Showing papers by "Sean Pinney published in 2005"

Acceptable recipient outcomes with the use of hearts from donors with hepatitis-B core antibodies.

Abstract: Background The shortage of available donors limits cardiac transplantation. Use of hearts from patients with hepatitis-B core antibodies could expand the donor pool but are usually avoided because of concern about virus transmission. We conducted a retrospective review to determine the safety of transplanting hearts from donors with hepatitis-B core antibodies. Methods We reviewed donor and recipient charts for patients who underwent transplantation at our center between January 1, 1997, and December 1, 2002. Results A total of 541 heart transplantations were performed in this time period. Thirty-three patients (aged 47.5 ± 18.8 years) received hearts from core-antibody-positive donors (aged 37.7 ± 10.8 years). Of these, 5 patients received prophylactic antibiotic treatment with lamivudine after transplantation. Only 1 patient (baseline surface-antigen-negative and without prophylaxis) experienced donor-transmitted hepatitis B infection 10 months after transplantation that was treated with lamivudine. Two patients (baseline surface-antibody-negative) had hepatitis B seroconversion, becoming surface-antibody positive without evidence of infection. None of the 5 patients who received prophylaxis with lamivudine had donor-transmitted hepatitis, and only 1 lamivudine-treated patient had surface antibodies. Post-transplant survival in this small cohort was similar to that for all patients who underwent transplantation at our center during this time period. Conclusions Transplantation of hearts from donors with hepatitis-B core antibodies is associated with a small viral-transmission risk, with or without post-transplant, anti-viral prophylaxis. Use of these donor hearts should be considered safe and may help to augment the available donor pool.

Reduced myocardial blood flow during left ventricular assist device support: a possible cause of premature bypass graft closure.

Abstract: Our aim was to determine the effect of left ventricular assist device (LVAD) implantation on bypass graft patency and to measure myocardial oxygen consumption (MVO 2 ) and blood flow during LVAD support. Five patients who underwent coronary artery bypass grafting and required LVAD implantation for post-cardiotomy cardiogenic shock had coronary angiography during device support to assess graft patency. Positron emission tomography measurements were made in a separate cohort of LVAD patients with dilated cardiomyopathy to assess the effects of LVAD support on MVO 2 and myocardial blood flow. In this small series, LVAD unloading led to a high rate of premature graft occlusion in post-cardiotomy cardiogenic shock patients supported with a device; whereas, positron emission tomography measurements showed significantly reduced MVO 2 and myocardial flood flow in dilated cardiomyopathy patients supported with an LVAD, compared with healthy subjects. Reduced myocardial blood flow may be implicated in the premature graft failure observed in post-cardiotomy cardiogenic shock patients and may negatively impact the potential for myocardial recovery and device weaning in this population.

Anti-human leukocyte antigen antibodies are associated with restenosis after percutaneous coronary intervention for cardiac allograft vasculopathy.

Abstract: BACKGROUND Percutaneous coronary intervention (PCI) to palliate cardiac allograft vasculopathy (CAV) has been associated with high restenosis rates, possibly related to increased inflammation associated with this disease. Whether markers of immunologic rejection are associated with restenosis in this population is unknown. The goal of the study was to determine the predictors of restenosis after PCI for CAV. METHODS Records were reviewed retrospectively from a single, high-volume cardiac transplant center. Clinical, angiographic, and immunologic data were collected on all patients postorthotopic heart transplantation (OHT) that had subsequent PCI. Restenosis was defined as greater than 50% stenosis at the previous intervention site. RESULTS PCI was successfully performed on 62 de novo lesions in 40 patients an average of 6.8+/-3.9 years after OHT. Angiographic follow-up data was available for 79%, with an average follow-up of 1.54+/-1.22 years. The 1-year restenosis rate was 49% (64% for balloon percutaneous transluminal coronary angioplasty and 33% for coronary stenting [P=0.09 for difference]). The frequency of immunoglobulin (Ig)G antibody to major histocompatibility complex (MHC) class I antigen was highly associated with risk of restenosis (hazard ratio [HR] 11.33, P=0.01). Greater stenosis severity and smaller target vessel diameter were also predictors of restenosis as in the nontransplant population. CONCLUSIONS The findings suggest that in patients postPCI for CAV, humoral allo-immunity may contribute to restenosis and that IgG antibodies to MHC class I antigen may help predict the risk of restenosis after PCI in this population.

Recent diagnostic and therapeutic innovations in heart failure management.

Abstract: Although there has been substantial progress in the treatment of congestive heart failure over the last several decades, it is clear that heart failure continues to burden our aging population. As the epidemic of heart failure grows, there remains an unmistakable need for novel diagnostic and therapeutic options in its management. In this article, we review recent innovations in the management of congestive heart failure, highlighting several recent clinical trials.

Balloon Dilatation of Coronary Sinus Spasm During Placement of a Biventricular Pacing Lead

Abstract: A 48-year-old man with a history of idiopathic dilated cardiomyopathy, Class 3 symptoms of congestive heart failure, and left bundle-branch block with QRS duration of 164 ms was referred for revision of his implantable cardioverter-defibrillator to a biventricular pacing device. At the time of initial cardioverter-defibrillator implantation at an outside hospital, a coronary sinus (CS) lead was not placed because of …