RESUMEN

BACKGROUND: The MicroMed DeBakey ventricular assist device (VAD) (MicroMed Technology, Inc, Houston, TX) is the first long-term axial flow circulatory assist device to be introduced into clinical trials as a bridge to transplantation. Clinical trials began in Europe in November 1998 and in the United States in June 2000. METHODS: To qualify for the study, the patients must be listed for cardiac transplantation and must have demonstrated profound cardiac failure. There were no exclusions to the MicroMed DeBakey VAD implant other than those patients who would typically be excluded from cardiac transplantation. RESULTS: As of September 2000, 51 patients have been implanted with the MicroMed DeBakey VAD. A detailed evaluation of the first 32 patients has been completed. With current data, the probability of survival at 30 days after VAD implant is 81%. CONCLUSIONS: The clinical trial demonstrated that the MicroMed DeBakey VAD is capable of providing adequate circulatory support in patients with severe heart failure, sufficient to recover and return to normal activities while awaiting a heart transplantation. Much has been learned about the function of the device and its continuous flow in humans.

Asunto(s)

Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Diseño de Equipo , Femenino , Humanos , Masculino , Implantación de Prótesis/métodos

RESUMEN

Mice homozygous for the targeted deletion of the c/ebp alpha gene, which expresses the CCAAT/enhancer-binding protein alpha (C/EBP alpha), did not store hepatic glycogen and died from hypoglycemia within 8 hours after birth. In these mutant mice, the amounts of glycogen synthase messenger RNA were 50 to 70 percent of normal and the transcriptional induction of the genes for two gluconeogenic enzymes, phosphoenolpyruvate carboxykinase and glucose-6-phosphatase, was delayed. The hepatocytes and adipocytes of the mutant mice failed to accumulate lipid and the expression of the gene for uncoupling protein, the defining marker of brown adipose tissue, was reduced. This study demonstrates that C/EBP alpha is critical for the establishment and maintenance of energy homeostasis in neonates.

Asunto(s)

Proteínas de Unión al ADN/fisiología , Metabolismo Energético , Proteínas Nucleares/fisiología , Tejido Adiposo/metabolismo , Tejido Adiposo Pardo/metabolismo , Animales , Animales Recién Nacidos , Glucemia/metabolismo , Proteínas Potenciadoras de Unión a CCAAT , Proteínas Portadoras/genética , Proteínas de Unión al ADN/genética , Femenino , Regulación de la Expresión Génica , Glucosa-6-Fosfatasa/genética , Glucógeno Sintasa/genética , Glucógeno Sintasa/metabolismo , Homeostasis , Humanos , Canales Iónicos , Metabolismo de los Lípidos , Hígado/metabolismo , Glucógeno Hepático/metabolismo , Masculino , Proteínas de la Membrana/genética , Ratones , Ratones Noqueados , Proteínas Mitocondriales , Proteínas Nucleares/genética , Fosfoenolpiruvato Carboxiquinasa (GTP)/genética , ARN Mensajero/metabolismo , Albúmina Sérica/genética , Proteína Desacopladora 1