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Craig H Selzman - One of the best experts on this subject based on the ideXlab platform.

  • ventricular assist devices or Inotropic Agents in status 1a patients survival analysis of the united network of organ sharing database
    The Annals of Thoracic Surgery, 2014
    Co-Authors: Curtis J Wozniak, Josef Stehlik, Bradley C Baird, Stephen H Mckellar, Howard K Song, Stavros G Drakos, Craig H Selzman
    Abstract:

    Background Improved outcomes as well as lack of donor hearts have increased the use of ventricular assist devices (VADs), rather than Inotropic support, for bridging to transplantation. Recognizing that organ allocation in the highest status patients remains controversial, we sought to compare outcomes of patients with VADs and those receiving advanced medical therapy. Methods The United Network of Organ Sharing (UNOS) database was used to compare survival on the waiting list and posttransplantation survival in status 1A heart transplantation patients receiving VADs or high-dose/dual Inotropic therapy or an intraaortic balloon pump( IABP), or both. Adjusted survival was calculated using Cox's proportional hazard model. Results Adjusted 1-year posttransplantation mortality was higher among patients with VADs compared with patients receiving Inotropic Agents alone (hazard ratio [HR], 1.48; p p  = 0.03) and among those with isolated left-sided support (HR, 1.33; p  = 0.008). When patients who received IABPs were added and analyzed after 2008, the left ventricular assist device (LVAD) group had similar survival (HR, 1.2; p  = 0.3). Survival on the waiting list, however, was superior among patients with LVADs (HR, 0.56; p p Conclusions Although posttransplantation survival is better for patients who are bridged to transplantation with Inotropic treatment only, the cost of failure of Inotropic Agents is significant, with a nearly doubled mortality for those who later require VAD support. Survival on the waiting list appears to be improved among patients receiving VAD support. Careful selection of the appropriate bridging strategy continues to be a significant clinical challenge.

Ferenc Petak - One of the best experts on this subject based on the ideXlab platform.

  • reversing cholinergic bronchoconstriction by common Inotropic Agents a randomized experimental trial on isolated perfused rat lungs
    Anesthesia & Analgesia, 2019
    Co-Authors: Gergely H Fodor, Sam Bayat, Barna Babik, Walid Habre, Ferenc Petak
    Abstract:

    BACKGROUND The ability of Inotropic Agents to alter airway reactivity and lung tissue mechanics has not been compared in a well-controlled experimental model. Therefore, we compared the potential to alter lung tissue viscoelasticity and bronchodilator effects of commonly used Inotropic Agents in an isolated perfused rat lung model. METHODS After achieving steady state lung perfusion, sustained bronchoconstriction was induced by acetylcholine (ACh). Isolated rat lungs were then randomly allocated to 6 groups treated with either saline vehicle (n = 8) or incremental concentrations of inotropes (adrenaline, n = 8; dopamine, n = 7; dobutamine, n = 7; milrinone, n = 8; or levosimendan, n = 6) added to the whole-blood perfusate. Airway resistance (Raw), lung tissue damping (G), and elastance were measured under baseline conditions, during steady-state ACh-induced constriction and for each inotrope dose. RESULTS No change in Raw was observed after addition of the saline vehicle. Raw was significantly lower after addition of dopamine (maximum difference [95% CI] of 29 [12-46]% relative to the saline control, P = .004), levosimendan (58 [39-77]%, P < .001), and adrenaline (37 [21-53]%, P < .001), whereas no significant differences were observed at any dose of milrinone (5 [-12 to 22]%) and dobutamine (4 [-13 to 21]%). Lung tissue damping (G) was lower in animals receiving the highest doses of adrenaline (difference: 22 [7-37]%, P = .015), dobutamine (20 [5-35]%, P = .024), milrinone (20 [6-34]%, P = .026), and levosimendan (36 [19-53]%, P < .001) than in controls. CONCLUSIONS Although dobutamine and milrinone did not reduce cholinergic bronchoconstriction, they reversed the ACh-induced elevations in lung tissue resistance. In contrast, adrenaline, dopamine, and levosimendan exhibited both potent bronchodilatory action against ACh and diminished lung tissue damping. Further work is needed to determine whether these effects are clinically relevant in humans.

Curtis J Wozniak - One of the best experts on this subject based on the ideXlab platform.

  • ventricular assist devices or Inotropic Agents in status 1a patients survival analysis of the united network of organ sharing database
    The Annals of Thoracic Surgery, 2014
    Co-Authors: Curtis J Wozniak, Josef Stehlik, Bradley C Baird, Stephen H Mckellar, Howard K Song, Stavros G Drakos, Craig H Selzman
    Abstract:

    Background Improved outcomes as well as lack of donor hearts have increased the use of ventricular assist devices (VADs), rather than Inotropic support, for bridging to transplantation. Recognizing that organ allocation in the highest status patients remains controversial, we sought to compare outcomes of patients with VADs and those receiving advanced medical therapy. Methods The United Network of Organ Sharing (UNOS) database was used to compare survival on the waiting list and posttransplantation survival in status 1A heart transplantation patients receiving VADs or high-dose/dual Inotropic therapy or an intraaortic balloon pump( IABP), or both. Adjusted survival was calculated using Cox's proportional hazard model. Results Adjusted 1-year posttransplantation mortality was higher among patients with VADs compared with patients receiving Inotropic Agents alone (hazard ratio [HR], 1.48; p p  = 0.03) and among those with isolated left-sided support (HR, 1.33; p  = 0.008). When patients who received IABPs were added and analyzed after 2008, the left ventricular assist device (LVAD) group had similar survival (HR, 1.2; p  = 0.3). Survival on the waiting list, however, was superior among patients with LVADs (HR, 0.56; p p Conclusions Although posttransplantation survival is better for patients who are bridged to transplantation with Inotropic treatment only, the cost of failure of Inotropic Agents is significant, with a nearly doubled mortality for those who later require VAD support. Survival on the waiting list appears to be improved among patients receiving VAD support. Careful selection of the appropriate bridging strategy continues to be a significant clinical challenge.

Gergely H Fodor - One of the best experts on this subject based on the ideXlab platform.

  • reversing cholinergic bronchoconstriction by common Inotropic Agents a randomized experimental trial on isolated perfused rat lungs
    Anesthesia & Analgesia, 2019
    Co-Authors: Gergely H Fodor, Sam Bayat, Barna Babik, Walid Habre, Ferenc Petak
    Abstract:

    BACKGROUND The ability of Inotropic Agents to alter airway reactivity and lung tissue mechanics has not been compared in a well-controlled experimental model. Therefore, we compared the potential to alter lung tissue viscoelasticity and bronchodilator effects of commonly used Inotropic Agents in an isolated perfused rat lung model. METHODS After achieving steady state lung perfusion, sustained bronchoconstriction was induced by acetylcholine (ACh). Isolated rat lungs were then randomly allocated to 6 groups treated with either saline vehicle (n = 8) or incremental concentrations of inotropes (adrenaline, n = 8; dopamine, n = 7; dobutamine, n = 7; milrinone, n = 8; or levosimendan, n = 6) added to the whole-blood perfusate. Airway resistance (Raw), lung tissue damping (G), and elastance were measured under baseline conditions, during steady-state ACh-induced constriction and for each inotrope dose. RESULTS No change in Raw was observed after addition of the saline vehicle. Raw was significantly lower after addition of dopamine (maximum difference [95% CI] of 29 [12-46]% relative to the saline control, P = .004), levosimendan (58 [39-77]%, P < .001), and adrenaline (37 [21-53]%, P < .001), whereas no significant differences were observed at any dose of milrinone (5 [-12 to 22]%) and dobutamine (4 [-13 to 21]%). Lung tissue damping (G) was lower in animals receiving the highest doses of adrenaline (difference: 22 [7-37]%, P = .015), dobutamine (20 [5-35]%, P = .024), milrinone (20 [6-34]%, P = .026), and levosimendan (36 [19-53]%, P < .001) than in controls. CONCLUSIONS Although dobutamine and milrinone did not reduce cholinergic bronchoconstriction, they reversed the ACh-induced elevations in lung tissue resistance. In contrast, adrenaline, dopamine, and levosimendan exhibited both potent bronchodilatory action against ACh and diminished lung tissue damping. Further work is needed to determine whether these effects are clinically relevant in humans.

Wilbert S Aronow - One of the best experts on this subject based on the ideXlab platform.

  • use of Inotropic Agents in treatment of systolic heart failure
    International Journal of Molecular Sciences, 2015
    Co-Authors: Sohaib Tariq, Wilbert S Aronow
    Abstract:

    The most common use of inotropes is among hospitalized patients with acute decompensated heart failure, with reduced left ventricular ejection fraction and with signs of end-organ dysfunction in the setting of a low cardiac output. Inotropes can be used in patients with severe systolic heart failure awaiting heart transplant to maintain hemodynamic stability or as a bridge to decision. In cases where patients are unable to be weaned off inotropes, these Agents can be used until a definite or escalated supportive therapy is planned, which can include coronary revascularization or mechanical circulatory support (intra-aortic balloon pump, extracorporeal membrane oxygenation, impella, left ventricular assist device, etc.). Use of Inotropic drugs is associated with risks and adverse events. This review will discuss the use of the inotropes digoxin, dopamine, dobutamine, norepinephrine, milrinone, levosimendan, and omecamtiv mecarbil. Long-term Inotropic therapy should be offered in selected patients. A detailed conversation with the patient and family shall be held, including a discussion on the risks and benefits of use of inotropes. Chronic heart failure patients awaiting heart transplants are candidates for intravenous Inotropic support until the donor heart becomes available. This helps to maintain hemodynamic stability and keep the fluid status and pulmonary pressures optimized prior to the surgery. On the other hand, in patients with severe heart failure who are not candidates for advanced heart failure therapies, such as transplant and mechanical circulatory support, Inotropic Agents can be used for palliative therapy. Inotropes can help reduce frequency of hospitalizations and improve symptoms in these patients.