Andrä Wasler

The role of CYP3A5 genotypes in dose requirements of tacrolimus and everolimus after heart transplantation.

Kniepeiss D, Renner W, Trummer O, Wagner D, Wasler A, Khoschsorur GAli, Truschnig‐Wilders M, Tscheliessnigg K‐H. The role of CYP3A5 genotypes in dose requirements of tacrolimus and everolimus after heart transplantation. 
Clin Transplant 2011: 25: 146–150.

The impact of overweight on the development of diabetes after heart transplantation.

Abstract:  Background:  Overweight is defined with a body mass index (BMI) >25. A BMI >25 is known as an independent risk factor for increased morbidity and mortality. The influence of an increased BMI on the development of diabetes and on survival after heart transplantation (HTX) was investigated.

Mondphasen und Operationskomplikationen — eine Analyse von mehr als 14.000 Fällen

ZusammenfassungGrundlagen: In den letzten Jahren werden zunehmend Einflüsse des Mondes auf Naturvorgänge diskutiert, wonach insbesondere das menschliche Verhalten, Krankheitsinzidenzen und die Reaktion auf operative Eingriffe mit den Mondphasen variieren sollen. Hinsichtlich postoperativer Komplikationen wird in Laienpublikationen behauptet, daß generell bei zunehmendem Mond und insbesondere bei Vollmond vermehrt mit Komplikationen gerechnet werden müßte. Methoden: Wir untersuchten retrospektiv die perioperative Mortalität von 14.970 Patienten, die in Allgemeinanästhesie einem chirurgischen Eingriff unterzogen wurden, in Relation zu den Mondphasen zum Operationszeitpunkt. Ergebnisse: Es zeigte sich, daß weder mit zu- oder abnehmendem Mond noch mit Vollmond eine signifikante Erhöhung der letalen Komplikationen auftrat und daß sich nicht einmal eine Tendenz in die behauptete Richtung abzeichnete. Ergänzend wurden die postoperativen Verläufe von 600 Patienten mit thoraxchirurgischen Operationen hinsichtlich aller postoperativen Komplikationen detailliert untersucht. Wiederum zeigte sich kein Zusammenhang mit den Mondphasen. Schlußfolgerungen: Unsere Untersuchungen weisen darauf hin, daß die behaupteten Zusammenhänge zwischen Mondphasen und Operationskomplikationen durch Beobachtung nicht bestätigt werden können und damit als Aberglaube zu betrachten sind.SummaryBackground: During the last years potential influences of lunar phases on human behaviour, incidence of disease and postoperative outcome has been discussed. As far as surgical procedures are concerned, the lay press claims that operations carried out at waxing moon or particularly at full moon carry a higher risk of perioperative complications than surgical procedures performed at waning moon. Methods: In the present retrospective study we investigated perioperative mortality of 14.970 patients undergoing surgical procedures in general anaesthesia in relation to moon phases at the time of surgery. Results: Neither waxing moon nor full moon caused a significantly increased mortality. Additionally, there was also no trend compatible with statements previously published. In a subset of 600 patients who underwent thoracic surgery, all types of complications (lethal and non-lethal) were examined. Again there was no relationship with lunar phases. Conclusions: These results show that observation does not support previous statements concerning moon phase at the time of operation and perioperative outcome. These claims have to be regarded as superstition.

The role of serum albumin in the prediction of malnutrition in patients at least five yr after heart transplantation.

Malnutrition after heart transplantation (HTX) is related to graft sclerosis. The risk for malnutrition is often underestimated by conventional measurements. We aimed to compare these with objective assessors for malnutrition.

Donor heart selection and outcomes: An analysis of over 2,000 cases

BACKGROUND Decision-making when offered a donor heart for transplantation is complex, and supportive data describing outcomes according to acceptance or non-acceptance choices are sparse. Our aim was to analyze donor heart acceptance decisions and associated outcomes at a single center, and after subsequent acceptance elsewhere. METHODS This investigation was a retrospective analysis of data obtained from the University of Vienna Medical Center and Eurotransplant centers for the period 2001 to 2015. RESULTS Our center accepted 31.8% (699 of 2,199) of donor hearts offered. Unlike other centers, the acceptance rate, with or without transplantation, did not increase over time. Of the donor hearts rejected by our center, 38.1% (572 of 1,500) were later accepted elsewhere. Acceptance rates were twice as high for donor hearts initially rejected for non-quality reasons (339 of 601, 56.4%) compared with initial rejection for quality reasons (233 of 899, 25.9%). Three-year patient survival rate was 79% at Vienna; for donor hearts initially rejected by Vienna for non-quality reasons or quality reasons, it was 73% and 63%, respectively (p < 0.001). Outcomes at other centers after transplantation of grafts rejected by Vienna varied according to the reason for rejection, with good 3-year survival rates for rejection due to positive virology (77%), high catecholamines (68%), long ischemic time (71%), or low ejection fraction (68%), but poor survival was observed for hearts rejected for hypernatremia (46%), cardiac arrest (21%), or valve pathology (50%). CONCLUSIONS A less restrictive policy for accepting donor hearts at our center, particularly regarding rejection for non-quality reasons or for positive virology, high catecholamine levels, longer ischemic time, or low ejection fraction, could expand our donor pool while maintaining good outcomes.

Positionspapier der Österreichischen Kardiologischen Gesellschaft zum Einsatz der extrakorporalen Membranoxygenation (ECMO) bei Erwachsenen kardiologischen Patienten@@@Use of ECMO in adult patients with cardiogenic shock: a position paper of the Austrian Society of Cardiology.

The use of ECMO to stabilize critically ill patients with severely depressed cardiac function and hemodynamics increased in the last years due to broader availability, better performance and easier implantation of the devices. The present guidelines of the Austrian Society of Cardiology focus on the use of ECMO in adult non-operated patients with cardiac diseases. Not only indications and contraindications are highlighted, but also the equally important issues of monitoring, complication management, measures during implantation and operation, and weaning of the devices are treated in detail. Thereby the present guidelines aim to optimize the use of ECMO in the individual centers, and aim to help current non-ECMO centers in developing a local ECMO-program or to contact ECMO-centers for discussion of individual patients.ZusammenfassungDurch die Verfügbarkeit verbesserter ECMO Geräte mit einfacherer Implantation und einfacherem stabilerem Betrieb, findet die ECMO Implantation zunehmende Verbreitung. Das vorliegende Positionspapier der Österreichischen Kardiologischen Gesellschaft beleuchtet den Einsatz der ECMO bei erwachsenen kardiologischen nicht-postoperativen Patienten. In diesem Positionspapier werden nicht nur Indikationen- Kontraindikationen beleuchtet sondern auch Maßnahmen während des ECMO Betriebes – Monitoring und Komplikationsmanagement sowie das ECMO weaning behandelt. Mit diesen detaillierten Leitlinien soll der Einsatz der ECMO österreichweit verbessert, wenig erfahrenen Zentren eine Unterstützung für den eigenständigen Aufbau eines ECMO-Programmes geliefert und nicht ECMO-Zentren eine Hilfestellung für die Kontaktaufnahme mit ECMO-Zentren geboten werden.SummaryThe use of ECMO to stabilize critically ill patients with severely depressed cardiac function and hemodynamics increased in the last years due to broader availability, better performance and easier implantation of the devices. The present guidelines of the Austrian Society of Cardiology focus on the use of ECMO in adult non-operated patients with cardiac diseases. Not only indications and contraindications are highlighted, but also the equally important issues of monitoring, complication management, measures during implantation and operation, and weaning of the devices are treated in detail. Thereby the present guidelines aim to optimize the use of ECMO in the individual centers, and aim to help current non-ECMO centers in developing a local ECMO-program or to contact ECMO-centers for discussion of individual patients.