Heart transplantation is the «gold standard» of severe heart failure treatment. Sudden arrhythmic death is the leading cause of death among these patients. Amiodarone is the only antiarrhythmic drug with beneficial effect on survival of patients with end-stage heart failure. Given its long half-life, pre-transplant use of amiodarone has been extensively discussed focusing on divergent results regarding morbidity and mortality after heart transplantation. Its adverse clinical events after transplantation remain debatable. This review is aimed at evaluation of the impact of amiodarone pretransplant use on mortality and complications after heart transplantation.

10.15825/1995-1191-2017-2-133-138

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SUCCESSFUL TREATMENT OF A RECIPIENT WITH MASSIVE THROMBOSIS OF HEART TRANSPLANT LEFT CHAMBERS DURING EXTRACORPOREAL MEMBRANE OXYGENATION

Russian Journal of Transplantology and Artificial Organs (2016)

В. Н. Попцов V. M. Zakharevich Е. А. Спирина А. М. Golts С. Г. Ухренков

We present a case report of a 16-year-old man with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for primary graft failure after orthotopic heart transplantation who developed left atrium and left ventricular thrombosis despite systemic anticoagulation. The surgical thrombectomy was performed and the patient was successfully weaned off the extracorporeal support on the first day thereafter.

Extracorporeal

10.15825/1995-1191-2016-2-117-124

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DONOR HEART VALVES RECONSTRUCTION BEFORE TRANSPLANTATION

Russian Journal of Transplantology and Artificial Organs (2014)

S. V. Gautier Р. Ш. Саитгареев В. Н. Попцов Д. В. Шумаков Г. А. Акопов

Aim of study. The demonstration of our own experience in heart transplantation after valve reconstruction. Methods and results. From May 2012 to March 2013 3 mitral valve annuloplasties were performed to recipi- ents, requiring urgent HT and having extremely unfavorable prognosis of survival without HT. The recipients were classi fi ed as United Network for Organ Sharing (UNOS) IB, and all of them were on inotropic support. In one case, HT was performed after reconstruction of rheumatic mitral stenosis, in two other cases – after dege- nerative mitral regurgitation. The technical aspects are reviewed of ex-vivo mitral and tricuspid valves repair with concomitant heart transplantation. All patients were discharged from the hospital having excellent postope- rative recovery. Conclusion. Taking into consideration the demonstrated satisfactory result of surveillance and presence of signi fi cant experience in performing of reconstructive valve surgery among no-HT cardiosurgical patients, an increase in the pool of suitable donor organs is expected due to the liberalization of the selection criteria and the possibility of the innovative valve reconstruction procedures ex vivo .

Concomitant

10.15825/1995-1191-2013-2-36-43

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Strategy for prophylactic application of peripheral va-ecmo in transplantation involving expected extremely prolonged ischemia time

Russian Journal of Transplantology and Artificial Organs (2023)

В. Н. Попцов В. М. Захаревич Е. А. Спирина A. I. Skokova A. K. Solodovnikova

Heart transplantation (HT) with extremely prolonged (>6 hours) graft ischemia is associated with severe cardiac graft dysfunction. The high efficiency of prophylactic (preoperative initiation) veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to prevent severe hemodynamic disorders during cardiac surgery has been demonstrated. Objective : to determine the effect of prophylactic VA-ECMO on the perioperative period in HT with an expected graft ischemia >6 hours. Materials and methods . Thirty-eight recipients (33 (86.8%) males and 5 (13.2%) females), age 11–66 (44.7 ± 12.0) years (median 48.0 years) were examined. Pre-transplant mechanical circulatory support (MCS) using peripheral VA-ECMO was applied in 15 (39.5%) recipients, in 6 of whom by prophylactic technique. The recipients (n = 38) were divided into 3 groups: 1) «no pre-HT VA-ECMO» (n = 23); 2) «pre-HT VA-ECMO» (n = 9) – pre-transplant VA-ECMO as a bridge to HT; 3) «prophylactic VA-ECMO» (n = 6). Results . In «prophylactic VA-ECMO» group, extracorporeal circulation (ECC) (94.0 [85.5; 102.8] min) and reperfusion time (20.0 [18.3; 27.6] min) were shorter (p < 0.05) compared to «no pre-HT VA-ECMO» (161.0 [122; 191.5] and 60.0 [55.3; 70.5] min) and «pre-HT VA-ECMO» (127.0 [117; 150.3] and 35.0 [27.8; 48.8] min) groups. The vasoactive-inotropic score was lower (p < 0.05) in «pre-HT VA-ECMO» and «prophylactic VAECMO» groups compared to recipients in «no pre-HT VA-ECMO» group, 12.1 [11.2; 14.0] and 12.5 [11.7; 14.8] vs. 16.0 [15.0; 18.5], respectively. The groups did not differ in terms of incidence of severe primary dysfunction. The «pre-HT VA-ECMO» and «prophylactic VA-ECMO» groups were characterized by shorter duration of mechanical ventilation (MV) compared with «no pre-HT VA-ECMO» group (11.7 [10.0; 16.5] and 12.7 [11.3; 18.4], respectively, vs. 14.5 [13.0; 19.3]). The «no pre-HT VA-ECMO» and «prophylactic VA-ECMO» groups did not differ in the need for postoperative MST, 21.7% and 16.7%, respectively. The groups did not differ in terms of length of stay in the intensive care unit (ICU) and in-hospital mortality – 0% («prophylactic VA-ECMO») and 8.7% («no pre-HT VA-ECMO») and 11.1% («pre-HT VA-ECMO»), respectively. Conclusion . Prophylactic VA-ECMO in HT with extremely prolonged cardiac graft ischemia reduces ECC duration, reperfusion period, postoperative mechanical ventilation period, and the need for inotropic therapy.

10.15825/1995-1191-2024-1-55-66

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Preventive Peripheral VA ECMO in Heart Transplantation with Extremely Long Allograft Ischemic Time

The Journal of Heart and Lung Transplantation (2024)

В. Н. Попцов V. Zaharevich Е. А. Спирина A. I. Skokova A. Solodovnikova

10.1016/j.healun.2024.02.528

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Cystatin C in the diagnostics of acute kidney injury after heart transplantation

Russian Journal of Transplantology and Artificial Organs (2017)

А. Г. Строков Ya. L. Poz В. Н. Попцов А. О. Шевченко N. P. Shmerko

Aim . To examine the assumption that significant concentrations of cystatin C in urine are the manifestation of the tubular necrosis and, respectively, the severity of kidney damage after heart transplantation (HTx). Materials and methods . In this study we evaluated 33 heart recipients (6 women and 27 men, aged from 24 to 68 years old) who had risk factors of acute kidney injury: serum creatinine level >113 μmol/l and/or mechanical circulatory support requirement (20 patients, in 14 cases before HTx). Cystatin C concentration in serum and in urine was measured by DyaSis particle-enhanced immunoturbidimetric assay test «Cystatin C FS». Results . Recipients were divided into two groups according to the levels of cystatinuria. In the group with the significant (more than 0.18 mg/l) urinary cystatin C concentrations the requirement of renal replacement therapy (RRT) was 2.5-fold higher, and the mean duration of RRT was more than 10-fold longer. In 2 patients with the significant cystatinuria acute kidney injury (AKI) has transformed into end-stage renal disease (ESRD). Conclusion. Due to data obtained we may suppose that significant concentrations of cystatin C in urine are the marker of the tubular necrosis with the prolonged RRT requirement. Further studies are needed to justify this relationship.

Acute tubular necrosis

Renal replacement therapy

10.15825/1995-1191-2017-1-17-21

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Experience of outpatient follow-up of heart transplant recipients at Shumakov center

Russian Journal of Transplantology and Artificial Organs (2023)

I. I. Muminov Н. Н. Колоскова В. Н. Попцов В. М. Захаревич Н. П. Можейко

Heart transplantation (HT) is considered the optimal therapy for end-stage heart failure. In recent years, the number of operations performed has been growing, which has led to a rise in the number of heart transplant recipients requiring outpatient follow-up. Objective: to evaluate the effectiveness of the model of dual personalized follow-up of heart transplant recipients in the consultative and diagnostic department of Shumakov National Medical Research Center of Transplantology and Artificial Organs. Materials and methods . The study included 1,436 patients under outpatient follow-up from January 2008 to December 2022. Recipient data, results of laboratory and instrumental examination methods, nature and frequency of complications at different follow-up periods were analyzed. Results : At the time of discharge from the hospital, 98.7% of patients had received triple-drug immunosuppressive therapy; 6 months later, methylprednisolone was discontinued in 72.2% of recipients. Mean tacrolimus level during the 1-year follow-up was 8.7 ± 2.7 ng/mL; in the period from 1 to 5 years of followup, the mean was 5.1 ± 2.4 ng/mL. At year 1 after transplantation, 23 (1.7%) recipients had been converted to everolimus; by the end of year 5 of follow-up, the number had increased to 8.6%. The most frequently detected complications during outpatient follow-up were: hypertension (48.65%), post-transplant diabetes mellitus (7.24%), nephropathy (35.97%), and malignant neoplasms (4.2%). Recipient survival, excluding in-hospital mortality, was 96.5%; and 88.0% at year 1 and 5 of follow-up, respectively. Conclusion : The dual personalized approach model for outpatient follow-up and treatment of heart transplant recipients will improve recipient survival and quality of life in the long-term post-HT period.

Outpatient clinic

Everolimus

10.15825/1995-1191-2023-3-68-75

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Conversion to everolimus to preserve kidney function in a heart transplant recipient, a personalized approach of immunos uppressive therapy

Russian Journal of Transplantology and Artificial Organs (2018)

Н. Н. Колоскова Е. А. Никитина В. М. Захаревич I. I. Muminov V. S. Cvan

Heart transplantation is the «gold standard» of treatment severe heart failure. Patient survival after heart transplantation has improved dramatically since the availability of calcineurin inhibitor (CNIs). However, nephrotoxicity of CNIs has been largely responsible for the progressive development of renal dysfunction and reduces long-term patient survival. Use mTOR inhibitor in immunosuppressive therapy may improve renal function when everolimus is administered associated with a progressive reduction of CNIs. The purpose of our report is to demonstrate the successful case of conversion of the recipient after heart transplantation to everolimus and to evaluate the effectiveness of this drug during the observation year after heart transplantation.

Everolimus

Nephrology

Sirolimus

Nephrotoxicity

10.15825/1995-1191-2018-3-70-74

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Mid-term and long-term outcomes following heart transplantation with prolonged cold ischemia

Russian Journal of Transplantology and Artificial Organs (2023)

A. A. Fomichev В. Н. Попцов Д. А. Сирота M.O. Zhulkov Alexander Edemskiy

Objective : comparative analysis of long-term outcomes following heart transplantation (HT) with prolonged and short cold ischemia. Materials and methods . We analyzed the data of 29 orthotopic HT with >4 hours of cold ischemia. The transplant surgery was performed at Meshalkin National Medical Research Center between 2013 and the present time. Organs were obtained from donors from other regions. The control group consisted of 29 HTs with cold ischemia <4 hours, performed in the same period. The minimum distance between the transplant center and the donor base was about 250 km (Barnaul); the maximum distance was about 850 km (Krasnoyarsk). Recipient survival and postoperative peculiarities were analyzed. Results. In-hospital survival in the prolonged cold ischemia group was 89.7% (n = 26) with 3 deaths (10.3%). In the second group (<240 min), in-hospital survival was 79.3% (n = 23) with 6 (20.7%) deaths. The Kaplan-Meier survival analysis showed no difference between the groups (Log-Rank Test, P 1/4 0.59). In addition, cold ischemia time did not increase the risk of graft rejection and the risk of transplant coronary artery disease (TCAD). Conclusion. HT with cold ischemia >4 hours did not have worse outcomes than in short graft ischemia. This provides grounds for further accumulation of experience in the use of heart donors from remote locations.

Warm ischemia

Cold ischemia

Log-rank test

10.15825/1995-1191-2023-1-99-105

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