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Marasco SF, McLean J, Kure CE, Rix J, Lake T, Linton A, Farag J, Zhu MZL, Doi A, Bergin PJ, Leet AS, Taylor AJ, Hare JL, Patel HC, Kaye D, McGiffin DC. HeartMate 3 implantation with an emphasis on the biventricular configuration. Artif Organs 2024; 48:655-664. [PMID: 38459775 DOI: 10.1111/aor.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/21/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Right ventricular failure following implantation of a durable left ventricular assist device (LVAD) is a major driver of mortality. Reported survival following biventricular (BiVAD) or total artificial heart (TAH) implantation remains substantially inferior to LVAD alone. We report our outcomes with LVAD and BiVAD HeartMate 3 (HM3). METHODS Consecutive patients undergoing implantation of an HM3 LVAD between November 2014 and December 2021, at The Alfred, Australia were included in the study. Comparison was made between the BiVAD and LVAD alone groups. RESULTS A total of 86 patients, 65 patients with LVAD alone and 21 in a BiVAD configuration underwent implantation. The median age of the LVAD and BiVAD groups was 56 years (Interquartile range 46-62) and 49 years (Interquartile range 37-55), respectively. By 4 years after implantation, 54% of LVAD patients and 43% of BiVAD patients had undergone cardiac transplantation. The incidence of stroke in the entire experience was 3.5% and pump thrombosis 5% (all in the RVAD). There were 14 deaths in the LVAD group and 1 in the BiVAD group. The actuarial survival for LVAD patients at 1 year was 85% and BiVAD patients at 1 year was 95%. CONCLUSIONS The application of HM 3 BiVAD support in selected patients appears to offer a satisfactory solution to patients requiring biventricular support.
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Affiliation(s)
- Silvana F Marasco
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Janelle McLean
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Christina E Kure
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Julia Rix
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Tanieka Lake
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Ashlee Linton
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - James Farag
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Victoria, Australia
| | - Michael Z L Zhu
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Victoria, Australia
| | - Atsuo Doi
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Victoria, Australia
| | - Peter J Bergin
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Angeline S Leet
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Andrew J Taylor
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - James L Hare
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Heart Failure Research Laboratory, The Baker Institute, Melbourne, Victoria, Australia
| | - Hitesh C Patel
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - David Kaye
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
- Heart Failure Research Laboratory, The Baker Institute, Melbourne, Victoria, Australia
| | - David C McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Darbaidze Z, Hanke JS, Dogan G, Schmack B, Ruhparwar A, Schmitto JD. First in human implantation of the CorLog device for postoperative intravascular pressure sensing in left ventricular assist device patients. Artif Organs 2024; 48:567-569. [PMID: 38069483 DOI: 10.1111/aor.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 04/18/2024]
Affiliation(s)
- Zurab Darbaidze
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bastian Schmack
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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3
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Li Y, Xi Y, Wang H, Sun A, Deng X, Chen Z, Fan Y. The Impact of Rotor Axial Displacement Variation on Simulation Accuracy of Fully Magnetic Levitation Centrifugal Blood Pump. ASAIO J 2024:00002480-990000000-00455. [PMID: 38569187 DOI: 10.1097/mat.0000000000002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
The rotor axial displacement of the full magnetic levitation blood pump varies with the operating conditions. The effect of rotor axial displacement on simulation results is unclear. This study aimed to evaluate the effect of rotor axial displacement on the predicted blood pump flow field, hydraulic performance, and hemocompatibility through simulation. This study used the CentriMag blood pump as a model, and conducted computational fluid dynamics simulations to assess the impact of rotor displacement. Considering rotor axial displacement leads to opposite results regarding predicted residence time and thrombotic risk compared with not considering rotor axial displacement. Not considering rotor axial displacement leads to deviations in the predicted values, where the effects on the flow field within the blood pump, ratio of secondary flow, and amount of shear stress >150 Pa are significant. The variation in the back clearance of the blood pump caused by the ideal and actual rotor displacements is the main cause of the above phenomena. Given that the rotor axial displacement significantly impacts the simulation accuracy, the effect of rotor axial displacement must be considered in the simulation.
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Affiliation(s)
- Yuan Li
- From the Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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4
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Schmitto JD, Shaw S, Garbade J, Gustafsson F, Morshuis M, Zimpfer D, Lavee J, Pya Y, Berchtold-Herz M, Wang A, Gazzola C, Potapov E, Saeed D. Fully magnetically centrifugal left ventricular assist device and long-term outcomes: the ELEVATE registry. Eur Heart J 2024; 45:613-625. [PMID: 38036414 PMCID: PMC10959573 DOI: 10.1093/eurheartj/ehad658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND AIMS HeartMate 3 (HM3) is a fully magnetically levitated continuous flow left ventricular assist device, which received CE marking in 2015. The ELEVATE Registry was initiated to collect real-world outcomes in patients treated with HM3 post-CE Mark approval. METHODS A total of 540 subjects implanted at 26 centres between March 2015 and February 2017 were included in this registry. Of these, 463 received the device as a primary implant (primary implant cohort, PIC), 19 as a pump exchange (pump exchange cohort), and in 58 patients, only anonymized survival data were collected (anonymized cohort, AC). Patients in the PIC contributed to the baseline demographics, survival, adverse events, quality of life (QoL) (EuroQoL-5 Dimensions-5 Levels visual analogue scale), and functional capacity (6 min walk distance) assessments, while patients in the AC contributed only to survival. RESULTS Primary implant cohort patients had a mean age of 56 years and were predominantly male (89%) with 48% ischaemic aetiology. The majority of subjects was designated bridge to transplant (66%) and had INTERMACS Profiles 1-3 (70%). At baseline, the subjects had poor functional capacity (104 ± 140 m) and impaired QoL (35 ± 19 points). The overall survival rate of the PIC was 63.3% and survival free of stroke was 58.1% at 5 years. Significant improvements in functional capacity and QoL were observed and maintained for 5 years (301 ± 131 m and 64 ± 20 points, respectively). CONCLUSIONS Real-world data from the ELEVATE registry demonstrate an overall survival rate for primary implants of 63.3%. In the PIC, reductions in adverse events for patients in the extended follow-up and improved QoL and functional capacity were observed at 5 years in this patient population with advanced heart failure.
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Affiliation(s)
- Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, OE 6210, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Steven Shaw
- The Transplant Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Jens Garbade
- Department of Cardiothoracic Surgery, Klinikum Links der Weser, Bremen, Germany
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michiel Morshuis
- Department of Cardiothoracic Surgery, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Jacob Lavee
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuriy Pya
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | | | | | | | - Diyar Saeed
- Department for Cardiac Surgery, Heart Center, Leipzig, Germany
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5
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Mehra MR, Castagna F, Butler J. The transformative potential of left ventricular assist devices in advanced heart failure: no more a therapeutic orphan. Eur Heart J 2024; 45:626-628. [PMID: 38073194 PMCID: PMC10881096 DOI: 10.1093/eurheartj/ehad555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Affiliation(s)
- Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Francesco Castagna
- Center for Advanced Heart Disease, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, 3434 Live Oak, Dallas, TX 75204, USA
- University of Mississippi Medical Center, Jackson, MS, USA
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Hack M, Wood KL, Bjelic M, Paic F, Vidula H, Cheyne C, Chase K, Tallman M, Bernstein W, Wyrobek JA, Alexis JD, Gosev I. Less Invasive Left Ventricular Assist Device Implantation Is Safe and Feasible in Patients With Smaller Body Surface Area. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:445-451. [PMID: 37794726 DOI: 10.1177/15569845231198088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Smaller body surface area (BSA) frequently precludes patients from left ventricular assist device (LVAD) therapy. We sought to investigate the clinical outcomes in patients with small BSA undergoing less invasive LVAD implantation. METHODS We conducted a retrospective review of 216 patients implanted with HeartMate 3 LVAD (Abbott, Chicago, IL) via less invasive surgery at our institution. Patients were dichotomized based on their preimplant BSA for comparison between small BSA (≤1.8 m2) and normal/large BSA (>1.8 m2). We analyzed patient perioperative characteristics and outcomes. RESULTS In our study, small BSA was found in 32 patients (14.8%), while 184 patients (85.2%) had normal/large BSA. Women were more prevalent in the small BSA group (50.0% vs 13.0%, P < 0.001). Preoperative and intraoperative data showed comparable results. Major complications and hospital length of stay did not differ by BSA group. Patients with smaller BSA had significantly decreased pump parameters at discharge, including LVAD flow (4.11 ± 0.49 vs 4.60 ± 0.54 L/min, P < 0.001) and pump speed (5,200 vs 5,400 rpm, P < 0.001). Survival to discharge and within 6 months after implantation were similar between the groups. CONCLUSIONS Our study results suggest that less invasive HeartMate 3 implantation can be safely performed and demonstrates equivalent outcomes in patients with smaller body habitus. Randomized trials are required to confirm our data.
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Affiliation(s)
- Madelaine Hack
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | - Milica Bjelic
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Frane Paic
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | | | - Karin Chase
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Mark Tallman
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Wendy Bernstein
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Julie A Wyrobek
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | - Igor Gosev
- Division of Cardiac Surgery, University of Rochester, NY, USA
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7
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Hanke JS, Merzah AS, Arfai J, Haverich A, Schmitto JD, Dogan G. Der Patient am linksventrikulären Assist Device. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2023. [DOI: 10.1007/s00398-023-00571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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8
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Merzah AS, Hanke JS, Li T, Saad Merzah FA, Gabriel M, Derda AA, Homann K, Haverich A, Schmitto JD, Dogan G. Outcomes of modular cable exchange in HeartMate 3 patients versus conventional driveline repair in HeartMate II patients. Artif Organs 2023; 47:380-386. [PMID: 36148849 DOI: 10.1111/aor.14413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 07/20/2022] [Accepted: 09/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Driveline (DL) damages are a common difficulty among ventricular assist devices (VAD). Repairing the electrical fibers inside the DL on a running pump is hazardous and requires technical expertise, which is not easily available on site. A new feature of the HeartMate3 (Abbott, U.S.A.) LVAD is a modular driveline that allows an easy exchange of the DL cord. In this report we analyze our experiences with this feature. METHODS We performed a retrospective analysis of 302 patients who underwent either HeartMate II or HeartMate 3 implantation between February 2004 and September 2021. Patients were screened for driveline faults and need for exchange or repair of driveline or VAD exchange. Documented were baseline characteristics, reasons for DL or VAD exchange, and complications. Follow-up was three months after the procedure. RESULTS We present a cohort of 302 patients who underwent either HMII (n = 107;35.4%) or HM 3 (n = 195; 64.5%) implantation. Out of those, 40 patients (40/302; 13.2%) required driveline repair (DLRe) or exchange (DLEx). Out of 107 HMII patients, 9 showed severe DL damages (9/107; 8.4%). Six patients (6/9; 66.6%) underwent DLRe, two patients (2/6; 33.3%) required VAD exchange after DLRe, one patient (1/2;50%) experienced emergency VAD exchange after pump stop. The DLRe procedure in the other four patients (4/6; 66.6%) was successful. Due to damage to the internal driveline two patients (2/9; 22.2%) underwent emergency device exchange and one patient (1/9;11.1%) was listed for transplantation. 31 out 195 HM3 patients underwent exchange of the modular DL. In none of the cases, damages of the internal fibers were the reasons for the exchange. In 100% of the cases, damages of the external coating were the reason for DL exchange. In none of the cases, complications occurred after the exchange procedure. CONCLUSIONS Driveline damages are a habitual, recurrent complication in VAD patients. The exchange of the modular driveline cable of the HM3 is feasible and safe compared to the conventional DL repair in HMII patients. Risky repair attempts and surgical LVAD exchange due to major damages of the electrical fibers can be avoided successfully by the new feature of HM3 driveline.
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Affiliation(s)
- Ali Saad Merzah
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fadi A Saad Merzah
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Maria Gabriel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anselm A Derda
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Katharina Homann
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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9
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Gangwani MK, Aziz M, Nawras A, Priyanka F, Ahmed Z, Khan RS, Qamar MA, Haroon F, Aziz A, Smith WL, Kirshan Ravi SJ, Parikh V, Alyousif Z, Mahmood A, Tariq R, Rai D, Aronow WS. Predictors of gastrointestinal bleeding in patients following left ventricular assist device implantation: a systematic review and meta-analysis. Future Cardiol 2022; 18:957-967. [PMID: 36334072 DOI: 10.2217/fca-2022-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aim: Our study aims to provide a more holistic understanding of the available data and predictive risk factors for gastrointestinal bleed (GIB). Materials & methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science Core Collection and calculated relative risk and meta-regression was utilized to evaluate for risk factors in order to assess the effect of covariates. Results: Our meta-analysis reported a pooled prevalence rate of GIB of 24.4%. Meta-regression analysis did not yield a statistically significant association between GIB and risk factors, including age, gender, hypertension, chronic kidney disease and diabetes. Conclusion: Studies investigating larger sample sizes are required for conclusive findings.
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Affiliation(s)
| | - Muhammad Aziz
- Department of Gastroenetrology, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Ali Nawras
- Department of Gastroenetrology, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Fnu Priyanka
- Department of Medicine, Chandka Medical College, Larkana, Pakistan
| | - Zohaib Ahmed
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Raja Samir Khan
- Department of Gastroenetrology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Fawad Haroon
- Department of Internal Medicine, Mercy Hospital St. Louis, MO 63141, USA
| | - Abeer Aziz
- Department of Medicine, Aga Khan University, USA
| | - Wade Lee Smith
- Department of Toledo Libraries, University of Toledo, Toledo, OH 43614, USA
| | | | - Vishal Parikh
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY 14621, USA
| | - Zakaria Alyousif
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Asif Mahmood
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Raseen Tariq
- Department of Gastroenterology, Mayo Clinic, Rochester, MN 55902, USA
| | - Devesh Rai
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY 14621, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY 10595, USA
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10
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Inoue K, Fujita T, Yoshioka D, Tonai K, Yanagino Y, Kakuta T, Tadokoro N, Kawamoto N, Yamashita K, Kawamura A, Matsuura R, Kawamura T, Saito T, Kawamura M, Kainuma S, Fukushima S, Toda K, Miyagawa S. Short-Term Outcomes of Magnetically Levitated Left Ventricular Assist Device in Advanced Heart Failure ― The Japanese Cohort ―. Circ J 2022; 86:1961-1967. [DOI: 10.1253/circj.cj-22-0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koichi Inoue
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | | | - Kohei Tonai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yusuke Yanagino
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | | | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Ryohei Matsuura
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Tetsuya Saito
- Department of Cardiovascular Surgery, Osaka University Hospital
| | | | - Satoshi Kainuma
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital
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11
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Menchaca K, Ostos Perez CA, Draguljevic N, Paciletti J, Ghumman W, Faber C, Mirza S. Long-Term Withdrawal of Anticoagulation and Antiplatelet Therapy in a HeartMate 3 Left Ventricular Assist Device. Cureus 2022; 14:e28779. [PMID: 36111326 PMCID: PMC9462652 DOI: 10.7759/cureus.28779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
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Iskandar R, Federici C, Berns C, Blankart CR. An approach to quantify parameter uncertainty in early assessment of novel health technologies. HEALTH ECONOMICS 2022; 31 Suppl 1:116-134. [PMID: 35581685 DOI: 10.1002/hec.4525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/17/2022] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
Health economic modeling of novel technology at the early stages of a product lifecycle has been used to identify technologies that are likely to be cost-effective. Such early assessments are challenging due to the potentially limited amount of data. Modelers typically conduct uncertainty analyses to evaluate their effect on decision-relevant outcomes. Current approaches, however, are limited in their scope of application and imposes an unverifiable assumption, that is, uncertainty can be precisely represented by a probability distribution. In the absence of reliable data, an approach that uses the fewest number of assumptions is desirable. This study introduces a generalized approach for quantifying parameter uncertainty, that is, probability bound analysis (PBA), that does not require a precise specification of a probability distribution in the context of early-stage health economic modeling. We introduce the concept of a probability box (p-box) as a measure of uncertainty without necessitating a precise probability distribution. We provide formulas for a p-box given data on summary statistics of a parameter. We describe an approach to propagate p-boxes into a model and provide step-by-step guidance on how to implement PBA. We conduct a case and examine the differences between the status-quo and PBA approaches and their potential implications on decision-making.
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Affiliation(s)
- Rowan Iskandar
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, & Practice, Brown University, Providence, Rhode Island, USA
- Center of Excellence in Decision-Analytic Modeling and Health Economics Research, Sitem-insel, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Carlo Federici
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
| | - Cassandra Berns
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, & Practice, Brown University, Providence, Rhode Island, USA
- Center of Excellence in Decision-Analytic Modeling and Health Economics Research, Sitem-insel, Bern, Switzerland
| | - Carl Rudolf Blankart
- Center of Excellence in Decision-Analytic Modeling and Health Economics Research, Sitem-insel, Bern, Switzerland
- KPM Center for Public Management, University of Bern, Bern, Switzerland
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13
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Pourtau L, Beneyto M, Porterie J, Roncalli J, Massot M, Biendel C, Fournier P, Itier R, Galinier M, Lairez O, Delmas C. Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients. ESC Heart Fail 2022; 9:1931-1941. [PMID: 35338605 PMCID: PMC9065835 DOI: 10.1002/ehf2.13899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Left ventricular assist devices (LVADs) have reduced the mortality of patients with advanced heart failure both as bridge-to-transplant and as destination therapy. However, LVADs are associated with various complications, including bleedings, which affect the prognosis. The aim of the study was to explore the prevalence, management, and outcomes of haemorrhagic adverse events in LVAD recipients. METHODS AND RESULTS We conducted a retrospective, single-centre, cohort study including all patients who received an LVAD from January 2008 to December 2019 in our tertiary centre (Rangueil University Hospital, Toulouse, France). Bleeding events, death, and heart transplantation were collected from electronic medical files. Eighty-eight patients were included, and 43 (49%) presented at least one bleeding event. Gastrointestinal (GI) bleeding was the most frequent (n = 21, 24%), followed by epistaxis (n = 12, 14%) and intracranial haemorrhage (n = 9, 10%). Bleeding events were associated with increased mortality [hazard ratio (HR) 3.8, 95% confidence interval (CI) 1.5-9.3, P < 0.01], particularly in case of intracranial haemorrhage (HR 14.6, 95% CI 4.2-51.1, P < 0.0001). GI bleedings were associated with a trend towards increased mortality (HR 3.0, 95% CI 0.9-9.3, P = 0.05). Each bleeding episode multiplied the risk of death by 1.8 (95% CI 1.2-2.7, P < 0.01). Finally, only early bleedings (<9 months post-implantation) had an impact on mortality (HR 4.2, 95% CI 1.6-11.1, P < 0.01). Therapeutic management was mainly based on temporary interruption of anticoagulation and permanent interruption of antiplatelet therapy. Invasive management was rarely performed. CONCLUSIONS Haemorrhagic events in LVAD recipients are frequent and associated with increased mortality. GI bleedings are the most frequent, and intracranial haemorrhages the most associated with mortality. Management remains empirical requiring more research.
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Affiliation(s)
- Laetitia Pourtau
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
| | - Maxime Beneyto
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
| | - Jean Porterie
- Department of Cardiovascular SurgeryRangueil University HospitalToulouseFrance
| | - Jerome Roncalli
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
- Medical School of ToulousePaul Sabatier UniversityToulouseFrance
| | - Montse Massot
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
| | - Caroline Biendel
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
| | - Pauline Fournier
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
| | - Romain Itier
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
| | - Michel Galinier
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
- Medical School of ToulousePaul Sabatier UniversityToulouseFrance
| | - Olivier Lairez
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
- Medical School of ToulousePaul Sabatier UniversityToulouseFrance
- Department of Nuclear MedicineRangueil University HospitalToulouseFrance
| | - Clement Delmas
- Department of CardiologyRangueil University Hospital1 avenue Jean Poulhès, TSA 50032Toulouse31059France
- Medical School of ToulousePaul Sabatier UniversityToulouseFrance
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14
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Bansal A, Akhtar F, Desai S, Velasco-Gonzalez C, Bansal A, Teagle A, Shridhar A, Webre K, Ostrow S, Fary D, Parrino PE. Six-month outcomes in postapproval HeartMate3 patients: A single-center US experience. J Card Surg 2022; 37:1907-1914. [PMID: 35385586 PMCID: PMC9320844 DOI: 10.1111/jocs.16452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The European CE Mark approval study and the MOMENTUM 3 trial demonstrated safety and a reduction in hemocompatibility-related adverse events with the use of HeartMate 3 (HM3) device. This single-center study investigated the real-world experience in HM3 patients since FDA approval. METHODS This retrospective, observational study included patients implanted with the HM3 LVAD as a primary implant between October 2017 and March 2020. Patients were divided into trial group and postapproval group. The primary endpoint was survival at 6 months. Secondary endpoints were adverse events including pump thrombosis (requiring pump exchange), stroke, renal failure, acute limb ischemia, re-exploratory for bleeding, gastrointestinal bleeding, right ventricular failure, and driveline infection. RESULTS A total of 189 patients were implanted with HM3 device during the study period. 174 patients met the inclusion criteria: 82 patients in the trial group and 92 patients in the postapproval group. The postapproval group had younger patients, higher preoperative mean international normalized ratio, and greater numbers of patients with bridge to transplant (BTT) indications, IINTERMACS profile 1, and use of mechanical assist devices (other than IABP) than the trial group. Other characteristics between the two groups were comparable. Overall survival at 6 months in the postapproval group was 93.3% versus 93.8% (p = .88). The postapproval group demonstrated a statistically significant lower incidence of re-explorative surgery for bleeding (10.9% vs. 46.3, p = .01) than the trial group. CONCLUSION In this single-center study, the real-world 6-month survival in the postapproval group was comparable to the trial results. Further studies are needed to monitor long-term outcomes.
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Affiliation(s)
- Aditya Bansal
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,Faculty of Medicine, Ochsner Clinical School, The University of Queensland, New Orleans, Louisiana, USA
| | - Faisal Akhtar
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Sapna Desai
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Cruz Velasco-Gonzalez
- Center for Applied Health Services Research, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Anirudh Bansal
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Angie Teagle
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Avni Shridhar
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Karen Webre
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Sheila Ostrow
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - David Fary
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Patrick Eugene Parrino
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,Faculty of Medicine, Ochsner Clinical School, The University of Queensland, New Orleans, Louisiana, USA
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15
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Monteagudo-Vela M, Krasopoulos G, Athanasiou T, Tsui S, Kourliouros A. Impact of third-generation left ventricular assist devices on quality of life: Scoping review and meta-analysis. Artif Organs 2022; 46:1012-1018. [PMID: 35132647 DOI: 10.1111/aor.14186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/19/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Development in device technology and the scarcity of donor's hearts have increased the number of patients with advanced heart failure receiving durable left ventricular assist devices (LVADs) as a bridge to transplantation and destination therapy, with improved prognosis compared with guideline-directed medical therapy. We sought to examine the impact of modern durable LVADs on the quality of life (QoL) of the recipients. METHODS We carried out a systematic review of articles on QoL following the implantation of third-generation LVADs published between January 2010 and February 2021. Included studies were critically analyzed and evidence synthesis was carried out into a meta-analysis. RESULTS The systematic search yielded 269 articles, 11 of which met the search predefined criteria. Three of them reported results of randomized trials and eight were retrospective and registry studies. Statistically significant QoL improvement from baseline was observed in all published reports. When using the EuroQol 5L questionnaire (scale 0-100) as a QoL tool 6 months post-LVAD implantation, a meta-analysis of four included studies demonstrated a mean difference increase of 28.9 points (95% confidence interval: 26.71-31.14). CONCLUSIONS Third-generation LVADs confer a significant improvement in QoL and their use can be supported not only for prognosis but also for symptom control. Although methodological limitations should be considered, the available QoL outcomes can be a useful tool in patient selection and the decision-making process.
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Affiliation(s)
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals, Oxford, UK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College Healthcare, Hammersmith Hospital, London, UK
| | - Steven Tsui
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
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16
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Hemolytic Performance in Two Generations of the Sputnik Left Ventricular Assist Device: A Combined Numerical and Experimental Study. J Funct Biomater 2022; 13:jfb13010007. [PMID: 35076513 PMCID: PMC8788462 DOI: 10.3390/jfb13010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Currently, left ventricular assist devices (LVADs) are a successful surgical treatment for patients with end-stage heart failure on the waiting list or with contraindicated heart transplantation. In Russia, Sputnik 1 LVAD was also successfully introduced into clinical practice as a bridge-to-transplant and a destination therapy device. Development of Sputnik 2 LVAD was aimed at miniaturization to reduce invasiveness, optimize hemocompatibility, and improve versatility for patients of various sizes. Methods: We compared hemolysis level in flow path of the Sputnik LVADs and investigated design aspects influencing other types of blood damage, using predictions of computational fluid dynamics (CFD) and experimental assessment. The investigated operating point was a flow rate of 5 L/min and a pressure head of 100 mm Hg at an impeller rotational speed of 9100 min−1. Results: Mean hemolysis indices predicted with CFD were 0.0090% in the Sputnik 1 and 0.0023% in the Sputnik 2. Averaged values of normalized index of hemolysis obtained experimentally for the Sputnik 1 and the Sputnik 2 were 0.011 ± 0.003 g/100 L and 0.004 ± 0.002 g/100 L, respectively. Conclusions: Obtained results indicate obvious improvements in hemocompatibility and sufficiently satisfy the determined miniaturization aim for the Sputnik 2 LVAD development.
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17
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Castrodeza J, Ortiz-Bautista C, Fernández-Avilés F. Continuous-flow left ventricular assist device: Current knowledge, complications, and future directions. Cardiol J 2021; 29:293-304. [PMID: 34967940 PMCID: PMC9007493 DOI: 10.5603/cj.a2021.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
Long-term continuous-flow left ventricular assist devices have become a real alternative to heart transplantation in patients with advanced heart failure, achieving a promising 2-year event-free survival rate with new-generation devices. Currently, this technology has spread throughout the world, and any cardiologist or cardiac surgeon should be familiar with its fundamentals and its possible complications as well as the advances made in recent years. The aim of this review is to describe current knowledge, management of complications, and future directions of this novel heart-failure therapy.
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Affiliation(s)
- Javier Castrodeza
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain.
| | - Carlos Ortiz-Bautista
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain
- Universidad Complutense, Madrid, Spain
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18
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Kranzl M, Stoiber M, Schaefer AK, Riebandt J, Wiedemann D, Marko C, Laufer G, Zimpfer D, Schima H, Schlöglhofer T. Driveline Features as Risk Factor for Infection in Left Ventricular Assist Devices: Meta-Analysis and Experimental Tests. Front Cardiovasc Med 2021; 8:784208. [PMID: 34977190 PMCID: PMC8716483 DOI: 10.3389/fcvm.2021.784208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Risk factors for driveline infection (DLI) in patients with left ventricular assist devices are multifactorial. The aim of this study was to analyze the correlation between mechanical driveline features and DLI occurrence. Methods: A meta-analysis was conducted that included studies reporting DLI rates at 6 months after implantation of any of three contemporary devices (HVAD with Pellethane or Carbothane driveline, HeartMate II, and HeartMate 3). Further, outer driveline diameter measurements and ex-vivo experimental three-point bending and torsion tests were performed to compare the stiffness of the four different driveline types. Results: 21 studies with 5,393 patients were included in the meta-analysis. The mean weighted DLI rates ranged from 7.2% (HeartMate II) to 11.9% (HeartMate 3). The HeartMate II driveline had a significantly lower maximal bending force (Loadmax) (4.52 ± 0.19 N) compared to the Carbothane HVAD (8.50 ± 0.08 N), the HeartMate 3 (11.08 ± 0.3 N), and the Pellethane HVAD driveline (15.55 ± 0.14 N) (p < 0.001). The maximal torque (Torquemax) of the HeartMate II [41.44 (12.61) mNm] and the Carbothane HVAD driveline [46.06 (3.78) mNm] were significantly lower than Torquemax of the Pellethane HVAD [46.06 (3.78) mNm] and the HeartMate 3 [95.63 (26.60) mNm] driveline (p < 0.001). The driveline of the HeartMate 3 had the largest outer diameter [6.60 (0.58) mm]. A relationship between the mean weighted DLI rate and mechanical driveline features (Torquemax) was found, as the the HeartMate II driveline had the lowest Torquemax and lowest DLI rate, whereas the HeartMate 3 driveline had the highest Torquemax and highest DLI rate. Conclusions: Device-specific mechanical driveline features are an additional modifiable risk factor for DLI and may influence clinical outcomes of LVAD patients.
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Affiliation(s)
- Melanie Kranzl
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Stoiber
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | - Julia Riebandt
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christiane Marko
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Ludwig-Boltzmann-Institute for Cardiovascular Research, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Ludwig-Boltzmann-Institute for Cardiovascular Research, Vienna, Austria
| | - Heinrich Schima
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig-Boltzmann-Institute for Cardiovascular Research, Vienna, Austria
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig-Boltzmann-Institute for Cardiovascular Research, Vienna, Austria
- *Correspondence: Thomas Schlöglhofer ; orcid.org/0000-0003-4354-4860
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19
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Kamat I, Lamba H, Hines-Munson C, Hudson S, Liao K, Muldrew KL, Green S, Terwilliger A, Kaplan HB, Ramig RF, Maresso A, Trautner BW. Identifying Causative Microorganisms in Left Ventricular Assist Device Infections as a Guide for Developing Bacteriophage Therapy. J Surg Res 2021; 271:73-81. [PMID: 34847492 DOI: 10.1016/j.jss.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/20/2021] [Accepted: 10/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND As more left ventricular-assist devices (LVADs) are implanted, multidrug-resistant LVAD infections are becoming increasingly common, partly due to bacterial biofilm production. To aid in developing bacteriophage therapy for LVAD infections, we have identified the most common bacterial pathogens that cause LVAD driveline infections (DLIs) in our heart transplant referral center. MATERIALS AND METHODS We studied a retrospective cohort of patients who received LVADs from November 2003 to August 2017 to identify the common causative organisms of LVAD infection. We also studied a prospective cohort of patients diagnosed with DLIs from October 2018 to May 2019 to collect bacterial strains from DLIs for developing bacteriophages to lyse causative pathogens. LVAD infections were classified as DLI, bacteremia, and pump/device infections in the retrospective cohort. RESULTS In the retrospective cohort of 582 patients, 186 (32.0%) developed an LVAD infection, with 372 microbial isolates identified. In the prospective cohort, 96 bacterial strains were isolated from 54 DLIs. The microorganisms causing DLIs were similar in the two cohorts; the most common isolate was Staphylococcus aureus. We identified 6 prospective S. aureus strains capable of biofilm formation. We developed 3 bacteriophages that were able to lyse 5 of 6 of the biofilm-forming S. aureus strains. CONCLUSIONS Similar pathogens caused LVAD DLIs in our retrospective and prospective cohorts, indicating our bacterial strain bank will be representative of future DLIs. Our banked bacterial strains will be useful in developing phage cocktails that can lyse ≥80% of the bacteria causing LVAD infections at our institution.
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Affiliation(s)
- Ishan Kamat
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Harveen Lamba
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Casey Hines-Munson
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey, Veterans Affairs Medical Center, Houston, Texas
| | - Samuel Hudson
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Kenneth Liao
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute, Houston, Texas
| | - Kenneth L Muldrew
- Section of Infectious Disease, Department of Medicine, Baylor College of Medicine, One Baylor Plaza Houston, Texas; Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Sabrina Green
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Austen Terwilliger
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Heidi B Kaplan
- Department of Microbiology and Molecular Genetics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Robert F Ramig
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Anthony Maresso
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey, Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.
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20
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Nesta M, Cammertoni F, Bruno P, Massetti M. Implantable ventricular assistance systems (VAD) as a bridge to transplant or as 'destination therapy'. Eur Heart J Suppl 2021; 23:E99-E102. [PMID: 34650365 PMCID: PMC8503528 DOI: 10.1093/eurheartj/suab101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Heart failure is a complex clinical syndrome associated with a high mortality and morbidity rate. Despite the extensive pharmacological armamentarium, a non-negligible percentage of patients develop advanced heart failure and require further therapies. In these circumstances, heart transplantation remains the treatment of choice, but the limited number of donors and the reduction of potential candidates have made necessary to develop new technologies. Since the 1980s, left ventricular assist devices (LVADs) have been introduced and have completely revolutionized the landscape of advanced heart failure treatments. This article has identified the categories of patients who can benefit from the implantation of an LVAD and summarized the new classifications. In addition, the main LVADs are described, analysing the results of the main clinical studies, with particular reference to adverse events. Although there is no perfect LVAD, a multidisciplinary team approach, dedicated to the treatment of advanced heart failure, can guide the choices on the best device to implant, in order to minimize complications and improve the patient’s quality of life.
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Affiliation(s)
- Marialisa Nesta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Federico Cammertoni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Piergiorgio Bruno
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Massimo Massetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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21
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Molina EJ, Ahmed S, Jain A, Lam PH, Rao S, Hockstein M, Kadakkal A, Hofmeyer M, Rodrigo ME, Najjar SS, Sheikh FH. Outcomes in patients with smaller body surface area after HeartMate 3 left ventricular assist device implantation. Artif Organs 2021; 46:460-470. [PMID: 34516000 DOI: 10.1111/aor.14065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/05/2021] [Accepted: 09/03/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Due to anatomic and physiologic concerns, prior generations of the left ventricular assist devices (LVAD) have frequently been denied to patients with small body size. However, outcomes in patients with small body surface area (BSA) following HeartMate 3 (HM3) LVAD implantation remain relatively unknown. METHODS A cohort of 220 patients implanted at a single center was divided into two groups: BSA ≤1.8 m2 (small BSA, n = 37) and BSA >1.8 m2 (large BSA, n = 183). We investigated baseline characteristics and clinical outcomes including survival and incidence of adverse events. RESULTS Small BSA patients were older (60 vs. 57 years), more likely female (60% vs. 20%), had a lower body mass index (24 vs. 32 kg/m2 ), lower incidence of diabetes (32% vs. 51%), history of stroke (5% vs. 19%), and left ventricular thrombus (0% vs. 11%). They had smaller left ventricular end diastolic diameter (64.8 vs. 69.3 mm). Pump speed and pump flows at discharge were lower in the small BSA group. Survival at 1 year and 2 years was 86% versus 87% and 86% versus 79% for small versus large BSA groups (p = 0.408), respectively. The rates of adverse events were similar between groups and there were no cases of confirmed pump thrombosis. The incidence of readmissions for low flow alarms was higher in the small BSA group (0.55 vs. 0.24 EPPY). CONCLUSIONS These findings demonstrate comparable outcomes in patients with small body size and suggest that this parameter should not be an exclusion criterion on patients who are otherwise candidates for HM3 LVAD implantation.
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Affiliation(s)
- Ezequiel J Molina
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute, Washington, DC, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Sara Ahmed
- Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Amiti Jain
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Phillip H Lam
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Sriram Rao
- Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Michael Hockstein
- Department of Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - Ajay Kadakkal
- Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Mark Hofmeyer
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Maria E Rodrigo
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Samer S Najjar
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Farooq H Sheikh
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
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22
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Gustafsson F, Netuka I. Progressive elimination of adverse events: the key to success for left ventricular assist devices. Eur J Heart Fail 2021; 23:1401-1403. [PMID: 34184382 DOI: 10.1002/ejhf.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Finn Gustafsson
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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23
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Marcel L, Specklin M, Kouidri S. The evolution of long-term pediatric ventricular assistance devices: a critical review. Expert Rev Med Devices 2021; 18:783-798. [PMID: 34160345 DOI: 10.1080/17434440.2021.1947245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The gap between the number of heart failure patients and the number of potential heart donors has never been larger than today, especially among the pediatric population. The use of mechanical circulatory support is seen as a potential alternative for clinicians to treat more patients. This treatment has proven its efficiency on short-term use. However, in order to replace heart transplant, the techniques should be used over longer periods of time.Areas covered: This review aims at furnishing an engineering vision of the evolution of ventricular assistance devices used in pediatrics. A critical analysis of the clinical complications related to devices generation is made to give an overview of the design improvements made since their inception.Expert opinion: The long-term use of a foreign device in the body is not without consequences, especially among fragile pediatric patients. Moreover, the size of their body parts increases the technical difficulties of such procedure. The balance between the living cells of the body is disturbed by the devices, mostly by the shear stress generated. To provide a safe mechanical circulatory support for long-term use, the devices should be more hemocompatible, preserving blood cells, adapted to the patient's systemic grid and miniaturized for pediatric use.
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Affiliation(s)
- Louis Marcel
- Arts Et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, Paris, France
| | - Mathieu Specklin
- Arts Et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, Paris, France
| | - Smaine Kouidri
- Arts Et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, Paris, France
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Schmitto JD, Mariani S, Li T, Dogan G, Hanke JS, Bara C, Pya Y, Zimpfer D, Krabatsch T, Garbade J, Rao V, Morshuis M, Beyersdorf F, Marasco S, Netuka I, Bauersachs J, Haverich A. Five-year outcomes of patients supported with HeartMate 3: a single-centre experience. Eur J Cardiothorac Surg 2021; 59:1155-1163. [PMID: 33585913 DOI: 10.1093/ejcts/ezab018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The HeartMate 3 left ventricular assist device was first implanted in 2014 and received the Conformité Européenne mark in 2015. Since then, several trials demonstrated its high haemocompatibility associated with good survival and low adverse events rates. Herein, we report our institutional experience with patients supported with HeartMate 3 for 5 years. METHODS This prospective cohort study included patients receiving a HeartMate 3 implantation in 2014 as part of the HeartMate 3 Conformité Européenne Mark clinical trial. Patients had follow-up visits every 3 months while on left ventricular assist device support, and all patients completed the 5-year follow-up. The primary end point was survival at 5 years. Secondary end points included adverse events, health status and quality of life. RESULTS Eight patients (men: 75%) aged 59 years (min-max: 52-66 years) were enrolled. At 5 years, survival was 100%. Patients remained on support for a median time of 1825 days (min-max: 101-1825 days); 2 patients successfully received cardiac transplants. No right heart failure, haemolysis, pump thrombosis, pump malfunction or neurological events occurred in any patients. A driveline infection was observed in 6 patients (0.25 events/patient-year). Compared to baseline, a significant improvement in quality of life and in New York Heart Association functional class was noted after the implant and for the whole follow-up time. A slight decline in kidney function and in the 6-min walk test results occurred after 3 years. CONCLUSIONS This study reports the longest single-centre follow-up of the HeartMate 3, showing excellent haemocompatibility over time with high survival and low complication rates at 5 years.
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Affiliation(s)
- Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Bara
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Yuriy Pya
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Vivek Rao
- Department of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center, Bad Oeynhausen, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, and Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Silvana Marasco
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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25
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Hanke JS, Mariani S, Merzah AS, Bounader K, Li T, Haverich A, Schmitto JD, Dogan G. Three year follow-up after less-invasive Left Ventricular Assist Device exchange to HeartMate 3. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:646-651. [PMID: 34057162 DOI: 10.23736/s0021-9509.21.11756-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Device exchange to a newer generation left ventricular assist device (LVAD) offers the opportunity to benefit from improved adverse events profiles. We present the three year results of a patient cohort undergoing VAD upgrades to a new generation device focusing on outcomes and adverse events. METHODS We present the first series of patients who underwent LVAD upgrade to HeartMate 3. All operations were performed less invasively. Follow-up time was three years after LVAD exchange. RESULTS Overall four HeartMate II and two HVAD patients underwent LVAD upgrade. In five cases severe infection of the VAD led to device exchange (83%, 5/6). Three year survival after LVAD exchange was 100% (6/6). In the follow-up examinations one patient showed a single syncope and several low flow alarms (1/6). The remaining five patients showed no technical malfunctions of the LVAD or hemodynamic adverse events (5/6). Four out of five patients whose devices had to be changed due to an infection suffered a local re-infection (4/5), which, however, did not require any further surgical intervention. Four patients were successfully transplanted and two patients were still on device support at three years after LVAD exchange. CONCLUSIONS Three-year outcomes and adverse events after LVAD exchange to HeartMate 3 show excellent results. The superior hemocompatibility in terms of pump thrombosis makes the HM3 a favored choice in case of LVAD exchange due previous pump thrombosis. However, in cases of exchange due to device infection the risk of reinfection remains high.
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Affiliation(s)
- Jasmin S Hanke
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ali S Merzah
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Karl Bounader
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany -
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26
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Mehra MR, Cleveland JC, Uriel N, Cowger JA, Hall S, Horstmanshof D, Naka Y, Salerno CT, Chuang J, Williams C, Goldstein DJ. Primary results of long-term outcomes in the MOMENTUM 3 pivotal trial and continued access protocol study phase: a study of 2200 HeartMate 3 left ventricular assist device implants. Eur J Heart Fail 2021; 23:1392-1400. [PMID: 33932272 PMCID: PMC8453814 DOI: 10.1002/ejhf.2211] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 01/02/2023] Open
Abstract
AIM The MOMENTUM 3 pivotal trial established superiority of the HeartMate 3 (HM3) left ventricular assist device (LVAD), a fully magnetically levitated centrifugal-flow pump, over the HeartMate II axial-flow pump. We now evaluate HM3 LVAD outcomes in a single-arm prospective continuous access protocol (CAP) post-pivotal trial study. METHODS AND RESULTS We enrolled 2200 HM3 implanted patients (515 pivotal trial and 1685 CAP patients) and compared outcomes including survival free of disabling stroke or reoperation to replace or remove a malfunctioning device (primary composite endpoint), overall survival and major adverse events at 2 years. The 2-year primary endpoint [76.7% vs. 74.8%; adjusted hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.71-1.08, P = 0.21] and overall survival (81.2% vs. 79.0%) were similar among CAP and pivotal cohorts despite sicker patients (more intra-aortic balloon pump use and INTERMACS profile 1) in CAP who were more often intended for destination therapy. Survival was similar between the CAP and pivotal trial in transplant ineligible patients (79.1% vs. 76.7%; adjusted HR 0.89, 95% CI 0.68-1.16, P = 0.38). In a pooled analysis, the 2-year primary endpoint was similar between INTERMACS profiles 1-2 ('unstable' advanced heart failure), profile 3 ('stable' on inotropic therapy), and profiles 4-7 ('stable' ambulatory advanced heart failure) (75.7% vs. 77.6% vs. 72.9%, respectively). The net burden of adverse events was lower in CAP (adjusted rate ratio 0.93, 95% CI 0.88-0.98, P = 0.006), with consequent decrease in hospitalization. CONCLUSIONS The primary results of accumulating HM3 LVAD experience suggest a lower adverse event burden and similar survival compared to the pivotal MOMENTUM 3 trial.
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Affiliation(s)
- Mandeep R Mehra
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | | | - Nir Uriel
- Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY, USA
| | | | - Shelley Hall
- Baylor University Medical Center, Dallas, TX, USA
| | | | - Yoshifumi Naka
- Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY, USA
| | | | | | | | - Daniel J Goldstein
- Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
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27
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Zimpfer D, Gustafsson F, Potapov E, Pya Y, Schmitto J, Berchtold-Herz M, Morshuis M, Shaw SM, Saeed D, Lavee J, Heatley G, Gazzola C, Garbade J. Two-year outcome after implantation of a full magnetically levitated left ventricular assist device: results from the ELEVATE Registry. Eur Heart J 2021; 41:3801-3809. [PMID: 33107561 DOI: 10.1093/eurheartj/ehaa639] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/26/2020] [Accepted: 07/27/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS The ELEVATE Registry was designed to study long-term outcomes with the Heartmate 3 (HM3), a fully magnetically levitated centrifugal ventricular assist device, in a real-world population following CE-mark approval. METHODS AND RESULTS A total of 540 patients, implanted in Europe and the Middle East were followed in ELEVATE. The registry included 463 patients receiving the HM3 as primary implant (Primary Implant Cohort), 19 patients underwent a pump upgrade from another device (Pump Exchange Cohort) and 58 patients who had experienced an outcome before having the possibility to sign the Informed Consent, for which only outcome data were collected (Anonymized Cohort). Data collection included demographics, survival, adverse events, EQ-5D Visual Analog Score quality of life (EQ-5D VAS QOL) questionnaire, and 6-min walk distance (6MWD). Mean age was 55.6 ± 11.7 years (89% male, 48% ischaemic cardiomyopathy). Seventy per cent of patients were in INTERMACS Profile 1-3 and 12.7% were on temporary mechanical circulatory support. Primary Implant Cohort survival was 83% after 2 years. In the Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation Primary Implant Cohort, strokes were observed in 10.2%, gastrointestinal bleedings in 9.7%, pump thrombosis in 1.5%, and outflow graft twists in 3.5%. Heartmate 3 implantation resulted in a significant and sustained improvement of functional capacity and QOL. CONCLUSION In a real-world population, cohort implanted with the HM3 left ventricular assist device we demonstrate good long-term survival, sustained improvement of functional capacity, and low rates of adverse events (including pump thrombosis). CLINICALTRIALS.GOV IDENTIFIER NCT02497950.
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Affiliation(s)
- Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel, 18-20 A-1090 Vienna, Austria
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Yuriy Pya
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
| | | | | | - Michiel Morshuis
- Department of Cardiothoracic Surgery, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Steven M Shaw
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Diyar Saeed
- Cardiovascular Surgery, University Hospital of Dusseldorf, Dusseldorf, Germany
| | - Jacob Lavee
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
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28
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Riebandt J, Wiedemann D, Sandner S, Angleitner P, Zuckermann A, Schlöglhofer T, Laufer G, Zimpfer D. Impact of Less Invasive Left Ventricular Assist Device Implantation on Heart Transplant Outcomes. Semin Thorac Cardiovasc Surg 2021; 34:148-156. [PMID: 33609672 DOI: 10.1053/j.semtcvs.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
Left ventricular assist device implantation without sternotomy (LIS) may simplify heart transplantation (HTX) by avoiding adhesions and eliminating the need for a re-sternotomy. This study investigates the impact of LIS LVAD implantation on HTX outcomes. A retrospective comparison of 46 patients undergoing HTX between 07/13 and 06/19 after conventional LVAD implantation with a full sternotomy (FS) and LIS LVAD implantation (LIS: n = 27 patients, 59%; FS: n = 19 patients, 41%) was performed. Endpoints were perioperative data including blood product use, de-novo formation of donor specific antibodies (DSAs) and survival. Patient demographics (mean age FS: 60.3 ± 9.3 years vs LIS 58.0 ± 7.7 years, P = 0.313; male gender FS: 84% vs LIS: 82%, P = 1.000; urgent HTX FS: 16% vs LIS 18%, P = 1.000) were comparable between LIS and FS patients. The primary finding was a significantly higher risk to develop de novo donor specific antibodies (DSAs) after HTX in patients of the FS group (FS: 36% vs LIS: 4%; P = 0.006). LIS patients had a significant reduction of intraoperative packed red blood cells (PRBCs) use (LIS: 4 (IQR 2-7) Units vs FS: 7 (IQR 4-8) Units; P = 0.045). Other adverse events rates and in-hospital mortality (LIS: 7% vs FS 5%, P = 1.000) were comparable between both groups. LIS LVAD reduces formation of donor specific antibodies after HTX.
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Affiliation(s)
- Julia Riebandt
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Angleitner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlöglhofer
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
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29
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Javorski MJ, Zaki A, Abas M, Elgharably H, Attia TS. Current era left ventricular assist devices. Future Cardiol 2021; 17:971-984. [PMID: 33563033 DOI: 10.2217/fca-2020-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Left ventricular assist devices (LVADs) have changed the landscape of treatment options for patients with end stage heart failure. Due to the limited availability of donor hearts for transplantation, LVADs have become an important option for many of these patients. Much progress has been made in the device industry since then, and newer devices continue to improve patient outcomes. In this review, we will discuss some of the key transitions in LVADs over the years, the current LVADs used in practice today, implantation techniques, the impact of the new heart allocation system on LVAD use and future prospective LVADs.
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Affiliation(s)
- Michael J Javorski
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular & Thoracic Institute, Cleveland Clinic Foundation, OH 44195, USA
| | - Anthony Zaki
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular & Thoracic Institute, Cleveland Clinic Foundation, OH 44195, USA
| | - Motaz Abas
- Ross University School of Medicine, Bridgetown, BB11093, Barbados
| | - Haytham Elgharably
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular & Thoracic Institute, Cleveland Clinic Foundation, OH 44195, USA.,Kaufman Center for Heart Failure Treatment & Recovery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Tamer S Attia
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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30
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Jefferson HL, Kent WDT, MacQueen KT, Miller RJH, Holloway DD, Fatehi Hassanabad A. Left ventricular assist devices: A comprehensive review of major clinical trials, devices, and future directions. J Card Surg 2021; 36:1480-1491. [PMID: 33476443 DOI: 10.1111/jocs.15341] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Heart failure is an increasingly prevalent medical condition associated with significant morbidity and mortality. In spite of optimal medical therapy, a large number of patients continue to deteriorate clinically and could potentially benefit from advanced therapies. While cardiac transplantation is an established therapy for end-stage heart failure, there are a limited number of donor hearts, and many patients may not be candidates. Over the past two decades, mechanical circulatory support and left ventricular assist devices (LVAD) have altered the heart failure management landscape. Herein we review the indications for LVAD implantation and how they have changed over time. We will also outline major technological evolutions in LVADs and summarize the landmark clinical trials pertaining to them. We also highlight the adverse events associated with LVADs and assess the limitations of the existing literature. Finally, we look ahead to the future of LVAD therapy for patients with advanced heart failure.
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Affiliation(s)
- Hallie L Jefferson
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - William D T Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kelsey T MacQueen
- Faculty of Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Robert J H Miller
- Section of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel D Holloway
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
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31
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Gordon JS, Maynes EJ, O'Malley TJ, Pavri BB, Tchantchaleishvili V. Electromagnetic interference between implantable cardiac devices and continuous-flow left ventricular assist devices: a review. J Interv Card Electrophysiol 2021; 61:1-10. [PMID: 33433742 DOI: 10.1007/s10840-020-00930-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Abstract
Many patients with continuous-flow left ventricular assist devices (CF-LVAD) have other, co-existing implantable cardiac devices. While such devices often function appropriately, there is potential for electromagnetic interference (EMI). A literature review was performed to identify cases of EMI between CF-LVAD and other implanted cardiac devices to better understand their etiology, outcomes, and the strategies used to overcome such interference. The cases identified included interference between CF-LVAD and pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy. The EMI reported in the current literature can be broken down into two general categories: interference leading to difficulty establishing telemetry and interference leading to impaired electrical signal sensing. Such interference led to inappropriate shock delivery in some cases. The type of interference, and thus treatments, differed and were device dependent. The strategies employed to reduce interference included metal shielding, physical manipulation to increase the distance between devices, and even exchange of the implanted device with another brand of the same class. To avoid such EMI in the future, physicians must be aware of the reported interference between certain devices, and manufacturers must work more closely to increase the compatibility of implanted cardiac devices.
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Affiliation(s)
- Jonathan S Gordon
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA
| | - Thomas J O'Malley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Behzad B Pavri
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA.
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32
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Netuka I, Pya Y, Zimpfer D, Potapov E, Garbade J, Rao V, Morshuis M, Beyersdorf F, Marasco S, Sood P, Gazzola C, Schmitto JD. First 5-year multicentric clinical trial experience with the HeartMate 3 left ventricular assist system. J Heart Lung Transplant 2021; 40:247-250. [PMID: 33500187 DOI: 10.1016/j.healun.2021.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Yuriy Pya
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Daniel Zimpfer
- Department of Cardiac Surgery, University of Vienna, Vienna, Austria
| | - Evgenij Potapov
- Department of Thoracic and Cardiovascular Surgery, German Heart Center, Berlin, Germany
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Vivek Rao
- Department of Cardiovascular Surgery, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michiel Morshuis
- Thoracic and Cardiovascular Surgery Clinic, Bad Oeynhausen, Germany
| | - Friedhelm Beyersdorf
- University Heart Center Freiburg, Medical Faculty, Albert-Ludwigs-University, Freiburg, Germany
| | - Silvana Marasco
- Cardiothoracic Unit, The Alfred Hospital, Melbourne, Australia
| | | | | | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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33
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Veenis JF, Radhoe SP, van Mieghem NM, Manintveld OC, Caliskan K, Birim O, Bekkers JA, Boersma E, Lenzen MJ, Zijlstra F, Brugts JJ. Remote hemodynamic guidance before and after left ventricular assist device implantation: short-term results from the HEMO-VAD pilot study. Future Cardiol 2021; 17:885-898. [PMID: 33410726 DOI: 10.2217/fca-2020-0182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: We aimed to assess the safety and feasibility of using CardioMEMS monitoring in patients before and after left ventricular assist device (LVAD) surgery. Patients & methods: Ten patients accepted for elective LVAD surgery were included, received a CardioMEMS at baseline and were categorized based on mean pulmonary artery pressure (mPAP) ≤25 mmHg (n = 4) or mPAP >25 mmHg [n = 6]) before LVAD surgery. Results: The combined end point of all-cause mortality, acute kidney injury and/or renal replacement therapy, and right ventricular failure occurred more often in patients with an mPAP >25 mmHg (83 vs 0%, p = 0.017). Conclusion: This pilot study demonstrates that combining CardioMEMS monitoring with LVAD therapy is safe and generates the hypothesis that patients with an mPAP >25 mmHg before LVAD surgery identify a very high-risk group for adverse clinical outcomes.
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Affiliation(s)
- Jesse F Veenis
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Sumant P Radhoe
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Ozcan Birim
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Eric Boersma
- Department of Epidemiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Mattie J Lenzen
- Department of Epidemiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015GD, The Netherlands
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Symalla T, Jeevanandam V. Choosing the appropriate left ventricular assist device for your patient. Indian J Thorac Cardiovasc Surg 2020; 36:256-264. [PMID: 33061210 DOI: 10.1007/s12055-019-00890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022] Open
Abstract
The increasing incidence of advanced heart failure and severe donor organ shortage for cardiac transplant has led to the development of implantable left ventricular assist devices (LVAD) for long-term mechanical circulatory support. There has been tremendous improvement in the device technology of LVADs, and there are a number of devices in use throughout the world. This article reviews the evidence behind each device and their unique features that can help when choosing a durable LVAD for an individual patient.
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Affiliation(s)
- Trever Symalla
- Department of Surgery Section of Cardiac Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL 60637 USA
| | - Valluvan Jeevanandam
- Department of Surgery Section of Cardiac Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL 60637 USA
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Mirza KK, Gustafsson F. Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device. Card Fail Rev 2020; 6:e29. [PMID: 33133643 PMCID: PMC7592460 DOI: 10.15420/cfr.2020.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
Abstract
Continuous-flow left ventricular assist devices (LVAD) are increasingly used as destination therapy in patients with end-stage heart failure and, with recent improvements in pump design, adverse event rates are decreasing. Implanted patients experience improved survival, quality of life (QoL) and functional capacity (FC). However, improvement in FC and QoL after implantation is not unequivocal, and this has implications for patient selection and preimplantation discussions with patients and relatives. This article identifies preimplantation predictors of lack of improvement in FC and QoL after continuous-flow LVAD implantation and discusses potential mechanisms, allowing for the identification of potential factors that can be modified. In particular, the pathophysiology behind insufficient improvement in peak oxygen uptake is discussed. Data are included from 40 studies, resulting in analysis of >700 exercise tests. Mean peak oxygen uptake was 13.4 ml/kg/min (equivalent to 48% of predicted value; 259 days after implantation, range 31–1,017 days) and mean 6-minute walk test distance was 370 m (182 days after implantation, range 43–543 days). Finally, the interplay between improvement in FC and QoL is discussed.
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Affiliation(s)
- Kiran K Mirza
- Department of Cardiology, Rigshospitalet Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet Copenhagen, Denmark
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Sex Differences in Patients Receiving Left Ventricular Assist Devices for End-Stage Heart Failure. JACC-HEART FAILURE 2020; 8:770-779. [PMID: 32653446 DOI: 10.1016/j.jchf.2020.04.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study sought to use INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) results to evaluate sex differences in the use and clinical outcomes of left ventricular assist devices (LVAD). BACKGROUND Despite a similar incidence of heart failure in men and women, prior studies have highlighted potential underuse of LVADs in women, and studies of clinical outcomes have yielded conflicting results. METHODS Patients were enrolled from the INTERMACS study who underwent implantation of their first continuous-flow LVAD between 2008 and 2017, and survival analyses stratified by sex were conducted. RESULTS Among the 18,868 patients, 3,984 (21.1%) were women. At 1 year, women were less likely to undergo heart transplantation than men (17.9% vs. 20.0%, respectively; p = 0.003). After multivariable adjustments, women had a higher risk of death (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 1.07 to 1.23; p < 0.001) and were more likely to incur post-implantation adverse events, including rehospitalization, bleeding, stroke, and pump thrombosis or device malfunction. Although women younger than 50 years of age had an increased risk of death compared to men of the same age (HR: 1.34; 95% CI: 1.12 to 1.6), men and women 65 years of age and older had a similar risk of death (HR: 1.09; 95% CI: 0.95 to 1.24). CONCLUSIONS This study found that women had a higher risk of mortality and adverse events after LVAD. Only 1 in 5 LVADs were implanted in women, and women were less likely to receive a heart transplant than men. Further investigation is needed to understand the causes of adverse events and potential underuse of advanced treatment options in women.
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Lescroart M, Hébert JL, Vincent F, Nguyen LS. Pulsatility in ventricular assistance devices: A translational review focused on applied haemodynamics. Arch Cardiovasc Dis 2020; 113:461-472. [DOI: 10.1016/j.acvd.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022]
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Effect of the Center Post Establishment and Its Design Variations on the Performance of a Centrifugal Rotary Blood Pump. Cardiovasc Eng Technol 2020; 11:337-349. [PMID: 32410073 DOI: 10.1007/s13239-020-00464-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The main purpose is to compare the characteristics and performance of a centrifugal blood pump with and without center post. Furthermore, to propose a center post design guide for the development of centrifugal blood pumps: finding the appropriate height and diameter of the center post. METHODS A centrifugal blood pump with different center post configurations is investigated using Computational Fluid Dynamics (CFD) in an extensive parametric approach. Height and diameter of the center post are varied on 4 levels each. Pressure head and hydraulic efficiency curves, pressure and velocity contours and volumetric histograms of scalar shear stress (SSS) distribution are discussed in detail. RESULTS The simulation results show uniform pressure distribution around the casing in the baseline design. Although obtaining the minimum Normalized Index of Hemolysis (NIH), average scalar shear stress (ASSS), and volumetric percentage ratios (SSS > 9, 50 and 150 Pa), a stagnation and recirculation zone in the impeller eye above the casing bottom is detected in center post free (H = 0 mm) pump. With the establishment and further increase of the center post height, the stagnation zone disappears gradually. The results also indicate that flow recirculation and stagnation around the circumference of the center post occurs when the center post has a small diameter. As the diameter increases, a reversed flow is formed between the impeller and the center post. CONCLUSIONS The center post can greatly reduce the stagnation zone occurring in the center post free pump. The diameter of center post makes a difference to the flow field in the gap between the impeller and the center post.
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Gustafsson F, Mirza KK, Pya Y, Shaw S, Diegeler A, Netuka I, Lavee J, Garbade J, Morshuis M, Heatley J, Saeed D, Potapov E, Schmitto JD, Zimpfer D. Predictors of Physical Capacity 6 Months After Implantation of a Full Magnetically Levitated Left Ventricular Assist Device: An Analysis From the ELEVATE Registry. J Card Fail 2020; 26:580-587. [PMID: 32417377 DOI: 10.1016/j.cardfail.2020.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/22/2020] [Accepted: 04/06/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND In patients with a continuous-flow left ventricular assist device, preimplant predictors of poor physical performance are not well-described. We aimed to identify predictors of inability to walk more than 300 m on 6-minute walk test (6MWT) 6 months after HeartMate 3 implantation. METHODS AND RESULTS Using data from the European Registry of Patients Implanted With a Full Magnetically Levitated LVAD, patients with available 6MWT at 6 months after implantation were included (N = 194) and grouped according to 6MWT distance (6MWD) of >300 m (n = 150) or 6MWD of <300 m (n = 44). Patients walking <300 m were older (60 ± 10 vs 52 ± 12 years; P < .001), more often New York Heart Association functional class IV (63% vs 42%; P = .03), and more often had type 2 diabetes (43% vs 17%; P < .001) at implantation. Atrial fibrillation was seen in 57% in those with a 6MWT of <300 m vs 31% in those walking longer (P < .002). Further, hemoglobin and estimated glomerular filtration rate was lower in those walking <300 m (both P < .01). In multivariable regression analysis, independent predictors of a 6MWD of <300 m were: atrial fibrillation (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.12-8.67), older age (OR for 10-year increment, 2.81; 95% CI, 1.55-5.07), New York Heart Association functional class IV (OR, 3.37; 95% CI, 1.27-8.98), and Interagency Registry for Mechanically Assisted Circulatory Support profile 1 or 2 (OR, 6.53; 95% CI, 1.92-22.19). CONCLUSIONS Six months after HeartMate 3 implantation, 77% of patients walked >300 meters in 6 minutes. Apart from age and measures of heart failure severity, atrial fibrillation at implantation is an independent predictor of low 6MWD at 6 months after implantation.
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Affiliation(s)
- Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Kiran K Mirza
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Yuri Pya
- National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Steven Shaw
- Manchester University NHS Foundation Trust, Southmoor Road, Manchester, UK
| | - Anno Diegeler
- Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany
| | - Ivan Netuka
- Herzchirurgie, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Germany
| | - Jacob Lavee
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jens Garbade
- Heart Transplantation Unit, Leviev Heart Center, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michiel Morshuis
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Jerry Heatley
- Department of Cardiothoracic Surgery, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | - Evgenij Potapov
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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40
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Less Invasive Left Ventricular Assist Device Implantation Is Safe and Reduces Intraoperative Blood Product Use: A Propensity Score Analysis VAD Implantation Techniques and Blood Product Use. ASAIO J 2020; 67:47-52. [DOI: 10.1097/mat.0000000000001165] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Karason K, Lund LH, Dalén M, Björklund E, Grinnemo K, Braun O, Nilsson J, van der Wal H, Holm J, Hübbert L, Lindmark K, Szabo B, Holmberg E, Dellgren G. Randomized trial of a left ventricular assist device as destination therapy versus guideline-directed medical therapy in patients with advanced heart failure. Rationale and design of the SWEdish evaluation of left Ventricular Assist Device (SweVAD) trial. Eur J Heart Fail 2020; 22:739-750. [PMID: 32100946 DOI: 10.1002/ejhf.1773] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Patients with advanced heart failure (AdHF) who are ineligible for heart transplantation (HTx) can become candidates for treatment with a left ventricular assist device (LVAD) in some countries, but not others. This reflects the lack of a systematic analysis of the usefulness of LVAD systems in this context, and of their benefits, limitations and cost-effectiveness. The SWEdish evaluation of left Ventricular Assist Device (SweVAD) study is a Phase IV, prospective, 1:1 randomized, non-blinded, multicentre trial that will examine the impact of assignment to mechanical circulatory support with guideline-directed LVAD destination therapy (GD-LVAD-DT) using the HeartMate 3 (HM3) continuous flow pump vs. guideline-directed medical therapy (GDMT) on survival in a population of AdHF patients ineligible for HTx. METHODS A total of 80 patients will be recruited to SweVAD at the seven university hospitals in Sweden. The study population will comprise patients with AdHF (New York Heart Association class IIIB-IV, INTERMACS profile 2-6) who display signs of poor prognosis despite GDMT and who are not considered eligible for HTx. Participants will be followed for 2 years or until death occurs. Other endpoints will be determined by blinded adjudication. Patients who remain on study-assigned interventions beyond 2 years will be asked to continue follow-up for outcomes and adverse events for up to 5 years. CONCLUSION The SweVAD study will compare survival, medium-term benefits, costs and potential hazards between GD-LVAD-DT and GDMT and will provide a valuable reference point to guide destination therapy strategies for patients with AdHF ineligible for HTx.
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Affiliation(s)
- Kristjan Karason
- Departments of Cardiology and Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars H Lund
- Departments of Cardiology and Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Dalén
- Departments of Cardiology and Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Björklund
- Departments of Cardiology and Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Karl Grinnemo
- Departments of Cardiology and Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Oscar Braun
- Departments of Cardiology and Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Johan Nilsson
- Departments of Cardiology and Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Henriette van der Wal
- Departments of Cardiology and Cardiothoracic Surgery, Linköping University Hospital, Linköping, Sweden
| | - Jonas Holm
- Departments of Cardiology and Cardiothoracic Surgery, Linköping University Hospital, Linköping, Sweden
| | - Laila Hübbert
- Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Krister Lindmark
- Department of Cardiology, Umeå University Hospital, Umeå, Sweden
| | - Barna Szabo
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Erik Holmberg
- Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Dellgren
- Departments of Cardiothorax Surgery and Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
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42
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Improving Outcomes on Destination Therapy Will Define the Future of Assist Devices. ASAIO J 2020; 66:e78. [PMID: 32079827 DOI: 10.1097/mat.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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43
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Outflow graft twisting of Heartmate III left ventricular-assisted device: A case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 27:568-571. [PMID: 32082927 DOI: 10.5606/tgkdc.dergisi.2019.17871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/19/2019] [Indexed: 11/21/2022]
Abstract
Outflow graft twisting of Heartmate III left ventricular-assisted device is a rare device complication and, due to the recent reports from transplant centers, the firm and the United States Food and Drug Administration have announced explanatory measures. When the outflow graft twisting occurs, the diagnosis and treatment should be done without any delay due to serious decline in the device output and unstable hemodynamics. This article describes the first case of an outflow graft twisting in Turkey.
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44
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Assessment of the Flow Field in the HeartMate 3 Using Three-Dimensional Particle Tracking Velocimetry and Comparison to Computational Fluid Dynamics. ASAIO J 2020; 66:173-182. [DOI: 10.1097/mat.0000000000000987] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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45
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Veenis JF, Brugts JJ. Remote monitoring for better management of LVAD patients: the potential benefits of CardioMEMS. Gen Thorac Cardiovasc Surg 2020; 68:209-218. [PMID: 31981137 DOI: 10.1007/s11748-020-01286-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/31/2019] [Indexed: 12/17/2022]
Abstract
Left ventricular assist devices (LVAD) are frequently used in the treatment of end-stage heart failure (HF), and due to the shortage of heart donors and destination programs, it is likely to keep on growing. Still, LVAD therapy is not without complications and morbidity and rehospitalization rates are high. New ways to improve LVAD care both from the side of the patient and the physician are warranted. Remote monitoring could be a tool to tailor treatment in these patients, as no feedback exists at all about patient functioning on top of the static pump parameters. We aim to provide an overview and evaluation of the novel remote monitoring strategies to optimize LVAD management and elaborate on the opportunities of remote hemodynamic monitoring with CardioMEMS, at home in these patients as the next step to improve care.
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Affiliation(s)
- Jesse F Veenis
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands.
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46
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The Predicament of Gastrointestinal Bleeding in Patients With a Continuous-Flow Left Ventricular Assist Device: Pathophysiology, Evaluation, and Management. Cardiol Rev 2020; 27:222-229. [PMID: 30365405 DOI: 10.1097/crd.0000000000000235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heart failure affects over 5 million Americans, with numbers expected to rise. While heart transplantation is the most effective long-term strategy for end-stage heart failure, there is a limited cardiac donor pool, and these organs are often unavailable at the time of need. Left ventricular assist devices, therefore, continue to be used to bridge this gap. Originally implanted as a bridge to transplant, these devices are now additionally utilized as destination therapy for patients ineligible for transplant. With the widespread applicability of these devices for not just temporary measures, but also for prolonged use, the short- and long-term impact on other organ systems has become more evident. For example, gastrointestinal (GI) bleeding, with an incidence approaching 30%, is one such complication post-continuous-flow left ventricular assist device implantation. This high incidence of GI bleeding is thought to stem from a combination of factors, including the need for concomitant anticoagulant and antiplatelet therapy, and intrinsic device-related properties resulting in acquired Von Willebrand disease and arteriovenous malformations. Due to the significant morbidity associated with these GI bleeding events, a standardized protocol optimizing medical and endoscopic management, alongside close coordination between the gastroenterology and cardiology services, should be advocated for and ultimately employed.
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47
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Leebeek FWG, Muslem R. Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:88-96. [PMID: 31808855 PMCID: PMC6913502 DOI: 10.1182/hematology.2019000067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Chronic heart failure (HF) is a growing health problem, and it is associated with high morbidity and mortality. Left ventricular assist devices (LVADs) are nowadays an important treatment option for patients with end-stage HF not only as a bridging tool to heart transplantation but also, as a permanent therapy for end-stage HF (destination therapy). The use of LVAD is associated with a high risk for bleeding complications and thromboembolic events, including pump thrombosis and ischemic stroke. Bleeding is the most frequent complication, occurring in 30% to 60% of patients, both early and late after LVAD implantation. Although the design of LVADs has improved over time, bleeding complications are still the most common complication and occur very frequently. The introduction of an LVAD results in an altered hemostatic balance as a consequence of blood-pump interactions, changes in hemodynamics, acquired coagulation abnormalities, and the strict need for long-term anticoagulant treatment with oral anticoagulants and antiplatelet therapy. LVAD patients may experience an acquired coagulopathy, including platelet dysfunction and impaired von Willebrand factor activity, resulting in acquired von Willebrand syndrome. In this educational manuscript, the epidemiology, etiology, and pathophysiology of bleeding in patients with LVAD will be discussed. Because hematologist are frequently consulted in cases of bleeding problems in these individuals in a critical care setting, the observed type of bleeding complications and management strategies to treat bleeding are also reviewed.
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Affiliation(s)
| | - R Muslem
- Cardio-Thoracic Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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48
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Lanfear AT, Hamandi M, Fan J, DiMaio JM, George TJ. Trends in HeartMate 3: What we know so far. J Card Surg 2019; 35:180-187. [PMID: 31692113 DOI: 10.1111/jocs.14319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The HeartMate 3 left ventricular assist device (LVAD) is a novel, intrapericardial, centrifugal-flow pump with a fully magnetically-levitated rotor designed to provide hemodynamic support in patients with end-stage heart failure. Unique aspects of this LVAD have allowed for improved hemocompatibility and the development of minimally-invasive implantation techniques. METHODS The PubMed, EMBASE, and Google Scholar databases were searched for publications relating to the HeartMate 3 device, with a focus on hemocompatibility related outcomes, anticoagulation management, and surgical techniques. RESULTS Nine articles analyzing hemocompatibility related outcomes from two clinical trials, two clinical studies, and one registry series were identified. CONCLUSION HeartMate 3 has reduced the rate of disabling stroke and pump thrombosis. However, despite increased hemocompatibility due to specialized design features, the residual risk of both surgical, and gastrointestinal bleeding remains a major adverse outcome. Different anticoagulation management and surgical techniques have been evaluated to address the remaining complications.
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Affiliation(s)
- Allison T Lanfear
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Mohanad Hamandi
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Joy Fan
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - J Michael DiMaio
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas.,Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Timothy J George
- Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital, Plano, Texas
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Miller PE, Caraballo C, Ravindra NG, Mezzacappa C, McCullough M, Gruen J, Levin A, Reinhardt S, Ali A, Desai NR, Ahmad T. Clinical Implications of Respiratory Failure in Patients Receiving Durable Left Ventricular Assist Devices for End-Stage Heart Failure. Circ Heart Fail 2019; 12:e006369. [DOI: 10.1161/circheartfailure.119.006369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:
The impact of respiratory failure on patients undergoing left ventricular assist device (LVAD) implantation is not well understood, especially since these patients were excluded from landmark clinical trials. We sought to evaluate the associations between immediate preimplant and postimplant respiratory failure on outcomes in advanced heart failure patients undergoing LVAD implantation.
Methods and Results:
We included all patients in the Interagency Registry for Mechanically Assisted Circulatory Support who were implanted with continuous-flow LVADs from 2008 to 2016. Of the 16 362 patients who underwent continuous-flow LVAD placement, 906 (5.5%) required preimplant intubation within 48 hours before implantation, and 1001 (6.1%) patients developed respiratory failure within 1 week after implantation. A higher proportion of patients requiring preimplant intubation were Interagency Registry for Mechanically Assisted Circulatory Support profile 1, required mechanical circulatory support, and presented with cardiac arrest or myocardial infarction (
P
<0.001, all). At 1 year, 54.3% of patients intubated preimplant were alive without transplant, 20.1% had been transplanted, and 24.2% died before transplant. Patients requiring preimplant intubation had higher rates of postimplant complications, including bleeding, stroke, and right ventricular assist device implantation (
P
<0.01 for all). Among Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients, preimplant intubation incurred additional risk of death at 1 year compared with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients not intubated (hazard ratio, 1.37 [95% CI, 1.13–1.65];
P
=0.001). After multivariable analysis, both preimplant intubation (hazard ratio, 1.20 [95% CI, 1.03–1.41];
P
=0.021) and respiratory failure within 1 week (hazard ratio, 2.54 [95% CI, 2.26–2.85];
P
<0.001) were associated with higher all-cause 1-year mortality.
Conclusions:
Respiratory failure both before and after LVAD implantation identifies an advanced heart failure population with significantly worse 1-year mortality. This data might be helpful in counseling patients and their families about expectations about life with an LVAD.
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Affiliation(s)
- P. Elliott Miller
- Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
- Yale National Clinician Scholars Program (P.E.M.), Yale University School of Medicine, New Haven, CT
| | - Cesar Caraballo
- Center for Outcomes Research & Evaluation (CORE) (C.C., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
| | - Neal G. Ravindra
- Department of Molecular Biophysics and Biochemistry (N.G.R.), Yale University School of Medicine, New Haven, CT
- Integrated Graduate Program in Physical and Engineering Biology (N.G.R.), Yale University School of Medicine, New Haven, CT
| | - Catherine Mezzacappa
- Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT
| | - Megan McCullough
- Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT
| | - Jadry Gruen
- Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT
| | - Andrew Levin
- Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT
| | - Samuel Reinhardt
- Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
| | - Ayyaz Ali
- Section of Cardiovascular Surgery (A.A.), Yale University School of Medicine, New Haven, CT
| | - Nihar R. Desai
- Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
- Center for Outcomes Research & Evaluation (CORE) (C.C., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
| | - Tariq Ahmad
- Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
- Center for Outcomes Research & Evaluation (CORE) (C.C., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
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Thiha S, Zaidi ARZ, Robert CA, Abbas MK, Malik BH. A Rising Hope of an Artificial Heart: Left Ventricular Assisted Device - Outcome, Convenience, and Quality of Life. Cureus 2019; 11:e5617. [PMID: 31696010 PMCID: PMC6820898 DOI: 10.7759/cureus.5617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Abstract
With the introduction of mechanical circulatory support, mainly continuous-flow left ventricular assisted devices (CF-LVAD), prolonging survival in end-stage heart failure patients can be seen in a new light. We also anticipate its use as a definitive therapy to overcome the limited donor organ resources for cardiac transplant. However, LVADs also have undesirable device-related complications and questionable improvement in the quality of life. In this review, we searched published articles using PubMed and Google Scholar to identify the complications and outcome of post-LVAD patients from 2014 to 2019. The studies we used included all study design types and a wide range of demographic variables focusing on age, sex, choice of LVAD as a bridge to cardiac transplant, or definitive therapy. For patients with New York Heart Association (NYHA) Class III B or IV or heart failure with reduced ejection fraction (HFrEF) with maximal medication therapy, there is a significant increase in mean ejection fraction from 4% to 6%. For patients with drug-induced cardiac toxicity or other causes of cardiac toxicity, with no significant risk factors, the ejection fraction increased to nearly 50% within 10-25 days of LVAD usage. There is also a substantial improvement in the quality of life in this literature review comparing to the pre-LVAD stage, as long as complications are taken into account. Data is limited for making an accurate judgment on the quality of life and functional capacity of LVADs. We found that the use of LVADs is not fully cost-effective, but still less financially burdening than a cardiac transplant. Although data from worldwide is limited and restricted to studies having a range of one to two years of follow-up, we conclude that LVADs are promising in improving cardiac function and the best bridging therapy available for patients waiting on a transplant.
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Affiliation(s)
- Suyeewin Thiha
- Internal Medicine, California Institute of Behavioural Neurosciences and Psychology, Fairfield, USA
| | | | | | - Mohammed K Abbas
- Internal Medicine, California Instititute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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