DA and the occurrence of pAMR within 1 year post-HTx independently influenced on the development of CAV.

DLI occurred one year or more after durable VAD implantation on average, regardless of the driveline derivation method. The double tunnel method contributed to opening the window for aggressive surgical treatment which more frequently resulted in a primary cure of the DLI than the conservative therapy.

Abstract Introduction Atrial functional mitral regurgitation (A-FMR) has been under-recognized until recently as a cause of FMR, and the prognostic difference between A-FMR and ventricular FMR (V-FMR) has not been fully elucidated. As there has been different mechanisms of FMR suggested in A-FMR and V-FMR, we hypothesized that prognosis and prognostic predictors of A-FMR may differ from those of V-FMR. Purpose To investigate the prognosis and prognostic predictors of A-FMR in comparison with V-FMR. Methods Among 1312 consecutive patients with grade 3+ (moderate to severe) or 4+ (severe) MR, 378 consecutive FMR patients were identified by excluding patients with degenerative MR, previous cardiac surgery, or concomitant aortic valve disease and/or mitral stenosis. FMR with ejection fraction (EF) <40% or FMR due to regional wall motion abnormalities with leaflet tethering were classified as V-FMR (N=288), and FMR due to left atrial (LA) and/or annular dilatation with preserved or mid-range EF (≥40%) were classified as A-FMR (N=90). All-cause death and heart failure hospitalization were analyzed as cardiovascular (CV) events in this study. Surgical or percutaneous mitral valve intervention without CV events was handled as not reaching an endpoint and these cases were censored. Results A-FMR were significantly older (76 [69–82] vs. 70 [58–77] years), higher rates of female (64 vs. 35%) and atrial fibrillation (88 vs. 42%), and lower B-type natriuretic peptide (BNP) values (169 [101–318] vs. 447 [213–952] pg/ml) compared to V-FMR (all P<0.05). On echocardiography, LV end-diastolic and end-systolic dimensions (52 [48–57] vs. 64 [58–72] mm, 34 [31–37] vs. 55 [48–64] mm), respectively) were smaller, and EF (55 [50–60] vs. 28 [19–35] %) and LA volume (99 [73–137] vs. 73 [57–91] ml/m2) were larger in A-FMR (all P<0.05). Effective regurgitant orifice area (32 [26–40] vs. 31 [24–45] mm2) and regurgitant volume (50±15 vs. 52±16 ml) were similar (both n.s.). During a median follow up of 1407 days, 206 (54%) patients developed CV events. Kaplan-Meier analysis revealed that V-FMR had a significantly higher rates of CV events compared to A-FMR (Figure) with adjusted hazard ratio (HR) of 1.762 [1.168–2.660], P=0.007 after adjusted for variables including age, sex, New York Heart Association functional class, previous heart failure hospitalization, estimated glomerular filtration rate (eGFR) and BNP. Further, stepwise multivariate analysis showed that independent prognostic predictors of A-FMR were LA volume and eGFR, while those for V-FMR were LA volume, age, and LV end-systolic dimension. Conclusions A-FMR had relatively better prognosis compared to V-FMR, and there were different prognostic predictors between A-FMR and V-FMR. Our results suggest that different treatment strategies need to be considered between A-FMR and V-FMR. The Kaplan-Meier life table Funding Acknowledgement Type of funding source: None

EVL with low-dose CNI might play a role in short-term improvement in renal function and TCAV in heart transplant patients. However, immunosuppressive regimen to furtherly improve renal function or TCAV mid-term after initiation of EVL should be investigated.

A re-exploration for bleedings is prevalently needed after CF-LVAD implantation, especially in patients with low post-operative platelet counts. As bleedings requiring a re-exploration were associated with poor prognosis, the risk stratification using post-operative platelet counts may be beneficial for patients who underwent CF-LVAD implantation.

Purpose Magnitude of functional recovery of the left ventricle (LV) is one of the critical determinants of prognosis post-implantation of ventricular assist device (iVAD) for non-ischemic dilated cardiomyopathy (NIDCM). Although predictive factors of the functional recovery are not fully understood, presence of immunocompetent cells in the myocardium is reported to be associated with the pathological stage and/or the myocardial viability. We aimed to explore relationships between functional recovery post-iVAD implantation and distribution of the immunocompetent cells in NIDCM. Methods In the last 5 years, iVAD such as HeartMateII was implanted in 50 patients with NIDCM for bridge-to-transplantation purpose, followed by β blocker and/or ACE inhibitor in the aim to enhance functional recovery. Results During the iVAD support, 12 patients (24%) underwent heart transplantation, while 2 patients (4%) died due to cerebral infarction. Four patients (8%) were treated for congestive heart failure in-hospital, while freedom from heart failure was 96±0.0% at 1 year and 89±0.1% at 5 years. Echocardiographical dimension of the LV was a significant predictive factor of heart failure post-iVAD implantation (P <0.05). There were 4 cases (8%) who showed improvement of EF by 10% or more at 6 months post-iVAD implantation. These 4 patients did not show death or heart failure during the iVAD support. While there was no significant predictive factor of improvement of EF by 10% or more, immunocompetent cells, such as T cells or macrophage, were predominantly present in the LV myocardium of the 4 patients showing the functional recovery post-iVAD implantation, as compared to that of the other patients (Figure). Conclusion Despite aggressive medical treatments post-iVAD implantation, functional recovery was not frequently seen in advanced stage of NIDCM. Immunocompetent cells in the LV myocardium might be a key to predict myocardial viability of this pathology. Magnitude of functional recovery of the left ventricle (LV) is one of the critical determinants of prognosis post-implantation of ventricular assist device (iVAD) for non-ischemic dilated cardiomyopathy (NIDCM). Although predictive factors of the functional recovery are not fully understood, presence of immunocompetent cells in the myocardium is reported to be associated with the pathological stage and/or the myocardial viability. We aimed to explore relationships between functional recovery post-iVAD implantation and distribution of the immunocompetent cells in NIDCM. In the last 5 years, iVAD such as HeartMateII was implanted in 50 patients with NIDCM for bridge-to-transplantation purpose, followed by β blocker and/or ACE inhibitor in the aim to enhance functional recovery. During the iVAD support, 12 patients (24%) underwent heart transplantation, while 2 patients (4%) died due to cerebral infarction. Four patients (8%) were treated for congestive heart failure in-hospital, while freedom from heart failure was 96±0.0% at 1 year and 89±0.1% at 5 years. Echocardiographical dimension of the LV was a significant predictive factor of heart failure post-iVAD implantation (P <0.05). There were 4 cases (8%) who showed improvement of EF by 10% or more at 6 months post-iVAD implantation. These 4 patients did not show death or heart failure during the iVAD support. While there was no significant predictive factor of improvement of EF by 10% or more, immunocompetent cells, such as T cells or macrophage, were predominantly present in the LV myocardium of the 4 patients showing the functional recovery post-iVAD implantation, as compared to that of the other patients (Figure). Despite aggressive medical treatments post-iVAD implantation, functional recovery was not frequently seen in advanced stage of NIDCM. Immunocompetent cells in the LV myocardium might be a key to predict myocardial viability of this pathology.

BACKGROUND:Bridge-to-decision (BTD) devices providing temporary mechanical circulatory support should be introduced to patients with advanced heart failure. This study evaluated the effectiveness and safety of a BTD device comprising an innovative extracorporeal continuous-flow temporary ventricular assist device (VAD) driven by a novel hydrodynamically levitated centrifugal flow blood pump. METHODS AND RESULTS:Nine patients, comprising 3 with dilated cardiomyopathy, 3 with fulminant myocarditis, and 3 with ischemic heart disease, and 6 males, whose mean age was 47.7±8.1 years, were enrolled into the study. Six patients had Interagency Registry for Mechanically Assisted Circulatory Support profile 1, and 3 were profile 2. The primary endpoint was a composite of survival free from device-related serious adverse events and complications during circulatory support. Eight patients received left ventricular support, of whom 3 received concomitant right ventricular support using extracorporeal membrane oxygenation circuits, as a consequence of severe respiratory failure. One patient with fulminant myocarditis received biventricular support using the novel VAD system. After 19.0±13.5 days, 3 patients were weaned from circulatory support, because their native cardiac function recovered, and 6 patients required conversion to a durable device as a bridge-to-transplantation. One patient had non-disabling ischemic stroke episodes, and no patients died. CONCLUSIONS:This novel extracorporeal VAD system with a hydrodynamically levitated centrifugal pump can safely and successfully bridge patients with advanced heart failure to subsequent therapeutic stages.

AIM:To test the hypothesis that the addition of a glucagon-like peptide-1 receptor agonist that can decrease glucose levels without increasing the hypoglycaemia risk will achieve appropriate glycaemic control during the peri-operative period.METHODS:We studied 70 people with Type 2 diabetes who underwent elective cardiac surgery. Participants were randomized to either an insulin-alone or an insulin plus liraglutide 0.6 mg/day group. We evaluated average M values, which indicated the proximity index of the target glucose level from day 1 to day 10.RESULTS:The average M value in the liraglutide plus insulin group was significantly lower than that in the insulin-alone group (liraglutide plus insulin 5.8 vs insulin-alone 12.3; P < 0.001). The frequency of insulin dose modification in the liraglutide plus insulin group was significantly lower than that in the insulin-alone group (odds ratio 0.19, 95% CI 0.08-0.49; P < 0.001). The frequency of hypoglycaemia in the liraglutide plus insulin group tended to be lower than that in the insulin-alone group (odds ratio 0.57, 95% CI 0.15-2.23; P = 0.21).CONCLUSIONS:The results of this study showed that the addition of low-dose liraglutide to insulin achieved lower M values than insulin alone, suggesting that the addition of low-dose liraglutide may achieve better glycaemic control during the peri-operative period. (Clinical trials registry no.: UMIN 000008003).

Abstract Background Late renal function dysfunction is an increasingly recognized complication in continuous flow left ventricular assist device (CF-LVAD) patients. Although hemolysis is prevalent in CF-LVAD patients and hemolysis may deteriorate renal function, the influence of persistent hemolysis on renal function in CF-LVAD patients remains to be investigated. Purpose To investigate the influence of persistent hemolysis on renal function in CF-LVAD patients, using lactate dehydrogenase (LDH) as a sensitive marker of hemolysis. Methods Excluding patients who died or underwent pump exchange for pump thrombosis, we retrospectively reviewed 65 consecutive adults who underwent HeartMateII implantation in our center from May 2011 to October 2017. Patient characteristics, chronotropic change of estimated glomerular filtration rate (eGFR) and LDH values weekly for 4 weeks and every 4 weeks between 4 and 48 weeks after implantation were collected. Then, calculating mean LDH during 48 weeks after implantation, study population was divided into low and high mean LDH groups at the median value of mean LDH. Results The median value of mean LDH was 304 U/l. Compared with low LDH patients, though high LDH patients were more likely female and had smaller body surface area, there were no significant difference in pre-operative eGFR between the groups (66.0±23.7 vs. 70.2±25.7 ml/min/1.73m2, p=0.495). After 40 weeks after implantation, high LDH patients had significantly lower eGFR than low LDH patients (71.0±23.7 vs. 87.1±31.4 ml/min/1.73m2, p=0.024). In multivariate linear regression analysis, mean LDH [parameter estimate: −0.10 (95% CI: −0.17 to −0.04), p=0.003] and post-operative pulse pressure [parameter estimate: 0.71 (95% CI: 0.05 to 1.37), p=0.036] were significantly associated with eGFR change during 48 weeks after HeartMateII implantation. Univariate and multivariate linear regression analysis for eGFR change Univariate parameter estimate 95% CI p value Multivariate parameter estimate 95% CI p value Bilirubin, mg/dl 9.97 3.82 to 16.13 0.002 6.55 −0.43 to 13.53 0.065 BNP, pg/ml 0.01 0.00 to 0.02 0.044 0.00 −0.01 to 0.01 0.528 Mean LDH during 4 to 48 weeks, U/l −0.11 −0.18 to −0.05 <0.001 −0.10 −0.17 to −0.04 0.003 Pre-operative right atrial pressure, mmHg 1.43 0.35 to 2.51 0.010 −0.06 −1.52 to 1.40 0.935 Post-operative pulse pressure, mmHg 0.77 0.03 to 1.52 0.042 0.71 0.05 to 1.37 0.036 Conclusions High mean LDH and low pulse pressure were associated with a significant decrease in eGFR late after HeartMateII implantation. Subclinical persistent hemolysis may be associated with late renal function deterioration in CF-LVAD patients.

Critical donor shortage has prompted promotion of marginal donor usage in heart transplantation (HTx). We developed modified bicaval anastomosis technique (mBCAT) which would achieve adjustable caval anastomosis to compensate the size-mismatch. This study was aimed to validate rationale of mBCAT for size-mismatch HTx with a focus on hemodynamic performance.

Cerebral vascular accident (CVA) is critical issue for patients with left ventricular assist device (LVAD). Whereas a balance between hemostasis and anticoagulation is important in early postoperative management, efficacy of early postoperative heparinization is uncertain. In this study, we explored the impact of early postoperative heparinization on the incidence of CVA in patients with HeartMate II (HMII).

Sarcopenia, progressive loss of skeletal muscle, is a frequent co-morbidity among patients with heart failure, and is also associated with poor clinical outcomes. A left ventricular assist device (LVAD) is an effective therapeutic option in patients with advanced heart failure, which improves not only survival but also improves physical functional capacity of these patients. It is not well clarified whether pre-operative sarcopenia is associated with poor outcomes after LVAD implantation. As urinary creatinine excretion rate (CER) has been one of easily obtainable established markers of muscle mass, in the present study, the relationship between CER and outcome after LVAD implantation was investigated.

INTRODUCTION:Tuberculous paradoxical reactions (PRs) are excessive immune reactions occurring after antituberculosis (TB) treatment and are commonly observed in immunocompromised hosts such as patients infected with the human immunodeficiency virus.CASE REPORT:We recently encountered a 63-year-old male heart transplant recipient who developed tuberculous PR after treatment for miliary TB. The patient had been receiving immunosuppressive therapy with cyclosporine and mycophenolate mofetil for over 15 years. The diagnosis of miliary TB was made based on the presence of intermittent fever and fatigue; thus, anti-TB treatments (isoniazid, levofloxacin, ethambutol, and pyrazinamide) were started, which led to rapid defervescence and regression of the granular shadow and pleural effusion. However, a new persistent fever and confused state developed 1 month after the anti-TB therapy was started. After excluding possible etiologies of the patient's symptom, a PR was suspected, and anti-TB drugs were continued; corticosteroids were added as anti-inflammatory agents. After that, he has shown a favorable course with long-term anti-TB chemotherapy.CONCLUSION:A PR should always be considered when the patients' symptoms of tuberculosis re-exacerbate after an appropriate anti-TB therapy. A PR commonly occurs in patients with various immunologic conditions including heart transplant recipients.

BACKGROUND:Left ventricular assist device (LVAD) therapy is the "gold standard" alternative therapy for patients with advanced heart failure. However, LVAD therapy is still uncommon in the Asia-Pacific region. Therefore, we aimed to elucidate the clinical outcomes of patients from Japan supported with the HeartMate II (HM-II) LVAD at our institution. METHODS:Ninety-two patients (mean 44.3 ± 12.1 years, 68 men, average body mass index 1.65 ± 0.28 m2; 81 with nonischemic cardiomyopathy) who underwent HM-II implantation for bridge to transplantation (n = 91) or for destination therapy in a clinical study (n = 1) at the National Cerebral and Cardiovascular Center between April 2013 and October 2017 were enrolled in this analysis. Preoperatively, most patients (n = 73, 79%) had an INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile of between level 2 and 4. Postoperatively, the average pump speed was 8602 ± 258 rpm and the hemodynamics were well compensated. RESULTS:Adverse events consisted of 38 (41.3%) hemolysis, 30 (32.6%) major infection, 27 (29.3%) major bleeding (6 [6.5%] with gastrointestinal bleeding), and 18 (19.6%) neurologic dysfunction events. Eighteen patients underwent heart transplantation (HTx) after an average of 32.9 ± 8.9 months of VAD support, and overall survival at both 6 months and 3 years was 96.3%. CONCLUSION:Clinical outcome among patients with HM-II at our institution is satisfactory for both survival and adverse events. The HM-II can provide effective hemodynamic support during the extremely long waiting period for HTx in Japan.

The decline in the number of suitable donor hearts has led to an increasing interest in the use of previously unacceptable donors. In Japan, if one candidate declines a donor heart it may be offered to other candidates. Since 2015, we have started to proactively transplant donor hearts declined. This single-centre study aimed to evaluate the outcome of recipients of donor hearts considered medically unsuitable for transplantation by at least 6 candidates.

Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized and potentially fatal complication of cardiac transplantation that commonly involves the gastrointestinal tract. Herein, we report a case of life-threatening gastrointestinal bleeding from recurrent terminal ileac ulcers mimicking PTLD in a heart recipient treated with everolimus (EVL). A 40-year-old man underwent heart transplantation for dilated cardiomyopathy 3 years prior to the current admission and was treated with tacrolimus and EVL. He was admitted to a local hospital because of fever, abdominal pain, and diarrhea. His symptoms persisted and, 3 weeks later, hematochezia occurred; thus, he was transferred to our hospital. As computed tomography and 18F-fluorodeoxyglucose positron emission tomography showed bowel-wall thickening of the terminal ileum, gastrointestinal PTLD was initially suspected. However, although colonoscopy— performed after switching EVL to mycophenolate mofetil (MMF)—showed terminal ileac ulcers, the histologic examination revealed no findings corresponding to PTLD. As EVL may delay ulcer healing, MMF was maintained for 3 months. After repeated colonoscopy showed ulcer healing, MMF was switched back to EVL for cardiac allograft vasculopathy prevention. Three weeks later, he was emergently admitted to a local hospital for life-threatening gastrointestinal bleeding from a recurrent terminal ileal ulcer, which required hemostatic forceps hemostasis. As EVL is suspected to be associated with recurrent ileal ulcers, EVL was again switched back to MMF. The ileal ulcers resolved, without recurrence in 3 months of clinical follow-up. This case demonstrates that cases of life-threatening gastrointestinal bleeding from recurrent terminal ileac ulcers can mimic PTLD in a heart recipient treated with EVL.

Management of late aortic regurgitation (AR) following left ventricular assist devices (LVAD) implantation is a crucial issue to improve long-term outcome. We analyzed the progression and impact of AR in these patients.

International Journal of Japanese SociologyVolume 26, Issue 1 p. 4-5 SPECIAL ISSUE - LOVE IN ASIA Introduction: Love in Asia Jun Kobayashi, Jun Kobayashi jun.kobayashi@fh.seikei.ac.jp Department of Contemporary Societies, Seikei University, 3-3-1, Kichijoji-Kitamachi, Musasino-shi, Tokyo, 180-8633 JapanSearch for more papers by this authorMasayuki Kanai, Masayuki Kanai mkanai@senshu-u.jp School of Human Sciences, Senshu University, 2-1-1, Higashimita, Tama-ku, Kawasaki-shi, Kanagawa, 214-8580 JapanSearch for more papers by this authorSaeko Kikuzawa, Saeko Kikuzawa skikuzaw@hosei.ac.jp Department of Sociology, Faculty of Social Sciences, Hosei University, 4342 Aihara, Machida, Tokyo, 194-0298 JapanSearch for more papers by this author Jun Kobayashi, Jun Kobayashi jun.kobayashi@fh.seikei.ac.jp Department of Contemporary Societies, Seikei University, 3-3-1, Kichijoji-Kitamachi, Musasino-shi, Tokyo, 180-8633 JapanSearch for more papers by this authorMasayuki Kanai, Masayuki Kanai mkanai@senshu-u.jp School of Human Sciences, Senshu University, 2-1-1, Higashimita, Tama-ku, Kawasaki-shi, Kanagawa, 214-8580 JapanSearch for more papers by this authorSaeko Kikuzawa, Saeko Kikuzawa skikuzaw@hosei.ac.jp Department of Sociology, Faculty of Social Sciences, Hosei University, 4342 Aihara, Machida, Tokyo, 194-0298 JapanSearch for more papers by this author First published: 29 March 2017 https://doi.org/10.1111/ijjs.12065Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume26, Issue1Special Issue: Love in AsiaMarch 2017Pages 4-5 RelatedInformation