Boston - American Association for Thoracic Surgery

More documents

Recommendations

Info

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSRESULTS: Age was 61.3 y, 73.0% were male, ejection fraction was 44.2 ± 17.3%.ECMO implantation was performed through thoracic (56.7%) or extrathoracic(42.3%) cannulation using femoral or axillary arterial and femoral venous cannulation.Additional IABP support was employed in 77.0%. Mean drainage loss was,3.2 and 4.4 liter 24 and 48h, respectively. 52.7% were successfully weaned fromECMO after mean 86h and 24.4% were discharged from the hospital after 41 ± 25 d.Hospital mortality was 75.6%. Neurological complications occurred in 21.3%,renal replacement therapy was indicated in 62.6%. Multivariate risk factors forhospital mortality were emergency indication (odds ratio OR 2.4), preoperativecardiogenic shock (OR 1.7), EF < 30% (OR 3.5), preoperative renal dysfunction(OR 4.2) and combined coronary and valve procedure (OR 5.7, p < 0.01 each), whileage >70 y and diabetes were none. Estimated cumulative survival was 18.1 ± 2.9%after 6 months, 16.7 ± 2.7% after one, 15.5 ± 1.6. and 16.1 ± 3.3% after five years. Riskfactors for late death were age, combined CABG + MV surgery and diabetes.CONCLUSION: Temporary ECMO support it is an acceptable option for patientswith PCS that otherwise would die and justified by the good long-term survival ofhospital survivors. However, because of high morbidity and mortality individualECMO indication has to be made on the specific risk profile.168
AMERICAN ASSOCIATION FOR THORACIC SURGERY40. Duration of LVAD Support Does Not Impact Post-CardiacTransplant Survival in the Continuous-Flow Pump EraRanjit John, 1 Francis D. Pagani, 2* Yoshifumi Naka, 3* John V. Conte, 4* Charles T. Klodell, 5Carmelo A. Milano, 6*† David Farrar, 7 O. Howard Frazier 8*1. Surgery, University of Minnesota, Minneapolis, MN, USA; 2. University ofMichigan, Ann Arbor, MI, USA; 3. Columbia University, New York, NY, USA; 4.Johns Hopkins, Baltimore, MD, USA; 5. University of Florida, Gainsville, FL, USA; 6.Duke University, Durham, NC, USA; 7. Thoratec Corporation, Pleasanton, CA, USA;8. Texas Heart Institute, Houston, TX, USAInvited Discussant: James KirklinOBJECTIVE: Previous evaluations of pulsatile left ventricular assist devices(LVADs) have shown that transplantation either early after LVAD implantation(6 months) adversely affected post-cardiac transplant survival.We sought to determine if the post-transplant survival of patients supported withnewer continuous flow LVADs was related to the duration of LVAD support.METHODS: The HeartMate II LVAD was implanted in 459 patients as a bridge-totransplantat 33 centers in a multicenter trial. Patients were divided into 5 groupsbased on duration of LVAD support as shown in the Table. The median age was 55(range 15–77), 45% had ischemic etiology, and 23% were females. Survival wasdetermined at 30 days and 1 year post post-transplantation.TUESDAYAfternoonTransplanted Patients Who Have Reached 30 Days or 1 Year Since TransplantationLVADDuration (Days)LVAD Patients atStart of IntervalPatients Transplantedin IntervalPost-TransplantSurvival30 Days 1-year0–30 459 19 100% 93%30–89 408 60 100% 91%90–179 311 63 95% 88%180–365 249 69 93% 93%>365 109 24 100% 86%Overall 97% 90%RESULTS: Of 459 patients, 236 underwent cardiac transplant after a medianduration of LVAD support of 143 days (longest: 3.2 yr), 87 died (19%), 12 (2.6%)recovered ventricular function and the device was removed, and 121 (26%) are stillon LVAD support. There were no significant differences in baseline demographicsamong the 5 groups. The overall 30 day and 1-year post-TX survival was 97% and90%. As shown in the Table, there were no significant differences in survival basedon the duration of LVAD support.* AATS Member† Second John H. Gibbon Jr. Research Scholarship 2001169
Page 1 and 2:
American Associationfor Thoracic Su
Page 3 and 4:
AMERICAN ASSOCIATION FOR THORACIC S
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120: AMERICAN ASSOCIATION FOR THORACIC S
Page 169: AMERICAN ASSOCIATION FOR THORACIC S
Page 221 and 222:
Page 223 and 224:
Page 227 and 228:
AATS FUTURE MEETINGSMay 1-5, 2010Me
show all

Boston - American Association for Thoracic Surgery

Create successful ePaper yourself

Delete template?

Save as template?