T Hübner1, T Nickel1, G Steinbeck2, S Massberg3, R Schramm4, B Reichart5, C Hagl4, A Kiwi1, Michael Weis6. 1. Medizinische Abteilung, Kliniken der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Renatastrasse 71a, 80639, Munich, Germany. 2. Zentrum für Kardiologie am Klinikum Starnberg, Starnberg, Germany. 3. Medizinische Klinik und Poliklinik I, Universitätsklinikum Großhadern der Ludwig-Maximilans Universität, Munich, Germany. 4. Herzchirurgische Klinik, Universitätsklinikum Großhadern der Ludwig-Maximilans Universität, Munich, Germany. 5. Walter Brendel Center for Experimental Medicine, Munich, Germany. 6. Medizinische Abteilung, Kliniken der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Renatastrasse 71a, 80639, Munich, Germany. prof.weis@krankenhaus-neuwittelsbach.de.
Abstract
AIM: Currently, more than 900 patients with end-stage heart failure are listed for heart transplantation in Germany. All patients on the Eurotransplant high-urgent status (HU) have to be treated in intensive care units and have to be relisted every 8 weeks. Long-term continuous inotropes are associated with tachyphylaxia, arrhythmias and even increased mortality. In this retrospective analysis, we report our single center experience with HU patients treated with intermittent inotropes as a bridging therapy. METHODS AND RESULTS: 117 consecutive adult HU candidates were treated at our intensive care heart failure unit between 2008 and 2013, of whom 14 patients (12 %) were stabilized and delisted during follow-up. In the remaining 103 patients (age 42 ± 15 years), different inotropes (dobutamine, milrinone, adrenaline, noradrenaline, levosimendan) were administered based on the patient's specific characteristics. After initial recompensation, patients were weaned from inotropes as soon as possible. Thereafter, intermittent inotropes (over 3-4 days) were given as a predefined weekly (until 2011) or 8 weekly regimen (from 2011 to 2013). In 57 % of these patients, additional regimen-independent inotropic support was necessary due to hemodynamic instabilities. Fourteen patients (14 %) needed a left- or biventricular assist device; 14 patients (14 %) died while waiting and 87 (84 %) received heart transplants after 87 ± 91 days. Cumulative 3 and 12 months survival of all 103 patients was 75 and 67 %, respectively. CONCLUSION: Intermittent inotropes in HU patients are an adequate strategy as a bridge to transplant; the necessity for assist devices was low. These data provide the basis for a prospective multicenter trial of intermittent inotropes in patients on the HU waiting list.
AIM: Currently, more than 900 patients with end-stage heart failure are listed for heart transplantation in Germany. All patients on the Eurotransplant high-urgent status (HU) have to be treated in intensive care units and have to be relisted every 8 weeks. Long-term continuous inotropes are associated with tachyphylaxia, arrhythmias and even increased mortality. In this retrospective analysis, we report our single center experience with HU patients treated with intermittent inotropes as a bridging therapy. METHODS AND RESULTS: 117 consecutive adult HU candidates were treated at our intensive care heart failure unit between 2008 and 2013, of whom 14 patients (12 %) were stabilized and delisted during follow-up. In the remaining 103 patients (age 42 ± 15 years), different inotropes (dobutamine, milrinone, adrenaline, noradrenaline, levosimendan) were administered based on the patient's specific characteristics. After initial recompensation, patients were weaned from inotropes as soon as possible. Thereafter, intermittent inotropes (over 3-4 days) were given as a predefined weekly (until 2011) or 8 weekly regimen (from 2011 to 2013). In 57 % of these patients, additional regimen-independent inotropic support was necessary due to hemodynamic instabilities. Fourteen patients (14 %) needed a left- or biventricular assist device; 14 patients (14 %) died while waiting and 87 (84 %) received heart transplants after 87 ± 91 days. Cumulative 3 and 12 months survival of all 103 patients was 75 and 67 %, respectively. CONCLUSION: Intermittent inotropes in HU patients are an adequate strategy as a bridge to transplant; the necessity for assist devices was low. These data provide the basis for a prospective multicenter trial of intermittent inotropes in patients on the HU waiting list.
Entities:
Keywords:
Heart failure; Heart transplantation; Inotropic therapy; Intensive care medicine
Authors: Paolo C Colombo; Javier E Banchs; Sulejman Celaj; Ashok Talreja; Justine Lachmann; Shailesh Malla; Nicholas B DuBois; Anthony W Ashton; Farhana Latif; Ulrich P Jorde; J Anthony Ware; Thierry H LeJemtel Journal: Circulation Date: 2004-12-20 Impact factor: 29.690
Authors: Michael J Bonios; John V Terrovitis; Stavros G Drakos; Fotis Katsaros; Chris Pantsios; Serafim N Nanas; John Kanakakis; George Alexopoulos; Savvas Toumanidis; Maria Anastasiou-Nana; John N Nanas Journal: Int J Cardiol Date: 2011-04-08 Impact factor: 4.164
Authors: A Hatzizacharias; T Makris; P Krespi; F Triposkiadis; P Voyatzi; N Dalianis; M Kyriakidis Journal: Am Heart J Date: 1999-08 Impact factor: 4.749
Authors: Simona Silvetti; Teresa Greco; Ambra Licia Di Prima; Marta Mucchetti; Castro Maria de Lurdes; Laura Pasin; Mara Scandroglio; Giovanni Landoni; Alberto Zangrillo Journal: Clin Res Cardiol Date: 2013-12-25 Impact factor: 5.460
Authors: Petri O Tuomainen; Jarkko Magga; Pekka Timonen; Kati Miettinen; Minna Kurttila; Esko Vanninen; Tomi Laitinen; Kirsi Timonen; Kari Punnonen; Ilkka Parviainen; Ari Uusaro; Olli Vuolteenaho; Matti Kivikko; Keijo Peuhkurinen Journal: Clin Res Cardiol Date: 2013-03-17 Impact factor: 5.460
Authors: Michael Weis; Gerhard Steinbeck; Bruno Reichart; Tassilo Hübner; Thomas Nickel; Steffen Massberg; Rene Schramm; Christian Hagl; Axel Kiwi Journal: Clin Res Cardiol Date: 2015-09-08 Impact factor: 5.460
Authors: Stephan Ensminger; Uwe Schulz; P Christian Schulze; Friedrich-Wilhelm Mohr; Jan Gummert Journal: Clin Res Cardiol Date: 2015-08-26 Impact factor: 5.460