Zeki Catav

Background/Aims: In this study, the results of patients who had orthotopic heart transplantation (OHT) in acute rejection who admitted to our clinic with decompensated heart failure and who could not undergo endomyocardial biopsy (EMB) were evaluated. Methods: The study included 27 patients who underwent OHT in our clinic between December 1998 and November 2021, who admitted with acute rejection causing decompensated heart failure during follow-up, and who could not undergo EMB and administered IV pulse steroid plus plasmapheresis. Demographics of patients, peri-treatment left ventricular functions, survival rates and causes of mortality were analyzed. Results: 19 (70.4%) were male and mean age was 28.7 ± 14.7 (range: 3-54). After OHT, overall survival rates were 92.6%, 77.6%, and 69.4% at 1st, 3rd and 5th year respectively. During the follow-up, the survival rates of patients who presented with decompensated heart failure and given pulse steroid plus plasmapheresis were 70.4%, 58.8%, and 53.4% at 1st, 3rd and 5th year respectively after plasmapheresis. Median rejection time after transplant was 19 months (range 0-113 months). Pre-, and post-treatment left ventricle ejection fractions were 25.11% ± 11.1%, and 52.14% ± 13.4% respectively (p<0.05). The leading causes of mortality were pneumonia causing sepsis (5/13 patients). Conclusions: In acute rejection patients with decompensated heart failure in whom EMB is not possible, administration of plasmapheresis in addition to IV pulse steroid therapy may have a positive effect on survival in this patient group. Özet Amaç: Bu çalışmada ortotopik kalp nakli (OHT) yapılan, takip sırasında dekompanze kalp yetmezliğine neden olan akut rejeksiyon ile kliniğimize başvuran ve endomiyokardiyal biyopsi (EMB) yapılamayan hastaların sonuçları değerlendirildi. Yöntemler: Çalışmaya Aralık 1998-Kasım 2021 tarihleri arasında kliniğimizde OHT yapılıp, takip sırasında dekompanze kalp yetmezliğine neden olan akut rejeksiyon ile başvuran ve EMB uygulanamayan, IV pulse steroid + plazmaferez uygulanan 27 hasta dahil edildi. Hastaların demografik özellikleri, tedavi öncesi sol ventrikül fonksiyonları, sağkalım oranları ve mortalite nedenleri analiz edildi. Bulgular: Hastaların 19'u (%70.4) erkekti ve yaş ortalaması 28.7 ± 14.7 (3-54) idi. OHT sonrası genel sağkalım oranları 1., 3. ve 5. yılda sırasıyla %92.6, %77.6 ve %69.4 idi. İzlemde dekompanze kalp yetmezliği ile başvuran ve pulse steroid + plazmaferez uygulanan hastaların plazmaferez sonrası 1., 3. ve 5. yılda sağkalım oranları sırasıyla %70.4, %58.8 ve %53.4 idi. Nakil sonrası median rejeksiyon süresi 19 aydı (0-113 ay). Tedavi öncesi ve sonrası sol ventrikül ejeksiyon fraksiyonları sırasıyla %25.11±%11.1 ve %52.14±%13.4 idi (p<0.05). Mortalitenin önde gelen nedeni ise sepsise neden olan pnömoni (5/13 hasta) idi. Sonuç: EMB'nin yapılmasının mümkün olmadığı dekompanze kalp yetmezliği olan akut rejeksiyon hastalarında, IV pulse steroid tedavisine ek olarak plazmaferez uygulanması sağkalımı olumlu etkileyebilir.

Continuous‐flow left ventricular assist devices (LVADs) reduce peak systolic flow, increase diastolic flow, and eliminate pulsatility of circulation. Altered blood flow may lead to a change in end‐organ perfusion. Analysis of the flow dynamics of the arteries of end‐organs, such as the brain, may indicate whether an organ is perfused sufficiently. The aim of this study is to evaluate and identify the flow pattern changes of carotid (CA) and middle cerebral arteries (MCA) in LVAD patients and to compare with heart failure patients and healthy volunteers. Eighty‐nine individuals were included in this cross‐sectional study. Participants were divided into three groups: LVAD patients (n=31), heart failure patients (n=26), and healthy volunteers (n=27). Carotid and transcranial Doppler ultrasonography were performed for all study groups for peak systolic velocity (PSV), end‐diastolic velocity (EDV), pulsatility (PI), and resistive (RI) indices of CA and MCA. Flow dynamics were compared between the groups. Doppler ultrasonographic data were analyzed median 12 (3‐47) months after LVAD implantation. CA‐PSV was lower in LVAD group compared with the other two groups (p), MCA‐PSV of LVAD and heart failure groups were similar and lower than healthy volunteers (p). The highest values for CA‐EDV were found in LVAD group (pp). For PI and RI, in all CA and MCA, LVAD group had lower indices compared with the other two groups (p). In addition, MCA flow analysis in patients with LVAD was identified for the first time with this study.