Heparin-induced thrombocytopenia (HIT) presents a unique challenge in patients requiring orthotopic heart transplantation (OHT). We sought to pool the existing evidence in a systematic review.Electronic search was performed to identify all relevant studies on OHT in patients with HIT. Patient-level data for 33 patients from 21 studies were extracted for statistical analysis.Median patient age was 51 [IQR 41, 55] years, with 75.8% (25/33) males. All patients had a clinical diagnosis of HIT, and anti-PF4/Heparin antibodies were positive in 87.9% (29/33). Median lowest reported platelet count was 46 × 109 /L [27.2, 73.5]. Intraoperatively, 61% (20/33) of patients were given unfractionated heparin (UFH), while 39% (13/33) were given alternative anticoagulants. The alternative agent subgroup required more antifibrinolytics [54% (7/13) vs 10% (2/20), P = .02] and clotting factors [69.2% (9/13) vs 15.0% (3/20), P < .01]. Perioperative thrombosis occurred more [53.8% (7/13) vs 0% (0/20, P < .01) in alternate agent subgroup. More patients in the alternate agent subgroup required post-operative transfusions [54% (7/13) vs 0% (0/20), P < .01]. Thirty-day mortality of 15.2% (5/33) was comparable between the subgroups.Heparin use during OHT may be associated with less adverse effects compared to use of other anticoagulants with no difference in 30-day mortality.
Introduction: Placement of cardiac implantable electronic devices (CIED) is thought to contribute to tricuspid regurgitation (TR). However, there are relatively few data comparing the impact of different CIED lead types on the incidence and progression of TR. Aims: This study sought to quantify the change in TR severity following implantation of CIEDs with different types of leads. Methods: Demographic, diagnostic, and outcome data were collected on patients from a single implanter of cardioverter defibrillators (ICD), right ventricle-paced pacemakers (RV-PM), or His bundle-paced pacemakers (His-PM) from 2016 to 2019. Patients with previous CIEDs undergoing upgrade procedures were excluded. Severity of TR was compared before and after CIED implantation using one-sided Wilcoxon-signed rank test. Results: A total of 97 patients receiving CIEDs were analyzed, including 23 with ICDs, 63 with RV-PMs, and 11 with His-PMs. Median patient age was 72 years [IQR: 63, 81], and 44% of patients were female. Echocardiograms were obtained a median of 20 days [4, 91] before CIED implantation and 31 months [18, 43] following implantation. Baseline TR grade was comparable between groups (p = 0.65). TR severity significantly worsened after ICD implantation (p = 0.035), RV-PM implantation trended toward worsening TR severity (p = 0.099), and no difference was noted after His-PM implantation (p = 0.68) (Figure). There was no significant change in RA pressure, RV size or function, or LVEF following CIED implantation. Conclusions: The effect of CIED leads on TR represents a spectrum related to the type of lead and whether the tricuspid valve is traversed. ICD leads, which are bulkiest and traverse the valve, significantly worsened TR. His-PM leads, which do not traverse the valve, have no apparent effect on TR. The impact of RV-PM leads on TR severity appears in-between ICD and His-PM leads - although the lead traverses the valve, it is lighter than ICD leads.
The Organ Procurement and Transplantation Network (OPTN) implemented modifications in 2018 to the adult heart transplant allocation system to better stratify the most medically urgent transplant candidates. We evaluated the impact of these changes on patients supported by a durable left ventricular assist device (LVAD) with chronic kidney disease (CKD).
