Sergey Preisman

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (31)83.49 Total impact

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    ABSTRACT: We present a case of an 83-year-old female who suffered from annular rupture with contained hematoma immediately after trans-apical implantation of balloon-expandable Sapien valve. The patient developed acute cardiogenic shock which resulted from an extrinsic compression of the left main coronary artery. We report the successful management of this complication. Copyright © 2015. Published by Elsevier Inc.
    Cardiovascular Revascularization Medicine 05/2015; 16(5). DOI:10.1016/j.carrev.2015.05.005
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    A Kogan · S Preisman · S Levin · E Raanani · L Sternik ·
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    ABSTRACT: Severe lung injury with the development of acute respiratory distress syndrome (ARDS) is a serious complication of cardiac surgery. The aim of this study was to determine the incidence, risk factors, and mortality of ARDS following cardiac surgery. We retrospectively analyze data in the period between January 2005 and March 2013. Of 6069 patients who underwent cardiac surgery during the study period, 37 patients developed ARDS during the postoperative period. The incidence of ARDS was 0.61%, with a mortality of 40.5% (15 patients). Multivariate regression analysis identified previous cardiac surgery, complex cardiac surgery, and more than three transfusions with packed red blood cells (PRBC) were independent predictors for developing ARDS. ARDS remains a serious, but very rare complication associated with significant mortality. In our study, previous cardiac surgery, complex cardiac surgery, and more than three transfusions of PRBC were independent predictors for the development of ARDS.
    Journal of Cardiac Surgery 12/2013; 29(1). DOI:10.1111/jocs.12264 · 0.89 Impact Factor
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    ABSTRACT: Background: Concomitant lesions of the heart and lung are uncommon, but when present they pose a challenge for cardiac and thoracic surgeons. Patients with lung cancer and heart disease are at a high risk for postoperative death or severe cardiovascular complications. Aim of the study: To report our results of concomitant cardiac surgery and lung resection. Material and methods: From 1994 to 2012, 18 patients with cardiac disorders and lung cancer or another lung disease were operated on. Twelve patients underwent coronary artery bypass grafting, 3 patients underwent aortic valve replacement and 3 patients underwent another cardiac surgery procedure. The pulmonary resections consisted of pneumonectomy in 1 patient, lobectomy in 6 patients and wedge excision in 10 patients. Follow-up was obtained for all 18 patients (mean follow-up 70.6 months; range 224 to 0.7 months). Results: The pathologic examination confirmed lung malignancy in 12 patients. Five patients were operated on due to a non-oncologic pathology and 1 patient underwent lung volume resection. Overall late survival was 88% and 67% at 1 and 5 years, respectively. Conclusions: Lung resection carried out concomitantly with cardiac surgery is safe and effective. A combined procedure avoids the need for a second major thoracic procedure and may improve clinical outcome.
    Polish journal of cardio-thoracic surgery 12/2013; 4(4):347-351. DOI:10.5114/kitp.2013.39735 · 0.21 Impact Factor
  • Sergey Preisman · Amihay Shinfeld · Ehud Raanani ·

    Journal of cardiothoracic and vascular anesthesia 09/2013; 28(3). DOI:10.1053/j.jvca.2013.03.028 · 1.46 Impact Factor
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    ABSTRACT: Quality improvement is an important pursuit for critical care teams. The authors performed an observational cohort study with historic control. Eight-bed cardiac surgery ICU in a tertiary university hospital. A total of 4,866 patients undergoing cardiac surgery over a 6-year period between January 2005 and December 2010. In this study, the influence of the introduction of a quality improvement program under the supervision of a newly appointed intensivist on patient outcomes after cardiac surgery was evaluated. Patients were further divided into three 2-year periods: Period I, 2005-2006, before appointment of an intensivist; Period II, 2007-2008, after appointment of an intensivist and initial introduction of a quality improvement program; and Period III, 2009-2010, after implementation of the program and introduction of Critical Care Information Systems. There were 1,633, 1,690, and 1,543 patients in each period, respectively. There was no significant difference in the severity of patient illness between the groups. Unadjusted in-hospital mortality decreased from 6.37% (104 patients) in Period I to 4.32% (73 patients) and 3.3% (51 patients) in Periods II and III, respectively (p< 0.01). Appointment of an intensivist-directed team model and introduction of quality improvement interventions were associated with decreased mortality after cardiac surgery.
    Journal of cardiothoracic and vascular anesthesia 09/2013; 27(6). DOI:10.1053/j.jvca.2013.02.028 · 1.46 Impact Factor
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    ABSTRACT: Patients with Marfan syndrome are referred for cardiac surgery due to root aneurysm with or without aortic valve regurgitation. Because these patients are young and frequently present with normal-appearing aortic cusps, valve sparing is often recommended. However, due to the genetic nature of the disease, the durability of such surgery remains uncertain. Between February 2004 and June 2012, 100 patients in our department suffering from aortic aneurysm with aortic valve regurgitation underwent elective aortic valve-sparing surgery. Of them, 30 had Marfan syndrome, were significantly younger (30 +/- 13 vs. 53 +/- 16 years), and had a higher percentage of root aneurysm, compared with ascending aorta aneurysm in their non-Marfan counterparts. We evaluated the safety, durability, clinical and echocardiographic mid-term results of these patients. While no early deaths were reported in either group, there were a few major early complications in both groups. At follow-up (reaching 8 years with a mean of 34 +/- 26 months) there were no late deaths, and few major late complications in the Marfan group. Altogether, 96% and 78% of the patients were in New York Heart Association functional class I-II in the Marfan and non-Marfan groups respectively. None of the Marfan patients needed reoperation on the aortic valve. Freedom from recurrent aortic valve regurgitation > 3+ was 94% in the Marfan patients. Aortic valve-sparing surgery in Marfan symdrome patients is safe and yields good mid-term clinical outcomes.
    The Israel Medical Association journal: IMAJ 08/2013; 15(8):439-42. · 0.90 Impact Factor
  • J. Lavee · A. Segev · S. Preisman · D. Freimark · V. Guetta ·
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    ABSTRACT: Patients with left ventricular assist device (LVAD) may develop significant aortic regurgitation (AR) and require high-risk surgical intervention. Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with severe aortic stenosis not amenable for surgery but has also been used in high risk patients for pure AR with good results. We report the first-in-man case of transfemoral (TF) TAVI in an LVAD patient with severe AR.Methods and MaterialsA 55 year old female with severe idiopathic dilated cardiomyopathy underwent HeartMate II LVAD implantation on November 2010 as bridge to transplant. Following a hemodynamic uneventful one year at home she gradually developed symptoms of severe left heart failure and echo showed severe non calcified AR. Our local Heart Team recommended TF TAVI as the preferred option and after discussing the options the patient gave her consent for that approach. The procedure was performed on August 8, 2012, under mild sedation without reduction or interruption of the LVAD rotation speed (9400 rpm). The right femoral artery was used for access under local anesthesia and an 18Fr guiding sheath was introduced percutaneously. No pre-dilation of the aortic valve was performed. A stiff guide-wire was placed in the left ventricle, carefully avoiding its entrapment in the LVAD apical inflow cannula, and a 29mm CoreValve (Medtronic, Minneapolis, MN) was implanted without need for rapid pacing. Aortography showed minimal residual AR and no blockage of the LVAD outflow graft in the ascending aorta. The patient was stable hemodynamicaly throughout the procedure and recovered with no complications. Echo on the second post-TAVI day showed no residual AR and she was discharged home. On 3 months follow up her clinical status has improved significantly and she remains with no AR on repeat echo studies.ResultsTF TAVI should be considered as a safe and viable solution for severe AR in LVAD patients.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S187-S188. DOI:10.1016/j.healun.2013.01.454 · 6.65 Impact Factor
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    ABSTRACT: Anticoagulation with heparin is recommended in patients with an intra-aortic balloon pump (IABP) to prevent thrombosis and embolization. However, anticoagulation increases the risk of bleeding, particularly in the early postoperative period after cardiac surgery. We investigated the safety of heparin-free management after IABP insertion in patients who underwent cardiac surgery. We studied 203 consecutive patients who received perioperative IABP support between August 2004 and December 2011. All patients were managed without heparin and were followed for thrombotic and/or hemorrhagic complications. Patients were divided into two groups, according to time of IABP treatment following surgery. Group I, 81 patients (39.9%) were treated less than 24 hours following surgery and Group II, 122 patients (60.1%) were treated more than 24 hours following surgery. Vascular complications developed in seven patients (3.4%), two in Group I and five in Group II. Three patients had major and four had minor limb ischemia. There were no major bleeding complications, but minor bleeding complications were observed in eight patients (4.2%). In patients undergoing cardiac surgery with IABP support, the rate of thromboembolic complications was relatively low compared to historical controls. Heparin-free management may reduce the risk of hemorrhagic complications, with a low risk of thrombotic complications. Heparin should not be routinely used in patients requiring IABP after cardiac surgery.
    Journal of Cardiac Surgery 07/2012; 27(4):434-7. DOI:10.1111/j.1540-8191.2012.01484.x · 0.89 Impact Factor
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    ABSTRACT: Chronic thromboembolic pulmonary hypertension, a rare complication of pulmonary embolism is amenable to thrombendarterectomy (TEA) and when successful, improves exercise capacity and normalizes resting pulmonary arterial pressure. To test if exercise capacity and exercise gas exchange are also normalized after successful TEA. Over a period of 4 years, 5 patients underwent TEA at Sheba Medical Center. All experienced marked clinical improvement; their functional capacity (NYHA class) improved by 1-3 stages and resting pulmonary blood pressure normalized. One to 3 years after surgery each underwent a 6 minute walking test and incremental exercise to measure maximal oxygen uptake. It was found that following TEA, the 6 minute walking distance improved by 100-215 meters and more. Maximal oxygen uptake remained below normal in 4/5 cases and ranged 42-87% of predicted values. Hemoglobin oxygen saturation that was normal after TEA at rest, fell in all with exercise to 91-96%. Exercise gas exchange remained abnormal, consistent with residual pulmonary vascuLar disease. Thrombendarterectomy in chronic thromboembolic pulmonary hypertension caused marked clinical improvement and normalized resting pulmonary arterial pressures. Exercise capacity also improved but peak oxygen uptake remained below normal and exercise gas exchange remained abnormal. Chronic thromboembolic pulmonary hypertension can be effectively treated. However, despite remarkable improvement, residual pulmonary vascular disease persists and is not relieved following successful operation.
    Harefuah 02/2012; 151(2):74-8, 129, 128.
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    ABSTRACT: To evaluate the value of blood lactate value in predicting postoperative mortality (primary outcome), duration of ventilation, and length of stay in an intensive care unit (ICU) and hospital (secondary outcomes). We performed a prospective observation study on 1,820 consecutive patients undergoing open heart surgery in a tertiary university medical center. Blood lactate levels were obtained from patients on admission to the cardiac surgical ICU and measured serially. All patients were divided into three groups according to their maximum blood lactate levels: group I (normolactatemia, lactate ≤2.2 mmol/l), 332 patients; group II (mild hyperlactatemia, lactate 2.2-4.1 mmol/l), 1,054 patients; and group III (severe hyperlactatemia, lactate ≥4.4 mmol/l), 434 patients. Maximum blood lactate levels ≥4.4 mmol/l during the first 10 h post admission were associated with prolonged ventilation time, longer ICU stay, and increased mortality (P < 0.001). Hyperlactatemia is common after cardiac surgery. Maximal lactate threshold ≥4.4 mmol/l in the first 10 h after operation accurately predicts postoperative mortality.
    Journal of Anesthesia 11/2011; 26(2):174-8. DOI:10.1007/s00540-011-1287-0 · 1.18 Impact Factor
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    ABSTRACT: BACKGROUND: The involvement of mitochondria in pathological states, such as neurodegenerative diseases, sepsis, stroke, and cancer, are well documented. Monitoring of nicotinamide adenine dinucleotide (NADH) fluorescence in vivo as an intracellular oxygen indicator was established in 1950 to 1970 by Britton Chance and collaborators. We use a multiparametric monitoring system enabling assessment of tissue vitality. In order to use this technology in clinical practice, the commercial developed device, the CritiView (CRV), is tested in animal models as well as in patients. METHODS AND RESULTS: The new CRV enables the optical monitoring of four different parameters, representing the energy balance of various tissues in vivo. Mitochondrial NADH is measured by surface fluorometry/reflectometry. In addition, tissue microcirculatory blood flow, tissue reflectance and oxygenation are measured as well. The device is tested both in vitro and in vivo in a small animal model and in preliminary clinical trials in patients undergoing vascular or open heart surgery. In patients, the monitoring is started immediately after the insertion of a three-way Foley catheter (urine collection) to the patient and is stopped when the patient is discharged from the operating room. The results show that monitoring the urethral wall vitality provides information in correlation to the surgical procedure performed.
    Journal of Biomedical Optics 06/2011; 16(6):067004. DOI:10.1117/1.3585674 · 2.86 Impact Factor
  • Sergey Preisman · Ehud Raanani ·

    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 11/2010; 39(6). DOI:10.1016/j.ejcts.2010.10.017 · 3.30 Impact Factor
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    Sergey Preisman · Alexander Kogan · Kira Itzkovsky · Gleb Leikin · Ehud Raanani ·
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    ABSTRACT: Anti-platelet therapy is associated with increased perioperative bleeding. Although current guidelines call for its caessation 5-10 days prior to cardiac surgery, this could constitute an increased risk of preoperative myocardial infarction. The optimal safe period from discontinuation of anti-platelet therapy to surgery is as yet unknown for the individual patient. We investigated whether preoperative thromboelastography (TEG) with platelet mapping could predict bleeding tendency in patients (on recent anti-platelet therapy) undergoing coronary artery bypass grafting (CABG). We prospectively evaluated 59 patients on aspirin and clopidogrel therapy who underwent CABG. Of them, 25 patients received aspirin alone. TEG with platelet mapping was performed immediately prior to surgery in all 59 patients. During the first 24h post-surgery, 9/59 patients bled excessively (1216 + or - 310 ml in excessive bleeding vs 576 + or - 155 ml in non-bleeding patients). Of the patients bled excessively, eight received clopidogrel treatment prior to surgery. However, 26 of the remaining 34 patients receiving clopidogrel did not bleed significantly. Clopidogrel-induced platelet dysfunction diagnosed by platelet mapping discerned between patients who demonstrated excessive bleeding and those who did not (78% - sensitivity, 84% - specificity, p=0.004). Aspirin-induced platelet dysfunction did not reflect a bleeding tendency. Of all patients, 85% did not respond to a standard dose of clopidogrel, whereas 44% did not respond to aspirin. TEG with platelet mapping is able to predict excessive postoperative blood loss among patients who underwent CABG and recent anti-platelet therapy. The prevalence of non-responsiveness to anti-platelet therapy, including clopidogrel, is higher in patients undergoing coronary artery bypass grafting than in the general population. In this study, aspirin-induced platelet dysfunction did not influence postoperative blood loss.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2010; 37(6):1367-74. DOI:10.1016/j.ejcts.2009.12.044 · 3.30 Impact Factor
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    ABSTRACT: Giant left atrium (GLA) is seen in a variety of cardiac conditions. The GLA is diagnosed by combining the patient's history, physical examination, and imaging techniques, along with a computed tomographic chest scan, echocardiogram, and barium swallow test. We recently operated on a severely symptomatic 71-year-old woman with GLA (135 mm x 192 mm). We were forced to anesthetize her with negative pressure ventilation before connecting to the cardiopulmonary bypass circuit. Her postoperative course and long-term follow-up were uneventful. The procedure for GLA reduction is safe, even in very high-risk patients. Negative pressure ventilation may be used successfully as a bridge to cardiopulmonary bypass in certain cases.
    The Annals of thoracic surgery 01/2010; 89(1):269-71. DOI:10.1016/j.athoracsur.2009.03.102 · 3.85 Impact Factor
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    ABSTRACT: We sought to compare early and late clinical and echocardiographic outcomes of patients undergoing minimally invasive mitral valve repair by means of the port-access and median sternotomy approaches. Between 2000 and 2009, 503 patients had mitral valve repair, of whom 143 underwent surgical intervention for isolated posterior leaflet pathology: 61 through port access and 82 through median sternotomy. The port-access group had better preoperative New York Heart Association functional class (P = .007) and a higher rate of elective cases (97% vs 87%, P = .037). Other preoperative characteristics were similar between the groups, including mitral valve pathology and repair techniques. Operative, bypass, and clamp times were significantly longer in the port-access group. Mean hospital stay was 5.3 +/- 2.5 days in the port-access group versus 5.7 +/- 2.5 days in the median sternotomy group (P = .4). Early postoperative echocardiographic analysis showed that most patients in both groups had none or trivial mitral regurgitation and none of the patients had greater than grade 2 mitral regurgitation. Follow-up extended for up to 100 months (mean, 34 +/- 24 months). New York Heart Association class improved in both groups (P = .394). Freedom from reoperation was 97% and 95% in the port-access and median sternotomy groups, respectively. Late echocardiographic analysis revealed that 82% (49/60) in the port-access group and 91% (73/80) in the median sternotomy group were free from moderate or severe mitral regurgitation (P = .11). In isolated posterior mitral valve pathology, quality of mitral valve repair with the port-access approach can compare with that with the conventional median sternotomy approach.
    The Journal of thoracic and cardiovascular surgery 12/2009; 140(1):86-90. DOI:10.1016/j.jtcvs.2009.09.035 · 4.17 Impact Factor
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    ABSTRACT: Intraoperative management directed to early extubation of children undergoing cardiac surgery has been suggested as a viable alternative to prolonged postoperative mechanical ventilation. The authors evaluated the safety and efficacy of this approach in a randomized prospective trial. A prospective randomized observational study. A single university-affiliated hospital. One hundred consecutive pediatric patients (age 1 month-15 years, weight 3.0-51 kg) requiring cardiac surgery. Patients younger than 1 month of age and those requiring mechanical ventilation before the operation were considered ineligible for the study. Patients were randomly allocated to a group with anesthetic management and extubation in the operating room (early group [EG]) and a group with elective prolonged mechanical ventilation (control group [CG]). A difference in outcome as reflected by the pediatric intensive care unit (PICU) and hospital lengths of stay and postoperative morbidity and mortality was analyzed. A separate analysis was performed in children younger than 3 years old. The extubation time in the CG was 25.0 +/- 26.9 hours. No differences in mortality, the need for re-exploration for bleeding, the need for reintubation, the incidence of abnormal chest radiographic findings, or cardiac and septic complications between groups were found. PICU and postoperative hospital lengths of stay were significantly shorter in patients in the EG (3.3 +/- 1.9 days in the EG v 5.8 +/- 4.1 in the CG, p < 0.001, and 7.4 +/- 2.9 days in the EG v 11.2 +/- 6.8 days in the CG, p = 0.009). In children undergoing cardiac surgery, anesthetic management with early cessation of mechanical ventilation appears to be safe and decreases hospital and PICU length of stay. However, because the size of the study did not allow for the detection of possible differences in perioperative mortality, only a large multicenter study may provide a definite answer to this question. The present study may be treated as a pilot for such a trial.
    Journal of cardiothoracic and vascular anesthesia 06/2009; 23(3):348-57. DOI:10.1053/j.jvca.2008.11.011 · 1.46 Impact Factor
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    ABSTRACT: We hypothesize that in the presence of reduced oxygen delivery and extraction, blood flow will be redistributed in order to protect the most vital organs (e.g., brain and heart) by increasing their regional blood flow, while O2 delivery to the less vital organs (e.g., GI tract or urethral wall) will diminish. Evaluation of mitochondrial function in vivo could be done by monitoring the oxidation reduction state of the respiratory chain. Thus, the NADH redox state of less vital organs could serve as an indicator of overall O2 imbalance as well as an endpoint of resuscitation. We have therefore tested, in a pig model, a new medical device providing real time data on NADH redox state and tissue blood flow- TBF This device contains a modified three way Foley catheter with a fiber optic probe which connects the measurement unit to the tested tissue. Female pigs underwent graded hemorrhage (GH) or Aortic clamping (AC). The main effects of GH started when blood volume decreased by 30%. At 40% blood loss, minimal levels of TBF were correlated to the maximal NADH levels. The values of the 2 parameters returned to baseline after retransfusion of the shed blood. Aortic clamping led to significant decrease in TBF while NADH levels increased. After aortic declamping the parameters recovered to normal values. Due to the short length of the urethra in female pigs and the instable contact between the probe and the tissue, inconsistency of the responses was observed. Our preliminary results show that the CritiView may be a useful tool for the detection of body O2 imbalance.
    Proceedings of SPIE - The International Society for Optical Engineering 02/2009; 7173. DOI:10.1117/12.808690 · 0.20 Impact Factor
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    ABSTRACT: "Fast-track" pathways have been successfully used in low-risk, relatively young patients after all types of surgical procedures including cardiac surgery. An increase in the number of referrals of older patients for cardiac surgery prompted the present study on the use of a "fast-track" pathway in septuagenarians and octogenarians. Risk factors for the unsuccessful application of the "fast-track" pathway in these elderly patients were determined. A retrospective observational study. A single tertiary-care, university-affiliated center. All 70-year-old or older patients undergoing cardiac surgery between January 1, 2004 and June 30, 2007 were included. Septuagenarians were compared with octogenarians. During the 42-month period, 860 cardiac operations were performed on 576 septuagenarians and 284 octogenarians. The "fast-track" pathway was successful in 54.5% and 37.3%, respectively. On multiple logistic regression analyses, stroke, renal failure, and procedures other than primary isolated coronary artery bypass graft surgery were independently associated with failed early extubation, delayed intensive care unit discharge, and delayed hospital discharge in both groups. Infections and atrial fibrillation were independent risk factors for delayed hospital discharge in both groups and delayed intensive care unit discharge in the octogenarians. In the octogenarians only, congestive heart failure was an independent risk factor for failed early extubation, delayed intensive care unit discharge, and delayed hospital discharge. A "fast-track" pathway may be applied in selected septuagenarians and octogenarians. Age alone should not exclude consideration for "fast-track" management.
    Journal of cardiothoracic and vascular anesthesia 09/2008; 22(4):530-5. DOI:10.1053/j.jvca.2008.02.001 · 1.46 Impact Factor
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    David Mishaly · Probal Ghosh · Sergey Preisman ·
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    ABSTRACT: Median sternotomy has been the conventional approach for correction of congenital cardiac defects despite poor cosmetic results at times. Right anterior minithoracotomy was, therefore, assessed as an alternative procedure with a better cosmetic outcome. From October 2002 through February 2007, 75 patients underwent correction of congenital cardiac malformations with the use of cardiopulmonary bypass through right anterior minithoracotomy involving a short incision through the fifth intercostal space and the minimally invasive cannulation. Of them, 18 patients were infants, 42 were children, and 15 were adult. The average age was 9.26 +/- 14.1 years (range, 1.2 to 56). The average weight was 19.59 +/- 24.3 kg (range, 8.5 to 118 kg). The corrected defects included atrial septal defect type II, sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage, atrial component of atrioventricular septal defect, perimembranous ventricular septal defects with patent foramen ovale, mitral valve repair (complex), repair of cleft mitral valve, cor triatum atrial septal defect, repair of double-chambered right ventricle and extraction of atrial septal defect closure device. Skin incisions were as long as 5 cm. There was no operative or late mortality or major morbidity. The mean cardiopulmonary bypass time was 58.67 +/- 35.11 minutes (range, 32 to 263). Sixty-five patients were extubated in the operating room; the remaining 10 patients were extubated within 4 hours. Cosmetic result was very satisfactory in all patients. Two adult patients complained of some right chest musculoskeletal discomfort. The right anterior minithoracotomy incision is a safe and effective alternative to a median sternotomy for correction of congenital heart defects. Cosmetic results are highly satisfactory.
    The Annals of thoracic surgery 04/2008; 85(3):831-5. DOI:10.1016/j.athoracsur.2007.11.068 · 3.85 Impact Factor
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    ABSTRACT: Patients in cardiogenic shock (CS) or with terminal heart failure (THF) are at imminent risk of death while waiting for heart transplantation (HTx). Implantation of left or bi-ventricular assist device (LVAD/BiVAD) as a bridge to HTx may save many of these doomed patients' lives. Between March 1994 and December 2006, 29 terminally ill patients (age 2.5-65 years, mean 48 years) underwent VADs implantation as bridge to HTx. The HeartMate VE LVAD was used in 18 patients, Thoratec pneumatic BiVAD in 7, Berlin Heart Excor BiVAD in one, and HeartMate II axial flow, Thoratec pneumatic and Biomedicus centrifugal LVADs in one each. Indications for VADs implantation were CS in 16 patients (55%) and intractable THF in 13 pts (45%). Etiologies were ischemic in 20 patients, idiopathic dilated, myocarditis and congenital in 2 patients each, and valvular, post partum and HTx graft vasculopathy in one patient each. Seventeen patients (59%) survived VADs implantation and underwent HTx or are ongoing. Mean survival on VADs was 72 days (range 1-353 days, total 5.2 patient years). Seven patients (24%) were discharged home while on LVAD support for a mean of 146 days. Nine of the transplanted patients (64%) were discharged home. In 4 LVAD patients the cause of death was RV failure necessitating later implantation of RVAD. VADs implantation as bridge to HTx in CS or THF saves many of these doomed patients, sometimes providing quality out-of-hospital life while waiting for HTx. Early recognition of RV failure and liberal use of BiVAD is important.
    Harefuah 12/2007; 146(11):833-6, 911.

Publication Stats

537 Citations
83.49 Total Impact Points


  • 1997-2013
    • Tel Aviv University
      • • Department of Internal Medicine
      • • Sackler Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 2007-2012
    • Sheba Medical Center
      • Department of Pathology
      Gan, Tel Aviv, Israel
  • 2005
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France