and Thoratec HeartMate III (1). Of the surgical cases, 107 VADs were explanted at the time of heart transplantation, 44 were exchanged due to device failure, ...
Abstracts S267 Conclusion: Of nearly 9000 pt encounters, one pt in five was categorized has having RHF using the new IM definition. At 1 wk post-implant, a third of pts are categorized as having RHF, 85% of whom are being treated with inotropes. At 1 mth, 16% of pts have RHF and the prevalence of RHF doesn’t change substantially throughout the first year of support. The application of the new INTERMACS definition of RHF may provide a more sensitive measure to assess the impact of not only early RHF, but late RHF as well.
7( 28) Avoiding Readmission After LVAD Implantation: Can We Predict It? S.J. Forest , Y. Xia, D.J. Goldstein. Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY. Purpose: Readmission following implantation of continuous flow left ventricular assist devices (CF-LVAD) is common, affects patient quality of life, and is costly. We sought to identify risk factors associated with readmission within one year of discharge among patients receiving CF-LVADs. Methods: We conducted a retrospective review of our institutional experience including all adult patients implanted with a contemporary CF-LVAD. Patients who were admitted within the first year of discharge from index hospitalization were compared to those who were not. Freedom from readmission at one year was evaluated using the Kaplan Meier method. A Cox-proportional hazards model for time to readmission using backwards elimination was used for multivariate analysis. A p-value = 2R, pAMR:0, DSA: Neg ; Mixed with 5 patients ACR: > = 2R, pAMR> 1 (i+), DSA: Pos; Antibody Mediated Rejection (AMR) with 5 patients ACR: 0, pAMR> 1 (i+), DSA: Pos; Control with 5 patients: ACR:0, pAMR:0, DSA: Neg. We isolated the small RNA fraction from total RNA extraction. The samples were then sequenced with Ion Proton in order to define the expression of mature miRNAs. We performed subsequent analysis with edgeR package to identify differentially expressed miRNAs in the different groups. Results: The groups were compared in pairs and we found a total of 2300 miRNAs in all the patients. The analysis of differentially expressed miRNAs showed a typical profile for each group: 1. Mixed Vs AMR: only 2 miRNAs overexpressed in the Mixed group: hsamiR-20 and hsa-miR-31 (fold change 4,83 e 5,84 respectively) suggesting a similarity between the two types. 2. ACR Vs AMR: 18 miRNAs overexpressed and 2 miRNAs underexpressed in the ACR 3. Mixed Vs ACR Vs: 10 miRNAs overexpressed and 37 miRNAs underexpressed in the Mixed group. Conclusion: This study demonstrate that miRNAs profile on EMBs differentiate the three types of rejection. The miRNAs differentially expressed are involved in pathophysiological mechanisms of rejection such as immune system cells cycle regulation and proliferation, inflammatory pathways NFkB mediated and endothelial remodeling. According to our results the miRNAs up or down expressed modulate these pathways in a way peculiar for the different types of rejection. 7( 30) Pathology of Ventricular Assist Devices: A Tertiary Care Center’s 15-Year Experience G.A. Fishbein , R.F. Padera. Department of Pathology, Brigham and Women’s Hospital, Boston, MA. Purpose: As ventricular assist device (VAD) technology advances and the use of new devices increases, pathologists have a unique opportunity to identify VAD-associated complications both when clinically apparent and incidental. Using electronic medical databases, we sought to summarize the pathologist’s 15-year experience with VADs at a tertiary care center. Methods: Using an electronic pathology database, we initiated a search on the terms, “ventricular assist device”, over the period of 1/1/2000 to 10/30/2015. Clinical histories, gross descriptions, microscopic evaluations, and/or gross photographs were reviewed. Results: Over the 15-year period, there were 155 surgical cases and 49 autopsies at which time left, right, or biventricular VADs were available for examination. The 235 devices evaluated included the Thoratec HeartMate II (n= 85), Thoratec or TCI HeartMate (56), Thoratec PVAD (32), HeartWare HVAD (10), TandemHeart (10), Thoratec IVAD (6), CentriMag (3), Abiomed BVS 5000 (2), and Thoratec HeartMate III (1). Of the surgical cases, 107 VADs were explanted at the time of heart transplantation, 44 were exchanged due to device failure, and
