Heart transplantation represents the only effective method of treatment of intractable heart diseases. Cardiomyopathy with heart dilation, inoperable congenital heart diseases and heart failure after the heart surgery represent the most common indications for heart transplantation in pediatrics. Hypoplastic left heart syndrome is the most frequent indication for the heart transplantation in neonates and infants. In infants steroids-free immunosuppression is used or steroids are withdrawn 6 to 12 months after the transplantation. Graft failure, acute rejection and infection are the most common causes of death after transplantation. Long-term results and the quality of life depend on the occurrence of rejection, infection, graft vasculopathy, lymphoproliferative disease and side effects of immunosuppression. Posttransplant graft vasculopathy, however, represents the most dangerous late complication, which requires retransplantation. Improvement of the transplantation program improves the survival rate as well as the quality of life after transplantation. Survival after heart transplantation is 80% in one year and 50% in ten years interval. Better results can be achieved in neonates. Lack of donors, demanding economical and organisational conditions and the unresolved legislation problems preclude wider use of heart transplantation in children. Research for more effective, safer and cheaper pharmacotherapy in the prevention and treatment of rejection, infection and complications of immunosuppression is required. Long-term effects and the quality of life after heart transplantation in children, as well as possibilities of mechanical heart support and xenotransplantation must be also studied.

• MeSH
• dítě MeSH
• lidé MeSH
• perioperační péče MeSH
• transplantace srdce * metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

Heart transplantation has become in recent decades an established method for the treatment of advanced heart failure. Precisely, it was in January 2014 when 30 years have passed since the start of clinical heart transplantation program at the Institute for Clinical and Experimental Medicine. 936 heart transplants were performed by the end of 2013. The transplant program has reached considerable development since its beginnings. The knowledge of whole issue has deepened, indication criteria have been extended, new immunosuppressives are available and many of them are still in research. Life expectancy of patients has been prolonged and quality of life has improved. Nevertheless, the care of transplant patient is very complicated task for medical professionals and brings a lot of problems to solve.

• MeSH
• dějiny 20. století MeSH
• dějiny 21. století MeSH
• lidé MeSH
• transplantace srdce dějiny   MeSH
• Check Tag
• dějiny 20. století MeSH
• dějiny 21. století MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• historické články MeSH
• Geografické názvy
• Česká republika MeSH

Solid organ transplantation (heart, lung, liver, kidney, pancreas, small interesting and their combinations) are standard therapy of terminal organ failure. Czech Republic belongs to the states with developed transplantation program. The results correspond with current knowledge and results of leading centers in the world, as demostrated in this article. Organ donor shortage is major factor limiting development of organ transplantations as elsewhere in the Europe or in the world.

• MeSH
• dárci tkání MeSH
• lidé MeSH
• transplantace jater statistika a číselné údaje   MeSH
• transplantace ledvin statistika a číselné údaje   MeSH
• transplantace orgánů statistika a číselné údaje   MeSH
• transplantace plic statistika a číselné údaje   MeSH
• transplantace slinivky břišní statistika a číselné údaje   MeSH
• transplantace srdce statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Antibody-mediated rejection (AMR) is a serious complication of organ transplantation, and its treatment is complex. The aim of this study was to assess immunoadsorption (IA) for treatment-immunized patients before heart transplantation (HTX) and as the first step of AMR treatment after HTX. METHODS: The cohort consisted of 10 patients (8 men, 2 women; age range, 20-57 years). For 3 of these patients, IA was included in the desensitization protocol before HTX; for 7 patients, IA was the first step of the treatment protocol. One patient underwent IA before and after HTX. RESULTS: A comparison of values before IA and after the last procedure showed a decrease in immunoglobulin subgroups (G, M, and A). In patients before HTX, a decline was noted in panel reactive antibodies. After HTX, IA procedures led to a significant decrease in donor-specific antibody (DSA) class I; DSA class II fell in 6 of 7 patients, with 51% falling below the detection limit. CONCLUSIONS: IA in patients during HTX is safe procedure for reducing DSA. The removal of antibodies is the first step in comprehensive treatment and must be followed by a procedure that prevents their further development.

• MeSH
• dárci tkání MeSH
• desenzibilizace imunologická metody   MeSH
• dospělí MeSH
• imunosorpční techniky * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• protilátky imunologie   MeSH
• rejekce štěpu imunologie   MeSH
• transplantace ledvin MeSH
• transplantace srdce metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• Názvy látek
• protilátky MeSH

BACKGROUND: Heart transplantation (HTx) is an established therapeutic option for children with end-stage heart failure. Comprehensive pediatric nationwide HTx program was introduced in 2014 in the Czech Republic. The aim of this study was to evaluate its mid-term characteristics and outcomes and to compare them with international data. METHODS: Retrospective observational study, including all patients who underwent HTx from June 2014 till December 2022. Data from the institutional database were used for descriptive statistics and survival analyses. RESULTS: A total of 30 HTx were performed in 29 patients with congenital heart disease (CHD, N = 15, single ventricular physiology in 10 patients) and cardiomyopathy (CMP, N = 14). Ten patients were bridged to HTx by durable left ventricular assist devices (LVADs) for a mean duration of 104 (SD 89) days. There was one early and one late death during median follow-up of 3.3 (IQR 1.3-6.1) years. Survival probability at 5 years after HTx was 93%. Two patients underwent re-transplantation (one of them in an adult center). Significant rejection-free survival at 1, 3, and 6 years after HTx was 76%, 63%, and 63%, respectively. CONCLUSIONS: The introduced pediatric HTx program reflects the complexity of the treated population, with half of the patients having complex CHD and one-third being bridged to HTx by LVADs. Mid-term results are comparable to worldwide data. The data confirm the possibility of establishing a successful nationwide pediatric HTx program in a relatively small population country with well-developed pediatric cardiovascular care and other transplantation programs.

• Klíčová slova
• child, heart transplantation, nationwide, ventricular assist device,
• MeSH
• dítě MeSH
• dospělí MeSH
• kardiomyopatie * MeSH
• lidé MeSH
• podpůrné srdeční systémy * MeSH
• retrospektivní studie MeSH
• srdeční selhání * chirurgie   MeSH
• transplantace srdce * MeSH
• vrozené srdeční vady * MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy for some of these indications, but there remains a need for additional evidence to guide best practices. As a result, the use of ECMO may vary widely across centers. The purpose of this document is to highlight key aspects of care delivery, with the goal of codifying the current use of this rapidly growing technology. A major challenge in this field is the need to emergently deploy ECMO for cardiac failure, often with limited time to assess the appropriateness of patients for the intervention. For this reason, we advocate for a multidisciplinary team of experts to guide institutional use of this therapy and the care of patients receiving it. Rigorous patient selection and careful attention to potential complications are key factors in optimizing patient outcomes. Seamless patient transport and clearly defined pathways for transition of care to centers capable of providing heart replacement therapies (e.g., durable ventricular assist device or heart transplantation) are essential to providing the highest level of care for those patients stabilized by ECMO but unable to be weaned from the device. Ultimately, concentration of the most complex care at high-volume centers with advanced cardiac capabilities may be a way to significantly improve the care of this patient population.

• Klíčová slova
• Cardiac arrest, Cardiac failure, Critical care networks, Extracorporeal life support, Extracorporeal membrane oxygenation, Hospital organization, Mechanical circulatory support, Position article,
• MeSH
• dospělí MeSH
• kardiogenní šok * MeSH
• lidé MeSH
• mimotělní membránová oxygenace * MeSH
• podpůrné srdeční systémy MeSH
• srdeční selhání * terapie   MeSH
• transplantace srdce MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Optical Coherence Tomography (OCT) is an intravascular imaging modality enabling detailed evaluation of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). However, its clinical application remains hampered by time-consuming manual quantitative analysis. We aimed to validate a semi-automated quantitative OCT analysis software (Iowa Coronary Wall Analyzer, ICWA-OCT) to improve OCT-analysis in HTx patients. 23 patients underwent OCT evaluation of all three major coronary arteries at 3 months (3M) and 12 months (12M) after HTx. We analyzed OCT recordings using the semiautomatic software and compared results with measurements from a validated manual software. For semi-automated analysis, 31,228 frames from 114 vessels were available. The validation was based on a subset of 4287 matched frames. We applied mixed model statistics to accommodate the multilevel data structure with method as a fixed effect. Lumen (minimum, mean, maximum) and media (mean, maximum) metrics showed no significant differences. Mean and maximum intima area were underestimated by the semi-automated method (β-methodmean = - 0.289 mm2, p < 0.01; β-methodmax = - 0.695 mm2, p < 0.01). Bland-Altman analyses showed increasing semi-automatic underestimation of intima measurements with increasing intimal extent. Comparing 3M to 12M progression between methods, mean intimal area showed minor underestimation (β-methodmean = - 1.03 mm2, p = 0.04). Lumen and media metrics showed excellent agreement between the manual and semi-automated method. Intima metrics and progressions from 3M to 12M were slightly underestimated by the semi-automated OCT software with unknown clinical relevance. The semi-automated software has the future potential to provide robust and time-saving evaluation of CAV progression.

• Klíčová slova
• Cardiac allograft vasculopathy, Heart transplantation, Intravascular imaging, Optical coherence tomography, Validation,
• MeSH
• koronární cévy MeSH
• lidé MeSH
• nemoci koronárních tepen * MeSH
• nemoci srdce * MeSH
• optická koherentní tomografie metody   MeSH
• prediktivní hodnota testů MeSH
• software MeSH
• transplantace srdce * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The present experiments were performed to evaluate if increased heart tissue concentration of fatty acids, specifically myristic, palmitic and palmitoleic acids that are believed to promote physiological heart growth, can attenuate the progression of unloading-induced cardiac atrophy in rats with healthy and failing hearts. Heterotopic abdominal heart transplantation (HT(x)) was used as a model for heart unloading. Cardiac atrophy was assessed from the ratio of the native- to-transplanted heart weight (HW). The degree of cardiac atrophy after HT(x) was determined on days 7, 14, 21 and 28 after HT(x) in recipients of either healthy or failing hearts. HT(x) of healthy hearts resulted in 23+/-3, 46+/-3, 48+/-4 and 46+/-4 % HW loss at the four time-points. HT(x) of the failing heart resulted in even greater HW losses, of 46+/-4, 58+/-3, 66+/-2 and 68+/-4 %, respectively (P<0.05). Activation of "fetal gene cardiac program" (e.g. beta myosin heavy chain gene expression) and "genes reflecting cardiac remodeling" (e.g. atrial natriuretic peptide gene expression) after HT(x) was greater in failing than in healthy hearts (P<0.05 each time). Exposure to isocaloric high sugar diet caused significant increases in fatty acid concentrations in healthy and in failing hearts. However, these increases were not associated with any change in the course of cardiac atrophy, similarly in healthy and post-HT(x) failing hearts. We conclude that increasing heart tissue concentrations of the fatty acids allegedly involved in heart growth does not attenuate the unloading-induced cardiac atrophy.

• MeSH
• heterotopická transplantace metody   MeSH
• kardiomyocyty metabolismus   MeSH
• krysa rodu Rattus MeSH
• kyselina myristová metabolismus   MeSH
• kyselina palmitová metabolismus   MeSH
• kyseliny mastné mononenasycené metabolismus   MeSH
• myokard metabolismus   patologie   MeSH
• potkani inbrední LEW MeSH
• srdeční selhání metabolismus   chirurgie   MeSH
• transplantace srdce metody   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kyselina myristová MeSH
• kyselina palmitová MeSH
• kyseliny mastné mononenasycené MeSH
• palmitoleic acid MeSH Prohlížeč

The heart transplant program at the Institute for Clinical and Experimental Medicine in Prague was established on January 31, 1984. Through November 2012, 881 orthotopic cardiac transplantations have been performed, with an annual rate of about 40 procedures. Current legislation concerning solid organ transplantations in the Czech Republic is described. Like other centers, we have noticed an increasing age of donors, and, reflecting the shortage of grafts, we have expanded our selection criteria for heart transplantation. The advent of a mechanical circulatory support program at our center in April 2003 has given us another valuable tool in the management of chronic heart failure patients. Currently, around half of our patients are transplanted from mechanical support. Nonischemic etiology of heart failure is a leading cause of transplantation at our center, followed by ischemic cardiomyopathy, valvular heart lesions, and adult congenital heart diseases. Our current immunosupression protocol, including induction therapy, is outlined in detail and survival rates, as well as most common complications and our treatment strategies, are also discussed.

• MeSH
• ateroskleróza epidemiologie   MeSH
• dítě MeSH
• dospělí MeSH
• homologní transplantace MeSH
• incidence MeSH
• infekce epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory epidemiologie   MeSH
• podpůrné srdeční systémy statistika a číselné údaje   trendy   MeSH
• předškolní dítě MeSH
• rejekce štěpu epidemiologie   mortalita   terapie   MeSH
• senioři MeSH
• srdeční selhání epidemiologie   mortalita   chirurgie   MeSH
• transplantace srdce mortalita   statistika a číselné údaje   trendy   MeSH
• výběr pacientů MeSH
• vysokoškolská lékařská centra statistika a číselné údaje   MeSH
• získávání tkání a orgánů statistika a číselné údaje   trendy   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

Prior studies demonstrated sex-related differences in many aspects of chronic heart failure (HF), and in the appropriate use, individual response or complication rates with non-pharmacological treatment, too. There is seasonal variability in morbidity and mortality of HF with significant gender differences, partially due to respiratory diseases, which may be potentionally preventable by vaccination. Quitting smoking is associated with substantial decrease in morbidity and mortality in HF patients which is similar in magnitude to the effect of an appropriate beta-blocker use. Yet little emphasis has been placed on smoking cessation strategies in women with HF and should be adopted as vigorously as proven medical therapy. Complications of catheter ablation for atrial fibrillation were more frequent in females. Gender disparity exists in the use of implantable cardioverter-defibrillators and cardiac resynchronization therapy, although they are beneficial for both women and men. Smaller women have limited access to left ventricular assist device (LVAD) because these devices require a minimum body surface to fit properly. Women were more likely than men to develop severe right ventricular failure after implantation of LVAD. Lower cut-off level of peak oxygen consumption was suggested for women to determine optimal timing for heart transplantation. Disease management programs probably narrows gender differences in quality of care and survival among HF patients. Women with HF have less access to cardiologists, although this consultation is associated with better quality of care, particularly for women. Despite these known sex differences, recommendations for HF are the same for women and men, because prospective sex-specific clinical trials have not been performed.

• MeSH
• defibrilátory implantabilní MeSH
• disparity zdravotní péče * MeSH
• lidé MeSH
• odvykání kouření MeSH
• podpůrné srdeční systémy MeSH
• sexuální faktory MeSH
• srdeční selhání patofyziologie   terapie   MeSH
• transplantace srdce MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH