AHA News: Women and Men Tolerate Heart Transplants Equally Well, But Men May Get Better Hearts

FRIDAY, Oct. 11, 2019 (American Heart Association News) — Women are just as likely as men to survive after a heart transplant despite often getting poorer-quality donor hearts, new research shows.

The findings, published this week in the American Heart Association journal Circulation: Heart Failure, sought to shed new light on what role, if any, gender plays in surviving a heart transplant. Past research on post-transplant survival rates and gender have told conflicting stories.

For the new study, researchers looked at data from 34,198 international heart transplant recipients from 2004 to 2014 and, after adjusting for recipient and donor factors, they found “no significant survival difference” between men and women.

“That’s a pretty novel finding,” said study author Dr. Yasbanoo Moayedi, a postdoctoral medical fellow at Stanford University in California. “We already know that women are hugely under-represented as recipients of heart transplants, but the striking thing about the new findings is there’s no difference in survival when matched to their male counterparts.”

The study also found women who get heart transplants appear to have lower-risk features than male recipients, with fewer instances of diabetes, high blood pressure, smoking, peripheral vascular disease and past cardiovascular surgery. Yet, women appear to receive higher-risk hearts than men.

“We need to better understand the matching of risk with recipient,” Moayedi said. “We hypothesize that women tend to deteriorate more acutely, and they’re sicker, so they take any heart that’s available.”

She said the findings suggest women with advanced heart failure need to be referred a bit earlier for transplant.

“One takeaway of the study is that maybe we’re missing the optimal window [for women],” she said. “Many factors may determine access to transplant, but gender should not be one of the them.”

The study was limited by its observational nature and its lack of data on waitlist mortalities, donor race and information about how sick patients where when they received a transplant.

Dr. Monica Colvin, a heart failure-transplant cardiologist who was not involved in the research, called it “a contemporary analysis” because it included newer devices and current medical therapy.

“There have been anecdotes of women having worse survival than men after heart transplant and studies have been conflicting,” said Colvin, director of the Heart Failure Network Strategy at the University of Michigan. “This study should dispel that myth and inform doctors that there really is no difference. We should not delay or defer referral for this lifesaving treatment based on concern for differential survival in women.”

An estimated 6.2 million U.S. adults have heart failure. In 2018, there were 3,408 heart transplants, according to the federal Organ Procurement and Transplantation Network.

Moayedi would like to see future studies explore why more women don’t undergo heart transplants and how a doctor’s gender might play into that decision.

“Is it that women don’t see themselves worthy enough for a heart transplant? As a patient, should I be more of an advocate for my symptoms? These things need to be looked at more systematically to learn how to best help the patient,” Moayedi said.

Colvin advises women with advanced heart failure to be seen at an advanced heart failure center “and seek out as much information as they can. It’s important to know what all your options are.”

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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Chinese Blockbuster ‘Ne Zha’ Gets U.S. Release thanks to Well Go

We’ve been covering the phenomenal performance of Chinese animated feature Ne Zha in the country for the past few weeks, and now, we’re happy to report that the movie will be released in the U.S. on August 29 by indie distributor Well Go USA Entertainment. The film will play exclusively in 3D Imax Theaters on that date, and will get a nationwide expansion on Sept. 6. Ne Zha has earned over $ 555 million in China and is the biggest animated release and the fourth biggest theatrical release of all time in that country.

Produced by Beijing Enlight Pictures and written and directed by first-time feature filmmaker Yang Yu (aka Jiao Zi). The pic is described as a fresh take on a well-known work of classical Chinese mythology. It centers on a son of the gods who finds himself a feared outcast because of a divine prophecy that he will bring destruction to the world. He faces a choice between good and evil in order to break with the prophecy and become a hero. The movie has struck a chord with audiences, as it has scored 9.7/10 on the ticketing app Maoyan.

Among Well Go’s other recent releases are Lee Chang-dong’s Burning, Zhang Yimou’s Shadow and Yuen Woo-Ping’s Master Z: The Ip Man Legacy.

Here is the film’s trailer:

Source: The Hollywood Reporter

Animation Magazine

A Less Invasive Fix Works Well for Abdominal Aneurysm

THURSDAY, May 30, 2019 — Bulges (aneurysms) in the abdominal aorta can pose real danger, but research suggests a less invasive method may be as good a fix for the problem as traditional surgery.

The less invasive procedure is called endovascular repair. There are a number of short-term benefits to this less invasive fix, such as shorter hospital stays and faster recovery. But until now, it wasn’t clear if long-term survival was as good.

“Endovascular repair is durable, and mortality is similar to open surgery,” said study co-author Dr. Julie Freischlag, chief executive officer of Wake Forest Baptist Health in Winston-Salem, N.C.

Dr. John Osborne, an American Heart Association spokesperson and director of cardiology at State of the Heart Cardiology in Dallas, Texas said this is a very important study and the long-term data “clearly swings the balance in favor of endovascular repair.”

Traditionally, repair of a bulge — or aneurysm — in the abdominal aorta required a large incision from the chest to the belly button, according to the U.S. National Institutes of Health. Left untreated, such an aneurysm can burst, creating a life-threatening emergency.

Endovascular repair is done by threading a catheter from the groin to the aneurysm. Then, a stent graft (a flexible tube with metal support) is place in the weakened area of the aorta to strengthen it and lessen pressure on the aorta walls.

Freischlag said there are a number of benefits to the endovascular repair, such as fewer deaths during the procedure than in open surgery, shorter hospital stays and less pain. People also recover faster after endovascular repair.

“Patients who have endovascular graft repair go back to work quicker, usually within a month. With open, it can be three to six months,” Freischlag said.

The study included almost 900 people who needed abdominal aorta aneurysm repair. They were undergoing elective surgery, not emergency surgery.

Slightly more than half (444 patients) were randomly selected to undergo endovascular repair. The other half had open surgery (437 patients). The researchers tracked patients’ health for up to 14 years.

During that time, 68% of those in the endovascular group died, compared to 70% of the open surgery group.

There were 12 deaths related to aneurysms (2.7%) in the endovascular group and 16 (3.7%) in the open group.

More patients in the endovascular group had to undergo second procedures, the study found. Freischlag said this is a known concern with endovascular repair. In fact, people who’ve had endovascular repair have to go back at least yearly to have the repaired area checked (via imaging, such as ultrasound, CT or MRI).

Not everyone who has an abdominal aneurysm is a candidate for endovascular repair. Freischlag said a patient has to have “good anatomy,” which essentially means that surgeons need a good area to place a stent.

Both Freischlag and Osborne said that endovascular repairs for abdominal aneurysms have been done for about 20 years now, so most vascular surgeons should be experienced in doing the procedure.

Both also said that the long-term survival rates might be even better if the study were started today because the grafts have improved and surgeons are now more experienced.

Risk factors for abdominal aortic aneurysms include older age, being male, having high blood pressure or ever smoking more than 100 cigarettes. “That’s how much smoking increases the risk. That’s just five packs of cigarettes,” said Osborne, who wasn’t involved with the study.

While abdominal aortic aneurysms are considered a “white male disease,” Freischlag said that women can get them, and that anyone who has a family history of aortic aneurysms should let their doctor know because about a third of people who have a family history will also have the condition.

People who have an increased risk need to be screened with abdominal ultrasound, Osborne said.

“It’s important to find these aneurysms before they rupture,” he noted.

The findings were published May 29 in the New England Journal of Medicine.

More information

The Society for Vascular Surgery offers more about endovascular repair.

© 2019 HealthDay. All rights reserved.

Posted: May 2019

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Doctor Not Available for Diabetes Care? Nurse Practitioners Do Just as Well