the study was to determine the risk factors and functional correlates associated with early microvascular dysfunction in heart transplant recipients. METHODS AND RESULTS: Sixty-three heart transplant recipients who had coronary physiology assessment, right heart catheterization, and echocardiography performed at the time of their first annual evaluation were included in the study. Microvascular dysfunction was assessed using the recently described index of microcirculatory resistance. The presence of microvascular dysfunction, predefined by an index of microcirculatory resistance >20, was observed in 46% of patients at 1 year. A history of acute rejection and undersized donor hearts were associated with microvascular dysfunction at 1 year, with odds ratio of 4.0 (1.3-12.8) and 3.6 (1.2-11.1), respectively. Patients with microvascular dysfunction had lower cardiac index (3.1±0.7 versus 3.5±0.7 L/min per m(2); P=0.02) and mild graft dysfunction measured by echocardiography-derived left and right myocardial performance indices ([0.54±0.09 versus 0.43±0.09; P<0.01] and [0.47±0.14 versus 0.32±0.05; P<0.01], respectively). Microvascular dysfunction was also associated with a higher likelihood of death, graft failure, or allograft vasculopathy at 5 years after transplant (hazard ratio, 2.52 [95% CI, 1.04-5.91]). CONCLUSIONS: A history of acute rejection during the first year and smaller donor hearts were identified as risk factors for early microvascular dysfunction. Microvascular dysfunction assessed using index of microcirculatory resistances at 1 year was also associated with worse graft function and possibly worse clinical outcomes.


Assuntos
Rejeição de Enxerto/epidemiologia , Transplante de Coração/fisiologia , Microcirculação/fisiologia , Microvasos/fisiopatologia , Adulto , Estudos de Coortes , Ecocardiografia , Feminino , Rejeição de Enxerto/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco
17.
Am J Cardiol ; 108(5): 665-8, 2011 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-21684511

RESUMO

Although not a definitive treatment, percutaneous coronary intervention offers a palliative benefit to patients with cardiac allograft vasculopathy. Given the superior outcomes with drug-eluting stents (DESs) over bare metal stents (BMSs) in native coronary artery disease, similar improvements might be expected in transplant patients; however, the results have been mixed. Consecutive cardiac transplantation recipients at a single center receiving a stent for de novo cardiac allograft vasculopathy from 1997 to 2009 were retrospectively analyzed according to receipt of a DES versus a BMS. The angiographic and clinical outcomes were subsequently evaluated at 1 year. The baseline clinical and procedural characteristics were similar among those receiving DESs (n = 18) and BMSs (n = 16). Quantitative coronary angiography revealed no difference in the reference diameter, lesion length, or pre-/postprocedural minimal luminal diameter. At the 12-month angiographic follow-up visit, the mean lumen loss was significantly lower in the DES group than in the BMS group (0.19 ± 0.73 mm vs 0.76 ± 0.97 mm, p = 0.02). The DES group also had a lower rate of in-stent restenosis (12.5% vs 33%, p = 0.18), as well as a significantly lower rate of target lesion revascularization (0% vs 19%, p = 0.03). At 1 year, DESs were associated with a lower composite rate of cardiac death and nonfatal myocardial infarction (12% vs 38%, p = 0.04). In conclusion, DESs are safe and effective in the suppression of neointimal hyperplasia after percutaneous coronary intervention for cardiac allograft vasculopathy, resulting in significantly lower rates of late lumen loss and target lesion revascularization, as well as a reduced combined rate of cardiac death and nonfatal myocardial infarction.


Assuntos
Doença das Coronárias/terapia , Transplante de Coração , Stents , Aspirina/administração & dosagem , Distribuição de Qui-Quadrado , Clopidogrel , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Stents Farmacológicos , Feminino , Humanos , Imunossupressores/administração & dosagem , Masculino , Metais , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Inibidores da Agregação Plaquetária/administração & dosagem , Estudos Retrospectivos , Fatores de Risco , Sirolimo/administração & dosagem , Ticlopidina/administração & dosagem , Ticlopidina/análogos & derivados , Transplante Homólogo , Resultado do Tratamento , Moduladores de Tubulina/administração & dosagem
18.
Rev. esp. cardiol. (Ed. impr.) ; 63(4): 451-471, abr. 2010. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-81104

RESUMO

En los últimos años, varios estudios han indicado que la función ventricular derecha es un factor predictivo importante de la supervivencia en los pacientes con cardiopatías congénitas, hipertensión pulmonar o insuficiencia cardiaca izquierda. Nuestro conocimiento de la insuficiencia cardiaca derecha ha mejorado considerablemente a lo largo de las últimas dos décadas. En este artículo de revisión, nuestro objetivo es presentar de forma crítica la evidencia que subyace en el tratamiento de la insuficiencia cardiaca derecha. Se llevó a cabo una revisión sistemática de la literatura médica, con el empleo de PubMed y el informe más reciente del Registro Central Cochrane de Ensayos Controlados, para identificar estudios realizados entre enero de 1975 y enero de 2010. La búsqueda se centró en ensayos observacionales y en ensayos controlados y aleatorizados, así como en los metaanálisis. Se revisa sistemáticamente la evidencia que subyace en el empleo de bloqueadores beta, inhibidores de la enzima de conversión de angiotensina, óxido nítrico inhalado, warfarina o terapia de resincronización en la insuficiencia cardiaca derecha. Se comentan también los nuevos tratamientos que están surgiendo, como los moduladores metabólicos, así como algunos aciertos y errores en el tratamiento de la insuficiencia cardiaca derecha (AU)


In recent years, several studies have shown that right ventricular function is an important predictor of survival in patients with congenital heart disease, pulmonary hypertension or left heart failure. Our understanding of right heart failure has improved considerably over the last two decades. In this review article, our objective was to provide a critical summary of the evidence underlying the management of right heart failure. A systematic review of the literature was performed using PubMed and the latest issue of the Cochrane Central Register of Controlled Trials to identify studies conducted between January 1975 and January 2010. The literature search encompassed observational studies, randomized controlled trials and meta-analyses. The evidence underlying the use of beta-blockade, angiotensin-converting enzyme inhibitors, inhaled nitric oxide, hydralazine, warfarin, and resynchronization therapy in right heart failure was systematically reviewed. Emerging new therapies, such as metabolic modulators, and the pearls and pitfalls of managing right heart failure are also discussed in the article (AU)


Assuntos
Humanos , Medicina Baseada em Evidências/tendências , Insuficiência Cardíaca/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Insuficiência Cardíaca/tratamento farmacológico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Óxido Nítrico/uso terapêutico , Varfarina/uso terapêutico , Metabolismo
19.
Rev Esp Cardiol ; 63(4): 451-71, 2010 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-20334811

RESUMO

In recent years, several studies have shown that right ventricular function is an important predictor of survival in patients with congenital heart disease, pulmonary hypertension or left heart failure. Our understanding of right heart failure has improved considerably over the last two decades. In this review article, our objective was to provide a critical summary of the evidence underlying the management of right heart failure. A systematic review of the literature was performed using PubMed and the latest issue of the Cochrane Central Register of Controlled Trials to identify studies conducted between January 1975 and January 2010. The literature search encompassed observational studies, randomized controlled trials and meta-analyses. The evidence underlying the use of beta-blockade, angiotensin-converting enzyme inhibitors, inhaled nitric oxide, hydralazine, warfarin, and resynchronization therapy in right heart failure was systematically reviewed. Emerging new therapies, such as metabolic modulators, and the pearls and pitfalls of managing right heart failure are also discussed in the article.


Assuntos
Medicina Baseada em Evidências , Insuficiência Cardíaca , Árvores de Decisões , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos
20.
J Heart Lung Transplant ; 29(3): 306-15, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19853478

RESUMO

BACKGROUND: During the past 25 years, advances in immunosuppression and the use of selective anti-microbial prophylaxis have progressively reduced the risk of infection after heart transplantation. This study presents a historical perspective of the changing trends of infectious disease after heart transplantation. METHODS: Infectious complications in 4 representative eras of immunosuppression and anti-microbial prophylaxis were analyzed: (1) 38 in the pre-cyclosporine era (1978-1980), (2) 72 in the early cyclosporine era (1982-1984), where maintenance immunosuppression included high-dose cyclosporine and corticosteroid therapy; (3) 395 in the cyclosporine era (1988-1997), where maintenance immunosuppression included cyclosporine, azathioprine, and lower corticosteroid doses; and (4) 167 in the more recent era (2002-2005), where maintenance immunosuppression included cyclosporine and mycophenolate mofetil. RESULTS: The overall incidence of infections decreased in the 4 cohorts from 3.35 episodes/patient to 2.03, 1.35, and 0.60 in the more recent cohorts (p < 0.001). Gram-positive bacteria are emerging as the predominant cause of bacterial infections (28.6%, 31.4%, 51.0%, 67.6%, p = 0.001). Cytomegalovirus infections have significantly decreased in incidence and occur later after transplantation (88 +/- 77 days, pre-cyclosporine era; 304 +/- 238 days, recent cohort; p < 0.001). Fungal infections also decreased, from an incidence of 0.29/patient in the pre-cyclosporine era to 0.08 in the most recent era. A major decrease in Pneumocystis jiroveci and Nocardia infections has also occurred. CONCLUSIONS: The overall incidence and mortality associated with infections continues to decrease in heart transplantation and coincides with advances in immunosuppression, the use of selective anti-microbial prophylaxis, and more effective treatment regimens.


Assuntos
Doenças Transmissíveis/epidemiologia , Cardiopatias/cirurgia , Transplante de Coração , Infecções Oportunistas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/prevenção & controle , Estudos de Coortes , Feminino , Transplante de Coração/imunologia , Transplante de Coração/mortalidade , Humanos , Imunossupressores/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/prevenção & controle , Infecções Oportunistas/imunologia , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/virologia , Estudos Retrospectivos , Viroses/epidemiologia , Viroses/prevenção & controle
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...