The prevalence of heart failure (HF) has been steadily increasing and it now creates an enormous social and economic burden. HF is a syndrome characterized by a high mortality rate, frequent hospitalization, a reduced quality of life, and a complex therapeutic regimen. In the last three decades, major progress in both the diagnosis and management of HF has taken place, and the pharmacologic and non-pharmacologic advances have led to a significant improvement in survival and symptoms in HF patients. After an accurate diagnosis, a proper HF management plan requires a multi-level team approach comprised of the correct combination of drug therapy, device therapy, and surgery, including heart transplantation. In this review, we focused on the pharmacologic and non-pharmacologic treatment strategies for HF with reduced ejection fraction. The goal was to develop treatment guidelines based on significant evidence derived from large clinical trials.
Diagnosis ; Drug Therapy ; Heart Failure* ; Heart Failure, Systolic ; Heart Transplantation ; Hospitalization ; Humans ; Mortality ; Prevalence ; Quality of Life

Heart failure is a complex pathophysiological syndrome that can occur in children from a variety of diseases, including cardiomyopathies, myocarditis, and congenital heart disease. The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole. Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking. Ventricular assist devices (VADs) have taken an increasingly important role in the management of advanced heart failure in children. The predominant role of these devices has been as a bridge to heart transplantation, and excellent results are currently achieved for most children with cardiomyopathies. There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts. Additionally, there is an active investigation and interest in expansion of VADs beyond the predominant utilization as a bridge to a heart transplant into ventricular recovery, device explant without a heart transplantation (bridge to recovery), and placement of devices without the expectation of recovery or transplantation (destination therapy).
Adult ; Cardiomyopathies ; Child ; Heart ; Heart Defects, Congenital ; Heart Failure* ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Infant ; Mortality ; Myocarditis ; Pediatrics

Heart transplantation is now regarded as the treatment of choice for end-stage heart failure. To improve long-term results of the heart transplantation, we analyzed causes of death relative to time after transplantation. A total of 201 consecutive patients, 154 (76.6%) males, aged > or = 17 yr underwent heart transplantation between November 1992 and December 2008. Mean ages of recipients and donors were 42.8 +/- 12.4 and 29.8 +/- 9.6 yr, respectively. The bicaval anastomosis technique was used since 1999. Mean follow up duration was 6.5 +/- 4.4 yr. Two patients (1%) died in-hospital due to sepsis caused by infection. Late death occurred in 39 patients (19.4%) with the most common cause being sepsis due to infection. The 1-, 5-, and 10-yr survival rates in these patients were 95.5% +/- 1.5%, 86.9% +/- 2.6%, and 73.5% +/- 4.1%, respectively. The surgical results of heart transplantation in adults were excellent, with late mortality due primarily to infection, malignancy, and rejection. Cardiac deaths related to cardiac allograft vasculopathy were very rare.
Adult ; Anastomosis, Surgical/methods ; Female ; Follow-Up Studies ; Graft Rejection/mortality ; Heart Transplantation/*mortality ; Humans ; Immunosuppression/methods ; Infection/mortality ; Male ; Middle Aged ; Neoplasms/mortality ; Postoperative Complications/mortality/surgery ; Survival Rate ; Transplantation/*mortality ; Treatment Outcome

The survival rate after lung transplantation has increased in recent years, leading to an increase in non-pulmonary conditions that require surgical intervention. These post-transplant surgical procedures, however, are associated with high mortality and morbidity rates. Intra-abdominal conditions are the most common reasons for surgical intervention. We describe here two patients who underwent abdominal surgery under general anesthesia following lung transplantation. One patient underwent cholecystectomy due to cholecystitis after heart-lung transplantation, and the other patient had an exploratory laparotomy for duodenal ulcer perforation after double lung transplantation. Depending on the type of transplant intervention, the physiology of the transplanted lung must be considered for general anesthesia. Knowledge of underlying conditions and immunosuppressive therapy following transplantation are important for safe and effective general anesthesia.
Anesthesia* ; Anesthesia, General ; Cholecystectomy ; Cholecystitis ; Duodenal Ulcer ; Heart-Lung Transplantation ; Humans ; Laparotomy ; Lung ; Lung Transplantation* ; Mortality ; Physiology ; Survival Rate

BACKGROUND: Lung transplantation is a definitive therapy for a variety of end stage lung diseases. Since 1996, we have performed thirteen cases of lung transplantation including two retransplantations, and we analyzed the outcomes, complications, and survivals of these patients. MATERIAL AND METHOD: We retrospectively analyzed the medical records of thirteen cases from July, 1996 to July, 2005. RESULT: During the period, 11 patients had undergone 13 lung and heart-lung transplantations, and two patients had retransplantation due to allograft failure. Mean age of recipients were 45.2+/-10.7 years (range, 25~59). Early complications were bleeding, reperfusion injury, and infection and late complications were mainly infection and post-transplantation lymphoproliferative disease. Excluding the operative mortality, the mean survival period was 16.5 months (2~60 months). Two retransplantations had been performed 2 weeks and 13 months after single lung transplantations. CONCLUSION: In order to achieve long term survival, early detection of complications and proper treatment in addition to surgical skills are necessary, and these efforts can promote better lung transplantation programs in the near future.
Allografts ; Heart-Lung Transplantation ; Hemorrhage ; Humans ; Lung Diseases ; Lung Transplantation* ; Lung* ; Medical Records ; Mortality ; Reperfusion Injury ; Retrospective Studies

BACKGROUND: The transplantation of organs between phylogenetically disparate or harmonious species has invariably failed due to the occurrence of hyperacute rejection or accerelated acute rejection. But concordant cardiac xenograft offer us an opportunity to study xenotransplantation in the absence of hyperacute rejection. Current therapeutics for the prolongation of survival of rodent concordant xenotransplantation are not ideal with many regimens having a high mortality rate. Cyclosporine A & Mycophenolate Mofetil are new immunosuppresive agent which has been shown to be effective at prolonging survival of allograft, as purine synthesis inhibitor. MATERIAL AND METHOD: We used white mongrel rats as recipient and mice as donor, divided 4 groups(n=6), control group(Group 1) has no medication or pretreatment, Group 2 has splenectomy as pretreatment 7~10 days before transplantation, Group 3 has Cyclosporine A treatment group, Group 4 has combined treatment of Cyclosporine A & Mycophenolate Mofetil(RS 61443). We compared survival time. RESULT: We can't find significant difference of survival time between each groups. CONCLUSION: We concluded that rejection of cardiac xenograft was different from rejection of allograft, and new immunossuppresive Agent(Mycophenolate Mofetil, Cyclosporine A) was not effective for prolongation of survival time after cardiac xenograft.
Allografts ; Animals ; Cyclosporine ; Heart* ; Heterografts* ; Humans ; Immunosuppression ; Mice* ; Models, Theoretical* ; Mortality ; Rats* ; Rodentia ; Splenectomy ; Tissue Donors ; Transplantation ; Transplantation, Heterologous

Serious complications involving the alimentary tract are commonly reported following cardiac transplantation and may be associated with significant morbidity and mortality. Between April 1994 and April 1996, 17 patients underwent orthotopic cardiac transplantation at the Buchon Sejong General Hospital. Recipients comprised 15 males and 2 females with a mean age of 33-years old. Basic immunosuppressive therapy was accomplished with immuran and cyclosporine and prednisolone. Gastrointestinal complications developed in 10 patients(58.8%), including gastritis[n=4(23.5%)], nonspecific enteritis[n=3(17.6%)], cholecystitis[n=1(5.8%)], perianal abscess[n=1(5.8%)] and panperitonitis due to mesenteric infarction[n=1(5.8%)]. Among them three patients required surgical procedures and one is dead due to sepsis and multiple organic failure(surgical mortality:33.3%). Gastrointestinal complications in cardiac transplantation are frequent cause of postoperative morbidity and mostly step benign courses, they should be detected as soon as possible and be managed with aggressive intervention. Early, aggressive surgical intervention may reduce subsequent mortality.
Adult ; Azathioprine ; Cyclosporine ; Female ; Heart Transplantation* ; Hospitals, General ; Humans ; Male ; Mortality ; Prednisolone ; Sepsis

BACKGROUND AND OBJECTIVES: Coronary artery disease (CAD) in a transplanted heart has been a major cause of morbidity and mortality for the transplantation patients who survive more than 1 year. The incidence and characteristic pattern of coronary artery disease after heart transplantation in Koreans are not known. The aim of this study is to determine the incidence and characteristics of significant CAD and the coronary arterial remodeling pattern after heart transplantation by using intravascular ultrasound (IVUS). SUBJECTS AND METHODS: We evaluated a total of 101 consecutive patients who had been examined via serial (over one year interval) IVUS and coronary angiogram. The patients were divided into two groups according to the period of the serial IVUS follow-up. The post-transplant early period (EP) group (n=58) was defined when IVUS was performed within the first month and at one year after heart transplantation, and the post-transplant late period (LP) group (n=43) was defined when IVUS was performed after one year and subsequently over another one year interval. RESULTS: The CAD-free survival rates, as assessed by coronary angiogram, were 99% at 5 years, 89% at 7 years and 71% at 9 years. In the EP group, 17 patients (29%) had donor lesions and 8 patients (14%) had de novo lesions. For the donor lesions, the diffuse and concentric lesions were 12%, respectively, and the remodeling index was 2.3+/-6.5, which represents a positive remodeling pattern. For the de novo lesion, the diffuse lesions were 25%, the concentric lesions were 13% and the remodeling index was -2.5+/-4.9, which represent a negative remodeling pattern. CONCLUSIONS: The incidence of significant CAD with diffuse and concentric lesions after heart transplantation was low in Koreans. The coronary arterial remodeling pattern was negative in the early period, and then it became positive during the late period.
Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies ; Heart Transplantation* ; Heart* ; Humans ; Incidence ; Mortality ; Survival Rate ; Tissue Donors ; Ultrasonography*

Heart failure (HF) is an important cardiovascular disease because of its increasing prevalence, significant morbidity, high mortality, and rapidly expanding health care cost. The number of HF patients is increasing worldwide, and Korea is no exception. There have been marked advances in definition, diagnostic modalities, and treatment of HF over the past four decades. There is continuing effort to improve risk stratification of HF using biomarkers, imaging and genetic testing. Newly developed medications and devices for HF have been widely adopted in clinical practice. Furthermore, definitive treatment for end-stage heart failure including left ventricular assist device and heart transplantation are rapidly evolving as well. This review summarizes the current state-of-the-art management for HF and the emerging diagnostic and therapeutic modalities to improve the outcome of HF patients.
Biomarkers ; Cardiovascular Diseases ; Diagnosis ; Genetic Testing ; Health Care Costs ; Heart Failure* ; Heart Transplantation ; Heart* ; Heart-Assist Devices ; Humans ; Korea ; Mortality ; Prevalence ; Prognosis

BACKGROUND: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. METHODS: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of 58.4+/-43.6 months. RESULTS: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). CONCLUSION: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.
Adult* ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Heart Failure ; Heart Transplantation* ; Heart* ; Heart-Lung Transplantation ; Hemorrhage ; Humans ; Incidence ; Kidney Transplantation ; Korea ; Length of Stay ; Lymphocele ; Mortality ; Pericardial Effusion ; Postoperative Complications* ; Renal Insufficiency ; Stroke ; Transplants ; Wound Infection