Cardiac transplantation: costs and ethics.
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Ethics, Medical↗
Biomedical subjects
M Sekela
Publications and source records attributed to M Sekela.
A model to predict survival at time of postcardiotomy intraaortic balloon pump insertion.
To facilitate timely application of new forms of cardiac support to patients at highest risk after cardiotomy despite conventional support with the intraaortic balloon pump, an accurate prediction of survival must be available at the time of weaning from cardiopulmonary bypass. We, therefore, acquired 240 demographic, disease, and perioperative characteristics of 322 patients (mortality rate, 48.4%) who required IABP support to separate from bypass. Four variables available before or within 10 minutes of the first attempt at weaning from bypass significantly predicted mortality by stepwise logistic regression: complete heart block as demonstrated by need for temporary pacing at weaning (p < 0.001), advanced age (p < 0.002), preoperative blood urea nitrogen concentration (p = 0.036), and female sex (p = 0.048). An equation generated by the logistic model predicted a 72.2% survival rate in the 25% of patients at least risk (actual survival rate, 71.6%); in the 25% at greatest risk, death was predicted in 73.0%, and the actual mortality rate was 74.1%. The equation was then prospectively applied to 330 intraaortic balloon pump-supported patients managed at another institution. The overall mortality rate there was 41.2%; in the 25% at least risk, predicted survival rate was 70.5% (actual survival rate, 77.1%), and in the 25% at greatest risk, predicted mortality rate was 75.7% (actual mortality rate, 62.7%). Thus, retrospectively at one institution and prospectively at another, the equation generated by this model based only on data available at the time of weaning from bypass was able to define one subgroup of patients 2.6 to 2.7 times as likely to die as another subgroup from within similar cohorts.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Pericardial flap to minimize internal mammary artery anastomotic tension.
A technique is described that decreases tension on the left internal mammary artery anastomosis in patients whose lungs have herniated across the midline.
Herniorrhaphy↗
A unique, efficient, implantable, electromechanical, total artificial heart.
A completely implantable, one piece electromechanical total artificial heart (TAH) intended for permanent human use was developed. It consisted of left and right conically shaped pusher-plate blood pumps sandwiching a thin centerpiece with a compact, efficient electromechanical actuator. The actuator consisted of a direct current brushless motor; a planetary roller screw fit the space between the two conically shaped pusher-plates. The rotational motion of the motor was converted to the rectilinear motion of the rollerscrew to displace the left and right pusher-plates in the left master alternate mode. The diameter of the assembled TAH was 97 mm, with a central thickness of 82 mm. The overall weight was 620 g, with a displaced volume of 510 ml. The pump provided flows of 3-8 L/min with a preload of 1-15 mmHg against an afterload of 100 mmHg. The net efficiency ranged from 15% to 18%. This model showed good fit in the pericardial space of heart transplant recipients (body weight, 77 kg).
Cardiac Output↗
Single lung transplantation involving a donor with documented pulmonary sarcoidosis.
We report the case of a 32-year-old female patient with primary pulmonary hypertension who received a lung transplant from a donor who, unbeknownst to the medical staff, had pulmonary sarcoidosis diagnosed by lung biopsy 16 months earlier. After 16 months of follow-up, our patient did not show any histologic, radiologic, or clinical evidence of pulmonary sarcoidosis involving the transplanted lung. We reviewed the transplant experience involving donors or recipients with known sarcoidosis, and the available data suggest that normal organs transplanted into recipients with preexisting sarcoidosis are likely to develop sarcoid granulomas, whereas organs from donors with known sarcoidosis given to a "normal" recipient do not appear to develop significant or progressive disease. Although the available data in this regard are limited, we do believe that, on the basis of current information, sarcoidosis cannot be considered a priori to be an absolute contraindication to organ donation.
Adult↗