Intra-arterial or percutaneous locoregional therapies (LRT) are often employed to maintain potential liver transplant (LT) recipients with hepatocellular carcinoma (HCC) within T2/Milan criteria. Predictors of survival when LRT is used as destination therapy in those who are either ineligible or unwilling for LT remain poorly defined. We evaluated predictors of 3-year survival with destination LRT in a population of cirrhotic patients diagnosed with HCC, presenting within T2 criteria, and either ineligible or unwilling for LT. The cohort surviving 3 years had a significantly lower model for end-stage liver disease (MELD) score at HCC diagnosis (9.7 vs. 11.4, P= 0.037) and MELD following initial locoregional therapy (10.7 vs. 13.3, P= 0.008) compared to those not surviving three years despite similar demographic, tumor, and treatment variables. LRT as destination therapy results in modest intermediate term survival, with liver function at presentation and immediately following initiation of LRT predicting intermediate survival with this approach.

Background: Approximately two percent of the population in Sweden suffers from heart failure. The next three decades will see a dramatic increase in people at risk of heart failure and with a shortage of available donors, alternatives to transplantation need to be used. The heart-assist device can be obtained as destination therapy or as bridge to transplantation and implies challenges for patient’s quality of life. Aim: To examine how patients living with a heart-assist device experience their quality of life from the perspectives of physical, mental, and social health.  Method: A literature review with qualitative design. The results of the study are based on eleven qualitative studies acquired from the databases PubMed, CINAHL and Web Of Science. Selected articles were examined using the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU: s) template for qualitative methodology.  Result: Three main categories and ten subcategories were identified. One category was physical health, with the following subcategories: Adaptations to deal with everyday life, limitations in everyday life and physical ability. Another category was mental/ spiritual health with following subcategories: negative emotions, strategies for dealing with the situation, beliefs and experiences of control and acceptance. The final category was social health, with the following subcategories: relationship with family and friends, social support and changed self-image.  Conclusion: To receive and carry a heart-assist device poses great challenges for patients and their social environment. Through a holistic approach nurses can create good conditions for patients to experience a good quality of life. / Bakgrund: Cirka två procent av Sveriges befolkning drabbas av hjärtsvikt. De förestående tre decennierna kommer innebära en dramatisk ökning av människor med risk att drabbas av hjärtsvikt och med brist på tillgängliga donatorer, behöver alternativ till transplantation nyttjas. Det mekaniska hjälphjärtat kan erhållas som destinationsterapi eller i väntan på transplantation. Behandlingen är krävande och innebär utmaningar för patienten och dennes livskvalitet. Syfte: Att undersöka hur patienter som lever med ett mekaniskt hjälphjärta upplever sin livskvalitet utifrån perspektiven fysisk, psykisk och social hälsa. Metod: Allmän litteraturöversikt med analys av kvalitativa studier. Studiens resultat baseras på elva kvalitativa studier som inhämtats från databaserna PubMed, CINAHL och Web Of Science. Valda artiklar kvalitetsgranskades med hjälp av SBU:s mall för studier med kvalitativ forskningsmetodik.  Resultat: Tre huvudkategorier och tio underkategorier identifierades. En kategori var fysisk hälsa med underkategorierna: anpassningar för att hantera det vardagliga livet, begränsningar i vardagen och fysisk förmåga. Den andra kategorin var psykisk-/spirituell hälsa med underkategorierna: negativa känslor, strategier för att hantera situationen, tro, samt upplevelser av kontroll och acceptans. Den tredje kategorin var social hälsa som innefattade följande underkategorier: relationen till familj och vänner, socialt stöd och förändrad självbild.  Slutsats: Att bära ett mekaniskt hjälphjärta ställer stora krav på patienten och dennes omgivning. Sjuksköterskan kan genom ett holistiskt arbetssätt skapa goda förutsättningar för att patienten ska uppleva en god livskvalitet.

Habilitacijos procedūrai teikiamoje mokslo darbų apžvalgoje apibendrinama Vilniaus universiteto Širdies ir kraujagyslių ligų klinikoje taikyto sunkaus širdies nepakankamumo gydymo patirtis. Įrodytas intraaortinės kontrapulsacijos balionėliu taikymo tikslingumas pacientams su dekompensuota dilatacine kardiomiopatija. Įvertintas dirbtinių skilvelių, kaip tilto į transplantaciją ar likimo terapiją efektyvumas. Nustatyta, kaip techniniai dirbtinių skilvelių pakeitimai gali daryti įtaką gydymo rezultatams. Ištirtas dirbtinių skilvelių poveikis recipiento imuninei sistemai prieš ir po transplantacijos. Apžvelgti alternatyvūs širdies transplantacijai chirurginiai gydymo metodai. Pasiūlyta originali modifikuotos labirinto operacijos technika, įvertintas jos saugumas, efektyvumas ir galimybė derinti su kitomis širdies operacijomis. Prognozuojamos ateities tendencijos labai sunkiam širdies nepakankamumui gydyti. Šiame darbe remiamasi kartu su bendraautoriais atliktų tyrimų 2001-2009 m. rezultatais. Autorius visuose apžvelgiamuose tyrimuose dalyvavo tiesiogiai, kaip padalinio, kuriame gydomi pacientai su labai sunkiu širdies nepakankamumu, vadovas ir kaip chirurgas. Remiantis publikuota medžiaga buvo daryti pranešimai ir Lietuvoje, ir užsienyje. / The experience of treatment of end-stage heart failure cumulated at Vilnius University Cardiovascular Surgery Clinic is provided for habilitation procedure. The experience of intraaortic balloon counterpulsation for the patients suffering from decompensated dilatative cardiomyopathy has been proven. The efficacy of artificial ventricular assist devices as a bridge to transplantation or destination therapy has been evaluated. The role of technical modifications of ventricular assist devices for the outcomes of treatment has been assessed. The impact of assist devices on the immune status of the patient pre- and post-transplantation has also been evaluated. The alternative methods of treatment instead of heart transplantation are reviewed. The original technique of modified maze procedure is proposed; the safety, efficacy and possibilities of combining this technique with other heart operations are assessed. The future trends for treatment of end-stage heart failure are predicted. This study is based on the investigations performed with co-authors during the period since 2001 to 2009. The author has participated directly in all reviewed investigations as the head of the department where patients suffering from end-stage heart failure are being treated and as well as a surgeon. The reports based on the published material have been presented in Lithuania and abroad.