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By Fang J.C., Couper G.S.

James C. Fang, MD, and Gregory S. Couper, MD, have assembled a panel of well-known surgeons and cardiologists to study the newest scientific, clinical, and investigational surgical and mechanical techniques to center failure in hopes of enhancing the lives of this hard staff of sufferers. issues diversity from such conventional techniques as high-risk surgical revascularization in complex coronary artery disorder, to extra novel techniques corresponding to ventricular reconstruction and mechanical support units. Many chapters are contributed through the unique pioneers of particular surgical ideas, which supply s beneficial viewpoint from own event.

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Outcomes in patients who are hepatitis B surface antigen-positive before transplantation: an analysis and study using the joint ISHLT/UNOS thoracic registry. J Heart Lung Transplant 2000;19:781. 24. Ko WJ, Chou NK, Hsu RB, et al. Hepatitis B virus infection in heart transplant recipients in a hepatitis B endemic area. J Heart Lung Transplant 2001;20:865. 25. Nguyen MH, Wright TL. Therapeutic advances in the management of hepatitis B and hepatitis C. Curr Opin Infect Dis 2001;14:593. 26. Fishman JA, Rubin RH.

A subsequent report from the ISHLT Registry also compared mycophenolate with azathioprine and found a significant improvement in survival at 1 year (96 vs 93%) and 3 years (91 vs 86%), providing further support for the superiority of mycophenolate in a larger (although retrospective) analysis (112). Data from the ISHLT Registry indicated that 70% of patients transplanted between 1999 and 2001 were receiving mycophenolate, and 15% were receiving azathioprine (2). Two newer drugs, sirolimus (also called rapamycin) and its derivative everolimus, are also antiproliferative agents; they are collectively referred to as TOR (target of rapamycin) inhibitors.

As described regarding the management of pulmonary hypertension in the pretransplant setting, a variety of intravenous agents with vasodilatory and/or inotropic properties have been used postoperatively to reduce pulmonary vascular resistance and support right heart function. Dobutamine (92) and milrinone (93) are effective in this setting, combining inotropic support for both the left and the right ventricle with pulmonary vasodilation. The utility of nonspecific vasodilators like dobutamine, milrinone, and isoproterenol may be limited by systemic vasodilation and hypotension, especially if the systemic vascular resistance is already low (see below).

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