Can SARS-CoV-2 trigger new onset of autoimmune disease in adults? A case-based review.

Introduction: Although it has been proposed that SARS-CoV-2 can cause autoimmunity by inducing a transient immunodeficiency of both innate and acquired immunity components in which the immune system fails to identify autoantigens adequately, the exact mechanism that causes this disease remains unknown. We aim to systematically review of existing case reports for evidence of new autoimmune diseases in adults caused by SARS-CoV-2 infection. Methods: PRISMA-P 2020 method was used to search for literature in "PubMed" databases using the string "COVID-19 AND autoimmune disease AND complication". We used JBI Critical Appraisal Checklist to assess the articles' quality. Results: The literature search yielded 666 articles. 58 articles met our eligibility criteria. Based on our critical appraisal, we placed 35 articles in the good category and 23 articles in the medium category. Data was synthesized by grouping similar data into a table, including: gender, age, COVID-19 severity, types of autoimmune diseases, autoimmune profile and relevant findings, when autoimmune diseases are diagnosed, complications, and outcome to draw conclusions. The new onset of autoimmune disease in adult triggered by SARS-CoV-2 included Guillain-Barré syndrome and Miller Fisher syndrome, systemic lupus erythematosus, immune thrombocytopenia, autoimmune haemolytic anemia, latent autoimmune diabetes in adults, myositis, acute demyelinating encephalomyelitis, autoimmune encephalitis, central nervous system vasculitis, and autoimmune thyroid diseases. Conclusion: SARS-CoV-2 can trigger new onset of a variety of autoimmune diseases. Doctors who take care patients infected by COVID-19 must be aware of the complications of autoimmune diseases. Future cohort or cross-sectional studies on SARS-CoV-2-related autoimmune disease should be conducted.

Diagnostic accuracy of antibody-based rapid diagnostic tests in detecting coronavirus disease 2019: systematic review.

Introduction: The rapid transmission of coronavirus disease 2019 (COVID-19) requires a fast, accurate, and affordable detection method. Despite doubts of their diagnostic accuracy, rapid diagnostic tests (RDTs) are used worldwide due to their practicality. This systematic review aims to determine the diagnostic accuracy of antibody-based RDTs in detecting COVID-19. Material and methods: A literature search was carried out on five journal databases using the PRISMA-P 2015 method. We included all studies published up to February 2021. The risk of bias was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Diagnostic Test Accuracy Studies. Data regarding peer-review status, study design, test kit information, immunoglobulin class, target antigen, and the number of samples were extracted and tabulated. We estimated the pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with a 95% confidence interval. Results: Thirty-three studies met the eligibility criteria. The pooled data results showed that the combined detection method of IgM or IgG had the highest sensitivity and NPV, which were 73.41% (95% CI: 72.22-74.57) and 75.34% (95% CI: 74.51-76.16), respectively. The single IgG detection method had the highest specificity and PPV of 96.68% (95% CI: 96.25-97.07) and 95.97% (95% CI: 95.47-96.42%), respectively. Conclusions: Antibody-based RDTs are not satisfactory as primary diagnostic tests but have utility as a screening tool.

Long-term results of heart transplantation for end-stage valvular heart disease.

BACKGROUND: In general, heart transplantation for patients with heart failure improves survival. However, the outcomes of heart transplantation for patients with end-stage valvular heart disease are less well reported. This is a substantial group of patients, many of whom have had previous cardiac surgery. They therefore may be considered a subgroup with a poor prognosis. This study reports on the outcomes of heart transplantation for patients with end-stage valvular heart disease. PATIENTS AND METHODS: From March 1989 to December 2004, 75 consecutive adult heart transplantations were performed for end-stage valvular heart disease. Clinical characteristics were retrieved from a computerized database. RESULTS: The early mortality risk in heart transplantation for end-stage valvular heart disease was 13%, compared to 8% for other indications (p = 0.12). The main causes of early death were rejection (20%) and right ventricular failure (20%). The total follow-up time was 415 patient-years. During the follow-up, another 23 patients died (55/1000 patient-years of late mortality rate), mostly due to infection (43%) and multiorgan failure (22%). Multivariable analysis demonstrated that increased waiting time to heart transplantation correlated with increased survival (HR = 0.998, p = 0.04). The survival at 1, 5, 10, and 15 years was 70%, 64%, 56%, and 46% compared to 78%, 68%, 53%, and 41% for other indications, respectively (p = 0.5). CONCLUSION: The outcomes of heart transplantation for patients with end-stage valvular heart disease are similar to those for other patients. Apparently, the longer the waiting time to heart transplantation the better the outcome becomes.

Long-term patency of cephalic vein in coronary bypass surgery.

In the situation where the saphenous veins were unavailable, cephalic vein was the second choice in the beginning of 1980s. The routine use of saphenous vein and recent enthusiasm for arterial surgical myocardial revascularization lead to less attention on this conduit. We reported a patient undergoing redo coronary bypass surgery after 18 years of having cephalic vein grafts.

Impact of recipient's age on heart transplantation outcome.

BACKGROUND: The shortage of donor hearts stimulates the debate whether heart transplantation is justified for older recipients. We studied the effect of recipient's age on heart transplantation outcome in a large cohort of recipients. METHODS: Between March 1989 and December 2004, 1262 adult recipients underwent heart transplantation. Recipients were divided into two groups: 540 recipients aged younger than 55 years and 722 aged 55 years or older. RESULTS: The overall 30-day mortality risk was 9%, at 6% for recipients younger than 55, and 10% for recipients 55 years or older (p = 0.005). Rejection, multiorgan failure, infection, and right heart failure dominated the causes of early death in both groups. The 1-, 5-, 10-, and 15-year survival was 84%, 75%, 60%, and 50%, respectively, for recipients younger than 55 years, and 73%, 63%, 48%, and 35%, respectively, for recipients aged 55 years and older (p < 0.001). The mortality rate for those who survived the first month was 58/1000 patient-years. The main causes for late mortality were cardiac allograft vasculopathy, rejection, and infection for recipients younger than 55 years; and infection, malignancies, and rejection for recipients aged 55 years or older. Both the crude and adjusted hazard ratio increased with increasing recipient's age. CONCLUSIONS: The outcome of heart transplantation in older recipients is less favorable than in younger recipients. The decision to offer heart transplantation to recipients older than 55 years should be considered cautiously.

Risk factor analysis in pediatric heart transplantation.

BACKGROUND: Steady assessment of risk factors will enable identification of patients at higher risk for post-transplant death, and may thus improve organ utilization and outcomes. In this study we aimed to identify the risk factors of mortality in pediatric heart transplantation. METHODS: Between November 1989 and February 2004, there were 116 orthotopic heart transplantations performed in patients <18 years of age at our institution. RESULTS: The 30-day mortality risk was 12% (dilated cardiomyopathy 7%, congenital heart disease 26%; univariate analysis: p = 0.023). The main cause of 30-day mortality was primary graft failure (36%). The late mortality rate was 31 per 1,000 person-years. The main causes of late mortality were acute rejection (44%) and cardiac allograft vasculopathy (26%). The 1-, 5-, 10- and 15-year survival rates were 85%, 77%, 65% and 53%, respectively. Male donor (odds ratio [OR] 6.33, 95% confidence interval [CI] 1.11 to 36.01) and cardiopulmonary bypass >210 minutes (OR 43.05, 95% CI 1.11 to 1,669) were risk factors for 30-day mortality. Risk factors for 1- and 5-year mortality were body weight ratio <0.8 (OR 40.36, 95% CI 3.04 to 536.47) and male donor (OR 3.36, 95% CI 1.05 to 10.75), respectively. Recipient age <1 year (OR 64.65, 95% CI 1.69 to 2,466.77) and donor-recipient body surface area mismatch of <0.9 (OR 10.58, 95% CI 1.03 to 108.25) were risk factors for 10-year mortality. CONCLUSIONS: Pediatric heart transplantation can be performed with an expectation of excellent results. Certain risk factors suggest poorer outcomes.

Survival analysis in heart transplantation: results from an analysis of 1290 cases in a single center.

BACKGROUND: The clinical profiles of recipients and donors eligible for the procedure as well as the procedure itself have changed over time. We determined the impact of changes in baseline risk profiles at different transplant periods on outcome, and the time-specific distribution of causes of death. PATIENTS AND METHODS: Adult heart transplantations were performed consecutively on 1290 patients. Three transplant periods were defined: 1989-1993, 1994-1998, and 1999-2004. RESULTS: Recipient age and body mass index, previous cardiac surgery, high urgency status, need of ventricular assist device, waiting time (to transplantation and on ventricular assist device), donor age and body mass index, donor-recipient body mass index mismatch, and ischemic and cardiopulmonary bypass time were significantly different over the three transplant periods. There was, however, no significant difference in mortality risk. The major causes of deaths were: acute rejection, multiorgan failure, and right heart failure (1-5 years); cardiac allograft vasculopathy and malignancy (>5-10 years); and malignancy and infection (>10 years). The overall 1-, 5-, 10- and 15-year survival was respectively 77%, 67%, 53% and 42%. There was no difference in survival by different transplant periods (p=0.68). CONCLUSION: Despite clearly increased baseline risk profiles over time, the outcome of adult heart transplantation remains stable and encouraging. Cardiac allograft vasculopathy, malignancy, and infection threaten the long-term survival.

Scimitar syndrome presenting in adults.

Scimitar syndrome is a rare and complex congenital anomaly, which is characterized by the image of a Turkish sword on the chest X-ray. Very few cases in adults are reported in the literature. The long-term results of scimitar syndrome after surgical correction remain disappointing. We report an adult patient with scimitar syndrome undergoing surgery at our center.

Pediatric heart transplantation: current clinical review.

Heart failure has been recognized as a major public health problem. Its incidence and prevalence is increasing and imposes substantial burden on the health care system. Despite much progress in development of many new drugs and innovations in palliative surgical strategy, nontransplant cardiac surgical procedures and the use of mechanical assist devices, pediatric heart transplantation remains the best treatment option for patients with end-stage heart failure. So far, more than 6000 pediatric heart transplantations have been performed worldwide. This article reviews some clinical aspects of pediatric heart transplantation, including the history, indications and contraindications, donor evaluation and recipient management, surgical techniques, risk factors of mortality, and survival of pediatric heart transplantation. The short- and long-term outcomes of pediatric heart transplantation are encouraging. However, the lack of donor hearts still hampers its clinical application.

Long-term experiences on cardiac retransplantation in adults.

BACKGROUND: It remains disputed whether cardiac retransplantation should be performed. This study aimed to evaluate our long-term experiences on cardiac retransplantation in adults. PATIENTS AND METHODS: Between March 1989 and December 2004, 2% (28/1290) of cardiac retransplantations were performed. RESULTS: The reasons for cardiac retransplantation were cardiac allograft vasculopathy (n=13; 47%), primary graft failure (n=11; 39%), and refractory acute rejection (n=4; 14%). The 30-day mortality risk was 29% (acute rejection: 50%; primary graft failure: 36%; cardiac allograft vasculopathy: 15%, p=0.324), compared to 8.5% for primary cardiac transplantation (p<0.001). The causes of early death were acute rejection (n=3; 37%), multiorgan failure (n=3; 37%), primary graft failure (n=1; 13%), and right ventricular failure (n=1; 13%). The late mortality rate was 96/1000 patient-years. The causes of late death were acute rejection (n=4; 50%), cardiac allograft vasculopathy (n=2; 25%), multiorgan failure (n=1; 13%), and infection (n=1; 13%). The 1-, 5-, 10-, and 15-year survival was respectively 78, 68, 54, and 38% (primary cardiac transplantation), and 46, 41, 32, and 32% (cardiac retransplantation) (p=0.003). The short-term survival for cardiac retransplantation due to cardiac allograft vasculopathy was likely better than primary graft failure and refractory acute rejection (p=0.09). CONCLUSION: The overall outcomes of cardiac retransplantation are significantly inferior to primary cardiac transplantation. Cardiac retransplantation should be only performed for selected patients.

Heart transplantation in children: clinical outcomes in a single center.

BACKGROUND: Despite being accepted as the best treatment for end-stage heart diseases, the long-term benefit of heart transplantation in children remains a matter of controversial debate. This study aimed to evaluate our clinical experience with heart transplantation in children. METHODS: From March 1989 to December 1999, 93 consecutive orthotopic heart transplantations in children (less than 18 years of age) were performed at the Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW in Bad Oeynhausen, Germany. Clinical data were retrieved from a computerized database. Follow-up information was 100% completed. RESULTS: The main indications for heart transplantation were dilated cardiomyopathy (68%) and congenital heart disease (31%). Early mortality risk was 14% +/- 3.6%. Primary graft failure (39%) was the main cause of early death. Total follow-up time was 694 patient-years (mean, 104.1 +/- 42.8 months). Twenty-three patients died during follow-up, resulting in 33 of 1,000 patient-years of late mortality rate. Acute rejection (43%) and allograft vasculopathy (26%) were attributed to late mortality. The 1-, 5-, 10-, and 15-year survival was 83%, 74%, 63%, and 50%, respectively. Recipient age less than one year (p = 0.02) and ischemia time greater than 300 minutes (p = 0.04) were associated with decreased survival. Social activities at the end of follow-up were school (69%), working (19%), and at home (12%). CONCLUSIONS: Heart transplantation is a rational and durable treatment option for children with end-stage heart diseases. The long-term outcomes and quality of life after heart transplantation in children are encouraging.

Predictors of mortality after aortic valve replacement.

Aortic valve replacement (AVR) is recommended as a standard surgical procedure for aortic valve disease. Still the evidence for commonly claimed predictors of post-AVR prognosis, in particular mortality, appears scant. This systematic review reports on the evidence for predictors of post-AVR mortality, and may be helpful in pre-surgical risk-stratification. In PubMed, we searched for original reports of post-AVR follow-up studies. We assessed the quality of study design and methods with a standardized checklist. Data of the reported predictors of mortality and outcomes were extracted. Twenty-eight studies met our inclusion criteria. Sixteen studies were considered of high quality. There is strong evidence that the risk of early mortality is increased by emergency surgery, while the risk of late mortality is increased with older age and preoperative atrial fibrillation. There is moderate evidence that the risk of early mortality is increased by older age, aortic insufficiency, coronary artery disease, longer cardiopulmonary bypass time, reduced left ventricular ejection fraction (LV-EF), infective endocarditis, hypertension, mechanical valves, preoperative pacing, dialysis-dependent renal failure and valve size; and that the risk for late mortality is increased by emergency surgery and urgency of the operation. There is little evidence for high New York Heart Association class, concomitant coronary artery bypass graft and many other commonly claimed risk factors for post-AVR mortality. The reported evidence on predictors of post-AVR mortality will help for pre-surgical risk-stratification, i.e. to discern patients at high or low risk for early and late post-AVR mortality. Future prognostic studies should take the evidence from this review into account and should focus on derivation of a predictive model for post-AVR survival.