J.C. Mullen

Pretransplant diabetes, not donor age, predicts long-term outcomes in cardiac transplantation.

Abstractu2003 Background and Aim: Accepting donors of advanced age may increase the number of hearts available for transplantation. Objectives were to review the outcomes of using cardiac donors 50 years of age and older and to identify predictors of outcome at a single institution. Methods: A retrospective analysis of all adult cardiac transplants (n = 338) performed at our institution between 1988 and 2002 was conducted. Results: Of these, 284 patients received hearts from donors <50 years old and 54 received hearts from donors ≥50 years old. Recipients of hearts from older donors had a greater frequency of pretransplant diabetes (19% vs 33%), renal failure (16% vs 30%), and dialysis (3% vs 9%). There were no differences in ICU or postoperative length of stay, days ventilated, or early rejection episodes. Recipients of older donor hearts, however, had increased perioperative mortality (7% vs 17%; p = 0.03). Multivariate analysis identified older donors (OR 2.599; p = 0.03) and donor ischemia time (OR 1.006; p = 0.002) as significant predictors of perioperative mortality. Actuarial survival at 1 (87% vs 74%), 5 (76% vs 69%), and 10 (59% vs 58%) years was similar (p = 0.08) for the two groups. Separate multivariate analyses identified pretransplant diabetes as the sole predictor of long‐term survival (HR 1.659; p = 0.02) and transplant coronary disease (HR 2.486; p = 0.003). Conclusions: Despite increased perioperative mortality, donors ≥50 years old may be used with long‐term outcomes similar to those of younger donor hearts. This has potential to expand the donor pool. Pretransplant diabetes has a significant impact on long‐term outcomes in cardiac transplantation and requires further investigation.

Massive Left Atrial Sarcoma Presenting With Severe Congestive Heart Failure

Primary intimal sarcomas of the left atrium are extremely rare and highly aggressive tumours. To our knowledge, only 4 cases have been reported to date. We report on a 42-year-old man who presented with signs of congestive heart failure and was found to have an enormous left atrial bilobed tumour with obstruction of the mitral valve. The patient underwent a surgical excision of the sarcoma. The tumour recurred 8.5 months later and the patient required right pneumonectomy.

A randomized controlled trial of daclizumab versus anti-thymocyte globulin induction for heart transplantation

BackgroundThe purpose of this study was to test the efficacy and safety of daclizumab (DZM) versus anti-thymocyte globulin (ATG) as a component of induction therapy in heart transplant recipients.MethodsThirty heart transplant patients were randomized to receive either ATG or DZM during induction therapy. Patients in the DZM group received an initial dose of 2 mg/kg intravenous (IV) at the time of transplant and 1 mg/kg IV on postoperative day 4.DiscussionRecipient, donor, and intraoperative variables did not differ significantly between groups. The cost of induction therapy, total drug cost, and hospital ward costs were significantly less for the DZM group. Average absolute lymphocyte and platelet counts were significantly higher in the DZM group. There were no significant differences in the incidence of rejection, infection, malignancy, or steroid-induced diabetes. One year survival was excellent in both groups (87%, Pu2009=u20090.1). Daclizumab is a safe component of induction therapy in heart transplantation.

Large left atrial myxoma causing mitral valve obstruction: diagnosis by computed tomography.

Large Left Atrial Myxoma Causing Mitral Valve Obstruction: Diagnosis by Computed Tomography Molly Thangaroopan, M.D., F.R.C.P.C.,∗ Brian Chiu, M.D., F.R.C.P.C.,† Nanthan Thangaroopan, B.Sc.,∗ John Mullen, M.D., M.Sc., F.R.C.S.C.,† Leslie Kasa, M.D., F.R.C.P.C.† ∗Division of Cardiology, Toronto General Hospital, Toronto, Ontario and †University of Alberta Hospital and Grey Nuns Hospital, Edmonton, Alberta, Canada

Successful Recycling of a Previously Transplanted Heart: Another Option for Limited Resources

We report a case of successful reuse of a previously transplanted heart. The organ was retransplanted 16 days after the initial transplantation into a 60-year-old man who had previously received a left ventricular assist device.

Contrast Echocardiography without Contrast Agent for Display of Intraventricular Mass

Graphical abstract