Complications of retained pacemaker hardware in heart transplant recipients: case series and review of the literature

AbstractHeart transplantation (HT) in patients with prior cardiovascular implantable electronic devices (CIEDs) is becoming more common, in parallel with the increased use of CIEDs for patients with advanced heart failure. Complete removal of CIED components during HT is not always feasible, and it is thus surprising that the literature addressing the implications of retained CIED components is limited. Indeed, there are neither guidelines nor consensus regarding the need for removal of these CIED fragments. This issue is nonetheless becoming important in light of the increase in the percentage of HT candidates having CIEDs, on the one hand, and newer therapeutic immunosuppressive protocols with higher bacterial infection potential, on the other. Thus, with the aim to study the implications of retained CIED fragments as a step towards establishing a therapeutic approach for the unique population of HT recipients with CIED remnants, we present here a case series of HT patients with retained CIED fragments who developed complications of infections together with a review of the available literature.
Source: Infection - Category: Infectious Diseases Source Type: research

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ConclusionPatients newly diagnosed with ATTRv amyloidosis have substantial healthcare utilization and costs in the first year, primarily the initial months, post-diagnosis. Further research should examine later costs associated with disease progression and end-of-life care.
Source: Neurology and Therapy - Category: Neurology Source Type: research
Cardiac Cancer (CC) that arises from or involves the heart can present as heart failure, chest pain, stroke or another thromboembolic event. Although patients with CC have limited treatment options, in other organ cancers such as hepatocellular carcinoma, liver transplant improves 5-year overall survival in carefully selected patients1. For CC, however, the benefit of replacing the cancerous heart is uncertain because one-year survival is generally estimated around 50% after this rare operation.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Research Correspondence Source Type: research
Studies have shown that highly selected patients undergoing combined heart-kidney (HK) and heart-liver transplants (HLv) have short- and long-term outcomes comparable to those observed in primary heart transplantation (HT). Adults patients with stage D heart failure that underwent combined HK, HLv and heart-lung (HL) were identified in the United Network for Organ Sharing (UNOS) registry between 1991 and 2016, with follow-up through March 2018. We conducted inverse probability of treatment weighting (IPTW) survival analysis of long-term survival stratified by type of combined organ transplant, accounting for donor, recipie...
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
AbstractAimsNephrotoxicity of calcineurin inhibitors (CNIs) is associated with adverse events in patients undergoing heart transplant (HTx), although studies directly comparing tacrolimus (TAC) versus cyclosporin A (CsA), especially in combination with everolimus and low ‐dose CNIs approach, are limited. Thus, we sought to investigate the associations of TAC and CsA with clinical outcomes in HTx recipients, with specific focus on renal function.Methods and resultsFrom August 2007 to February 2017, 72 consecutive patients (39 treated with TAC vs. 33 with CsA) receivingde novo HTx in a single transplant centre were retrosp...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
Conclusions. The key comorbidities that predict poorer 2-year survival outcomes after kidney transplantation have been identified in this large prospective cohort study. The findings will facilitate assessment of individual patient risks and evidence-based decision making.
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research
AbstractThe heart transplantation is a stressful event, and its waiting time is often associated with worsening of clinical conditions and deterioration of the patient ’s quality of life. Spirituality plays an important role in mental health, so the present study was conducted to investigate the relationship between spiritual health and quality of life of patients undergoing cardiac transplantation. The present descriptive study was performed on 48 patients unde rgoing cardiac transplantation at the Shahid Rajaee Cardiovascular Center in Tehran during the first half of 2016. The data were collected by Ellisan–P...
Source: Journal of Religion and Health - Category: Medical Ethics Source Type: research
AbstractAimsRight ventricular hypertrophy (RVH) is a common finding in Anderson –Fabry disease (AFD), but the prognostic role of right ventricular (RV) involvement has never been assessed. The aim of our study was to evaluate the prognostic significance of RVH and RV systolic function in AFD.Methods and resultsForty ‐five AFD patients (56% male patients) with extensive baseline evaluation, including assessment of RVH and RV systolic function, were followed‐up for an average of 51.2 ± 11.4 months. RV systolic function was assessed by standard and tissue Doppler echocardiography. Cardiovascula...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
AbstractPurpose of ReviewThe use of durable ventricular assist devices (VAD) to manage end-stage heart failure is increasing, but infection remains a leading cause of morbidity and mortality among patients with VAD. In this review, we synthesize recent data pertaining to the epidemiology, diagnosis, management, and prevention of VAD infections, discuss transplant considerations in patients with VAD infections, and highlight remaining knowledge gaps. We also present a conceptual framework for treating clinicians to approach these infections that draws on the same principles that guide the treatment of analogous infections t...
Source: Current Heart Failure Reports - Category: Cardiology Source Type: research
Abstract Arrhythmogenic right ventricular cardiomyopathy (ARVC) appears in most patients to be an inherited disease characterized by fibrofatty replacement of myocytes extending from epicardium to endocardium in the right ventricle. The disease process results in life-threatening ventricular arrhythmias and ventricular dysfunction. In the absence of a gold standard diagnostic test and despite the progress in imaging techniques, ARVC is often misdiagnosed and earlier detection of the disease is challenging. Pre-procedural identification and localization of the substrate can be determined from the analysis of surfac...
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
We report the first successful case of extended Impella RP use as a safe and effective bri dge to orthotopic heart transplant in an LVAD patient with refractory, haemodynamically significant late RV failure. The Impella RP provided support for 37 days. Haemodynamically intolerant arrhythmia precluded use of inotropic support. No adverse complications related to percutaneous Impella RP su pport were seen. We also review potential considerations for mechanical circulatory support strategies in this setting: central RV assist device cannulation requires sternotomy incision that can impact subsequent cardiac surgeries, wh...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Case Report Source Type: research
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