Raj K. Bose

Treatment of Peripartum Cardiomyopathy With Mechanical Assist Devices and Cardiac Transplantation

BACKGROUND Peripartum cardiomyopathy is a life threatening illness. If maximal medical therapy fails, patients may then be treated with mechanical circulatory support devices and (or) cardiac transplantation. Our purpose is to demonstrate the long-term efficacy of these surgical interventions. METHODS A retrospective review of 18 patients diagnosed with peripartum cardiomyopathy from 1994 to 2009 was conducted. RESULTS Eighteen patients were referred with a median of seven year delay between onset of symptoms and presentation. Eight (44%) had medical therapy with only one death at five years, seven are alive, and two patients are awaiting transplantation. Six patients were implanted with devices. From this group, there were two hospital deaths, one native heart recovery, and three heart transplants with 100% survival. Four patients (21%) were treated with transplantation alone and all survived. Combined device and (or) transplant survival was 80% at one year. CONCLUSIONS The natural history of this group varied; 38% of the medically treated patients are stable on medical therapy (3 of 8) and 67% of the device patients (4 of 6) are alive. One of six device patients (17%) was successfully bridged to native heart recovery. Mechanical assist devices can be used as a bridge to recovery or as a bridge to cardiac transplantation for the treatment of peripartum cardiomyopathy patients who fail medical management. In addition, cardiac transplantation alone is also a viable treatment option for patients who fail medical management and do not require a mechanical assist device.

211 A CLINICAL STUDY OF THE EFFICACY OF THE THERAPEUTIC APPLICATION OF PLATELET-RICH PLASMA GEL ON THE SAPHENOUS VEIN HARVEST SITE IN CORONARY ARTERY BYPASS GRAFTING.

The application of platelet-rich plasma gel (PRP) to surgical wounds has been advocated during the past 11 years; however, very few studies of the efficacy of PRP gel have been performed within the cardiovascular surgery arena. Patients undergoing coronary artery bypass grafting (CABG), in which the saphenous vein is harvested, have a 10 to 20% risk of wound complications to the leg. Application of PRP provides hyperphysiologic levels of growth factors to the wound, with perceived benefits including less patient discomfort, shorter hospital stays, and a decreased incidence of postoperative surgical site infection. Publication of the data has the potential to impact the use of PRP gel in the cardiothoracic setting and beyond. The studys protocol dictates that the patient is used as their own control, with PRP being applied to specified incision sites during the time of surgery. To date, 14 patients (7 diabetics) have been enrolled, 31 sites used as control, and PRP application to 38 sites. Evaluations are made beginning 24 hours postoperatively addressing issues of pain, numbness, erythema, infection, swelling, and general healing. Both qualitative and quantitative evidence offer diminutive substantiation to warrant PRP application. However, the goal of the study is to evaluate patients for a minimum of 6 weeks postoperatively in order to comprehensively determine any benefits. There have been no incidences of infection in either control or application site, and only one incidence of delayed/accelerated healing has been observed in a patient with pitting peripheral edema beginning 3 days postoperatively. Ultimately, a patient population of 30 to 40 individuals are to be followed from which more conclusive results can be obtained.

Successful management of empyema in a patient with a total artificial heart

A description of successful management of a patient who developed an empyema as a postoperative complication following the insertion of a CardioWest total artificial heart (TAH) as a bridge to cardiac transplantation is presented. By using traditional methods of management, the patient recovered and went on to transplant.