Historically, 2-year survival after VAD implant has been sub-optimal, and no patient management algorithms have been formally tested to determine their effect on 2-year survival.
METHODS: The study comprised 76 patients, of whom 26 had a VAD as destination
therapy (DT) and 50 as a bridge to transplant (BIT), from July 1, 2003, to June 30, 2008. Survival before and after initiation of ISP was compared. A parametric hazard multivariable analysis, with a time-varying Selleckchem BIX 01294 covariable for implementation of ISP, was used to evaluate of other factors affecting survival.
RESULTS: Survival at 16 months was 100% for DT patients who received a VAD after August 1, 2006 vs 64% for the earlier era (p = 0.06). For BIT, 16- month survival was 71% vs 43% (p = 0.03). Predicted 2-year survival before and after implementation of the ISP improved from 30% to 87% for DT (p = 0.02) and from 20% to 61% for BIT patients (p = 0.01). Predictors of midterm survival by multivariable analysis included ISP (p = 0.004), younger age (p = 0.03), non-emergent implant (p < 0.0001), and isolated left ventricular VAD (p < 0.0001). CHIR-99021 After adjustment for covariables, the ISP was associated with a 70% reduction in the hazard for death for the entire cohort (p = 0.004). The effect of ISP was also significant in the patients who
received the HeartMate XVE (Thoratec, Pleasanton, CA), which spanned both eras of the study.
CONCLUSIONS: Survival improved for DT and BIT VAD patients after implementation of the ISP, with a dramatic decrease in hazard for death. Although the transition from pulsatile
to axial flow technology occurred during the study period and likely contributed to improved outcomes, the institution of the ISP provided an important and selleck screening library significant contribution to improved survival through a proactive approach to patient management, allowing earlier identification of potential adverse events. For optimal outcomes, VAD patients require intensive follow-up surveillance protocols that have previously become standard in the care of heart transplant patients. J Heart Lung Transplant 2011;30:879-87 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.”
“The transient electric current of surfactants dissolved in a nonpolar solvent is investigated both experimentally and theoretically in the parallel-plate geometry. Due to a low concentration of free charges the cell can be completely polarized by an external voltage of several volts. In this state, all the charged micelles are compacted against the electrodes. After the voltage is set to zero the reverse current features a sharp discharge spike and a broad peak. This shape and its variation with the compacting voltage are reproduced in a one-dimensional drift-diffusion model.