Barry H. Greenberg

Effects of long-term vasodilator therapy on electrocardiographic abnormalities in chronic aortic regurgitation

Electrocardiographic abnormalities develop in patients with chronic aortic regurgitation (AR). Although vasodilator drugs may reduce left ventricular (LV) volume overload, the effects of such therapy on electrocardiographic abnormalities have not been previously evaluated. Accordingly, electrocardiograms were analyzed before and after double-blind, randomized administration of either hydralazine or placebo in 54 patients with chronic AR. These patients were without limiting symptoms and had preserved ejection fraction on entry in the study. The magnitude of ST-segment depression and Romhilt-Estes point score for LV hypertrophy were assessed. Baseline ST depression and LV hypertrophy scores in the placebo and hydralazine groups were not significantly different. At follow-up, after a mean of 19 +/- 6 months, there was a significant reduction in ST depression in patients taking hydralazine (n = 28) compared with patients given placebo (n = 26): -0.023 +/- 0.044 vs 0.029 +/- 0.055 mV, respectively (p = 0.0001); and in the LV hypertrophy score (-1.1 +/- 2.2 vs 0.9 +/- 2.3 points, respectively; p = 0.002). Hydralazine-treated patients also had significant decreases in LV end-diastolic and end-systolic volume indexes, and a significant increase in ejection fraction. These results suggest that such vasodilator therapy may be beneficial in patients with chronic AR.

Decrease in Driveline Infections with Change in Driveline Management Protocol

We retrospectively reviewed records of left VAD recipients at our institution, based on driveline management. Group 1: daily driveline dressing change consisting of chlorhexidine cleansing, sterile 4x4 gauze, and use of an abdominal binder. Group 2: Dressing change every 3 days consisting of chlorhexidine cleansing, non-sterile silver-impregnated foam with overlying clear dressing, and use of a driveline anchor. Follow-up was censored at first DLI, device removal, transplant or death. Additionally, Group 1 patients’ follow-up was censored when the change in protocol occurred. Statistical analysis: Student’s t-test, Fisher’s exact test, Kaplan-Meier curve and log-rank test.

Caregiver Burden is Low Nine to Twelve Months after Ventricular Assist Device Implantation

Nearly half of the caregivers were the patient’s spouse or partner (55%) with a mean age of 57 years. When evaluating caregiver burden difficulty, 23/31 (74.2%) of the caregivers experienced little to no difficulty, 5/31 (16.1%) had mild difficulty, and 3/31 (9.6%) noted moderate difficulty. When assessing caregiver burden demand, 17/31 (54.8%) experienced little to no demand, 8/31 (25.8%) reported mild to moderate, 5/31 (16.1%) noted moderate to severe, and 1/31 (3.2%) had severe demand. Using the Baka’s scale, 27/31 (87.1%) reported that VADs were not disruptive to their lives. Citation: Ghashghaei, R et al “Caregiver Burden is Low Nine to Twelve Months after Ventricular Assist Device Implantation” The VAD Journal, 2. doi: http://dx.doi.org/10.13023/VAD.2 016.19