Effects of ketone body 3-hydroxybutyrate on cardiac and mitochondrial function during donation after circulatory death heart transplantation.

Normothermic regional perfusion (NRP) allows assessment of therapeutic interventions prior to donation after circulatory death transplantation. Sodium-3-hydroxybutyrate (3-OHB) increases cardiac output in heart failure patients and diminishes ischemia-reperfusion injury, presumably by improving mitochondrial metabolism. We investigated effects of 3-OHB on cardiac and mitochondrial function in transplanted hearts and in cardiac organoids.

Ex-situ oxygenated hypothermic machine perfusion in donation after circulatory death heart transplantation following either direct procurement or in-situ normothermic regional perfusion.

Background: Heart transplantation in donation after circulatory death (DCD) relies on warm perfusion using either in situ normothermic regional perfusion (NRP) or ex situ normothermic machine perfusion. In this study, we explore an alternative: oxygenated hypothermic machine perfusion (HMP) using a novel clinically applicable perfusion system, which is compared to NRP with static cold storage (SCS).

Methods: In a porcine model, a DCD setting was simulated, followed by either (1) NRP and SCS (2) NRP and HMP with the XVIVO Heart preservation system or (3) direct procurement (DPP) and HMP.

Clamping of the Aortic Arch Vessels During Normothermic Regional Perfusion Does Not Negatively Affect Donor Cardiac Function in Donation After Circulatory Death.

Background: The hemodynamic effects of aortic arch vessel (AAV) clamping during normothermic regional perfusion (NRP) in donation after circulatory death is unknown. We investigated effects of AAV clamping during NRP compared with no clamping in a porcine model.

Methods: In 16 pigs, hemodynamic parameters were recorded including biventricular pressure-volume measurements and invasive blood pressure.

Balloon pulmonary angioplasty for patients with chronic thromboembolic pulmonary hypertension previously operated by pulmonary endarterectomy.

Balloon pulmonary angioplasty improved hemodynamics, walking distance, and World Health Organization functional class in patients with chronic thromboembolic pulmonary hypertension not eligible for pulmonary endarterectomy (Non-PEA) and patients with persistent pulmonary hypertension after PEA (PEA). More mild complications were observed in PEA- compared to Non-PEA.

Association of residual pulmonary hypertension with survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.

This study investigated whether residual pulmonary hypertension (PH), defined as early postoperative mean pulmonary artery pressure (mPAP) of ≥30 mmHg, after undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) was associated with long-term survival. All patients who underwent PEA for CTEPH at two Scandinavian centers were included in this study. Baseline characteristics and vital statuses were obtained from patient charts and national health-data registers.

Clamping of the Aortic Arch Vessels During Normothermic Regional Perfusion After Circulatory Death Prevents the Return of Brain Activity in a Porcine Model.

Background: The cerebral effect of clamping following normothermic regional perfusion (NRP) in donation after circulatory death (DCD) remains unknown. We investigated the effect of cerebral reperfusion during NRP and the preventive effect of clamping on brain function in a porcine model.

Methods: In 16 pigs, intracranial physiological parameters were recorded, including pressure, cerebral blood perfusion (CBF), temperature, and oxygen.

Sex and survival following pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a Scandinavian observational cohort study.

Studies have suggested sex-related survival differences in chronic thromboembolic pulmonary hypertension (CTEPH). Whether long-term prognosis differs between men and women following pulmonary endarterectomy for CTEPH remains unclear. We investigated sex-specific survival after pulmonary endarterectomy for CTEPH.

Long-term changes of exercise hemodynamics and physical capacity in chronic thromboembolic pulmonary hypertension after pulmonary thromboendarterectomy.

Background: A substantial number of chronic thromboembolic pulmonary hypertension (CTEPH) patients experience dyspnea on exertion and limited exercise capacity despite surgically successful pulmonary endarterectomy (PEA). We sought to prospectively evaluate resting and peak exercise hemodynamics before, 3 and 12 months after PEA in consecutive CTEPH-patients and correlate it to physical functional capacity.

Methods And Results: Twenty consecutive CTEPH-patients were examined.

Long-term changes of resting and exercise right ventricular systolic performance in patients with chronic thromboembolic pulmonary hypertension following pulmonary thromboendarterectomy - A two-dimensional and three-dimensional echocardiographic study.

Aims: To characterize right ventricular (RV) geometry and function in chronic thromboembolic pulmonary hypertension (CTEPH) patients at rest and during exercise before pulmonary thromboendarterectomy (PEA), and at 3 and 12 months after PEA using two-dimensional and three-dimensional echocardiography with reference to clinical performance and exercise capacity.

Methods And Results: Forty subjects (20 CTEPH patients and 20 controls) were enrolled between December 2014 and January 2017. Three-dimensional echocardiography demonstrated a significant reduction and normalization of end-diastolic and end-systolic RV volumes in CTEPH patients 12 months after PEA.

Large Solid Right Atrial Thrombus Treated by AngioVac Catheter-Based Suction Thrombectomy.

We present the successful treatment of a large solid right atrial thrombus by the catheter-based suction embolectomy system AngioVac® (AngioDynamics, NY, USA). A previously healthy 60-year-old male was referred with acute pulmonary embolism, a large deep vein thrombus and a large right atrial thrombus. After one week of anticoagulation, the size of the atrial thrombus was unaltered, and the patient was treated by catheter-directed embolectomy using the AngioVac system.

Survival, graft function, and incidence of allograft vasculopathy in heart transplant patients receiving adverse risk profile donor hearts.

Aim: To clarify if use of adverse cardiovascular risk profile (ARP) grafts is associated with impaired long-term outcomes after heart transplantation (HTx).

Methods: Survival was obtained from Scandia Transplant and a local database.

Arp Donor Inclusion Criteria: ≥55 years, diabetes mellitus, arterial hypertension, hypoxemia-induced death, impaired left ventricular (LV) ejection fraction.

Prostacyclins have no direct inotropic effect on isolated atrial strips from the normal and pressure-overloaded human right heart.

Prostacyclins are vasodilatory agents used in the treatment of pulmonary arterial hypertension. The direct effects of prostacyclins on right heart function are still not clarified. The aim of this study was to investigate the possible direct inotropic properties of clinical available prostacyclin mimetics in the normal and the pressure-overloaded human right atrium.

Results from more than 20 years of surgical pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Denmark.

Objectives: Chronic thromboembolic pulmonary hypertension is a fatal disease if left untreated, and pulmonary endarterectomy (PEA) is the potentially curable treatment of choice. We aimed to estimate the current in-hospital mortality rate, complication rate and long-term survival for patients with chronic thromboembolic pulmonary hypertension undergoing PEA in Denmark.

Methods: All chronic thromboembolic pulmonary hypertension patients who underwent PEA in the period 1994 till 2016 were consecutively enrolled in our single-centre study.

Left ventricular global longitudinal strain predicts major adverse cardiac events and all-cause mortality in heart transplant patients.

Background: Left ventricular global longitudinal strain (LVGLS) is a robust longitudinal myocardial deformation marker that is strongly affected by cardiac allograft vasculopathy (CAV), microvascular dysfunction, and acute cellular rejection (ACR). We evaluated graft deformation for risk stratification in long-term heart transplant (HTx) patients.

Methods: The study included 196 patients who underwent HTx between 2011 and 2013.

[Diagnosis and treatment of chronic thromboembolic pulmonary hypertension in Denmark].

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important differential diagnosis in patients with unexplained dyspnoea. CTEPH is under-recognized and carries a poor prognosis without treatment. Surgical pulmonary endarterectomy is the preferred treatment for the majority of patients.

[A combination of cardiac arrest and cerebral haemorrhage treated with extracorporeal membrane oxygenation].

A 46-year-old, healthy woman with sudden hemiplegia and nausea suffered cardiac arrest during transport to the hospital. This was treated en route with LUCAS-2. A computed tomography ruled out cerebral haemorrhage, and an electricardiogramme showed inferior myocardial infarction.

Twenty years' experience at the Heart Transplant Center, Aarhus University Hospital, Skejby, Denmark.

Objectives: The Heart Transplantation Center, Aarhus University Hospital, Skejby, now has 20 years' experience with heart transplantation (HTX). This study aims to evaluate long-term outcome after HTX including incidences of cancer and severe renal dysfunction.

Design: Outcomes were reviewed using the transplant database of our department, the Scandiatransplant database, hospital medical records, and national database of biopsies.

Pulmonary endarterectomy after pulmonary infectious embolisms.

Pulmonary endarterectomy (PEA) is a well-established procedure in the treatment of chronic thromboembolic pulmonary hypertension (CTPH). The procedure is known to increase functional outcome and to raise the 5-year survival rate. We report 2 cases of pulmonary valve endocarditis and secondary embolisms causing sustained pulmonary hypertension.

Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry.

Objective: Pulmonary endarterectomy is a curative surgical treatment option for the majority of patients with chronic thromboembolic pulmonary hypertension. The current surgical management and postoperative outcome of patients enrolled in an international registry on chronic thromboembolic pulmonary hypertension were investigated.

Methods: The registry included newly diagnosed (≤6 months) consecutive patients with chronic thromboembolic pulmonary hypertension from February 2007 to January 2009.

[Surgical treatment of pulmonary embolism].

This case report describes three cases of acute massive pulmonary embolism treated with surgical embolectomy at Skejby Sygehus (Aarhus University Hospital), Denmark, in the period from March 2005 to January 2006. It was necessary to open each pulmonary artery in all three patients in order to remove as much of the embolic material as possible. The three patients survived the operation, although one had hypoxic brain damage resulting from cardiac arrest prior to hospitalization.

[Severe anterior myocardial infarction caused by amphetamine abuse].

We present a case showing that intake of amphetamine can cause severe anterior myocardial infarction with acute severe pump failure. Acute angiography revealed massive proximal thrombotic occlusion of the LAD, the first diagonal branch and septal branches in a 28-year-old man. Thrombectomy, balloon dilation and stenting were performed.

Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ten years experience in Denmark.

Objectives: To evaluate survival and functional outcome in patients treated by pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension in Denmark.

Design: Follow-up of the first 50 patients operated at Aarhus University Hospital, Denmark.

Results: Fifty patients underwent PEA in the period from 1994 to mid 2004.