Objetivo: determinar el impacto psicológico del COVID-19 en los pacientes con cáncer y valorar las variables clínicas y sociodemográficas que influyen en este. Método: se evaluó mediante una metodología observacional, analítica y transversal (T1), el impacto psicológico de la pandemia en 88 pacientes con cáncer de los servicios de Oncología Médica (n=31), Oncología Radioterápica (n=31) y Hemato-Oncología (n=26) del Hospital Universitario 12 de Octubre. Para ello se empleó la Escala Hospitalaria de Ansiedad y Depresión (HAD) y The Posttraumatic Stress Disorder Checklist (PCL-5). Además, se evaluaron las variables sociodemográficas y clínicas empleando un cuestionario de elaboración propia. Resultados: no se hallaron diferencias significativas en la sintomatología presentada por los pacientes de los tres servicios. Del total de participantes, un 22,7%, un 13,6% y un 15,9% obtuvieron puntuaciones clínicas de ansiedad, depresión y estrés postraumático, respectivamente. Asimismo, se encontró una relación directa entre el miedo a contraer el virus y la sintomatología ansioso-depresiva y postraumática (p<0,001). También entre el miedo a contagiar el virus y la depresión (p=0,002) y el miedo a contagiarlo y la sintomatología ansiosa y postraumática (p<0,001). Conclusiones: a pesar de la elevada presencia de sintomatología ansioso-depresiva y postraumática en los participantes, los porcentajes hallados son parecidos a los obtenidos en estudios pre-pandémicos. Los pacientes con un mayor miedo a contraer/contagiar el virus presentaron mayores puntuaciones en la sintomatología clínica, indicando esto la relevancia de evaluar el miedo y la posibilidad de emplearlo como herramienta de cribado.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal lung disease with a poor prognosis and increasing incidence. Pirfenidone and nintedanib are the only approved treatments for IPF but have limited efficacy and their mechanisms of action are poorly understood. Here we have examined the effects of pirfenidone and nintedanib in a human model of lung fibrogenesis, and compared these with the putative anti-fibrotic compounds Lipoxin A4 (LXA4), and senicapoc, a K Ca 3.1 ion channel blocker. Methods: Early fibrosis was induced in cultured human lung parenchyma using TGFβ1 for 7 days, ± pirfenidone, nintedanib, or LXA4. Pro-fibrotic responses were examined by RT-PCR, immunohistochemistry and soluble collagen secretion. Results: Thirty six out of eighty four IPF and fibrosis-associated genes tested were significantly upregulated by TGFβ1 in human lung parenchyma with a ≥0.5 log2FC ( n = 32). Nintedanib ( n = 13) reduced the mRNA expression of 14 fibrosis-associated genes including MMPs (MMP1,−4,−13,−14), integrin α2, CXCR4 and PDGFB, but upregulated α-smooth muscle actin (αSMA). Pirfenidone only reduced mRNA expression for MMP3 and −13. Senicapoc ( n = 11) previously attenuated the expression of 28 fibrosis-associated genes, including αSMA, several growth factors, collagen type III, and αV/β6 integrins. Pirfenidone and nintedanib significantly inhibited TGFβ1-induced fibroblast proliferation within the tissue, but unlike senicapoc, neither pirfenidone nor nintedanib prevented increases in tissue αSMA expression. LXA4 was ineffective. Conclusions: Pirfenidone and nintedanib demonstrate modest anti-fibrotic effects and provide a benchmark for anti-fibrotic activity of new drugs in human lung tissue. Based on these data, we predict that the K Ca 3.1 blocker senicapoc will show greater benefit than either of these licensed drugs in IPF.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive disease of unknown aetiology. TGFβ1 is a key cytokine driving pro-fibrotic myofibroblast activity. Ca2+ signals are critical in TGFβ1 driven pro-fibrotic functions and the Ca2+ permeable transient receptor potential (TRP)A1 channel is implicated in TGFβ1-driven pro-fibrotic responses. The role of TRPA1 in human lung fibrosis is unknown. Methods: Human lung myofibroblasts (HLMFs) were derived from non-fibrotic (NF) and IPF lung tissue. TRP channel expression and function were examined using RT-PCR, patch clamp electrophysiology and flow cytometry. TRPA1 activity was investigated using the TRPA1 agonists allyl-isothiocyanate (AITC) and JT010 and the selective antagonist A96707A. A human experimental model of lung fibrosis was used to assess the activity of TRPA1 ex vivo. Results: TRPA1 was the most abundant TRP channel in HLMFs out of 22 TRP channels analysed in both NF and IPF donors. TRPA1 agonists elicited functional TRPA1 currents in HLMFs which were inhibited by A96707A. TGFβ1 reduced both TRPA1 protein and mRNA expression in HLMFs, and TRPA1 mRNA expression was downregulated in lung tissue exposed to TGFβ1. Blocking TRPA1 did not inhibit myofibroblast contraction, changes in αSMA stress fibres, or FBS-induced wound healing. Furthermore, TRPA1 blockers did not inhibit TGFβ1-induced fibrotic changes in the experimental model of fibrosis. Conclusion: HLMFs express TRPA1. TRPA1 blockers do not prevent HLMF pro-fibrotic activity or TGFβ-induced experimental fibrosis.

Introduction Idiopathic pulmonary fibrosis (IPF) is a progressive and invariably lethal interstitial lung disease. Animal models help with understanding disease mechanisms, but to-date, the bleomycin mouse model of lung fibrosis has failed to predict drug efficacy. We have developed a human model of lung fibrosis that provides a more physiological representation for the assessment of anti-fibrotic strategies in IPF. Pirfenidone and nintedanib are currently approved for the treatment of IPF but have limited efficacy and their mechanisms of action are poorly understood. In this study we have compared the anti-fibrotic effects of pirfenidone, nintedanib and a potential novel therapy, senicapoc (KCa3.1 channel inhibitor) in our human model. Methods 2 mm3 pieces of human lung parenchyma were cultured for 7 days in DMEM ± TGFβ1 (10 ng/ml) ± pirfenidone (500 µM), nintedanib (1 µM), senicapoc (100nM). Pro-fibrotic pathways were examined by RT-PCR and soluble collagen secretion. Results In 45 donor lung samples tested, 44 out of 84 IPF- and fibrosis-associated genes tested were significantly upregulated by TGFβ1. Nintedanib (n=13) and pirfenidone (n=11) dysregulated the mRNA expression of 14 and 2 fibrosis-associated genes respectively. Nintedanib attenuated the TGFβ1-dependent upregulation of mRNA for numerous MMPs, Integrin’s and PDGF, but upregulated α-SMA. Pirfenidone attenuated the TGFβ1-dependent expression of MMP3 and 13, but did not upregulate the expression of any genes. In comparison, senicapoc (n=11) attenuated TGFβ1-dependent upregulation of 28 fibrosis-associated genes, including α-SMA, PDGF, collagen type III, ITGAV and ITGB6. Conclusions This human experimental model of lung fibrosis recapitulates pro-fibrotic events evident in IPF and shows sensitivity to pirfenidone and nintedanib inhibition. Pirfenidone and nintedanib impact different molecular pathways. Senicapoc inhibited significantly more fibrosis-associated genes than pirfenidone and nintedanib, supporting the view that KCa3.1 channels are a promising target for the treatment of IPF

Introduction: Idiopathic pulmonary fibrosis (IPF) is an invariably fatal interstitial lung disease. The two currently approved drugs for the treatment of IPF (pirfenidone, nintedanib) have limited efficacy and their mechanisms of action are poorly understood. In this study we have compared the anti-fibrotic effects of these drugs using a human model of experimental lung fibrosis. Methods: 2 mm3 pieces of human lung parenchyma were cultured for 7 days in DMEM ± TGFβ1 (10 ng/ml) ± pirfenidone (500 mM) or nintedanib (1 mM). Pro-fibrotic pathways were examined by RT-PCR and soluble collagen secretion. Results: In 45 donor lung samples tested, 44 out of 84 IPF- and fibrosis-associated genes tested were significantly upregulated by TGFβ1, using a threshold of 0.5 log2 fold change. Nintedanib (n=13 donors) and pirfenidone (n=11 donors) dysregulated the mRNA expression of 14 and 2 fibrosis-associated genes respectively (≥ log2 fold change). Nintedanib attenuated the TGFβ1-dependent upregulation of mRNA for MMP1, 13 and 14, and PDGF, but upregulated α-smooth muscle actin and CTGF. Pirfenidone attenuated the TGFβ1-dependent expression of MMP3 and 13, but did not upregulate the expression of any genes. Both nintedanib and pirfenidone reduced the TGFβ1-dependent secretion of soluble collagen into the culture supernatants. Conclusions: This human experimental model of lung fibrosis recapitulates pro-fibrotic events evident in IPF and shows sensitivity to pirfenidone and nintedanib inhibition. Pirfenidone and nintedanib impact different molecular pathways.

El uso más frecuente de la asistencia circulatoria mecánica (ACM) es como puente al trasplante cardíaco, aunque va en aumento la intención de recuperación. Estudiamos nuestra experiencia y progreso en este último campo. Material y métodos: Desde 1992 hemos hecho 54 ACM (78% con Abiomed BVS), de las que 11 se destetaron con fracción de expulsión (FE) entre 35-55%, en 8 hombres y 3 mujeres, con 48 años de media. En nueve la ACM fue de duración corta (6,5 días) por shock cardiogénico, poscardiotomía (4 coronarios; 2 valvulares postinfarto agudo de miocardio [IAM] en 2 y un fallo primario postrasplante). En dos más, se retiró en una miocarditis post partum a los 42 días, con Abiomeds BVS y 5000, y en una miocardiopatía tóxica a los 135 días con una bomba implantable Incor. Resultados: Tres (27%) fallecieron en el hospital por infecciones y fallo multiorgánico. A largo plazo, uno lo hizo al año por paro cardiorrespiratorio, y otro a los quince por IAM. Los destetados a largo plazo también siguen bien, 0,7 y 2,6 años después. Conclusiones: La recuperación de la función ventricular con ACM es posible no sólo en fallos agudos, sino también a largo plazo en IAM, miocarditis y miocardiopatías dilatadas. Debemos ser prudentes antes de decidir un trasplante.

La asistencia circulatoria mecánica se emplea cuando han fracasado todos los tratamientos posibles. Por ello, antes de su aplicación bastantes pacientes presentan ya contraindicaciones, absolutas o relativas, que hay que valorar de forma rápida y exhaustiva para una selección adecuada. En indicaciones agudas y urgentes, como en el shock cardiogénico, es muy importante no retrasar la indicación. Las enfermedades crónicas de órganos vitales avanzadas no suelen mejorar con la asistencia, aunque sí pueden hacerlo las agudas, dentro de ciertos límites. Los aparatos de larga duración suelen aplicarse en situaciones no urgentes, estables, lo que facilita mejores resultados. Describimos las contraindicaciones más importantes: edad avanzada, fallo orgánico, infecciones activas, hemorragia, vasoplejía, esperanza de vida no cardíaca muy corta. Las escalas de riesgo ayudan a su valoración. La mortalidad y complicaciones de la asistencia son frecuentes y elevadas, en especial en el primer mes, aunque persisten durante toda su aplicación. La hemorragia, el fallo orgánico, la infección, la tromboembolia y los fallos de los aparatos son las de mayor incidencia. Estos últimos se van reduciendo, al tiempo que se va alargando su durabilidad (bombas axiales). Aunque los progresos de la asistencia han sido más lentos de lo deseado, los niveles de aparataje y funcionamiento no se corresponden con el escaso uso que, en general, se hace en nuestro país.

BACKGROUND:Toxic cardiomyopathies are rare and the most frequent cause are anthracycline compounds. Early acute toxicity can be reversible, but at present the only effective therapy for late end-stage anthracycline cardiomyopathy seems to be a heart transplantation. Currently, this transplantation is contraindicated in cases of cancer, at least during the first 4 or 5 years. Recently, implantable axial pumps have shown good results and are used with increasing frequency as destination therapy.METHODS:We present a case of end-stage heart failure due to a toxic cardiomyopathy after a bilateral breast cancer treated with resection and chemotherapy (doxorubicin and trastuzumab). Ejection fraction was 23% with dobutamine. A left ventricular axial pump (Incor) was implanted.RESULTS:The immediate postoperative course was uneventful. The left ventricular function improved and on the fourth month the ejection fraction was 55%. On postoperative day 135, the pump was explanted. After 1.5 years, the patient is doing well, with an ejection fraction of 57%.CONCLUSION:This is the first application of an implantable axial pump in Spain. Although toxic cardiomyopathies are rare, in cases of late end-stage left ventricular failure and when the heart transplantation is contraindicated, the implantation of an axial pump can be the solution. The results in previous cases are unknown, although it is possible, as in our case.

Mechanical circulatory support is usually a last resort therapy. Before its application some patients have absolute or relative contraindications and have to be evaluated in a fast and exhaustive manner, to achieve an adequate selection. In acute and emergency indications, such as cardiogenic shock, it is critical not to delay the indication. Associated advanced chronic diseases very rarely improved with support, although acute complications can improve. We describe the most frequent contraindications: advanced age, organ failure, active infections, bleeding, vasoplegia, short life expectancy. The use of screening scales to prevent survival is important. Mortality and complications related to circulatory support support are very frequent and numerous, especially in the first month, although they persist during all the time. Bleeding, organ failure, infections and thromboembolism have the highest incidence. Prevention and fast diagnosis and treatment are very important. Mechanical failure of the devices is decreasing. Durability is increasing, especially with axial pumps. Although the progress of the mechanical circulatory support has been much slower than desired, the quality and quantity of the devices available today does not correspond with the infrequent use of these devices in our country.

Objective. Heart transplantation (HT) due to valvular cardiornyopathy is rare, namely, about 3% of cases in the Registry of the International Society for Heart and Lung Transplantation (ISHLT). Usually, these patients present some risk factors such as previous valvular operations and pulmonary hypertension. Since there are few studies in the literature, we retrospectively analyzed our early and long-term results.Materials and Methods. We studied our experience in 22 HT cases for valvular cardiomyopathy (9.3% of our total experience), namely, 12 men and 10 women, of overall mean age of 52.6 +/- 1.0 years. Five patients had mitral; 8, aortic; and 1, tricuspid valve disease; 7 had double valve disease and 1, triple valve disease. Nineteen patients (87%) had been operated previously between 1 and 4 times. The mean ejection fraction was 23% +/- 7.3% and the mean New York Heart Association (NYHA) functional class was 3.7. Fifty-three percent of the patients had pulmonary hypertension. Two patients were operated as an emergency "O." We used the standard HT technique.Results. Four patients (18%) were reoperated due to hemorrhage. The hospital mortality was 2 cases (9%). Another patients (9%) died on follow-up due to cardiac allograft vasculopathy. All surviving patients have been followed to the end of 2006. The mean follow-up has been 72 +/- 53 months. They are functional class I or II.Conclusions. HT for this indication was more frequent in our experience than in the Registry of the ISHLT. The immediate and long-term results were good, with an 82% mean survival at 6 years. HT can be a good treatment for patients with valvular cardiornyopathy and bad ventricular function and/or multiple valvular reoperations.

AIM It was believed that amiodarone-related adverse respiratory effects were found only when receiving amiodarone on a long-term basis, but several reports seem to contradict this hypothesis. The aim of this study was to evaluate, in an intensive care unit (ICU), the possibility of acute respiratory toxicity induced by short-term amiodarone administration following cardiac surgery. METHODS We conducted a prospective clinical trial of 111 consecutive patients admitted to our ICU after cardiac surgery (basically, coronary artery bypass graft and/or valve surgery) and who received short-term prophylactic amiodarone treatment if they were considered at high risk of developing atrial fibrillation. We administered 900 mg/day intravenously for the first 2 days and 600 mg/day on the following days of the ICU stay. The oxygenation index (PaO2/FiO2 ratio) was evaluated at admission, and then 24 and 48 h postsurgery. RESULTS One-hundred and two patients were included in the study (9 were excluded for bradycardia), and 25 received amiodarone treatment. The Parsonnet and APACHE II scores differed slightly between the treated and nontreated groups. There were no significant differences between the treated and nontreated groups with respect to left atrial pressure, the number of packed red cells transfused or the oxygenation index at admission and 24 and 48 h postsurgery. CONCLUSION The short-term administration of amiodarone under the conditions of the present study does not seem to affect respiratory function.

ObjectivesTo assess the impact of highly active antiretroviral therapy (HAART) on the blood pressure (BP) of naive patients after 1 year of treatment.MethodsA prospective, observational study of 95 HIV-positive patients in our Unit starting HAART between January 2001 and October 2002 and maintaining the same regimen for 48 weeks of follow-up was carried out. Data on blood pressure (BP) and demographic, epidemiological, clinical, immunovirological and therapeutic characteristics related to HIV infection were collected prior to HAART and at week 48. High blood pressure (HBP) [systolic BP (SBP) >= 140 mm Hg and/or diastolic BP (DBP) >= 90 mm Hg] was defined according to international criteria.ResultsOf the 95 patients, 78 were men, 44% had AIDS and 68% were smokers, and their mean age was 40 years. At week 48 the prevalence of HBP was 26% and SBP, DBP and pulse pressure (PP) increased (121.8 versus 116.6 mm Hg, P=0.0001; 76.3 versus 69.7 mm Hg, P=0.004; 46.9 versus 43.8 mm Hg, P=0.001, respectively). Univariate analysis showed that HBP was associated with older age, higher body mass index (BMI), higher baseline lipids, and higher baseline BP. A linear regression model adjusting for age and sex suggested a significant impact of older age, higher baseline SBP, higher baseline hypercholesterolaemia and lower baseline CD4-cell count on SBP increase.ConclusionsBlood pressure increased after 48 weeks of HAART, leading to an important prevalence of hypertension. The increase in SBP depended on age and baseline lipid profile and immunological status. BP should be periodically measured and treated when necessary in HIV-infected patients on HAART.

AIM:Atrial fibrillation (AF) is common after cardiac surgery, but prophylaxis for patients especially prone to developing this arrhythmia has not been studied to date. We investigated amiodarone as prophylaxis for AF in selected patients after open-heart surgery.METHODS:In the first stage we studied a group of 204 consecutive cardiac surgery patients and devised a formula from some of the known risk factors of AF for each sex to serve as a predictor model. In this first group we were able to quantify the probability of developing this arrhythmia. In the second stage we applied this formula to a group of 231 consecutive cardiac surgery patients and then selectively treated the high-risk patients for AF: 25 men (16.1%) and 29 women (53.7%). In the first 24 h of treatment with amiodarone, 22 patients (10 men and 12 women) were excluded from the study due to sinus bradycardia. Therapy consisted of amiodarone 900 mg intravenously every 24 h for the first 2 postoperative days, followed by 600 mg intravenously every 24 h until discharge from the Intensive Care Unit.RESULTS:Expected AF in males fell from 34.4% (52/151) in the observation group to 11% (17/155) in the treated group, and in females from 50.9% in the observation group (27/53) to 9.3% (5/54) in the treated group (P<0.001).CONCLUSIONS:Patient-selective prophylaxis of AF with amiodarone can be a highly effective measure.

Primary rhesus monkey kidney (MK) cells have long been the cells of choice for isolation and propagation of the human paramyxoviruses (parainfluenza 1, 2, 3, 4A, 4B, and mumps). However, problems with the supply and cost of MK cells and the presence of endogenous viruses, including herpes B virus and SV-5, necessitated a search for an alternative cell line. Continuous cell cultures of human origin (L132, A-549, HuT-292, HEK, G-293, G-401, A-498, A-704, CAKI-1, RD) and simian origin (LLC-MK2, BSC-1, MA-104, Vero) were evaluated for their capacity to support the growth of the human paramyxoviruses, as followed by cytopathic effect, hemadsorption, hemagglutination, and EIA. NCI-H292 (HuT-292) human lung mucoepidermoid carcinoma cells (ATCC # CRL-1848) proved to be the most sensitive line for cultivating all serotypes and strains of the paramyxoviruses. These cells were also shown to be a suitable substitute for MK in primary isolation of paramyxoviruses from clinical specimens. RPMI-1640 with 1.5µg/ml trypsin was the preferred maintenance medium; alternatively, Eagle's MEM supplemented with 1.5µg/ml trypsin and 0.1% ITS was satisfactory. NCI-H292 cells are a continuous line with excellent growth characteristics, although the genetic polyploidy of the cells may limit the number of passages of usable cells.

Monoclonal antibodies were prepared to the F and M proteins of parainfluenza 4A and 4B and to mumpsvirus to obtain reagents that could be configured into type-specific yet broadly-reactive IFA, EIA, and TR-FIA tests. Several antibodies to parainfluenza 4A also detected subtype 4B, although to a somewhat lower signal, and thus were well suited to generic parainfluenza type 4 tests that were comparable to similar tests previously described for parainfluenza types 1, 2, and 3. Monoclonals to subtype 4B were less able to detect 4A because of high background problems in one or another test. Monoclonals to mumpsvirus F protein were completely type-specific. These antibodies were screened by IFA and EIA for broad reactivity with diverse strains of each virus and were configured into optimized EIA and TR-FIA tests. The all-monoclonal tests were then compared to polyclonal tests in terms of their ability to detect virus in clinical specimens. The all-monoclonal TR-FIA was uniformly the most sensitive, detecting virus in 80% of culture-positive parainfluenza 4A specimens, 67% of parainfluenza 4B specimens, and 90% of mumps specimens, compared to 40-67% for the monoclonal EIA tests and 33-60% for the polyclonal EIA tests. For parainfluenza 4 TR-FIA, mean P/N values were 379 for subtype 4A cell culture fluids (228 for subtype 4B cultures) and 57 for 4A clinical specimens (43 for 4B specimens). For mumpsvirus TR-FIA, mean P/N values were 27 for culture fluids and 32 for clinical specimens. The sensitivities of the TR-FIA were determined with purified virus to be 0.28 ng virus per well for parainfluenza 4A and 0.70 ng virus per well for mumpsvirus.

Mycophenolate mofetil (MMF) has a better clinical profile than azathioprine in heart transplantation (HT). Forty-five recipients (aged 53 +/- 9 yr) were retrospectively evaluated (first year of follow-up) post-MMF introduction since its advent in 1997 (mean daily dose: 1.97 +/- 0.2 g). MMF was used (mean post-HT time: 40 +/- 27 months) for: (i) renal insufficiency attenuation (group 1 = 20); (ii) steroid reduction because of osteoporosis (group 2 = 12); (iii) treatment of persistent cellular rejection (group 3 = 7) and vascular graft disease (VGD) (group 4 = 6). Mean changes (groups 1-2) were: creatinine 172 +/- 59, 158 +/- 51, 153 +/- 57 mumol/L (at baseline, 6 and 12 months, respectively; p < 0.001). Cyclosporine daily dose: 219 +/- 37, 166 +/- 46, 176 +/- 98 mg, respectively (p < 0.001). Cyclosporine blood concentration: 151 +/- 40, 103 +/- 41, 83 +/- 34 ng/mL, respectively (p < 0.004). Prednisone daily dose: 8.3 +/- 2, 5.2 +/- 1, 4.1 +/- 1 mg, respectively (p < 0.001). Cellular rejection (group 3) was successfully treated (86%) but the outcome of VGD did not improve after the switch (group 4). Our limited experience (with caution) confirms the reported benefits of MMF particularly attenuating renal insufficiency.

In June 2000, we successfully performed an orthotopic cardiac transplant in a 52-year-old man who, together with a B-cell chronic lymphocytic leukemia (Binet Stage A, Rai Stage 1), also had end-stage dilated idiopathic myocardiopathy. We describe his case and the 2 years of cancer-free follow-up. To our knowledge, this is the first report of a heart transplant in this setting.

Interstitial pneumonitis is a temporary side effect of sirolimus therapy and has been described mainly in renal transplant recipients. It is considered to be dose dependent and has been documented in patients receiving at least 5 mg daily, or in patients with blood concentration plateaus >15 ng/ml. In general, clinical and radiologic features improve after discontinuation and, to the best of our knowledge, no reports of fatalities have been published. Our report documents the death in a heart transplant recipient (52-year-old man) that resulted from a loading-dose administration (15 mg), and we report the association of persistently increased blood concentrations (>20 ng/ml) during most of the scheduled administration period.

Introduction. The mortality of cardiogenic shock (CS) after an acute myocardial infarction (AMI) still remains high. Thrombolysis, PTCA or CABG, when possible, can improve the results, but when all the treatments fail death is almost certain.Objective. We investigate the use of the mechanical circulatory assistance (MCA) and heart transplantation (HT) to improve the adverse results in this irreversible situation.Methods. Among 11 patients with irreversible CS after an AMI we used a MCA (Abiomed BVS-5000). After improvement and hemodynamic stabilization, we performed heart transplantation in 7 patients of mean age 52 years (35-60) including two women. The MCA was univentricular in 7 patients and biventricular in 4. Mean duration of the MCA was 5 days (1-12).Results. Three patients died during the MCA: two due to cerebrovascular accidents and one multiorgan failure. Weaning was possible in one patient. Among Seven transplanted patients one died due to sepsis. Seven (64%) patients are long-term survivors.Conclusion. When all the treatments have failed for CS after an AMI, MCA may be used as a bridge to heart transplantation in a select group of patients where the procedure is not contraindicated. The long-term results of 64% survivors in our experience is satisfactory.