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1、Metabolic Stress Testing,Mancini D et al. Circulation 1991; 83: 778-786.,Group 1: peak VO2 14 Group 3: rejected for OHTx,AGE DISTRIBUTION OF HEART RECIPIENTS (1/1982-6/2003),% of Transplants,J Heart Lung Transpl. 2004; 23: 796-803.,DIAGNOSIS IN ADULT HEART TRANSPLANTS,HEART TRANSPLANTATION Kaplan-Me
2、ier Survival (1/1982-6/2006),J Heart Lung Transplant 2008;27: 937-983.,UMN Cardiac Transplant Survival,NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR,J Heart Lung Transplant 2008;27: 937-983,HEART TRANSPLANTS: Donor Age by Year of Transplant,J Heart Lung Transpl. 2004; 23: 796-803.,Description of UNOS
3、 Status Levels,Status IA RHC in place and: two or more inotropes regardless of dose IV milrinone at least 0.5 mcg/kg/min IV dobutamine at least 7.5 mcg/kg/min 30 days following medical stabilization after VAD implantation Status IB inotrope-dependent LVAD not meeting criteria for IA status No advant
4、age for being hospitalized Status II Not inotrope-dependent and no VAD Priority on UNOS list based on status level and duration of time in that status level No credit given for time at a lower status level,Stevenson LW et al. Circulation 2003;108:492-7.,Inotropic Therapy for End-Stage Heart Failure,
5、University of Minnesota VAD Implants,HeartMate II,Pulsatile vs Continuous Flow LVADs,Pulsatile / Volume Displacement,Continuous / Rotary,HeartMate II as BTT,Miller L, Boyle A, et al. NEJM 2007; 357: 893.,HeartMate II BTT Clinical Trial Adverse Event Rates,Events / Patient Year,1Frazier OH, et al. J
6、Thor CV Surg 2001,Miller L, John R, Boyle A, et al. NEJM 2007; 357: 893.,HM II as BTT in Women,Outcomes at one year,Pamboukian S, Boyle A, et al. Circulation. 2008;118:S-1016,VentrAssist as Bridge to Transplant,VentrAssist Components,Implantable blood pump Powered via percutaneous lead Controller lo
7、gs parameters & alarms Battery or AC power supply Laptop PC for clinician use,Blood pump,Outflow cannula,Controller and battery receptacle,Percutaneous lead,Inflow cannula,Worldwide VentrAssist Experience*,* As of 3/3/09,Study Outcomes: Interim Analysis Population (n=98),Boyle A et al. ACC Late Brea
8、king Clinical Trial 2009.,Newest VAD: Heartware,VADs vs CRT for NYHA Class IV Heart Failure,2 Year Mortality with CRT/CRT-D in NYHA Class IV Patients,Lindenfeld J et al. Circulation 2007; 115: 204-212.,COMPANION NYHA Class IV Patients,Lindenfeld J et al. Circulation 2007; 115: 204-212.,Improvement i
9、n Median Distance Walked in Six Minutes: HeartMate II vs CRT/CRT-D,Boyle A et al. Presented at ACC 2008.,Conclusions,Test to determine candidacy for transplant is metabolic stress test Median survival post-transplant is 10 years Frequency of transplantation is declining Long term inotropic therapy not very successful Continuous flow VADs show good long term survival with reduced adverse events VADs now approved for BSA as low as 1.2 CRT for NYHA Class IV heart failure not terribly effective,