RESUMEN
AIMS: This EUROMACS study was conducted with the primary aim of investigating the association between a centre's annual caseload and postoperative outcomes among patients undergoing left ventricular assist device (LVAD) implantation. METHODS AND RESULTS: A total of 4802 patients identified between 2011 and 2020 from 35 participating centres were dichotomized based on the annual caseload of the treating centre at the time of device implant (≤30 vs. >30 LVAD implantations/year). The primary endpoint was 1-year survival. Secondary outcomes included overall survival analysis, device-related adverse events and readmissions. Cumulative follow-up was 10 003 patient-years, with a median follow-up of 1.54 years (interquartile range 0.52-3.15). Patients from higher volume centres more frequently presented in INTERMACS levels 1 and 2, suffered from right heart dysfunction and needed inotropic support. No difference was observed in adjusted 1-year survival. Adjusted overall survival probability was lower in higher volume centres (p = 0.002). In the subgroup analysis of HeartMate 3 devices only, higher volume centres were associated with decreased odds of 1-year survival (adjusted odds ratio 0.43, 95% confidence interval 0.20-0.97, p = 0.041). Similar findings were observed in the cumulative (i.e. learning curve) caseload analyses. CONCLUSION: In patients undergoing LVAD implantation, centre volume was not associated with 1-year survival, but was related to device-related adverse events. Patient profiles differed with respect to centre size. These findings underscore the necessity for ongoing quality improvement initiatives in all centres, regardless of their annual caseload. Efforts are needed to standardize patient selection and preconditioning to further improve patient outcome.
RESUMEN
The ingested pump inflow thrombus, although rare, is a potentially life-threatening complication of left ventricular assist devices. During the last years, the backwash maneuver is considered an alternative method to pump replacement for the treatment of inflow thrombosis, showing high success rate in selected patients with HeartWare HVAD devices. However, that was not the case in our present report, in which we detail the application of this method in two HeartMate3 patients with ingested pump inflow thrombus. Washing out the thrombus was not feasible in either case, possibly due to mechanical aspects of the inflow part of the HeartMate3 pump. As a result, we remain skeptical regarding the use of the method in HeartMate3 patients with inflow thrombosis.
Asunto(s)
Foramen Oval Permeable/complicaciones , Ventrículos Cardíacos/patología , Hipoxia/etiología , Infarto/etiología , Infarto del Miocardio con Elevación del ST/fisiopatología , Anciano , Angioplastia/métodos , Aspirina/administración & dosificación , Aspirina/uso terapéutico , Angiografía Coronaria/métodos , Quimioterapia Combinada , Ecocardiografía Transesofágica/métodos , Electrocardiografía/métodos , Foramen Oval Permeable/diagnóstico por imagen , Humanos , Infarto/diagnóstico , Masculino , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/uso terapéutico , Antagonistas del Receptor Purinérgico P2Y/administración & dosificación , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/terapia , Ticagrelor/administración & dosificación , Ticagrelor/uso terapéutico , Resultado del Tratamiento , Troponina T/sangreRESUMEN
Kounis syndrome is a relatively rare entity in which allergic or hypersensitivity reactions (including anaphylaxis) coexist with acute coronary syndromes. We report a case of Kounis syndrome type I variant in a 51-year-old male, victim of an out-of-hospital cardiac arrest a few minutes after a hymenoptera sting. Ιn-hospital cardiopulmonary resuscitation was provided and return of spontaneous circulation was achieved. The post-resuscitation electrocardiogram revealed ST-segment elevation in leads II, III, aVF, and ST depression in leads V2, V3, and V4. After administration of corticosteroids, antihistamines, nitrates, and a calcium-channel blocker the electrocardiogram rapidly returned to normal. There was no elevation in markers of myocardial necrosis and the coronary angiography revealed normal coronary arteries. According to the clinical course and the laboratory findings the diagnosis of Kounis syndrome type I variant was made. Only a few cases of Kounis syndrome in the setting of cardiopulmonary arrest have been published. We believe that in these cases, the recognition of the main underlying cause that lead to arrest (acute coronary syndrome or severe anaphylactic reaction) plays an important role in the choice of the most appropriate treatment for the patient.