Search

Phosphodiesterase-5 inhibitors (PDE5I) are frequently implemented after left ventricular assist device implantation (LVAD) to improve right heart hemodynamics. No prospective study has yet evaluated the net benefit of off-label long-term PDE5I on clinical outcomes and their potential risks. We aimed to evaluate the impact of PDE5I on bleeding risk as well as severity and type of bleeding according to The Bleeding Academic Research Consortium (BARC) classification after LVAD implantation. We retrospectively reviewed the database of our heart failure unit to identify adult patients who received a durable LVAD at our institution from December 2010 through May 2019. Patients were included in the analysis if they were discharged on oral PDE5I after LVAD implantation. Patients were excluded if they had received biventricular assist-devices, in case of postoperative death during the index hospitalization, follow-up interruption or follow-up in an affiliated hospital. Major bleeding was defined as fatal bleeding, and/or symptomatic bleeding in a critical area or organ, and/or bleeding causing a fall in hemoglobin level of 2 g/dL (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells. All non-major bleedings were considered minor bleedings. The analytic cohort included 109 patients. Seventy-five patients (69%) received long-term PDE5I therapy and thirty-four (31%) did not receive PDE5I. At 12 months 19 (17%) patients experienced cumulatively 28 bleeding events (26 events in patients on PDE5I, 2 not on PDEI5) leading to 27 red blood cell transfusions (all in the PDE5I group). Patients on PDE5I had higher bleeding rates (23% vs. 6%, p = 0.03) and more bleeding events per patient (0.32 vs. 0.06, p = 0.03). Most events concerned major bleeding (24 events, 85.7%) and 50% non-gastrointestinal bleeding. BARC Type 2 had the highest incidence and was more frequent in the PDE5I group (19 vs 3%, p = 0.03). Hospitalizations for bleeding and their duration were numerically higher for PDE5I (0.28 vs 0.03 hospitalizations, p = 0.07 and 2.4 vs. 0.2 days, p = 0.07, respectively). Long-term PDE5I treatment after LVAD increases the risk of bleeding at 12 months after LVAD implantation. The role of off-label PDE5I in LVAD patients remains unclear and should be further clarified in contemporary patient and device cohorts. [ABSTRACT FROM AUTHOR]

Left ventricular assist device (LVAD) therapy is associated with improved survival and quality of life (QoL) in advanced heart failure (HF) patients. Sexual dysfunction is common among HF patients and considered an important hamper to QoL. The aim of the study was the evaluation of prevalence of erectile dysfunction (ED) in LVAD recipients and its association with QoL and depression. This is a prospective, single-center, cross-sectional study. We included male LVAD patients who were clinically stable after at least 3 months post-implantation. Erectile function was assessed with the International Index of Erectile Function (IIEF-5) with a score of ≤ 21 being confirmatory for ED. QoL and depression were estimated with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Patient Health Questionnaire depression scale (PHQ-8), respectively. Association between binary variables was estimated by the x2 test. Pearson's correlation was run to assess the relationship between IIEF-5, KCCQ, and PHQ-8 scores. We included 52 patients on continuous-flow LVAD. Mean age was 57 years and bridge to transplant was the therapeutic goal in 79% of patients. Median time on device support was 707 days. HeartMate III was the most common device type (69%) followed by HeartWare (31%). According to IIEF-5 assessment, 78% of all study patients had ED. Mean IIEF-5 score was 11.9 ± 8.8, KCCQ 79.7 ± 5.5 %, and PHQ-8 score 6.3 ± 5.7. There was no significant association between ED and common comorbidities (chronic kidney disease, diabetes, peripheral arterial disease, coronary artery disease, hypertension, atrial fibrillation, stroke). ED was not associated with the intake of beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, sacubitril/valsartan, aldosterone antagonists, sodium-glucose co-transporter 2 inhibitors, or phosphodiesterase-5 inhibitors (PDE5i). There was a statistically significant negative correlation between IIEF-5 score and depression severity scale (r = -0.44, p < 0.014) while no significant correlation between IIEF-5 and KCCQ score was observed (r = 0.19, p = 0.25). ED is highly prevalent among LVAD recipients and is associated with severity of depressive symptoms. There is no association of ED with HF drugs and major comorbidities and PDE5i use is not associated with the prevalence of ED in this cohort. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Transcranial Doppler sonography (TCD) provides accurate confirmation of cerebral circulatory arrest (CCA) in brain death (BD), but is not feasible in patients with absent temporal bone windows. We added the transorbital approach in the TCD protocol for the diagnosis of CCA and compared findings with angiography. Furthermore, we evaluated whether reporting the angiographic and sonographic confirmation of CCA to relatives of brain-dead patients improves their comprehension and satisfaction with the medical information. Patients and Methods: Eighty-two clinically brain-dead patients underwent 4-vessel angiography, TCD of the basilar and middle cerebral arteries, and transorbital Doppler sonography (TOD) of the internal carotid arteries. Relatives were randomly allocated to 41 in whom BD was presented as a clinical diagnosis (group A) and to 41 in whom BD was presented as a clinical diagnosis confirmed by TCD and angiography (group B). Comprehension and satisfaction of the relatives were assessed using an interview and a questionnaire. Results: Both angiography and TCD verified CCA in all cases (k = 1). In 11 patients with failure of the transtemporal approach, CCA was confirmed by the transorbital recordings. The addition of TOD enabled 15.5% more cases of CCA to be diagnosed by TCD. Group B exhibited improved comprehension and satisfaction rates (P < .05). Conclusions: The addition of TOD increases the efficacy of TCD in confirming CCA in BD. Reporting confirmation of CCA to families of brain-dead patients may improve their comprehension and satisfaction with the provided medical information. [Copyright &y& Elsevier]

Previous magnetoencephalography (MEG) studies in healthy right-handed subjects have shown activation in the left posterior lateral aspect of temporal lobe accompanied by sources in the supramarginal gyrus (Broadmann areas 21,22) during language comprehension tasks. We used the method of functional magnetic resonance imaging to determine whether a similar comprehension task in which participants had to discriminate between feminine and neuter abstract nouns elicited activation in the same regions of the temporal lobes. A baseline condition was also used that required participants to discriminate between two different pitch tones. All six subjects showed significant activity in left superior and middle temporal gyrus (Broadmann areas 21,22) and five of them showed maximum activation in this area. Our results are in agreement with those of the MEG studies, demonstrating the concordance of the two methods and the validity of this task. [Copyright &y& Elsevier]

Heart Transplantation (HTX) is an established therapy for endstage Heart Failure with excellent long term results. However, shortage of donor organs leads to increased use of extended criteria organs and rising numbers of high risk recipients on the high-urgency list and on mechanical circulatory support (MCS). Donor organ machine perfusion (MP) allows continuous warm perfusion of the beating heart, thus reducing time of ischemia as well as allowing for standardized evaluation. AIM: analyze outcome of HTX using donor heart MP. In a retrospective single-center study, data from a prospectively collected database were analyzed. From July 2018 to September 2020, eleven hearts were retrieved and perfused using the Organ Care System (OCS), 9 hearts were transplanted. Criteria to use the OCS were 1) estimated ischemic time > 4 hours for any reason, 2) inotropes > 0.25 µg/kg/min, 3) LV-EF < 45%, 4) donors older than 55 years, 5) missing coronary angiography or suspected heart disease 6) previous surgery of recipient. 30-day and overall survival, major cardiac adverse events, graft function at follow up as well as rejection episodes were analyzed. All patients survived the procedure and the 30-day interval [time since HTX 8-799 d]. No MP related complications were noted. One patient died after 233 days due to sepsis. 4 patients were on temporary ECLS support in the early postoperative period (6-12d) due to initial right ventricular dysfunction. Graft ejection fraction beyond 14 days was ≥ 50% in all cases. Endomyocardial biopsies showed no rejection or mild rejection 1R in two cases (21d and 3 months surveillance biopsy). Two donor hearts were rejected after OCS perfusion 1) because of previously unknown coronary artery disease (angiography on OCS) and 2) due to underestimated aortic valve insufficiency and severe septum hypertrophy. Ex vivo normothermic MP during organ procurement is a safe and promising technique to expand the donor pool. Reduction of cold ischemic time while providing additional donor heart assessment and reconditioning options may increase the number of acceptable donor hearts and improve results. Future clinical trials will bring further evidence, clear guidelines regarding application of MP have to be developed. [ABSTRACT FROM AUTHOR]