Although the survival rate for left ventricular assist device (LVAD) therapy has improved, device-related complications are an unpredictable threat to the patient's quality of life. We focused on driveline infection, and aimed to determine whether specific features of drivelines affect the frequency of infection. We enrolled patients who underwent LVAD implantation and were followed-up at our institute between 2007 and 2015. We counted the occurrences of driveline infection requiring any antibiotic therapy over a 2-year study period. Furthermore, we experimentally measured and compared the outer diameters and stiffness of three devices. Of all, 72 patients received an LVAD during the enrollment period. LVADs were HeartMate II (n = 32), EVAHEART (n = 22), and DuraHeart (n = 18). The outer diameters and stiffness were measured in five of each device. HeartMate II group had the highest driveline infection-free rate among all three devices during the study period (p = 0.042). The driveline of the HeartMate II LVAD had a significantly smaller outer diameter and lower stiffness than that of the other two devices (p < 0.05 for both). In conclusion, device-specific driveline features may affect the development of driveline infection during LVAD therapy.
SummaryAlthough survival after heart transplantation (HTx) has improved in recent years, cardiac allograft vasculopathy (CAV) is still the leading cause of remote morbidity and mortality in HTx recipients, partly because of diffi culty with its diagnosis. In general, routine surveillance for CAV is advocated with coronary angiography accompanied by intravascular ultrasound (IVUS) if necessary. However, these modalities have limitations with respect to low spatial resolution, and suffi cient qualitative/quantitative assessment of coronary intima has not been accomplished. Recently, optical coherence tomography (OCT) has emerged as a novel intracoronary imaging technique using an optical analogue of ultrasound with a spatial resolution of 10-20 µm, which is 10 times greater than IVUS. We here experienced a 49-year-old male who received a HTx 3 years ago, and OCT was executed during low molecular weight dextran injection. OCT demonstrated distinct double intimal layers probably consisting of a donor-transmitted atherosclerotic layer and an inner intimal proliferation due to CAV, which was indistinguishable by IVUS and virtual histological analyses. We believe that OCT imaging is not only a new loadstar during treatment of CAV but also a new generation modality for screening for early CAV in HTx recipients. (Int Heart J 2014; 55: 178-180)
BackgroundWe compared the contribution of physical activity to the change in arterial stiffness between patients with and without diabetes in ischemic heart disease.MethodsWe studied 96 (diabetes) and 109 (without diabetes) patients with ischemic heart disease treated by percutaneous coronary intervention (PCI). Arterial stiffness was assessed by cardio-ankle vascular index (CAVI) at the first diagnosis of significant coronary ischemia and 6 months after PCI and optimal medical therapy. Physical activity was evaluated using the long form of the International Physical Activity Questionnaire (IPAQ).ResultsCAVI values increased more for diabetic patients than for non-diabetic. The IPAQ scores did not differ between the two groups. During follow-up, CAVI values did not significantly change in either group. In diabetic patients, the CAVI score for 48 patients did not change (NC-group) and 48 patients improved (Improved-group). Physical activity scores were 937.9 ± 923.2 and 1524.6 ± 1166.2 in the NC- and Improved-groups, respectively. IPAQ scores and uric acid levels significantly affect CAVI improvement after adjusting for age, sex, baseline CAVI, total cholesterol, and estimated glomerular filtration rate.ConclusionDetermining factors influencing CAVI improvement during follow-up were significantly different between patients with and without diabetes. IPAQ scores and uric acid levels were significantly correlated with CAVI changes.
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