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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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Arjomandi Rad A, Kapadia S, Zubarevich A, Nanchahal S, Van den Eynde J, Vardanyan R, Bareka M, Krasopoulos G, Quarto C, Ruhparwar A, Athanasiou T, Weymann A. Sex disparities in left ventricular assist device implantation outcomes: A systematic review and meta-analysis of over 50 000 patients. Artif Organs 2023; 47:273-289. [PMID: 36461903 DOI: 10.1111/aor.14469] [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: 09/28/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVAD) represent an important therapeutic option for patients progressing to end-stage heart failure. Women have been historically underrepresented in LVAD studies, and have been reported to have worse outcomes despite technological optimisation. We aimed to systematically explore the evidence on sex disparities in the use and outcomes of LVAD implantation. METHODS A systematic database search with meta-analysis was conducted of comparative original articles of men versus women undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to July 2022. Primary outcomes were stroke (haemorrhagic and ischaemic) and early/overall mortality. Secondary outcomes were LVAD thrombosis, right VAD implantation, major bleeding, kidney dysfunction, and device/driveline infection. RESULTS Our search yielded 137 relevant studies, including 22 meeting the inclusion criteria with a total of 53 227 patients (24.2% women). Overall mortality was higher in women (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.05-1.62, p = 0.02), as was overall stroke (OR 1.32, 95%CI 1.06-1.66, p = 0.01), including ischemic (OR 1.80, 95%CI 1.22-2.64, p = 0.003) and haemorrhagic (OR 1.72, 95%CI 1.09-2.70, p = 0.02). Women had more frequent right VAD implantation (OR 2.11, 95%CI 1.24-3.57, p = 0.006) and major bleeding (OR 1.40, 95%CI 1.06-1.85, p = 0.02). Kidney dysfunction, LVAD thrombosis, and device/driveline infections were comparable between sexes. CONCLUSIONS Our analysis suggests that women face a greater risk of adverse events and mortality post-LVAD implantation. Although the mechanisms remain unclear, the difference in outcomes is thought to be multifactorial. Further research, that includes comprehensive pre-operative characteristics and post-operative outcomes, is encouraged.
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Affiliation(s)
- Arian Arjomandi Rad
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Sharan Kapadia
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Sukanya Nanchahal
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Metaxia Bareka
- Department of Anaesthesiology, University of Laryssa, Laryssa, Greece
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospital NHS Trust, Oxford, UK
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Trust, London, UK
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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3
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Rodenas-Alesina E, Brahmbhatt DH, Rao V, Salvatori M, Billia F. Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review. Front Cardiovasc Med 2022; 9:1040251. [PMID: 36407460 PMCID: PMC9671519 DOI: 10.3389/fcvm.2022.1040251] [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: 09/09/2022] [Accepted: 10/18/2022] [Indexed: 08/26/2023] Open
Abstract
Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Cardiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Darshan H. Brahmbhatt
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Vivek Rao
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Marcus Salvatori
- Department of Anesthesia, University Health Network, Toronto, ON, Canada
| | - Filio Billia
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
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Rubinstein G, Lotan D, Moeller CM, DeFilippis EM, Slomovich S, Oren D, Yuzefpolskaya M, Sayer G, Uriel N. Sex differences in patients undergoing heart transplantation and LVAD therapy. Expert Rev Cardiovasc Ther 2022; 20:881-894. [PMID: 36409479 DOI: 10.1080/14779072.2022.2149493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Left ventricular assist device (LVAD) and heart transplantation (HT) are the two life-sustaining therapies that have revolutionized the management of end-stage heart failure (HF). Yet, significant sex differences exist with respect to their use and effects. AREAS COVERED This review summarizes sex differences in the utilization, outcomes, and complications of LVAD and HT. Particular emphasis is placed on leading clinical trials in the field, historical and recent large registries-based analyses, as well as contemporary technological and policy changes affecting these differences. EXPERT OPINION Women with advanced HF remain under-treated with guideline-directed medical therapy and are less likely to be referred for consideration for LVAD and HT. This remains true despite newer LVAD technology and the new heart transplant allocation system. Community outreach, education, as well as increased representation of women in clinical research may reduce inequities.
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Affiliation(s)
- Gal Rubinstein
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
| | - Dor Lotan
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
| | - Cathrine M Moeller
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
| | - Ersilia M DeFilippis
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
| | - Sharon Slomovich
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
| | - Daniel Oren
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
| | - Gabriel Sayer
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Center of Advance Cardiac Care, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, New York, NY, USA
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Bourque K, Fraser CE, Lorts A, Molina EJ, Kormos RL, Naka Y, Sheikh FH, Uriel NY, Morales DLS. Special Considerations for Durable Left Ventricular Assist Device Use in Small Patients. ASAIO J 2022; 68:619-622. [PMID: 35275881 DOI: 10.1097/mat.0000000000001716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | - Angela Lorts
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ezequiel J Molina
- MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | | | - Yoshifumi Naka
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Farooq H Sheikh
- MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | - Nir Y Uriel
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
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Outcomes in Smaller Body Size Adults after HeartMate 3 Left Ventricular Assist Device Implantation. Ann Thorac Surg 2022; 114:2262-2269. [PMID: 35452663 DOI: 10.1016/j.athoracsur.2022.03.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Outcomes in patients with smaller body size following HeartMate 3 Left Ventricular Assist Device (HM3) implantation are not well characterized. We sought to evaluate outcomes in smaller vs. larger BSA patients in the MOMENTUM 3 pivotal trial and its Continued Access Protocol cohort. METHODS The analysis cohort included 1015 HM3 patients divided into 2 groups: BSA≤1.70 m2 (small patients, n=82) and BSA>1.70 m2 (large patients, n=933). The composite primary endpoint was survival at 2-years free of disabling stroke or reoperation to replace or remove a malfunctioning device. Adverse events were compared between groups. RESULTS Smaller patients were more frequently women (56.1% vs. 17.7%, P<.001), had lower prevalence of diabetes (28.1% vs. 43.9%, P=.005) and hypertension (51.2% vs. 71.9%, P<.001), larger median indexed LVEDD (normalized by BSA, 40 vs. 33 mm/m2, P<.001), and lower median serum creatinine (1.1 vs. 1.3 mg/dl, P<.001). The proportion of patients achieving the composite endpoint at 2-years was 77% in both groups (adjusted HR = 1.14 [95% confidence interval: 0.68-1.91], P=.62). Two-year adverse event rates were also similar between groups except for sepsis (6.1% vs. 14.9%, P=.029) and cardiac arrhythmias (24.4% vs. 35.3%, P=.005), which were higher in the larger patients. CONCLUSIONS Outcomes following HM3 implantation were comparable between small and large patients. Smaller body size should not be used to deny HM3 implantation in patients who are otherwise suitable durable MCS candidates.
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Tonai K, Fukushima S, Tadokoro N, Kainuma S, Kawamoto N, Kakuta T, Koga-Ikuta A, Watanabe T, Seguchi O, Tsukamoto Y, Fukushima N, Fujita T. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:902-908. [PMID: 35106562 PMCID: PMC9070502 DOI: 10.1093/icvts/ivac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kohei Tonai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ayumi Koga-Ikuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasumasa Tsukamoto
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Corresponding author. Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka 564-8565, Japan. Tel: +81-6-6170-1070; fax: +81-6-6170-1424; e-mail: (T. Fujita)
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8
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Performance of the Jarvik 2000 left ventricular assist device on mid-term hemodynamics and exercise capacity. J Artif Organs 2021; 25:204-213. [PMID: 34826019 DOI: 10.1007/s10047-021-01302-3] [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: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
The hemodynamic and exercise capacity performance of the Jarvik 2000 left ventricular assist device (LVAD), which is generally used in patients with small body size and relatively preserved cardiac function, is not well understood. We retrospectively examined 18 patients implanted with the Jarvik 2000 LVAD. Pump rotation speed was optimized by the hemodynamic ramp test one year after implantation based on the criteria of mean pulmonary capillary wedge pressure (PCWP) < 18 mmHg, mean right atrial pressure (RAP) < 12 mmHg, and cardiac index (CI) > 2.2 L/min/m2 as well as echocardiographic parameters. Exercise capacity was assessed by cardiopulmonary exercise test in an optimized setting. To investigate the impacts of larger body surface area (BSA) and extremely impaired pre-implantation cardiac function on hemodynamics and exercise capacity, two correlation analyses based on BSA and original CI were performed. At a pump speed of 9500 ± 707 rpm, the mean pulmonary artery pressure, PCWP, RAP, and CI were 17 ± 5 mmHg, 9 ± 5 mmHg, 6 ± 4 mmHg, and 2.82 ± 0.54 L/min/m2, respectively. Only one patient failed to achieve the hemodynamic criteria. The peak VO2 and VE/VCO2 slope were 12.9 ± 3.1 mL/min/kg and 37.7 ± 15.0, respectively. There was an inverse correlation between original CI and heart rate (r = -0.60, p = 0.01), and a weak correlation between BSA and PCWP (r = 0.43, p = 0.08). Based on this study, the overall performance of the Jarvik 2000 device was acceptable, and the patients' body size and original cardiac function had minimum effect on the performance of this device.
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Molina E, Jain A, Ahmed S, Lam P, Rao S, Hockstein M, Kadakkal A, Hofmeyer M, Rodrigo M, Chou J, Najjar S, Sheikh F. The impact of left ventricular size on outcomes after centrifugal-flow left ventricular assist device implantation. Eur J Cardiothorac Surg 2021; 62:6425613. [PMID: 34788417 DOI: 10.1093/ejcts/ezab480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The influence of preoperative left ventricular size in outcomes following centrifugal-flow left ventricular assist device (LVAD) implantation has not been well characterized. METHODS A cohort of 313 patients who received a centrifugal-flow LVAD at a single institution was analysed. Using a maximally selected log-rank statistic, we investigated whether a left ventricular end-diastolic dimension (LVEDD) cut-off point was associated with worse outcomes. The cohort was then divided in 2 groups based on the LVEDD cut-off point. RESULTS An LVEDD cut-off point of 59 mm was found to predict worse survival. Smaller LVEDD patients (≤59 mm, N = 52) were older and more likely to have a history of coronary artery disease compared those with a larger LVEDD (>59 mm, N = 261). Smaller LVEDD patients had lower survival compared to larger LVEDD patients (71% vs 85% at 1 year and 58% vs 80% at 2 years, P = 0.003). The need for temporary right ventricular mechanical support was significantly higher in the smaller LVEDD cohort (11.5% vs 1.9%, P = 0.002). Pump flows at time of discharge were lower in the smaller LVEDD group (3.8 vs 4.2 l/min, P = 0.005), who also had a higher incidence of late right ventricular failure (23% vs 12%, P = 0.02), higher rates of gastrointestinal bleeding (0.416 vs 0.256 events per patient-year, P = 0.025) and higher readmissions secondary to low flow alarms (0.429 vs 0.240 events per patient-year, P = 0.007). Multivariable analysis demonstrated that smaller LVEDD, older age, high BUN and high bilirubin levels were independent predictors of worse survival. CONCLUSIONS In patients receiving a centrifugal-flow LVAD, smaller preoperative LVEDD (≤59 mm) was associated with lower survival and higher incidence of adverse outcomes.
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Affiliation(s)
- Ezequiel Molina
- Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, DC, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Amiti Jain
- Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, DC, USA
| | - Sara Ahmed
- Department of Cardiology, Advanced Heart Failure Program, Medstar Washington Hospital Center, Washington, DC, USA
| | - Phillip Lam
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Washington Hospital Center, Washington, DC, USA
| | - Sriram Rao
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Washington Hospital Center, 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 Washington Hospital Center, Washington, DC, USA
| | - Mark Hofmeyer
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Washington Hospital Center, Washington, DC, USA
| | - Maria Rodrigo
- Department of Cardiology, Advanced Heart Failure Program, Medstar Washington Hospital Center, Washington, DC, USA
| | - JiLing Chou
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, MD, USA
| | - Samer Najjar
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Washington Hospital Center, Washington, DC, USA
| | - Farooq Sheikh
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Washington Hospital Center, Washington, DC, USA
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10
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Krzelj K, Petricevic M, Gasparovic H, Biocina B, McGiffin D. Ventricular Assist Device Driveline Infections: A Systematic Review. Thorac Cardiovasc Surg 2021; 70:493-504. [PMID: 34521143 DOI: 10.1055/s-0041-1731823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infection is the most common complication in patients undergoing ventricular assist device (VAD) implantation. Driveline exit site (DLES) infection is the most frequent VAD infection and is a significant cause of adverse events in VAD patients, contributing to morbidity, even mortality, and repetitive hospital readmissions. There are many risk factors for driveline infection (DLI) including younger age, smaller constitution of patients, obesity, exposed velour at the DLES, longer duration of device support, lower cardiac index, higher heart failure score, DLES trauma, and comorbidities such as diabetes mellitus, chronic kidney disease, and depression. The incidence of DLI depends also on the device type. Numerous measures to prevent DLI currently exist. Some of them are proven, whereas the others remain controversial. Current recommendations on DLES care and DLI management are predominantly based on expert consensus and clinical experience of the certain centers. However, careful and uniform DLES care including obligatory driveline immobilization, previously prepared sterile dressing change kits, and continuous patient education are probably crucial for prevention of DLI. Diagnosis and treatment of DLI are often challenging because of certain immunological alterations in VAD patients and microbial biofilm formation on the driveline surface areas. Although there are many conservative and surgical methods described in the DLI treatment, the only possible permanent solution for DLI resolution in VAD patients is heart transplantation. This systematic review brings a comprehensive synthesis of recent data on the prevention, diagnostic workup, and conservative and surgical management of DLI in VAD patients.
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Affiliation(s)
- Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Mate Petricevic
- Division of Health Studies, Department of Cardiac Surgery, University of Split, University Hospital Center Zagreb, Zagreb, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - David McGiffin
- Department of Cardiothoracic Surgery and Transplantation, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
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11
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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: 7] [Impact Index Per Article: 1.8] [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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12
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Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 750] [Impact Index Per Article: 187.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
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Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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13
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14
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Frech A, Tarrence J, Natale G, Tumin D. Ventricular Assist Device Technology and Black-White Disparities on the Heart Transplant Wait List. Prog Transplant 2020; 31:80-87. [DOI: 10.1177/1526924820978591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Heart transplantation is the definitive treatment for end-stage heart failure. Left ventricular assist devices (LVADs) are a continually improving technology that extends life for some candidates on the heart transplant waiting list. Research Questions: Our objective is to compare Black-White differences in LVAD implantation and heart transplant outcomes during a period of technological innovation when the pulsatile flow LVAD was largely replaced by the continuous flow LVAD between 1999-2014. Design: We used transplant registry data from the United Network for Organ Sharing (N = 5,550) to identify Black and White patients with heart failure who used an LVAD as a bridge-to-transplant (BTT). Using logistic regression, we compared Black-White differences in access to newer LVAD technology and timing of implantation relative to wait listing for heart transplantation. We used competing-risks event history models to predict transplant outcomes across race, LVAD type, and timing of LVAD implantation. Results: Black and White candidates were equally likely to receive newer continuous flow LVADs, but Black candidates received LVADs later in the disease course (i.e. after transplant listing). This later timing of technological intervention contributed to poorer wait list outcomes among black transplant candidates, including lower likelihood of receiving a heart transplant and greater likelihood of being removed from the wait list due to worsening health. Discussion: Delayed LVAD implantation is more common among Black patients and is associated with poorer transplant outcomes.
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Affiliation(s)
- Adrianne Frech
- Department of Health Sciences, University of Missouri, Columbia, MO, USA
| | - Jake Tarrence
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Ginny Natale
- Program on Public Health, Stony Brook University, Stony Brook, NY, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
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15
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Huckaby LV, Seese LM, Aranda-Michel E, Mathier MA, Hickey G, Keebler ME, Sultan I, Gleason TG, Kilic A. Sex-Based Heart Transplant Outcomes After Bridging With Centrifugal Left Ventricular Assist Devices. Ann Thorac Surg 2020; 110:2026-2033. [PMID: 32376349 DOI: 10.1016/j.athoracsur.2020.03.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/22/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prior studies demonstrated that female sex is associated with an increased mortality after orthotopic heart transplantation (OHT). The impact of sex on OHT outcomes after bridging with newer-generation durable left ventricular assist devices (LVADs) remains unclear. METHODS The United Network for Organ Sharing database was queried to study OHT recipients bridged with a newer-generation LVAD (ie, HeartMate III or HeartWare) between 2010 and 2018. The primary outcome was mortality at 30 and 90-days and 1-year. Secondary outcomes included rates of posttransplant complications. Propensity score matching and Cox multivariable analysis were used to assess comorbidity-adjusted sex differences in outcomes. RESULTS A total of 3010 patients (76.7% male) bridged with newer-generation LVADs underwent OHT. After adjusting for relevant covariates, both age and heart failure etiology, but not sex, were independent predictors of mortality. In the matched cohorts, sex did not affect posttransplant outcomes, including renal failure, cerebrovascular events, allograft rejection, functional status, or mortality (all P > .05). Survival at 1-year after OHT was 90.5% in males and 92.8% in females (P = .058). CONCLUSIONS Among 3010 OHT recipients, matched females bridged with newer-generation HeartWare or HeartMate III LVADs have comparable posttransplant outcomes compared with males. Furthermore, survival at 1-year follow-up was not affected by sex; instead, it was driven by well-established risk factors including increased age, worse preoperative renal function, and heart failure etiology. These data suggest that considerable progress has been made in mitigating sex differences in heart failure outcomes in the modern era.
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Affiliation(s)
- Lauren V Huckaby
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laura M Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael A Mathier
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gavin Hickey
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary E Keebler
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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16
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Chivukula VK, Beckman JA, Prisco AR, Lin S, Dardas TF, Cheng RK, Farris SD, Smith JW, Mokadam NA, Mahr C, Aliseda A. Small Left Ventricular Size Is an Independent Risk Factor for Ventricular Assist Device Thrombosis. ASAIO J 2020; 65:152-159. [PMID: 29677037 DOI: 10.1097/mat.0000000000000798] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The prevalence of ventricular assist device (VAD) therapy has continued to increase due to a stagnant donor supply and growing advanced heart failure (HF) population. We hypothesize that left ventricular (LV) size strongly influences biocompatibility and risk of thrombosis. Unsteady computational fluid dynamics (CFD) was used in conjunction with patient-derived computational modeling and virtual surgery with a standard, apically implanted inflow cannula. A dual-focus approach of evaluating thrombogenicity was employed: platelet-based metrics to characterize the platelet environment and flow-based metrics to investigate hemodynamics. Left ventricular end-diastolic dimensions (LVEDds) ranging from 4.5 to 6.5 cm were studied and ranked according to relative thrombogenic potential. Over 150,000 platelets were individually tracked in each LV model over 15 cardiac cycles. As LV size decreased, platelets experienced markedly increased shear stress histories (SHs), whereas platelet residence time (RT) in the LV increased with size. The complex interplay between increased SH and longer RT has profound implications on thrombogenicity, with a significantly higher proportion of platelets in small LVs having long RT times and being subjected to high SH, contributing to thrombus formation. Our data suggest that small LV size, rather than decreased VAD speed, is the primary pathologic mechanism responsible for the increased incidence of thrombosis observed in VAD patients with small LVs.
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Affiliation(s)
| | | | - Anthony R Prisco
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Shin Lin
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Todd F Dardas
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Stephen D Farris
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Jason W Smith
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - Nahush A Mokadam
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, Washington
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17
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Left Ventricular Assist Device Inflow Cannula Insertion Depth Influences Thrombosis Risk. ASAIO J 2019; 66:766-773. [DOI: 10.1097/mat.0000000000001068] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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18
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Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Färber G, Hannan MM, Kukucka M, de Jonge N, Loforte A, Lund LH, Mohacsi P, Morshuis M, Netuka I, Özbaran M, Pappalardo F, Scandroglio AM, Schweiger M, Tsui S, Zimpfer D, Gustafsson F. 2019 EACTS Expert Consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg 2019; 56:230-270. [PMID: 31100109 PMCID: PMC6640909 DOI: 10.1093/ejcts/ezz098] [Citation(s) in RCA: 268] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.
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Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Christiaan Antonides
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain
| | - Alain Combes
- Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de médecine intensive-réanimation, Institut de Cardiologie, APHP, Hôpital Pitié–Salpêtrière, Paris, France
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Margaret M Hannan
- Department of Medical Microbiology, University College of Dublin, Dublin, Ireland
| | - Marian Kukucka
- Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antonio Loforte
- Department of Cardiothoracic, S. Orsola Hospital, Transplantation and Vascular Surgery, University of Bologna, Bologna, Italy
| | - Lars H Lund
- Department of Medicine Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Solna, Sweden
| | - Paul Mohacsi
- Department of Cardiovascular Surgery Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege University, Izmir, Turkey
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Cardiac Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Zurich Children's Hospital, Zurich, Switzerland
| | - Steven Tsui
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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19
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Chen S, Cantor RS, Auerbach S, Schumacher K, Almond CS, Eghtesady P, Alejos J, Das BB, Hong BJ, Jaquiss RDB, Kirklin JK, Jeewa A. Outcomes After Infections in Adolescents and Young Adults with Continuous-Flow Left Ventricular Assist Devices. ASAIO J 2019; 65:380-388. [PMID: 29762230 DOI: 10.1097/mat.0000000000000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infections in adult ventricular assist device patients increase subsequent mortality and stroke risk. Less is known about outcomes after infections in younger patients, where diabetes and obesity, risk factors associated with poor outcomes, are less prevalent. The purpose of this study was to examine outcomes after infections in adolescents and young adults with continuous-flow left ventricular assist devices (VAD) bridged to transplant. From Pediatric Interagency Registry for Mechanically Assisted Circulatory Support and Interagency Registry for Mechanical Circulatory Support registries, we identified patients aged 12-29 years with continuous-flow VADs implanted as bridged to transplant from September 2012 to March 2016. The primary predictor variable was first reported infection. The primary outcome was death on VAD support; secondary outcome was clinical stroke. Kaplan-Meier and Cox proportional hazard methods were used to compare outcomes between patients before or without infection and patients after infection. Ninety-two adolescents (12-18 years of age) and 224 young adults (19-29 years of age) with 3,748 patient-months of follow-up were included. Adolescents were smaller (body surface area 1.7 vs. 2.0 m, p < 0.01) and implanted at higher Interagency Registry for Mechanical Circulatory Support profiles (p = 0.005); there were no differences in diabetes and obesity, and survival on VAD was similar (p = 0.22). Among adolescents but not young adults, mortality increased after infection (hazard ratio 8.2, 95% confidence interval 1.6-42.6, p = 0.01). In contrast, stroke risk increased after infection in young adults (hazard ratio 3.1, 95% confidence interval 1.3-7.6, p = 0.01) but not in adolescents. Despite similar underlying risk factors, adolescents have increased mortality after infections, whereas young adults have increased strokes after infections. Both pre- and postimplant factors likely contribute to the discrepancy in outcomes between the two age cohorts.
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Affiliation(s)
- Sharon Chen
- From the Stanford University, Palo Alto, California
| | - Ryan S Cantor
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
- Kirklin Institute for Research and Surgical Outcomes, The University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Juan Alejos
- University of California, Los Angeles, California
| | - Bibhuti B Das
- Joe DiMaggio Children's Hospital, Hollywood, Florida
| | | | | | - James K Kirklin
- Kirklin Institute for Research and Surgical Outcomes, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Aamir Jeewa
- The Hospital for Sick Children, Toronto, Canada
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20
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Mechanical circulatory support challenges in pediatric and (adult) congenital heart disease. Curr Opin Organ Transplant 2018; 23:301-307. [DOI: 10.1097/mot.0000000000000522] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Seguchi O, Kuroda K, Kumai Y, Nakajima S, Yanase M, Wada K, Matsumoto Y, Fukushima S, Fujita T, Kobayashi J, Fukushima N. Clinical Outcomes of Patients With the HeartMate II Left Ventricular Assist Device: A Single-center Experience From Japan. Transplant Proc 2018; 50:2726-2732. [PMID: 30401385 DOI: 10.1016/j.transproceed.2018.03.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/02/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Left ventricular assist device (LVAD) therapy is the "gold standard" alternative therapy for patients with advanced heart failure. However, LVAD therapy is still uncommon in the Asia-Pacific region. Therefore, we aimed to elucidate the clinical outcomes of patients from Japan supported with the HeartMate II (HM-II) LVAD at our institution. METHODS Ninety-two patients (mean 44.3 ± 12.1 years, 68 men, average body mass index 1.65 ± 0.28 m2; 81 with nonischemic cardiomyopathy) who underwent HM-II implantation for bridge to transplantation (n = 91) or for destination therapy in a clinical study (n = 1) at the National Cerebral and Cardiovascular Center between April 2013 and October 2017 were enrolled in this analysis. Preoperatively, most patients (n = 73, 79%) had an INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile of between level 2 and 4. Postoperatively, the average pump speed was 8602 ± 258 rpm and the hemodynamics were well compensated. RESULTS Adverse events consisted of 38 (41.3%) hemolysis, 30 (32.6%) major infection, 27 (29.3%) major bleeding (6 [6.5%] with gastrointestinal bleeding), and 18 (19.6%) neurologic dysfunction events. Eighteen patients underwent heart transplantation (HTx) after an average of 32.9 ± 8.9 months of VAD support, and overall survival at both 6 months and 3 years was 96.3%. CONCLUSION Clinical outcome among patients with HM-II at our institution is satisfactory for both survival and adverse events. The HM-II can provide effective hemodynamic support during the extremely long waiting period for HTx in Japan.
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Affiliation(s)
- O Seguchi
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - K Kuroda
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Kumai
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - S Nakajima
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - M Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - K Wada
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Matsumoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - S Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - T Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - J Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - N Fukushima
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
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22
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Long-Term Pediatric Ventricular Assist Device Therapy: A Case Report of 2100+ Days of Support. ASAIO J 2018; 64:e1-e2. [DOI: 10.1097/mat.0000000000000546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Ward ST, Liang Q, Pagani FD, Zhang M, Kormos RL, Aaronson KD, Althouse AD, Nallamothu BK, Likosky DS. A roadmap for evaluating the use and value of durable ventricular assist device therapy. J Heart Lung Transplant 2018; 37:146-150. [PMID: 28711453 PMCID: PMC6746232 DOI: 10.1016/j.healun.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
Heart failure is a disease characterized by profound human suffering with limitations in survival despite treatment with guideline-directed medical therapies. Patients with heart failure frequently progress to advanced stages and often require cardiac transplantation or implantation of left ventricular assist devices (LVADs) to extend survival and improve quality of life. As the number of suitable heart donors, number of experienced medical centers and patient comorbidities place restrictions on the feasibility of cardiac transplantation, implantation of LVADs has emerged as a more frequently applied treatment as either a bridge to transplantation or as permanent therapy. Considerable data have documented improvements in survival, functional status and quality of life offered by LVADs, however, few studies have focused on identifying: (1) determinants of LVAD use across medical centers, (2) the relationship between the determinants of LVAD use and value (defined as quality divided by cost), and (3) how determinants of LVAD use are influenced or impacted by vulnerable populations. We propose a conceptual model that integrates the main determinants of LVAD utilization, which include technology, insurance coverage, market-, provider- and patient-level factors. We propose this paradigm as a necessary prerequisite for understanding LVAD usage and value. This conceptual framework provides a broader view for future studies, which are needed to inform emerging healthcare policies that influence dissemination of this expensive but life-prolonging medical therapy.
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Affiliation(s)
- Sarah T Ward
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Qixing Liang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Min Zhang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert L Kormos
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Keith D Aaronson
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew D Althouse
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
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24
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Stone ME, Pawale A, Ramakrishna H, Weiner MM. Implantable Left Ventricular Assist Device Therapy-Recent Advances and Outcomes. J Cardiothorac Vasc Anesth 2017; 32:2019-2028. [PMID: 29338999 DOI: 10.1053/j.jvca.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Marc E Stone
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Mount Sinai Medical Center, New York, NY
| | - Amit Pawale
- Department of Cardiac Surgery, Mount Sinai Medical Center, New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ.
| | - Menachem M Weiner
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Mount Sinai Medical Center, New York, NY
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25
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Doenst T, Essa Y, Jacoub K, Moschovas A, Gonzalez-Lopez D, Kirov H, Diab M, Bargenda S, Faerber G. Cardiac surgery 2016 reviewed. Clin Res Cardiol 2017; 106:851-867. [PMID: 28396989 DOI: 10.1007/s00392-017-1113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 01/09/2023]
Abstract
For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term "cardiac surgery". Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Yasin Essa
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Khalil Jacoub
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - David Gonzalez-Lopez
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Steffen Bargenda
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
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