Early Institution of Mechanical Support Improves Outcomes in Primary Cardiac Allograft Failure
Primary graft failure (PGF) is the leading cause of early mortality after cardiac transplantation, accounting for 27.1% of deaths within 30 days. PGF is defined as severe dysfunction of the cardiac allograft without any obvious anatomic or immunological cause. The purpose of this study was to analyz...
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| Veröffentlicht in: | The Journal of heart and lung transplantation 2005-12, Vol.24 (12), p.2037-2042 |
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| container_title | The Journal of heart and lung transplantation |
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| creator | Marasco, Silvana F. Esmore, Donald S. Negri, Justin Rowland, Michael Newcomb, Andrew Rosenfeldt, Franklin L. Bailey, Michael Richardson, Meroula |
| description | Primary graft failure (PGF) is the leading cause of early mortality after cardiac transplantation, accounting for 27.1% of deaths within 30 days. PGF is defined as severe dysfunction of the cardiac allograft without any obvious anatomic or immunological cause. The purpose of this study was to analyze our last 9 years of experience with cardiac transplantation to determine predictors of PGF and the influence on survival of our policy of early institution of mechanical circulatory support (MCS) in these patients.
Data on 214 consecutive cardiac transplants performed at The Alfred Hospital between January 1996 and August 2004 were reviewed. PGF was defined as right or left or biventricular failure manifesting as hypotension (systolic blood pressure |
| doi_str_mv | 10.1016/j.healun.2005.06.007 |
| format | Article |
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Data on 214 consecutive cardiac transplants performed at The Alfred Hospital between January 1996 and August 2004 were reviewed. PGF was defined as right or left or biventricular failure manifesting as hypotension (systolic blood pressure <90 mm Hg), low cardiac output (cardiac index <2.0 liter/min/m
2) and pulmonary capillary wedge pressure >20 mm Hg after coming off cardiopulmonary bypass despite inotropic support of up to 5 μg/min adrenaline and without any other obvious cause for the graft dysfunction.
PGF developed in 51 patients (24%). Significant factors in the development of PGF were long ischemic time, which became significant over 4 hours (odds ratio, 1.43;
p = 0.01) and increased donor age (odds ratio, 1.027;
p = 0.045). Fifteen patients required mechanical support, and of these, 10 survived to leave hospital.
PGF is the major cause of early mortality after cardiac transplantation. Significant risks for PGF are long allograft ischemic time and increased donor age. Once the patient has survived 30 days, however, the longer-term survival is not influenced by PGF. Our management strategy of early mechanical support has yielded good outcomes in this population with a high risk of early death.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/j.healun.2005.06.007</identifier><identifier>PMID: 16364846</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Age Factors ; Assisted Circulation ; Biological and medical sciences ; Cardiology. Vascular system ; Female ; Heart ; Heart Diseases - surgery ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Heart Transplantation ; Humans ; Ischemia ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; Postoperative Complications ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Analysis ; Time Factors ; Tissue Donors ; Transplantation, Homologous ; Treatment Outcome</subject><ispartof>The Journal of heart and lung transplantation, 2005-12, Vol.24 (12), p.2037-2042</ispartof><rights>2005 International Society for Heart and Lung Transplantation</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-762321e239be0d3409e9d923492fc818e24f16f590718b9c14fa72942bbc651c3</citedby><cites>FETCH-LOGICAL-c390t-762321e239be0d3409e9d923492fc818e24f16f590718b9c14fa72942bbc651c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1053249805004225$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17408851$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16364846$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marasco, Silvana F.</creatorcontrib><creatorcontrib>Esmore, Donald S.</creatorcontrib><creatorcontrib>Negri, Justin</creatorcontrib><creatorcontrib>Rowland, Michael</creatorcontrib><creatorcontrib>Newcomb, Andrew</creatorcontrib><creatorcontrib>Rosenfeldt, Franklin L.</creatorcontrib><creatorcontrib>Bailey, Michael</creatorcontrib><creatorcontrib>Richardson, Meroula</creatorcontrib><title>Early Institution of Mechanical Support Improves Outcomes in Primary Cardiac Allograft Failure</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>Primary graft failure (PGF) is the leading cause of early mortality after cardiac transplantation, accounting for 27.1% of deaths within 30 days. PGF is defined as severe dysfunction of the cardiac allograft without any obvious anatomic or immunological cause. The purpose of this study was to analyze our last 9 years of experience with cardiac transplantation to determine predictors of PGF and the influence on survival of our policy of early institution of mechanical circulatory support (MCS) in these patients.
Data on 214 consecutive cardiac transplants performed at The Alfred Hospital between January 1996 and August 2004 were reviewed. PGF was defined as right or left or biventricular failure manifesting as hypotension (systolic blood pressure <90 mm Hg), low cardiac output (cardiac index <2.0 liter/min/m
2) and pulmonary capillary wedge pressure >20 mm Hg after coming off cardiopulmonary bypass despite inotropic support of up to 5 μg/min adrenaline and without any other obvious cause for the graft dysfunction.
PGF developed in 51 patients (24%). Significant factors in the development of PGF were long ischemic time, which became significant over 4 hours (odds ratio, 1.43;
p = 0.01) and increased donor age (odds ratio, 1.027;
p = 0.045). Fifteen patients required mechanical support, and of these, 10 survived to leave hospital.
PGF is the major cause of early mortality after cardiac transplantation. Significant risks for PGF are long allograft ischemic time and increased donor age. Once the patient has survived 30 days, however, the longer-term survival is not influenced by PGF. Our management strategy of early mechanical support has yielded good outcomes in this population with a high risk of early death.</description><subject>Age Factors</subject><subject>Assisted Circulation</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Diseases - surgery</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Heart Transplantation</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Tissue Donors</subject><subject>Transplantation, Homologous</subject><subject>Treatment Outcome</subject><issn>1053-2498</issn><issn>1557-3117</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1rFTEUhgdRbK3-A5Fs7G7GfE0m2Qjl0uqFSgV1a8hkTmwumck1yRT6702ZC925Ou_iOYf3PE3znuCOYCI-Hbp7MGFdOopx32HRYTy8aM5J3w8tI2R4WTPuWUu5kmfNm5wPGGPKevq6OSOCCS65OG9-X5sUHtF-ycWXtfi4oOjQN7D3ZvHWBPRjPR5jKmg_H1N8gIzu1mLjXINf0PfkZ5Me0c6kyRuLrkKIf5JxBd0YH9YEb5tXzoQM707zovl1c_1z97W9vfuy313dtpYpXNpBUEYJUKZGwBPjWIGaFGVcUWclkUC5I8L1Cg9EjsoS7sxAFafjaEVPLLtoLre7teTfFXLRs88WQjALxDVrIRVhktIK8g20KeacwOnj9oMmWD951Qe9edVPXjUWunqtax9O99dxhul56SSyAh9PgMlVm0tmsT4_cwPHUvakcp83DqqNBw9JZ-thsTD5BLboKfr_N_kH3sSX2A</recordid><startdate>20051201</startdate><enddate>20051201</enddate><creator>Marasco, Silvana F.</creator><creator>Esmore, Donald S.</creator><creator>Negri, Justin</creator><creator>Rowland, Michael</creator><creator>Newcomb, Andrew</creator><creator>Rosenfeldt, Franklin L.</creator><creator>Bailey, Michael</creator><creator>Richardson, Meroula</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20051201</creationdate><title>Early Institution of Mechanical Support Improves Outcomes in Primary Cardiac Allograft Failure</title><author>Marasco, Silvana F. ; Esmore, Donald S. ; Negri, Justin ; Rowland, Michael ; Newcomb, Andrew ; Rosenfeldt, Franklin L. ; Bailey, Michael ; Richardson, Meroula</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-762321e239be0d3409e9d923492fc818e24f16f590718b9c14fa72942bbc651c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Age Factors</topic><topic>Assisted Circulation</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Diseases - surgery</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Heart Transplantation</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Tissue Donors</topic><topic>Transplantation, Homologous</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marasco, Silvana F.</creatorcontrib><creatorcontrib>Esmore, Donald S.</creatorcontrib><creatorcontrib>Negri, Justin</creatorcontrib><creatorcontrib>Rowland, Michael</creatorcontrib><creatorcontrib>Newcomb, Andrew</creatorcontrib><creatorcontrib>Rosenfeldt, Franklin L.</creatorcontrib><creatorcontrib>Bailey, Michael</creatorcontrib><creatorcontrib>Richardson, Meroula</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of heart and lung transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marasco, Silvana F.</au><au>Esmore, Donald S.</au><au>Negri, Justin</au><au>Rowland, Michael</au><au>Newcomb, Andrew</au><au>Rosenfeldt, Franklin L.</au><au>Bailey, Michael</au><au>Richardson, Meroula</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early Institution of Mechanical Support Improves Outcomes in Primary Cardiac Allograft Failure</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2005-12-01</date><risdate>2005</risdate><volume>24</volume><issue>12</issue><spage>2037</spage><epage>2042</epage><pages>2037-2042</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>Primary graft failure (PGF) is the leading cause of early mortality after cardiac transplantation, accounting for 27.1% of deaths within 30 days. PGF is defined as severe dysfunction of the cardiac allograft without any obvious anatomic or immunological cause. The purpose of this study was to analyze our last 9 years of experience with cardiac transplantation to determine predictors of PGF and the influence on survival of our policy of early institution of mechanical circulatory support (MCS) in these patients.
Data on 214 consecutive cardiac transplants performed at The Alfred Hospital between January 1996 and August 2004 were reviewed. PGF was defined as right or left or biventricular failure manifesting as hypotension (systolic blood pressure <90 mm Hg), low cardiac output (cardiac index <2.0 liter/min/m
2) and pulmonary capillary wedge pressure >20 mm Hg after coming off cardiopulmonary bypass despite inotropic support of up to 5 μg/min adrenaline and without any other obvious cause for the graft dysfunction.
PGF developed in 51 patients (24%). Significant factors in the development of PGF were long ischemic time, which became significant over 4 hours (odds ratio, 1.43;
p = 0.01) and increased donor age (odds ratio, 1.027;
p = 0.045). Fifteen patients required mechanical support, and of these, 10 survived to leave hospital.
PGF is the major cause of early mortality after cardiac transplantation. Significant risks for PGF are long allograft ischemic time and increased donor age. Once the patient has survived 30 days, however, the longer-term survival is not influenced by PGF. Our management strategy of early mechanical support has yielded good outcomes in this population with a high risk of early death.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16364846</pmid><doi>10.1016/j.healun.2005.06.007</doi><tpages>6</tpages></addata></record> |
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| subjects | Age Factors Assisted Circulation Biological and medical sciences Cardiology. Vascular system Female Heart Heart Diseases - surgery Heart failure, cardiogenic pulmonary edema, cardiac enlargement Heart Transplantation Humans Ischemia Length of Stay Male Medical sciences Middle Aged Postoperative Complications Predictive Value of Tests Retrospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Analysis Time Factors Tissue Donors Transplantation, Homologous Treatment Outcome |
| title | Early Institution of Mechanical Support Improves Outcomes in Primary Cardiac Allograft Failure |
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