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Copyright of Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: To evaluate postgraduate training period, social life and problems of cardiology residents in Turkey by using a questionnaire form and to compare with the core curriculum of European Society of Cardiology for general cardiology. METHODS: Overall, 529 residents of cardiology ages in range of 24-35 years (mean age: 26.5±2.0 years, 81.4% male) participated as volunteers in this cross-sectional survey study. An 86-item questionnaire form was used to evaluate the education process, capacity of knowledge and skill and social effectiveness level of participants. The questionnaire were composed both closed- and open-ended questions. The questionnaire form was filled in with the face-to-face communication method. The data of survey were compared with the core curriculum of European Society of Cardiology for general cardiology training period. Chi-square or Fischer exact test was used for statistical analysis. RESULTS: The participants were working in various university hospitals (70.3%) and training-research (state) hospitals in 31 different provinces in Turkey (40.8% in Marmara region). They visited 40±10 outpatients and 10±5 hospitalized pts daily in the clinics. The 3-5 residents worked at the clinic on night shifts and mostly (89%) 8 or more night shifts per month were held in their first training years. During first three-years of training 76% of residents have performed echocardiography, 40.8%-transesophageal echocardiography and 10% - intraoperative echocardiography. The 84.3% of them evaluated exercise tests, 76.4%-Holter electrocardiography and 53.3%-tilt-table tests. The rate of residents working in coronary angiography laboratories was 54.3%. The 53.7% of residents performed coronary angiography and 64%-only in the 4th year of their training. The number of coronary angiography performance was under expected when compared with European Society of Cardiology curriculum. The 18.5% of residents were participated as assistant researcher in an international multi-center study and only 10% had an article published in national journals (4.3% published in Science Citation Index). The 30.6% considered the cardiology training period in their centers to be insufficient, whereas 37.4% found it partially sufficient and 31.9% sufficient. Only 32.9% of participants could dedicate time for social activities. CONCLUSION: According to the referred core curriculum of ESC for general cardiology the training of cardiology residents in non-invasive applications is adequate however coronary angiography applications are slightly insufficient in Turkey. In addition, the number of publications per capita is quiet low. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is an uncommon disorder that may be hereditable, idiopathic or associated with conditions like drug exposure, connective tissue disease, HIV infection or congenital heart disease. Familial disease are usually due to mutations in the bone morphogenic protein receptor type 2 (BMPR2), activin-like kinase-type 1 (ALK1) and endoglin (ENG). Functional and structural changes in the pulmonary vasculature lead to increased pulmonary vascular resistance. Vascular remodeling involves endothelial dysfunction, activation of fibroblasts and smooth muscle cells and recruitment of circulating progenitor cells. Vasoconstriction has also been shown to affect the remodeling process. Genetics, cellular and molecular basis of PAH are discussed in the paper. [ABSTRACT FROM AUTHOR]

Hydatid disease can occur anywhere in the body and can demonstrate different imaging features that vary according to growth stage, associated complications, and affected tissue. Cardiovascular system involvement of hydatid disease is very rare. In this article, we present the cardiac magnetic resonance (MR) and thorax computed tomography (CT), MR angiography (MRA) findings of hydatid cysts located in the right ventricle and pulmonary arteries after surgical removal of hepatic hydatid cysts. [ABSTRACT FROM AUTHOR]

We aimed to compare the effects of new treatment modalities to conventional hormone replacement therapy (HRT) on left ventricular (LV) diastolic function, by means of conventional and tissue Doppler echocardiography and the myocardial integrated backscatter (IBS) in postmenopausal women. One hundred and fifty healthy postmenopausal women were included in this study. Subjects were assigned to one of the five groups receiving 1 year of treatment (estrogen, estrogen plus progesterone, raloxifene, tibolone or placebo). E and A wave velocity, E/A ratio, isovolumic relaxation time (IVRT), deceleration time (DT), peak early (Em) diastolic mitral annular velocity, E/Em ratio, the cyclic variation of integrated backscatter (CVIBS) and the mean value of the IBS signal (MIBS) were determined before and 12 months after therapy. E (76 +/- 10 vs. 98 +/- 8 cm/s, P = 0.0001 and 78 +/- 10 vs. 90 +/- 12 cm/s, P = 0.02, respectively), Em (14.3 +/- 2.4 vs. 16.4 +/- 2.5 cm/s, P = 0.001 and 15.1 +/- 3.4 vs. 16.2 +/- 3.5 cm/s, P = 0.01, respectively), and E/A ratio (1.15 +/- 0.3 vs. 1.42 +/- 0.4, P = 0.0001 and 1.0 +/- 0.2 vs. 1.22 +/- 0.2, P = 0.01, respectively) were increased significantly compared to pretreatment in both estrogen and raloxifene groups while DT, A, E/Em, and IVRT were significantly decreased. A significant increase in CVIBS and decrease in MIBS were detected 12 months after estrogen and raloxifene administration while no significant changes were observed in other groups. Changes in the MIBS and CVIBS were found to be independently associated with the observed changes in the diastolic function indexes during therapy. Both estrogen and raloxifene regimens may improve LV diastolic functions in healthy postmenopausal women. This improvement may be a result of direct cardiac effects on LV myocardium. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Myocardial bridge (MB) is a congenital anomaly characterized by narrowing during systole of some of the epicardial coronary arterial segments running in the myocardium. Although, it is considered as a benign anomaly, it may lead to such complications as acute myocardial infarction, ventricular tachycardia, syncope, atrioventricular block and sudden cardiac death. In this study, we aimed to investigate demographic, clinical and angiographic characteristics of the patients with MB found on coronary angiography. Methods: The present study included 71 patients with MB found on coronary angiographies performed in our institution between January 1999 and September 2003. Based on the findings on angiography, the patients were subdivided into group A (n=41) and group B (n=30). The patients in the group A had no atherosclerotic lesion and the patients in the group B had coronary artery disease in addition to MB. Angiographic, demographic and clinical characteristics of both groups were compared. Results: There were no differences between two groups in distribution of gender and risk factors of coronary artery disease whereas mean age of the patients in the group A was lower (47+/-5 years vs 55+/-11 years, p=0.01). Frequency of two or more risk factors for coronary artery disease in a particular patient was significantly higher in the group B (55% vs 30%, p=0.03). Myocardial bridge was located at proximal or mid segments of left anterior descending artery (LAD) in 40 patients whereas its presence in both LAD and right coronary artery was found only in one patient in group A. Mean bridging percent was 43+/-27% in group A. Localization of MB was LAD in 29 patients of group B. One patient with severe aortic valve stenosis in this group had MB at first septal branch. Mean bridging percent was 70+/-25% in group B, which was significantly higher than in group A (p<0.05). Atherosclerotic narrowing developed in only LAD in 14 patients, LAD and other vessels in 7 patients and in the vessels without MB in 9 patients. In patients with MB in LAD atherosclerotic narrowing of vessel developed proximally to the MB. Clinically, stable angina pectoris was seen more frequently in group A than group B (70% vs 35%, p=0.01), whereas the frequency of acute coronary syndrome was higher in group B (65% vs 30%, p=0.04). In regard to therapeutic approach, more patients in the group A received medical management (80% vs 50%, p=0.01), while more patients in the group B underwent surgical and percutaneous interventions (50% vs 18%, p=0.04). Conclusion: Myocardial bridge probability should be considered in young patients presenting with angina or if the same symptoms are persistent in the patients without more than one risk factor for coronary artery disease. Myocardial bridge may initiate the development of atherosclerotic lesion or may facilitate progression of atherosclerosis in the proximal segment of the vessel. The risk of acute coronary syndrome rises when atherosclerosis is superimposed on MB. Myocardial bridge should be considered in the young patients, presenting with angina or its equivalents without atherosclerotic lesions on coronary angiography. [ABSTRACT FROM AUTHOR]

Background: In the past decade, many studies have indicated that the combination of low doses of different classes of antihypertensive agents may be more efficacious than monotherapy while minimizing the likelihood of dose-dependent adverse effects (AEs).Objective: The aim of this study was to determine whether combination therapy with lower doses of candesartan and a calcium antagonist, felodipine, would be more effective and tolerable in controlling mild to moderate hypertension compared with either drug used alone.Methods: In this 18-week, single-center, double-blind, crossover study, patients with mild to moderate essential hypertension were randomized to 1 of 2 treatment groups after a 2-week placebo washout period. Patients in group 1 received candesartan 16 mg once daily and patients in group 2 received felodipine 5 mg once daily, for 6 weeks. All patients then received half-dose combination therapy (candesartan 8 mg plus felodipine 2.5 mg, once daily) for 6 weeks. Finally, patients received 6 weeks of monotherapy with the alternate medication (group 1 received felodipine 5 mg once daily and group 2 received candesartan 16 mg once daily).Results: Thirty patients (18 men, 12 women; mean [SD] age, 54.0 [4.9] years; range, 39-62 years) were included in the study. During both monotherapy periods, candesartan and felodipine significantly reduced blood pressure (BP) (both P < 0.001). BP further decreased with combination therapy (P < 0.001 in both groups). Overall, 90.0% (27/30) of the patients achieved the target BP at the end of combination therapy. The incidence of AEs was similar with combination therapy compared with either monotherapy.Conclusions: In this study population, candesartan and felodipine had additive effects when used in combination, even at low doses, in the treatment of hypertension. Therefore, the combination of candesartan and felodipine is an effective alternative to that of candesartan and hydrochlorothiazide. [ABSTRACT FROM AUTHOR]

Although technical refinements have improved the safety of cardiac operations, postoperative dysfunction of lung and other organs occurs frequently after cardiopulmonary bypass (CPB). The aim of the present study was to search the aetiopathogenesis of pulmonary complications due to CBP. Ten patients with stable coronary artery disease, undergoing coronary artery bypass grafting (CABG) surgery, were included in the study. Forty bronchoalveolar lavage (BAL) fluid samplings were performed in the 10 patients. Samples were obtained at the following time periods: (1) preoperatively; (2) at the end of the first hour after anaesthetic induction; (3) at the conclusion of 30 min of crossclamp on CPB; and (4) at the conclusion of 20 h after the end of CPB, postoperatively. Cell contents of bronchoalveolar lavage fluid, alveolar macrophage viability, eosinophil cationic protein (ECP) levels and myeloperoxidase (MPO) concentrations were analysed in each bronchoalveolar lavage fluids. While the percentage of preoperative macrophages was 85.90% and the percentage of preoperative neutrophils was 2.40%, they were 77.00% and 11.30% in the postoperative samples, respectively. Mean alveolar macrophage viability was 96.20% preoperatively and 90.40% in the postoperative period. Preoperative eosinophil cationic protein mean concentration was < 2 μg/l and mean response value (RV) was 28.80. Pre-operative mean myeloperoxidase concentration was 7.66 ng/ml. Postoperative eosinophil cationic protein mean response value was 63.40 and mean myeloperoxidase concentration was 59.25 ng/ml. There were significant differences between third and final samples with regard to both neutrophil percentages (p = 0.028) and MPO levels (p = 0.005). While the preoperative mean PaO[sub 2] value was 89.39 mmHg and mean SaO[sub 2] value was 97.12%, they were calculated in the postoperative arterial blood specimens of patients, without inhaling O[sub 2], as 65.31 mmHg and 93.84%. These changes between blood gas analyses reflect the impairment of the lungs (p = 0.009 and p = 0.007, respectively). Neither alveolar macrophage viability nor ECP levels changed significantly between consecutive periods. However, when the results of the first and fourth samples were compared, we saw the cumulative effects of CPB, in that alveolar macrophages lost their viability and ECP mean RVs rose. These changes were statistically significant (p = 0.027 and p = 0.013, respectively). However, postoperative ECP levels were not like those found in a patient with asthma. Also, changes between alveolar macrophage percentages (p = 0.028), between neutrophil percentages (p = 0.036) and between MPO concentrations (p = 0.005) were statistically significant. Again, changes in neutrophil percentages between first and final samples correlated with changes in MPO levels between same periods (r = 0.657, p = 0.039). [ABSTRACT FROM AUTHOR]

Purpose Iron deficiency (ID) is common in heart failure patients and is associated with reduced exercise capacity, fatigue, worsening heart failure and increased rate of heart failure hospitalization. Intravenous iron therapy allows restoration of iron deficiency, increasing hemoglobin levels and ameliorates functional capacity. In this study, we aimed to determine the efficacy and safety of ferric carboxymaltose (FCM) treatment in continuous flow LVAD patients Methods In the study, we retrospectively analysed 29 patients treated with 1000 mg IV iron (FCM) due to ID between June 2018 and October 2018. We evaluated the effect of therapy on functional capacity, six-minute walking distance(6MWD), and laboratory findings. Results Mean age of the population was 51.6 ± 13.4 years, and 69% of the patients were male. Mean body mass index(BMI) was 26.8 ± 5.47kg/m2. The mean follow-up period after FCM infusion was 97.8 ± 21.2 days. NYHA functional class decreased from 1.83 ± 0.46 to 1.39 ± 0.49. 6MWD increased from 371 ± 75 meters to 395 ± 60 meters, mean change was 13.7 ± 35 meters. Hematological parameters (hemoglobin, hematocrit, blood iron level, ferritin, TSAT) improved. Mean NT pro-BNP value decreased from 1520 ± 1429 pg/ml to 1513 ± 1817 pg/ml, mean change was 6.7 pg/ml. The number of thrombocytes decreased (276 ± 97 to 220 ± 49.8, mean change 56.1 ± 87.7), mean platelet volume increased (10.25 ± 1.01 to 10.43 ± 0.92, mean change 0.188±0.55) and platecrit decreased (0.28 ± 0.071 to 0.23 ± 0.047, mean change -0.048 ± 0.074) In the follow up period four patients developed pump thrombosis (PT) and treated with iv thrombolytic therapy. When we compare the iron treated patients with the ones who were not treated there was an increase in the rate of pump thrombosis although it did not reach significance (PT rates were respetively, 13.7% - 6.3%, p=0.239). The variables associated with pump thrombosis were BMI (PT:50.7 ± 13.7 kg/m2- nonPT:57.25 ± 10.6 kg/m2 p=0.001), increase in mean platelet volume (PT: 10.3 ± 0.94 fl - nonPT: 11.15 ± 0.17 fl, p=0.001) and increase in platecrit (PT: 0.225 ± 0.039 % - nonPT:0.282 ± 0.063%, p= 0.023) after therapy. Conclusion FCM therapy increased functional class and 6MWD in LVAD patients with ID. Natriuretic peptid levels decreased after therapy. However there was a trend in pump thrombosis after therapy. Further studies are needed to establish the safety of FCM therapy in this population. [ABSTRACT FROM AUTHOR]

Purpose Patients with left ventricular assist devices (LVAD) are at high risk of cerebrovascular events, including stroke and intracranial hemorrage (ICH). There is limited data available on risk factors and outcome associated with CNI events in LVAD population. In this study the incidence of ICH, outcome and associated risk factors were evaluated. Methods 340 patients implanted with continuous-flow LVAD from the year 2012 to 2018 were included in the study. Results During this time interval, 46 patients had ICH and the incidence rate of ICH was 0.022 per patient-year. ICH patients' mean age was 50.7 ± 11.8 years and 41 (89.1%) patients were men. The incidence of ICH was 14.3% (n=46). 15.2% of the events were hemorragic transformation after stroke, 8.7% were associated with high INR values, 13.6% developed after thrombolytic therapy for pump thrombosis and 63% were spontaneous (without any established predisposition). Traditional risk factors weren't determinative of hemorrhagic stroke events. 13.1% of ICH patients had a previous CNI event before LVAD implantation. The previous CNI event (whether an ischemic stroke or ICH) before LVAD implantation wasn't associated with postop of ICH. 76% of the spontaneous ICH patients had nonischemic cmp. This number was significantly higher than patients with ischemic origin (76% and 24% respectively p=0.047). ICH related mortality rate was 45.7%. Mortality mostly occurred in hemorrhagic transformation stroke patients (83.3%). Mortality rate was 34.5 % in spontaneous ICH patients. Death was significantly higher in ischemic cmp patients than in nonischemic population (63.6%-30.4% respectively, p=0.026) 41.4% of the spontaneous ICH patients had positive blood cultures within the previous 30 days or 7 days after the ICH event. The most frequent pathogen that caused bacteremia was gram-positive (75%) and the most frequent established pathogen was Staphylococcus aureus (41.7%). Another condition associated with spontaneous bleeding was bacteriemia due to driveline infection (75% n=9, p=0.001). The most frequent pathogen that caused bacteremia was gram-positive bacteria(75%) and the most frequent established pathogen was Staphylococcus aureus (41.7%). Conclusion ICH seen after LVAD implantation is associated with high mortality rates. Infection with positive blood cultures is a strong risk factor for ICH. Nonischemic cmp patients were found to be at higher risk. [ABSTRACT FROM AUTHOR]

Introduction HeartMate II (HMII; Thoratec Corporation, Pleasanton, Calif, United States) is a continuous-flow pump approved by the Food and Drug Administration (FDA) for bridge-to-transplantation (BTT) since 2008 and for destination therapy (DT) since 2010. Herein, we present the postoperative outcomes of HMII implantation due to end-stage heart failure in our center. Methods Twenty-eight patients (mean age, 51.2 ± 8.7 years; 1 female) were implanted with the HMII between August 2012 and August 2014. Indications were dilated (n = 18) and ischemic (n = 10) cardiomyopathy. The intended treatment was BTT in 24 and DT in 4 patients. Preoperative clinical status was International Registry for Mechanical Circulatory Support (INTERMACS) 2, 3, and 4 in 6, 14, and 8 patients, respectively. The procedure was performed via conventional sternotomy under cardiopulmonary bypass. Heparin, acetylsalicylic acid, and warfarin were used for postoperative anticoagulation. Results Mean duration of support was 326 days (median, 272). Three patients underwent heart transplantation and 22 remain on pump support. One patient died before discharge due to respiratory failure and 2 others died following a cerebral bleeding 248 and 265 days postoperatively, respectively. The survival rates at 6 and 12 months were 96% and 90%, respectively. Temporary right ventricular failure was observed in 2 patients. Two patients had pump thrombosis treated with anticoagulation management or pump exchange, whereas another patient who had aortic root thrombosis underwent reoperation for removal of the thrombus. Discussion Mechanical circulatory support with HMII axial flow pump seems to be effective and may provide good survival rates compared with optimum medical management and old-generation devices. Patient selection and timing of implantation are crucial for success. [ABSTRACT FROM AUTHOR]

Objective To report our initial experience with Heartmate 3 ventricular assist device (HM3) in cases with end-stage heart failure (ESHF). Methods Charts of 8 ESHF patients who underwent HM3 implantation in our clinic from January to June 2016 (group 1) and 16 patients who underwent HM2 implantation during 2015 (group 2) were reviewed retrospectively. Demographics as well as pre- and early postoperative medical data were noted and statistically analyzed between the 2 groups. Results No statistical difference was found in age or sex distribution between groups ( P > .05). Mean Interagency Registry for Mechanically Assisted Circulatory Support scores were 2.13 ± 0.99 and 3.38 ± 0.72 in groups 1 and 2, respectively ( P = .020). Mean cardiopulmonary bypass time, and chest tube drainage fluid volume and blood product requirement during intensive care unit (ICU) stay were 64.0 ± 13.9 minutes, 1,112.5 ± 516.7 mL, and 318.8 ± 271.2 mL, respectively, in group 1 and 89.0 ± 33.3 minutes, 2,081.3 ± 1,696.0 mL, and 1,118.8 ± 1,010.8 mL in group 2 ( P = .027, P = .019, and P = .040, respectively). Need for surgical revision and early mortality were not evident for group 1, although 4 cases (25.0%) required revision surgery, and early mortality was seen in 3 cases (18.8%) in group 2 ( P = .121 and P = .190, respectively). Mean durations of ICU stay and total postoperative hospitalization were 5.9 ± 2.0 and 18.3 ± 5.5 days, respectively in group 1 and 6.2 ± 4.3 and 18.0 ± 6.9 days in the surviving 13 patients of the group 2 ( P = .645 and P = .697, respectively). Conclusions With its shorter implantation time and reduced blood product requirement in the early postoperative period, the HM3 system was found to be safe and effective in ESHF treatment. [ABSTRACT FROM AUTHOR]

Cardiopulmonary exercise test parameters are among the best prognosticators for medically managed advanced heart failure. However, the prognostic value of pre & post-implantation CPET parameters in LVAD therapy is unclear and is evaluated in this study. Adult patients who were implanted with an LVAD and underwent CPET during the pre and/or post-implantation period were included to the study. Five parameters were derived from each CPET: vO 2 max, oxygen uptake efficiency slope (OUES), vE/vCO 2 min, vE/vCO 2 max and vE/vCO 2 Slope. The independent predictive relationship between CPET parameters and clinical outcomes was evaluated with multivariate analysis. Pre & post-implantation CPET cohorts included 191 and 122 patients respectively (Table 1). Among pre-implantation CPET parameters: vO 2 max was an independent predictor of in-hospital mortality; vO 2 max and OUES were independent predictors of 1-year, 3-year and 5-year mortality, whereas vE/vCO 2 min and vE/vCO 2 Slope were independent predictors of 5-year mortality (p<.05). No CPET parameter was associated with ICU or hospital length of stay, 30-day readmission or 90-day mortality (p>.05). Among post-implantation CPET parameters: vO 2 max was an independent predictor of 5-year mortality, while vE/vCO 2 min and vE/vCO 2 max were independent predictors of 3-year mortality (p<.05) (Table 2). CPET parameters derived from pre and post-implantation exercise tests have high predictive value for long-term outcomes in LVAD therapy. Except vO 2 max, CPET parameters' predictive capacity for early post-implantation outcomes appears to be limited. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study was to assess the effects of cardiac rehabilitation on the functional capacity, pulmonary functions, quality of life, and psychological state of patients who had heart failure (HF), heart transplantation (HTx), or a left ventricular assist device (LVAD). Methods: An 8-week exercise program was undertaken by 46 patients diagnosed with end-stage heart failure, 40 of whom had a heart transplantation and 11 were implanted with an LVAD. The patients' functionality was assessed with a maximal oxygen consumption test (pVO2), their psychological state with the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI), their quality of life (QOL) with the Short Form 36 (SF 36), and their pulmonary condition with pulmonary function tests (PFTs). Results: A significant improvement was observed in all forced vital capacity (%), forced expiratory volume in 1 second (%), pVO2, BDI, and most of the subscores of the SF 36 scores at the end of the exercise, compared with the pre-exercise period (P < .05). The intergroup evaluations showed no significant differences among the 3 groups in terms of all assessed changes (P > .05). Conclusion: An 8-week supervised exercise program was observed to improve functional capacity, PFT, QOL, and depression among patients who had HF, HTx, or LVAD. Supervised exercise should be recommended for every patient included in a heart transplant program. [Copyright &y& Elsevier]

Abstract: Background: The Berlin Heart EXCOR is a first-generation paracorporeal, pneumatic ventricular assist device that creates pulsatile flow. It can be used for long-term support of the left and/or right ventricule during end-stage heart failure. The aim of this study was to share our clinical experience in 54 patients. Methods: Between April 2007 and August 2012, 54 patients with end-stage heart failure underwent Berlin Heart EXCOR ventricular assist device implantation, including 5 females and 9 children. Twenty-four patients (44%) were in Intermacs level 1, 11 (21%) in level 2, and 19 (35%) in level 3. Biventricular support was applied to 13 patients. Device implantation was performed with an “on pump” beating heart technique while 6 other patients underwent intervention operations while the aortic valve has under cross-clamp. Tricuspid annuloplasty was performed in 6 patients. Results: There was no peroperative death. Nine patients (17%) underwent re-exploration because of hemorrhage in the early postoperative period. Heart transplantation was performed in 32 patients (59%), while 10 (19%) are still under pump support with a mean follow-up of 13 months. Although 1 was successfully weaned from the system, 11 patients (20%) died during the support. Pump-head exchange was required 19 times in 17 patients because of visible thrombus or fibrin deposit in the pump head or due to membrane rupture. Discussion: The use of long-term paracorporeal assist devices has decreased in recent years because of the increased popularity of implantable devices that permit longer survival and a better quality of life. We believe that the Berlin Heart EXCOR has a special role because it can be used in pediatric patients and especially in critical conditions like Intermacs levels 1 and 2. [Copyright &y& Elsevier]

Abstract: Aim: We investigated the prevalence and clinical characteristics of obstructive sleep apnea syndrome (OSAS) among heart transplantation patients. Methods: Among 86 surviving patients of mean age 43.07 ± 13.23 years including 35 men transplanted from April 1999 to November 2010, 43 (50%) agreed to participate in this study. Patients with apnea-hypopnea index (AHI) < 5 were labeled as “normal”, with an AHI > 5, as obstructive surgeon (OSA). According to the AHI, subjects were classified as with OSA (group 1; n = 25 of mean age 49.0 ± 12.1 years and including 21 men versus non OSA group 2; n = 18) of mean age 34.8 ± 10.1 years with 14 men. We recorded patient demographic features, medications, polysomnographi observations, laboratory measurements, as well as echocardiographic and angiographic parameters. Results: Prevalence of OSA (AHI > 5) was 58% (n = 25) with 30% (n = 14) as moderate or severe OSA (AHI > 15) OSA patients were significantly older, and showed a greater value of body mass index (BMI) and waist circumference. Echocardiographic findings revealed the only significant difference to be systolic arterial pressure. The apnea-hypopnea index showed significant correlation with age, BMI, waist circumference, neck circumference, Epworth score, duration of apnea episode, time of SaO2 under 90% and systolic arterial pressure (SPAP). An inverse correlation was observed between AHI and sleep efficiency, oxygen saturation, and percentage of time in random eye movement (REM) sleep. Multivariate backward logistic regression analysis indicated waist circumference, sleep efficiency, percentage of time in REM sleeps and duration of apnea episode to be independent predictors of AHI. Conclusion: OSA is prevalent among heart transplantation patients. Obesity is a risk factor and waist circumference, and independent predictor for OSA. [Copyright &y& Elsevier]

Abstract: Objective: Ventricular assist devices (VAD) are an important therapy that saves the lives of candidates a waiting heart transplantation (HTx). However, there are questions about posttransplantation effects of VADs. Methods: Seventy-four patients with end-stage heart failure who underwent HTx in our clinic between February 2007 and July 2011 were divided into two groups; a bridge cohort (n = 28) and a nonbridge group comprising 46 who underwent HTx without mechanical circulatory support. There mean ages were 39.89 ± 15.66 and 38.33 ± 16.23 years respectively. Significantly more patients in the bridge group, were man displayed anemia, were treated with anticoagulation therapy, and underwent a resternotomy. In the nonbridge group, more patients needed preoperative inotropic support. Results: Multiple logistic regression analysis revealed preoperative renal failure (P = .007, odds ratio [OR] 27) and inotropic support (P = .006, OR: 10,222) as well as longer cardiopulmonary bypasses (≥130 minutes, P = .001, OR: 11,24) to be risk factors for in-hospital mortality, which was 15.2% in nonbridge and 10.7% in bridge subjects, P = .733). Major adverse events, such as renal failure, pulmonary failure, right ventricular failure, neurological event, and reoperation due to bleeding, shown similar incidences between the groups. The amount of blood transfusion was significantly higher in the bridge group (2.34 U versus 3.56 U, P = .037). The preoperative incidence of human leukocyte antigen sensitization (panel reactive antibody ≥ 10%) and grade 2R were rejection episodes in the early period were similar. Conclusion: Early posttransplant results were not adversely or beneficially influenced by the use of VADs. Similar to other types of cardiac surgery, a patients preoperative condition seemed to be the major factor affecting mortality. [Copyright &y& Elsevier]

Abstract: Objective: We retrospectively analyzed our data to compare preoperative demographic, laboratory, echocardiographic, hemodynamic findings mortality and survival rates of heart transplantation patients with ischemic (ICM) and idiopathic dilated (IDCM) cardiomyopathy. Methods: The data of 144 patients transplanted from February 1998 to January 2011 were analyzed. 38 patients with ischemic ICM and 86 patients with IDCM were compared. Results: Recipient age, preoperative creatinine, recipient body mass index, intraoperative cross-clamp time, donor male sex ratio, recipient male sex ratio, hyperlipidemia ratio, and previous nitrate use were significantly higher and left ventricular end systolic diameter significantly lower in patients with ICM. Major causes of death after heart transplantation were infections (31.9%), right ventricle failure (14.8%), and sudden cardiac death (14.8%). Causes of death were not different between the groups. Overall mortality in the entire population was 37.9% (47/124), and it was not different between the groups (39.5% vs 37.2%; P = .48). Early mortality (<30 days) rate was 11.2% (14/124), late mortality rate was 26.6% (33/124), and no statistically significant difference was observed between the groups. Survival analysis showed that ICM patients were not associated with worse survival compared with IDCM (71.1% vs 81.1% after 1 year, 68.1% vs 73.0% at 2 years, and 54.2% vs 62.3% at 5 years; log rank = 0.57). Multivariate analysis showed that the only predictor of mortality was preoperative urea level and that heart failure etiology was not a predictor of this end point. Conclusions: Patients with ICM had similar survival and mortality rate compared with IDCM. [Copyright &y& Elsevier]

Abstract: Background: The aim of this study was to assess the long-term efficacy of stem cell transplantation with revascularization for patients with ischemic cardiomyopathy. Methods: We enrolled 17 patients with ischemic cardiomyopathy who had undergone autologous stem cell treatment. To assess myocardial ischemia and viability they underwent coronary angiography, stress tests with dobutamine, echocardiography, and positron emission tomography. Peripheral stem cells mobilized using granulocyte colony-stimulating factor (G-CSF) were collected by aphseresis for transplantation transmyocardially into the areas of injury during coronary artery bypass surgery to increase blood flow to the engrafted areas. Results: Three patients died in the early follow-up period and 4 patients with cardiac failure died during mid-term follow-up; they all underwent stem cell transplantation at 6 months after acute myocardial infarction. The mean follow-up period of the remaining 10 patients was 85.8 ± 9.2 months (range, 70–100). Mean left ventricular ejection fraction improved to 30.0 ± 6.7, whereas the preoperative mean left ventricular ejection fraction of the surviving patients was 25.6 ± 4.5 (P = .035). Mean New York Heart Association (NYHA) functional class decreased from 3.2 to 1.5 (P = .006). When the study population was divided into 2 subgroups according to the interval between acute myocardial infraction and surgery, the patients who underwent autologous stem cell transplantation within the first 6 months after myocardial infraction (Group 1) showed significantly lower NYHA scores at the last follow-up (P = .024 in Group 1 and P = .102 in Group 2). No side effects were observed to be due to the stem cell or G-CSF injections. Conclusion: Treatment of ischemic cardiomyopathy with autologous stem cell transplantation is easy and safe, opening a new window in the treatment of “no hope” patients. [Copyright &y& Elsevier]

Abstract: Background: Mechanical circulatory support has an important role in the surgical therapy for heart failure. Patients deteriorating on transplantation waiting lists or those unsuitable for transplantation have been treated with ventricular assist devices. In this report, we have presented application of ventricular assist systems for patients with end-stage heart failure. Methods: Between April 2007 and September 2010, we treated 37 patients with end-stage heart failure with mechanical circulatory support, including 5 children younger than 16 years of age. Three patients were females, and the overall mean age was 40 ± 18 years (range, 1.5–67). In 29 patients we implanted paracorporeal pneumatic ventricular assist devices. Axial flow pumps were chosen to support the left ventricle in 8 patients. Biventricular support was applied in 9 patients because of their poor preoperative clinical conditions and advanced evidence of right ventricular failure. Results: Heart transplantation was performed in 16 patients (43%). One subject, who was managed with a left ventricular assist device implantation and coronary bypass grafting, was weaned from the system because of recovery of ventricular functions. Eleven patients (30%) are still on pump support. Nine patients (24%) died during mechanical circulatory support. The most prevalent cause of mortality was multiorgan failure (n = 5; 13.5%). Cerebrovascular hemorrhage was the cause of death in 2 patients. One patient died due to acute lung injury, and an other due to malignant melanoma. Conclusion: Use of a ventricular assist device as a bridge-to-transplantation or as destination therapy can be performed with acceptable mortality. It may be the most promising option for patients with end-stage heart failure. Development of device technology, advanced monitoring of anticoagulation and anti-aggregation therapy, and greater clinical experience may yield better results. [Copyright &y& Elsevier]

Abstract: Background: End-stage heart failure can result from many cardiac and noncardiac entities that produce a poor prognosis. Medical and interventional modalities are widely used to treat this condition, although the ultimate therapy remains heart transplantation. Herein we present our clinical experience with 140 patients who underwent orthotopic heart transplantation. Methods: Between February 1998 and September 2010, we transplanted 140 patients with a mean age of 40 ± 13 years, including 109 men (77.8%) and 31 women (22%). There were 101 patients (73%) with dilated cardiomyopathy and 39 (27%) with ischemic cardiomyopathy. Two patients were retransplanted owing to graft failure. Sixteen patients on assist device support were successfully bridged to transplantation. Results: Eighteen patients (12.8%) died within 30 days with the most common causes being right ventricular failure (8/18, 44%) and infection (4/18, 22%). Overall mortality of 39% (55/140) was most commonly caused by infection (29%, 16/55) or right ventricular failure (20%, 11/55). Nine patients (16%) died suddenly outside of the hospital. Three patients died of rejection; 4 of graft failure, and 4 of malignant disease. Conclusions: Heart transplantation remains the standard treatment modality for end-stage cardiac failure. But significant waiting list mortality rates are due to the worldwide shortage of donors. Heart transplantation in Turkey is feasible for a small and strictly selected number of patients with nonreversible congestive heart failure. In recent years, ventricular assist device applications have successful bridged subjects to transplantation, saving many patients on active waiting lists. [Copyright &y& Elsevier]

Abstract: Objective: The objective of this study was to analyze the effect of pre-transplantation etiology and post-transplantation exercise on pulmonary function tests, functional capacities, psychological symptoms and quality of life among heart transplant patients. Methods: An eight-week exercise program was applied to 35 heart transplant patients with histories of ischemic heart failure (HF; n = 20) or dilated HF (n = 15). All patients were evaluated before and after exercise in terms of breathing function tests, functional capacity (FVC; maximal oxygen consumption, pVO2), psychological symptoms (Beck Depression Scale (BDS), Spielberger''s State-Trait Anxiety Inventory (STAI)) and quality of life (Short Form 36, SF-36). Results: At the end of the exercise compared to the pre-exercise period significant improvements were observed in all FVC%, FeV1%, FeV1/FVC%, pVO2, SF 36 scores reflecting physical function, physical role, pain, general health, vitality, social function, and emotional role (P < 0.05) among heart transplant patients who were operated due to ischemic or dilated heart failure. In contrast, no significant improvement was observed in the BDS and STAI scales (P > 0.05). There was no significant etiology-related difference between the groups in terms of the evaluated parameters (P > 0.05). Conclusion: We demonstrated improvements in function tests, functional capacity and quality of life for both ischemic and dilated heart transplant patients following a supervised exercise program. We concluded that the positive effect achieved by exercise was not related to pre-transplantation etiology. Whatever the preoperative etiology, a regular exercise program is recommended for heart transplant patients in the rehabilitation unit. [Copyright &y& Elsevier]

Purpose Risk scores for left ventricular assist device (LVAD) therapy are known to predict morbidity and adverse events in addition to mortality. This study evaluates the capacity of popular LVAD risk scores to predict cardiopulmonary exercise parameters. Methods Adult patients undergoing continuous flow LVAD implantation were prospectively followed. 5 risk scores were calculated before implantation: Model for End Stage Liver Disease (MELD), MELD excluding INR (MELD-XI), MELD including sodium (MELD-Na), HeartMate2 Risk Score (HMRS) and Destination Therapy Risk Score (DTRS). Cardiopulmonary exercise tests (CPET) were performed before and after implantation; peak oxygen consumption (vO 2 max), the lowest vE/vCO 2 ratio and exercise time were measured. Results 92 patients were implanted during the study period (Mortality Cohort) and 30 patients out of these completed pre- and post-implantation CPETs (CPET Cohort). Mean pre- and post-implantation CPET dates were 29±10 days before and 109±5 days following implantation. CPET parameters significantly improved after implantation (p<0.05) (Table 1). In multivariate analysis, all risk scores independently predicted 90-day mortality; MELD, MELD-XI, MELD-Na and HMRS independently predicted both pre- and post-implantation vE/vCO 2 while MELD-Na and HMRS were also independent predictors of pre- and post-implantation vO 2 max respectively (Table 2). Conclusion Four pre-implantation LVAD risk scores (HMRS, MELD, MELD-Na and MELD-XI) independently predict important cardiopulmonary exercise parameters such as vE/vCO 2 and vO 2 max in addition to mortality in LVAD therapy. [ABSTRACT FROM AUTHOR]

Purpose Frailty has been associated with morbidity and mortality in patients with heart failure and those undergoing cardiac surgery. Thus, assessment of frailty may help identify the patients that would likely experience adverse outcomes and those who would benefit the most from the left ventricular assist device (LVAD). We aimed to study the relationship between frailty and the cardiovascular outcomes in LVAD population. Methods A total of 52 patients (44 men; aged 52 ± 8 years) scheduled to undergo LVAD implantation were assessed for frailty, cognitive function (by means of Mini-Cog) and depression (with Patient Health Questionnaire). Fried's frailty phenotype was used to evaluate frailty (frail ≥3/5). Patients were observed for adverse events for 3 months. Results 29 patients (55%) were designated as frail. Frail patients had higher NT-proBNP values, higher NYHA class, and depression while frailty was associated with lower body mass index and body surface area. Frailty increased the risk of mortality or prolonged length of stay with 21 (72%) of 29 frail patients meeting the primary endpoint compared to 9 (39%) of 23 non-frail patients (p=0.03). Of the secondary outcomes, only postoperative ventricular arrhythmias reached statistical significance with being more common among frail patients than non-frail ones (p=0.01). Conclusion Frailty was associated with increased mortality or prolonged length of stay among LVAD patients. We recommend including frailty as a criterion for the selection of patients for LVAD. [ABSTRACT FROM AUTHOR]

The HeartWare HVAD monitor displays a real-time waveform of the flow provided by the LVAD. However, there are no commercially available methods to obtain this flow waveform data. We describe a novel algorithm that leverages sparse approximation with Gaussian dictionary to estimate aortic valve opening status from HVAD flow waveform data acquired via monitor snapshot. Stable adult patients receiving MCS therapy with an HeartWare HVAD were included. Aortic valve opening status was determined during routine echocardiography ("Open" = opens in ≥8/10 beats vs "Closed" = opens in ≤2/10 beats) and a photo of the HVAD monitor was taken with a smartphone at the same time. The flow waveform graph was digitized and interpolated using low frequency Fourier components for the purpose of low pass filtering and standardization of sampling frequency (Figure 1). Sparse approximations (SA) with Gaussian dictionary were generated for each signal using orthogonal matching pursuit (OMP). Waveforms with a closed Ao valve are better aligned with SA (Figure 2: 2a, 2b). Therefore, residual sum of squares (RSS) -which is a marker of deviation from SA- was used to estimate Ao valve status. 54 waveforms were acquired. Area under the ROC curve for RSS' capacity to estimate the status (open/closed) of a single beat was.766 (±.021) (p:.000). The SA-based algorithm had 83.33% overall accuracy for detecting aortic valve opening (sensitivity: 86.67%, specificity: 79.17%) from a 10 sec. signal (Figure 2). We describe a method for reliable data acquisition and estimation of aortic valve opening from a HVAD monitor snapshot. [ABSTRACT FROM AUTHOR]

LVAD implantation via left lateral thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative technique that uses a single incision and avoids anterior mediastinal planes in cases with hostile mediastinal anatomy. However, the long-term outcomes of outflow cannula to descending aorta anastomosis using contemporary LVADs are unknown and are evaluated in this study. Adult patients implanted with a continuous flow centrifugal LVAD (HeartWare HVAD) in an academic center were included to the study. Hospital stay following implantation, short & long-term survival and readmission patterns were compared between ascending and descending aorta anastomosis groups. Readmission analysis only included patients that survived >30 days following the index hospitalization. 338 patients (Asc Ao: 280, Desc Ao:58) were included to the study. Readmission analysis included 277 patients (Asc Ao: 231, Desc Ao: 46) and a total of 1043 readmissions during 667 years of follow-up were analyzed (Table 1). There was no significant difference in hospital-stay following implantation or 90-day, 1-year, 3-year and 5-year mortality between the two groups. Readmission-free survival, 30-day readmission, number of admissions per year and hospital length of stay per year were similar. Number of admissions for specific causes were not significantly different (Table 2). LVAD implantation via lateral thoracotomy with outflow cannula anastomosis to the descending aorta has a comparable survival and readmission profile with standard ascending aorta anastomosis in long-term follow-up. [ABSTRACT FROM AUTHOR]