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M T Swartz

Publications and source records attributed to M T Swartz.

81 records · Page 5Linked to original sources
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Mechanical circulatory assistance after heart transplantation.

Results with mechanical circulatory assistance for the treatment of profound cardiopulmonary failure after conventional heart surgery have been encouraging. Its usefulness after heart transplantation is not known. Since August 1982, eight patients (of 59 transplant patients) have required support 0 to 48 hours (mean, 19.5 hours) after transplantation. The ages of the patients ranged from 7 days to 52 years (mean, 28.4 years). Underlying recipient heart disease was ischemic in three patients, congenital in two, cardiomyopathic in two, and rheumatic in one patient. Preoperative North American Transplant Coordinators Organization (NATCO) classification was status 9 in one patient (on extracorporeal membrane oxygenation [ECMO]), status 1 in five patients, and status 3 in two patients. Reasons for graft failure, although usually multifactorial, were primarily pulmonary hypertension with right ventricular failure in five patients and pneumonia, hyperacute rejection, and fat embolus in one patient each. In three patients, there was a mismatch in graft size (too small in two adults and too large in one neonate). Graft ischemic times ranged from 75 to 229 minutes (mean, 171 minutes). Two patients received mechanical support with an intra-aortic balloon (IAB), three with ECMO, and three with a right ventricular assist device (RVAD). One of the patients on ECMO and two of the patients with an RVAD also had IABs. Duration of support ranged from 4 hours to 8 days (mean, 3.2 days). Initial hemodynamic stability was achieved in all patients. Complications were common, including sepsis in seven patients and kidney failure in five patients. Only three patients were weaned. One patient with pulmonary hypertension, who was treated with ECMO, died 36 hours after being weaned.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Heart transplantation charges: status 1 versus status 2 patients.

BACKGROUND: The current health care environment mandates closer scrutiny of health care dollar allocation. To better understand the distribution of heart transplantation costs, we reviewed hospital and physician billing of patients who underwent orthotopic heart transplantation between August 1988 and September 1993. METHODS: This study is a retrospective review of 107 consecutive cases. Charges and clinical results of United Network for Organ Sharing status 1 patients (n = 46), including 17 bridge to transplantation patients, were compared with those of United Network for Organ Sharing status 2 patients (n = 57). Charges were converted to 1992 dollars. RESULTS: During the first 12 months of the study, 77% of heart transplantations were performed in United Network for Organ Sharing status 2 patients, whereas over the last 12-month period, 25% of the transplantations were performed in status 2 patients. No significant differences were found in age, gender, type of cardiomyopathy, or survival between the status 1 and status 2 groups. The length of hospitalization for the status 1 group ranged from 8 to 138 days (mean 49 days) as opposed to 5 to 82 days (mean 17.5 days) for the status 2 group (p < 0.0001). Pretransplantation hospital charges were significantly higher for the status 1 group ($47,917 to $341,215, mean $109,116) when compared with status 2 ($0 to $10,035, mean $250) (p < 0.0001). No significant difference was found in posttransplantation hospital charges between status 1 ($47,917 to $210,027, mean $95,379) and status 2 patients ($48,093 to $380,745, mean $102,265). Total charges were significantly higher (p < 0.0001) for the status 1 group ($89,910 to $512,331, mean $239,375) when compared with the status 2 group ($63,885 to $455,680, mean $128,594). Total transplantation charges for the study period were $18,341,108. This amount could have paid for 77 status 1 transplantations or 143 status 2 transplantations. CONCLUSIONS: If current trends continue and the donor pool remains the same, most transplant recipients will be status 1, resulting in a comparable number of transplantations performed at twice the charges.

Cardiomyopathies↗
PubMedDate not supplied

Eleven years' experience with the Pierce-Donachy ventricular assist device.

During the last decade, mechanical circulatory support has been used in patients with cardiogenic shock refractory to conventional therapy. Since 1982, we supported 77 patients (78 implants) with Pierce-Donachy external pneumatic ventricular assist devices. Forty-two patients (35 after cardiotomy, four after heart transplantation, and three with acute infarction) 15 to 71 years of age (mean age 52 years) were supported for cardiac recovery. Left ventricular assist devices were used in 16 patients, right ventricular assist devices plus intraaortic balloon were used in nine, and biventricular assist devices were used in 17. Patients were supported 0.2 to 17 days (mean 4.4 days), 18 patients (43%) were weaned, and 11 (26%) survived. Complications included acute myocardial infarction (60%), bleeding (48%), infection (38%), and renal failure (24%). Bridging to transplantation was attempted in 35 patients (one patient underwent the procedure twice), 12 to 63 years of age (mean age 40 years). Left ventricular assist devices were used 19 times, and biventricular assist devices were used 17 times. Duration of support was 0.2 to 95 days (mean 24 days). All 20 patients who underwent transplantation were discharged. Of the 15 patients who did not undergo transplantation, two were weaned and survived, whereas the remaining 13 patients (who did not undergo transplantation because of complications) died with the device in place. In the patients in the bridge to transplantation group, bleeding occurred in 26%, infection in 55%, and renal failure in 15%. In the entire group of 77 patients, the incidence of ventricular assist device-related thromboembolism was 6%, but only 4% had neurologic deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

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