| 1. |
- Imamura, Teruhiko, et al.
(författare)
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Correction of hyponatremia by tolvaptan before left ventricular assist device implantation
- 2012
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Ingår i: International Heart Journal. - : International Heart Journal Association. - 1349-2365 .- 1349-3299. ; 53:6, s. 391-393
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Tidskriftsartikel (refereegranskat)abstract
- Hypervolemic hyponatremia is often complicated with advanced heart failure together with increased excretion of sodium by diuretics. Tolvaptan, an oral vasopressin-2-receptor antagonist, has been previously reported to improve congestion and correct hyponatremia through increased excretion of free water. However, there is little evidence concerning the administration of tolvaptan in patients with stage D heart failure. We experienced 2 patients with stage D heart failure who received 3.75 mg/day of tolvaptan to correct hyponatremia before ventricular assist device implantation. It may be useful, even for patients with stage D heart failure, to administer a low dose of tolvaptan to treat hyponatremia before ventricular assist device implantation to avoid a drastic alteration in serum sodium concentration perioperatively.
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| 2. |
- Imamura, Teruhiko, et al.
(författare)
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How to demonstrate the reversibility of end-organ function before implantation of left ventricular assist device in INTERMACS profile 2 patients?
- 2012
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Ingår i: Journal of Artificial Organs. - : Springer. - 1434-7229 .- 1619-0904. ; 15:4, s. 395-398
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Tidskriftsartikel (refereegranskat)abstract
- For the time being, in Japan, two recently approved implantable ventricular assist devices (VADs) are indicated only when a patient has been listed for heart transplantation or approved to be eligible for heart transplantation by in-hospital committee. The reversibility of end-organ dysfunction must be expected before VAD implantation, but it is often hard to prove during worsening clinical status. We report two patients whose end-organ dysfunction had been eventually demonstrated to be reversible by invasive procedures such as transluminal liver biopsy or transient insertion of intra-aortic balloon pumping.
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| 3. |
- Imamura, Teruhiko, et al.
(författare)
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Novel risk scoring system with preoperative objective parameters gives a good prediction of 1-year mortality in patients with a left ventricular assist device.
- 2012
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Ingår i: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 76:8, s. 1895-1903
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:As we have previously reported, the preoperative profile defined by INTERMACS is a good predictor for the prognosis after left ventricular assist device (LVAD) implantation, but is largely dependent on the physician's decision. Several other risk stratification systems including objective parameters (eg, Leitz-Miller, Columbia, Seattle Heart Failure Model, APACHE II) have been proposed to estimate patient's mortality after LVAD implantation.METHODS AND RESULTS:According to the preoperative data from 59 patients who received LVAD (10 implantable, 49 extracorporeal) since 2002 through 2010, we performed a logistic analysis and constructed a new scoring system (ie, the TODAI VAD score (TVAD score), assigning 8 points to serum albumin <3.2mg/dl (odds ratio [OR] 8.475), 7 points to serum total bilirubin >4.8mg/dl (OR 7.300), 6 points to left ventricular end-diastolic diameter <55mm (OR 5.917), 5 points to central venous pressure >11mmHg (OR 5.128)). The receiver-operating characteristic analysis showed that the area under the curve of our new scoring system (0.864) was significantly larger than any of the abovementioned 5 scoring methods (all P<0.05). With the TVAD score, low (0-8 points), intermediate (9-17 points), and high (18-26 points) risk strata had significantly different 1-year survival rates of 95%, 54%, and 14%, respectively (all P<0.001).CONCLUSIONS:The TVAD score can predict the prognosis after LVAD implantation much better than the previously known methods.
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| 4. |
- Irnamura, Teruhiko, et al.
(författare)
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An elevated ratio of early to late diastolic filling velocity recovers after heart transplantation in a time-dependent manner
- 2012
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Ingår i: Journal of Cardiology. - : Elsevier. - 0914-5087 .- 1876-4738. ; 60:4, s. 295-300
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSeveral groups have reported that an elevated ratio of early (E) to late (A) diastolic filling velocities is observed in patients after heart transplantation. However, the mechanism has not been fully analyzed.MethodsSerial echocardiography and hemodynamic study were performed in 16 patients who had received heart transplantation and had no evidence of rejection during 1 month after the operation.ResultsOn Day 1 after the surgery, E/A ratio was higher and peak velocity of A wave was lower than normal range among the patients after heart transplantation. E/A ratio and peak velocity of A wave gradually normalized during 1 moth after the surgery. Meanwhile, early mitral annular velocity and pulmonary capillary wedge pressure remained within normal range during the study period.ConclusionsLonger ischemic time during heart transplantation procedure may cause atrial stunning, but it appears to recover within 1 month. We have to be alert to misinterpretation of this “psuedo-psuedonormal” mitral inflow pattern early after transplantation.
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| 5. |
- Shiga, Taro, et al.
(författare)
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Combination evaluation of preoperative risk indices predicts requirement of biventricular assist device
- 2012
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Ingår i: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 76:12, s. 2785-2791
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Patients with biventricular assist device (BiVAD) placement have a poor prognosis, but preoperative risk factors for the necessity of BiVAD have not been fully elucidated.METHODS AND RESULTS:Data from 79 patients who received left ventricular assist device (LVAD) between November 2002 and December 2011 were retrospectively reviewed. Overall, 9 patients (11.4%) required BiVAD, and the survival rate of BiVAD patients was significantly lower than that of LVAD patients (P<0.001). Multivariate analysis for BiVAD requirement showed left ventricular diastolic diameter (LVDd) ≤62 mm (odds ratio [OR], 10.97; P=0.009) to be significantly associated with BiVAD requirement. Preoperative central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio ≥0.5 (OR, 13.09; P=0.028) was also significantly associated with BiVAD requirement. A new scoring system for predicting BiVAD requirement was created from the combination of CVP/PCWP ratio (≥0.5), body surface area (≤1.4 m(2)), preoperative continuous hemodiafiltration use, B-type natriuretic peptide (≥1,200 pg/ml) and LVDd (≤62 mm), and this had a significantly larger area under the curve (0.909; P=0.003) than right ventricular stroke work index on receiver operating characteristic analysis. A score >20 using the new scoring method indicated significantly high probability of BiVAD requirement (OR, 16.00; P=0.019).CONCLUSIONS:The new scoring method, which includes CVP/PCWP ratio, is a novel risk stratification tool for BiVAD therapy.
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