Publications by authors named "Yoshifumi Naka"
Prosthetic valve-related morbidity and mortality in patients with left ventricular assist devices (LVADs) remain unclear. We retrospectively reviewed patients who received a HeartMate II or 3 LVAD at our center between April 2004 and December 2022. Patients with a valve prosthesis in any position were included.
View Article and Find Full Text PDFBackground: Donor-derived cell-free DNA (dd-cfDNA) has emerged as a reliable, noninvasive method for the surveillance of allograft rejection in heart transplantation (HT) patients, but its utility in multi-organ transplants (MOT) is unknown. We describe our experience using dd-cfDNA in simultaneous MOT recipients.
Methods: A single-center retrospective review of all HT recipients between 2018 and 2022 that had at least one measurement of dd-cfDNA collected.
Article Synopsis
- The study looked at how to manage blood thinners after people got a special heart device called HeartMate 3.
- It compared two methods for checking the right dose of a blood thinner called unfractionated heparin (UFH).
- There were no big differences in bleeding or clotting problems between the two methods, but more research is needed to know which one is better.
Article Synopsis
- Donation after circulatory death heart transplantation may expand donor options, particularly benefiting patients with lower urgency status who are using durable left ventricular assist devices (LVADs).
- A study analyzed data from the United Network for Organ Sharing between 2019 and 2022, comparing outcomes of heart transplant recipients with LVADs to those receiving other bridging support, focusing on one-year mortality and several medical complications.
- While the one-year mortality rates showed no significant difference, patients with LVADs experienced higher rates of acute rejection, suggesting the need for careful monitoring and management post-transplant.
Article Synopsis
- This study analyzed the outcomes of 774 adult patients who received simultaneous heart-kidney transplants (SHK) under the revised UNOS heart allocation policy, focusing on 50 patients who were supported by veno-arterial extracorporeal life support (VA-ECLS) compared to 724 without.
- Results showed that VA-ECLS patients were younger and had better kidney function before transplant but faced higher rates of temporary dialysis and lower survival rates after the procedure, with significant differences in early mortality and cardiac allograft failure.
- The findings indicate that while VA-ECLS patients have similar renal outcomes post-transplant, they experience greater risks for early mortality and complications related to heart trans
Sex Disparities in the Management, Outcomes, and Transfer of Patients Hospitalized for Cardiogenic Shock.
J Soc Cardiovasc Angiogr Interv
March 2024
Article Synopsis
- Previous studies indicated that women experience worse outcomes than men when suffering from cardiogenic shock (CS), especially when treated at less advanced hospitals (spokes) compared to specialized centers (hubs).
- An analysis of over 618,000 hospitalizations revealed that women were less likely to be transferred to hubs, underwent fewer invasive procedures, and had higher in-hospital mortality rates compared to men.
- Findings suggest a need for further research to address the sex disparities in treatment and outcomes for women with cardiogenic shock, as they face greater challenges in receiving optimal care.
Article Synopsis
- The HeartMate 3 survival risk score was validated to predict survival chances for patients receiving a HeartMate 3 left ventricular assist device, categorizing them into different survival probability groups.
- A study involving 181 patients revealed that those in the high survival group had a significantly higher two-year survival rate compared to average and low survival groups, with rates of 93.5%, 81.6%, and 82.0%, respectively.
- Although the score's original stratification didn't clearly show survival differences, using a binary cutoff indicated better survival for patients in the high-risk category, demonstrating its potential utility in clinical settings.
Article Synopsis
- The study focuses on the long-term survival rates of adult patients with congenital heart disease who underwent orthotopic heart transplantation, distinguishing between those with single-ventricle versus biventricular circulation.
- A total of 61 patients were analyzed, with single-ventricle patients being younger and having more complications like cirrhosis and protein-losing enteropathy compared to biventricular patients.
- Five-year survival rates were significantly lower for single-ventricle patients (66%) than for biventricular patients (91%), indicating that the type of congenital heart disease affects post-transplant outcomes.
Article Synopsis
- - The study investigated the effects of two heart preservation methods—ice-cold storage (ICS) and the Paragonix SherpaPak CTS—on ischemia reperfusion injury (IRI) following heart transplantation, as ischemic times have increased since the 2018 allocation system change.
- - Analysis of biopsies from 90 heart transplant recipients showed similar IRI rates between the two methods, but the CTS group had a significant reduction in coagulative myocyte necrosis (CMN) from weeks 1 to 4, and both methods showed reductions by week 8.
- - Despite longer ischemic times with CTS, the study found no significant differences in rejection rates or survival between the groups, suggesting that CTS is a viable option
Article Synopsis
- The study examined how the age of heart transplant (HT) programs affects patient outcomes using data from 20,997 adult heart transplants performed between 2009 and 2019.
- Patients at new HT programs had a higher prevalence of certain health issues and received organs from less experienced donors compared to those at established programs, leading to more complications.
- Despite the differences in patient and donor selection and higher complication rates for new programs, all groups showed similar survival rates, suggesting a need for standardized practices to improve outcomes across programs.
The presence of adhesions and patent bypass grafts may create challenges for standard 14 mm outflow graft placement during left ventricular assist device implantation. We retrospectively describe our experience using a 10 mm Bioline Fusion graft (Getinge, Goteborg, Sweden) as the outflow graft in patients undergoing primary Heartmate 3 (Abbott, Abbott Park, IL) implantation. One hundred one patients underwent Heartmate 3 left ventricular assist device implantation, 80% via a thoracotomy approach, with the standard 14 mm outflow graft (78) or a 10 mm Bioline Fusion outflow graft (23).
View Article and Find Full Text PDFArticle Synopsis
- This study investigates the causes and impact of hospital readmissions in patients with HeartMate 3 (HM3) left ventricular assist devices (LVAD), revealing that readmissions are frequent and affect quality of life.
- Of 182 patients, 92% were discharged after initial hospitalization, experiencing a total of 407 unplanned readmissions, with major infections being the leading cause.
- Survival rates remained high despite readmissions, and certain factors like male gender, diabetes, and previous readmissions were linked to an increased risk of future hospitalizations.
Article Synopsis
- The study aimed to evaluate how aortic insufficiency develops in patients who had central aortic valve repair during continuous-flow left ventricular assist device placement.
- A review was conducted on 656 patients who received HeartMate II or 3 devices from 2004 to 2022, with 105 meeting the criteria for analysis, revealing that most were older men receiving the device as long-term therapy.
- Results showed high rates of freedom from moderate aortic insufficiency post-implantation (over 90% at three years) and a three-year survival rate of 63.4%, suggesting that central aortic valve repair could effectively address aortic insufficiency in these patients.
Article Synopsis
- Belatacept (BTC) is a fusion protein that inhibits T-cell activation and has primarily been used for immunosuppression in kidney transplants, but its effectiveness for heart transplant patients remains less understood.
- A retrospective study analyzed 21 heart transplant recipients who received BTC between 2017 and 2021, focusing on their health outcomes, including rejection rates and kidney function over a follow-up period that extended to December 2023.
- Results indicated that BTC treatment had a low rejection rate (4.8%) and stable graft function, with a slight improvement in kidney health for the majority of the patients, though a significant portion of them discontinued the treatment within the study period.
Background: Although much attention has been paid to admission and transfer patterns for cardiogenic shock, contemporary data are lacking on decompensated heart failure (HF) admissions and transfers and the impact of advanced therapy centers (ATCs) on outcomes.
Methods: HF hospitalizations were obtained from the Nationwide Readmissions Database 2016 to 2019. Centers performing at least 1 heart transplant or left ventricular assist device were classified as ATCs.
Article Synopsis
- Patients with HeartMate 3 LVADs show improved hemodynamics through pump speed adjustments, particularly during hemodynamic ramp tests conducted from 2015 to 2022.
- Out of 60 studied patients, only 58% had optimized filling pressures at baseline, but after speed adjustments, 65% achieved optimized measurements.
- Those who attained optimized pressures experienced significantly lower readmission rates over 6 and 12 months, mainly due to reduced cardiac-related hospitalizations, compared to nonoptimized patients.
Objectives: The HeartMate 3 (Abbott) left ventricular assist device provides substantial improvement in long-term morbidity and mortality in patients with advanced heart failure. The Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy study compares thoracotomy-based implantation clinical outcomes with standard median sternotomy.
Methods: We conducted a prospective, multicenter, single-arm study in patients eligible for HeartMate 3 implantation with thoracotomy-based surgical technique (bilateral thoracotomy or partial upper sternotomy with left thoracotomy).
Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for patients with cardiogenic shock. Although Impella or intra-aortic balloon pump (IABP) is frequently used for left ventricular unloading (LVU) during VA-ECMO treatment, there are limited data on comparative outcomes. We compared outcomes of Impella and IABP for LVU during VA-ECMO.
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- The study aimed to compare 3-year survival rates and readmission rates between patients receiving the HeartMate 3 (HM3) left ventricular assist device (LVAD) and those who underwent orthotopic heart transplantation (OHT) for advanced heart failure.
- A total of 381 adult patients were analyzed, and after matching based on propensity scores, both groups showed similar 3-year survival rates (83.7% for HM3 vs. 87.0% for OHT) with no significant statistical difference.
- However, the HM3 group experienced a higher average number of unplanned hospital readmissions over the 3-year period (3.89 for HM3 vs. 2.05 for OHT).
Background: The physiological response of the right ventricle (RV) following left ventricular assist device (LVAD) implantation is difficult to predict. We aimed to investigate RV geometric and functional changes after LVAD insertion and their effects on clinical outcomes.
Methods: We retrospectively reviewed 188 patients who underwent HeartMate 3 implantation at our center between November 2014 and September 2021.
Article Synopsis
- * Out of 10 documented pregnancies during LVAD support, 8 resulted in successful births, while 1 case involved maternal and fetal mortality and another was a spontaneous abortion.
- * The study emphasizes the importance of a collaborative care approach, proper medication management, and understanding the physiological changes during pregnancy to support maternal and fetal health while on LVAD.
Does lateral approach preserve the right ventricular function after HeartMate 3 insertion?
Interdiscip Cardiovasc Thorac Surg
October 2023
Objectives: Lateral thoracotomy (LT) approach may preserve the right ventricular (RV) function after left ventricular assist device (LVAD) implantation. This study evaluated the short- and long-term RV function using echocardiography after LVAD implantation via LT or median sternotomy (sternotomy).
Methods: The patients who underwent HeartMate 3 implantation were retrospectively reviewed.
Article Synopsis
- The study aimed to compare outcomes of younger (18-65 years) and older (over 65 years) patients who received simultaneous heart-kidney (SHK) transplants, analyzing data from 1398 recipients.
- Results showed that both age groups had similar baseline characteristics and that older patients did not experience higher mortality rates after transplantation, with 90-day survival rates at 85% and 7-year survival rates at 61% for both cohorts.
- The findings suggest that age and functional dependence should not be the sole criteria for excluding older patients from receiving SHK transplants; instead, a comprehensive assessment of their overall health and comorbidities is necessary.
Article Synopsis
- Aortic root thrombosis (ART) is a complication from using the HeartMate 3 (HM3) left ventricular assist device, and this study investigates its incidence and complications.
- In a cohort of 197 HM3 patients, 9.6% developed ART, and 7.6% experienced moderate or greater aortic insufficiency (AI) over an average follow-up period of 17.5 months.
- ART was linked to higher risks of severe outcomes, including death, stroke, and the need for aortic valve interventions, emphasizing the importance of monitoring for this complication in HM3 patients.