Endocarditis due to Granulicatella species is a rare and severe condition. Complications are frequent despite the use of appropriate antibiotic regimens.
BackgroundThe use of aortic counterpulsation therapy in advanced heart failure is
controversial.ObjectivesTo evaluate the hemodynamic and metabolic effects of intra-aortic
balloon pump (IABP) and its impact on 30-day mortality in patients
with heart failure.MethodsHistorical prospective, unicentric study to evaluate all patients
treated with IABP betwen August/2008 and July/2013, included in an
institutional registry named TBRIDGE (The Brazilian Registry of
Intra-aortic balloon pump in Decompensated heart failure - Global
Evaluation). We analyzed changes in oxygen central venous saturation
(ScvO2), arterial lactate, and use of vasoactive drugs
at 48 hours after IABP insertion. The 30-day mortality was estimated
by the Kaplan-Meier method and diferences in subgroups were evaluated
by the Log-rank test.ResultsA total of 223 patients (mean age 49 ± 14 years) were included.
Mean left ventricle ejection fraction was 24 ± 10%, and 30% of
patients had Chagas disease. Compared with pre-IABP insertion, we
observed an increase in ScvO2 (50.5% vs. 65.5%, p <
0.001) and use of nitroprusside (33.6% vs. 47.5%, p < 0.001), and a
decrease in lactate levels (31.4 vs. 16.7 mg/dL, p < 0.001) and use
of vasopressors (36.3% vs. 25.6%, p = 0.003) after IABP insertion.
Thirty-day survival was 69%, with lower mortality in Chagas disease
patients compared without the disease (p = 0.008).ConclusionAfter 48 hours of use, IABP promoted changes in the use of vasoactive
drugs, improved tissue perfusion. Chagas etiology was associated with
lower 30-day mortality. Aortic counterpulsation therapy is an
effective method of circulatory support for patients waiting for heart
transplantation.
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