Cardiac amyloidosis surgery

Jump to navigation Jump to search

Cardiac amyloidosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cardiac Amyloidosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Cardiac amyloidosis surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cardiac amyloidosis surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cardiac amyloidosis surgery

CDC onCardiac amyloidosis surgery

Cardiac amyloidosis surgery in the news

Blogs on Cardiac amyloidosis surgery

Directions to Hospitals Treating Cardiac amyloidosis

Risk calculators and risk factors for Cardiac amyloidosis surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Aarti Narayan, M.B.B.S [3]; Cafer Zorkun, M.D., Ph.D. [4]

Overview

When heart function is very poor, a heart transplant may be considered for some patients, but not those with AL type amyloidosis since their disease compromises many organs. In one type of secondary amyloidosis, liver transplantation is also required.

Surgery

Pacemaker

Patients with cardiac amyloidosis (CA) are prone to conduction system disease due to infiltration of the heart's electrical conduction system by the amyloid deposits. Progressive conduction system disease is common in TTR type CA and senile CA often requiring pacemaker implantation. Electrophysiologic function appears to be abnormal most commonly in the His-Purkinje system. Prolonged infra-His conduction time is an independent predictor of sudden death in these patients. [1]

Cardiac Transplantation

Heart transplantation is an option to be considered in the treatment of CA. Involvement of non-cardiac organs in AL type CA makes the patient not suitable for cardiac transplantation. Only 4% of the patients have isolated cardiac amyloidosis unlike senile CA. In those patients with isolated heart involvement, cardiac transplantation followed by initiation of autologous hematopoietic stem cell transplantation (HSCT) within 12 months, has been shown to be associated with better survival rates. However, selection of suitable candidates is a key step while considering cardiac transplantation. A suitable patient with AL type CA would be:

  • Young (<60 years age)
  • Mayo stage III CA
  • NYHA III/IV symptoms after adequate diuresis
  • Good renal and/or liver functioning
  • No significant autonomic neuropathy
  • Low-level bone marrow plasmacytosis
  • Should be eligible for HSCT after heart transplantation

According to a study in the UK, 5 year survival rates after transplantation were found to be lower compared with the rates after transplantation for non-AL amyloidosis[2].

References

  1. Reisinger J, Dubrey SW, Lavalley M, Skinner M, Falk RH (1997). "Electrophysiologic abnormalities in AL (primary) amyloidosis with cardiac involvement". Journal of the American College of Cardiology. 30 (4): 1046–51. PMID 9316537. Unknown parameter |month= ignored (help)
  2. Dubrey SW, Burke MM, Hawkins PN, Banner NR (2004). "Cardiac transplantation for amyloid heart disease: the United Kingdom experience". The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation. 23 (10): 1142–53. doi:10.1016/j.healun.2003.08.027. PMID 15477107. Unknown parameter |month= ignored (help)


Template:WikiDoc Sources