Jason Gluck

Systematic Review of Phosphodiesterase-5 Inhibitor Use in Right Ventricular Failure Following Left Ventricular Assist Device Implantation

Our aim was to identify relevant literature supporting the use of phosphodiesterase-5 (PDE5) inhibitors in patients with persistent pulmonary hypertension with signs of postprocedural right ventricular (RV) dysfunction following left ventricular assist device (LVAD) implantation. We searched MEDLINE, SCOPUS, and Web of Science from inception through November 27, 2014 for citations evaluating patients with end-stage heart failure necessitating LVAD, continuous and pulsatile, who received a PDE5 inhibitor to prevent RV failure. Outcomes of interest included changes in mean pulmonary artery pressure, pulmonary vascular resistance, central venous pressure, cardiac index, and mean arterial pressure. Results are presented qualitatively. Four citations (n = 83 patients) were included. These included a single case report, two retrospective case series, and a prospective open-label study with a historical control. All four studies utilized the PDE5 inhibitor sildenafil with various doses for up to 3 months. Sildenafil routinely reduced mean pulmonary artery pressures as soon as 90 min after administration. Reductions in pulmonary vascular resistance were also seen shortly after the procedure and maintained through 12-15 weeks. While one study saw improvements in postoperative central venous pressures, another did not. Evidence supporting PDE5 inhibitor use to attenuate RV failure in patients requiring an LVAD is weak.

Is Entresto good for the brain

The main stay pharmacotherapy for heart failure (HF) is targeted towards rennin-angiotensin-aldosterone (RAAS) and neprilysin pathways (NP). Both therapeutic strategies decreases morbidity and mortality but also carry considerable adverse effects. This review of the literature highlights the new generation of HF drug, sacubitril-valsartan (SV), trade name Entresto (researched as LCZ696, Novartis) which simultaneously blocks RAAS and NP. This dual action of angiotensin receptors blocker and neprilysin inhibitor (NPi) has improved HF prognosis and it is an evolution in the management of HF. Although the initial follow-up of patients treated with SV has yielded promising results, there are concerns regarding potential side effects especially an increase in the risk of Alzheimer’s disease (AD) and young onset of AD. NPi interferes with the breakdown and clearing of beta-amyloid peptides, the plaques seen in AD, raising concern for AD in SV patients. On the other hand, hypertension and cardiovascular diseases are established risk factors for AD which can be decreased by SV therapy. It is therefore essential that SV treated patients are followed up over an extended period of time to detect any adverse cognitive changes.

Left ventricular assist device implantation improves glycaemic control: a systematic review and meta-analysis: LVADs improve glycaemia

Heart failure (HF) and diabetes mellitus (DM) often coexist and have bidirectional association. Advanced HF is associated with worsened glycaemic control. This meta‐analysis investigated the effects of left ventricular assist device (LVAD) implantation on markers of DM control.

VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION AS A BRIDGE TO RIGHT VENTRICULAR RECOVERY FOLLOWING FAILURE OF RIGHT VENTRICULAR ASSIST DEVICE IN RIGHT VENTRICULAR FAILURE ACCOMPANYING PULMONARY EMBOLECTOMY

Extracorporeal membrane oxygenation (ECMO) has been used as a bridge to thrombolysis and embolectomy in massive pulmonary embolism. The role of right ventricle assist device (RVAD) and appropriate utility of ECMO in right ventricular (RV) failure during pulmonary embolectomy is not well described.

COMPLEX AORTIC COARCTATION: A MANAGEMENT DILEMMA

Complex congenital heart pathologies can often pose a management challenge. 27 yr old man with history of hypertension presented with fever of 3 week duration. Physical exam revealed 4/6 systolic murmur, and upper-lower extremity BP difference of 58 mmHg. TEE showed perforated anterior mitral

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) AS BRIDGE-TO-SURGERY FOR INFECTIVE ENDOCARDITIS

Timing of surgery for active infective endocarditis is challenging in patients with mechanical dysfunction and hemodynamic compromise. ECMO has been described in sepsis but is not reported with acute mechanical complication from endocarditis. A 35-year-old man presented with Streptococcus viridans