Postoperative outcomes were similar for both valves. An early hemodynamic advantage for the Trifecta valve lasted to approximately 1 year postoperatively but did not persist.

Preoperative contrast-enhanced ultrasound findings of the cervical carotid arteries are associated with development of MES on transcranial Doppler during exposure of the arteries in CEA, and the predictive accuracy of contrast-enhanced ultrasound is greater than that of GSM.

We compared the frequency of IgG type of HLA class I antibodies between patients with systemic lupus erythematosus (SLE) and healthy controls, using a highly sensitive FlowPRA method. Sixteen of 130 normal healthy males and two of 10 normal females without a history of pregnancy (none had ever been transfused) possessed HLA class I antibodies. In SLE, male, but not female patients, showed a significant increase in the frequency of the antibodies, as compared with the corresponding controls. The antibodies did not appear to be involved in the development of SLE because of no substantial relationship to the incidence of cytopenia or SLE disease activity index score. Each individual had 1 to 31 types of HLA class I antibodies. Interestingly, HLA class I antibodies did not correspond to the individual's own HLA antigens. Eight of 32 types of HLA class I antigens detected were rare in the Japanese population. These results suggest that an IgG component of naturally occurring HLA class I antibodies exists in human serum, and that these antibodies are not antibodies against self-antigens.

Heart transplantation from donation after circulatory death (DCD) donors has the potential to substantially increase overall heart transplant activity. The aim of this report is to review the first 8 y of our clinical heart transplant program at St Vincent’s Hospital Sydney, to describe how our program has evolved and to report the impact that changes to our retrieval protocols have had on posttransplant outcomes. Since 2014, we have performed 74 DCD heart transplants from DCD donors utilizing a direct procurement protocol followed by normothermic machine perfusion. Changes to our retrieval protocol have resulted in a higher retrieval rate from DCD donors and fewer rejections of DCD hearts during normothermic machine perfusion. Compared with our previously reported early experience in the first 23 transplants, we have observed a significant reduction in the incidence of severe primary graft dysfunction from 35% (8/23) to 8% (4/51) in the subsequent 51 transplant recipients (P < 0.01). The only withdrawal time interval significantly associated with severe primary graft dysfunction was the asystolic warm ischemic time: 15 (12–17) versus 13 (11–14) min (P < 0.05). One- and 5-y survival of DCD heart transplant recipients was 94% and 88%, comparable to that of a contemporary cohort of donation after brain death recipients: 87 and 81% (P-value was not significant). In conclusion, heart transplantation from DCD donors has become a major contributor to our overall transplant activity accounting for almost 30% of all transplants performed by our program in the last 2 y, with similar DCD and donation after brain death outcomes.

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