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Hamad EA, Byku M, Larson SB, Billia F. LVAD therapy as a catalyst to heart failure remission and myocardial recovery. Clin Cardiol 2023; 46:1154-1162. [PMID: 37526373 PMCID: PMC10577530 DOI: 10.1002/clc.24094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023] Open
Abstract
The management of chronic heart failure over the past decade has witnessed tremendous strides in medical optimization and device therapy including the use of left ventricular assist devices (LVAD). What we once thought of as irreversible damage to the myocardium is now demonstrating signs of reverse remodeling and recovery. Myocardial recovery on the structural, molecular, and hemodynamic level is necessary for sufficient recovery to withstand explant and achieve sustained recovery post-LVAD. Guideline-directed medical therapy and unloading have been shown to aid in recovery with the potential to successfully explant the LVAD. This review will summarize medical optimization, assessment for recovery, explant methodologies and outcomes post-recovery with explant of durable LVAD.
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Affiliation(s)
- Eman A. Hamad
- Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Mirnela Byku
- Department of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Sharon B. Larson
- Baptist Heart Institute at Baptist Memorial HospitalMemphisTennesseeUSA
| | - Filio Billia
- Peter Munk Cardiac CenterUniversity Health NetworkTorontoOntarioCanada
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2
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Teelucksingh S, Schueler S, Crowley TP, Ragbir M. A novel problem, a tested solution: A case of an infected left ventricular titanium plug. J Card Surg 2020; 35:3179-3182. [PMID: 32789921 DOI: 10.1111/jocs.14936] [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: 11/28/2022]
Abstract
Persistent infection of left ventricular-assisted devices are challenging to treat. We describe a case of a middle-aged man who presented with cardiogenic shock and profound heart failure from sarcoid myocarditis, necessitating the placement of a left ventricular assist device. After recovery of cardiac function, the device was decommissioned but complicated by infection in the implant bed, chest wall, and of the titanium plug left in situ. This to our knowledge is the first report of an infected titanium plug and we describe an option of using a latissimus dorsi flap using its vascularized tissues to treat the infected plug. This is another example where a multidisciplinary approach can yield rewarding results in cases such as these.
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Affiliation(s)
- Sachin Teelucksingh
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephen Schueler
- Department of Cardiac Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Timothy P Crowley
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Maniram Ragbir
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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3
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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: 240] [Impact Index Per Article: 48.0] [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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4
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Gradinariu G, Simon AR, Gaer J. A Rare and Late Complication After Left Ventricular Assist Device Explantation. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2017; 5:53-56. [PMID: 28868316 DOI: 10.12945/j.aorta.2017.16.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 03/12/2017] [Indexed: 11/18/2022]
Abstract
Late complications can arise after explantation of a left ventricular assist device. We report the case of a patient who presented at the age of 19 years with peri-partum cardiomyopathy and was initially managed with a biventricular support device, which was subsequently upgraded to an ambulatory left ventricular assist device. This was successfully explanted after myocardial recovery via a minimally invasive approach 7 months later. The patient re-presented 5 years following explantation with hemoptysis. At redo sternotomy, a 10-cm remnant of the outflow graft was found to be eroding the surface of the right lung. The conduit was excised and the stump oversewn. Eleven months later, she presented again with hemoptysis, and a pseudo-aneurysm was identified on the computed tomography scan. She underwent urgent open repair with peripheral cannulation and deep hypothermic total circulatory arrest. The Dacron stump was found to be partially dehisced, leaving a 2-3 cm defect in the ascending aorta. The defect was repaired with a bovine pericardial patch. The patient made a good recovery and was successfully discharged.
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Affiliation(s)
- George Gradinariu
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, United Kingdom
| | - André R Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, United Kingdom
| | - Jullien Gaer
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, United Kingdom
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5
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Haddad E, Lescure FX, Ghodhbane W, Lepage L, D'humieres C, Vindrios W, Yazdanpanah Y, Nataf P, Kirsch M. Left ventricular assist pump pocket infection: conservative treatment strategy for destination therapy candidates. Int J Artif Organs 2017; 40:0. [PMID: 28430300 DOI: 10.5301/ijao.5000561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Heart failure is a major cause of mortality and morbidity, particularly among patients with advanced disease and no access to cardiac transplantation. LVAD implantation is not only a bridge-to-transplantation option for patients awaiting a heart donor, but is often used as bridge-to-destination therapy in patients unsuited for transplantation for various reasons. LVAD infection is considered the second-most common cause of death in patients who survive the initial 6 months on LVAD support. Few reports describe the indications for chronic suppressing antibiotic therapy, device exchange, methods for exchanging infected devices, post-exchange antimicrobial management status, and the outcomes of such patients. CASE PRESENTATION This is the case of a 74-year-old male patient with numerous comorbidities who received urgent surgical management for severe heart failure with a HeartMate II. Six months later he developed an LVAD pump infection with methicillin-resistant Staphylococcus epidermidis, which was diagnosed with leucocyte scintigraphy. The patient received an omental graft over the LVAD and a chronic suppressive antibiotic regime. A marked leukocyte scintigraphy showed the infection's regression 6 months after the initiation of antibiotic treatment. DISCUSSION We concisely reviewed the driveline infections and the main aspects of the LVAD pump infection. We reviewed options for conservative and nonconservative management and showed that conservative management of the LVAD pump infection is possible. CONCLUSIONS There are no defined recommendations for the management of LVAD pump infection. This case is among the few in the literature showing that conservative treatment of an LVAD pump infection is possible.
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Affiliation(s)
- Elie Haddad
- Department of Infectious Diseases, Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Medical Sciences and Nursing Campus, Beirut - Lebanon
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Paris - France
- Department of Infectious Diseases, Bichat Hospital, Paris - France
| | | | - Walid Ghodhbane
- Department of Cardiac Surgery, Bichat Hospital, Paris - France
| | - Laurent Lepage
- Department of Cardiology, Bichat Hospital, Paris - France
| | | | - William Vindrios
- Department of Infectious Diseases, Bichat Hospital, Paris - France
| | | | - Patrick Nataf
- Department of Cardiac Surgery, Bichat Hospital, Paris - France
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital, Lausanne - Switzerland
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6
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El-Sayed Ahmed MM, Jones MB, Kanter JP, Boyce S, Jonas RA, Scheel J, Sinha P. Hybrid Exclusion of HeartMate ІІ Left Ventricular Assist Device After Bridge to Recovery. Ann Thorac Surg 2017; 101:e193-4. [PMID: 27211979 DOI: 10.1016/j.athoracsur.2015.10.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 11/28/2022]
Abstract
We present a hybrid technique of left ventricular assist device exclusion after bridge to recovery in a pediatric patient, using percutaneous occlusion of the outflow graft and surgical excision of driveline. This technique has the advantage of avoiding chest reentry and cardiopulmonary bypass.
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Affiliation(s)
- Magdy M El-Sayed Ahmed
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC; Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Melissa B Jones
- Critical Care Medicine, Children's National Health System, Washington, DC
| | - Joshua P Kanter
- Division of Cardiology, Children's National Health System, Washington, DC
| | - Steven Boyce
- Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, DC
| | - Richard A Jonas
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Janet Scheel
- Division of Cardiology, Children's National Health System, Washington, DC
| | - Pranava Sinha
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC.
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7
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Pettit SJ, Shapiro LM, Lewis C, Parameshwar JK, Tsui SS. Percutaneous withdrawal of HeartWare HVAD left ventricular assist device support. J Heart Lung Transplant 2015; 34:990-2. [DOI: 10.1016/j.healun.2015.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/05/2015] [Accepted: 02/08/2015] [Indexed: 10/24/2022] Open
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8
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Bridge to removal: a paradigm shift for left ventricular assist device therapy. Ann Thorac Surg 2014; 99:360-7. [PMID: 25442985 DOI: 10.1016/j.athoracsur.2014.07.061] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/30/2022]
Abstract
Ventricular assist devices have become standard therapy for patients with advanced heart failure either as a bridge to transplantation or destination therapy. Despite the functional and biologic evidence of reverse cardiac remodeling, few patients actually proceed to myocardial recovery, and even fewer to the point of having their device explanted. An enhanced understanding of the biology and care of the mechanically supported patient has redirected focus on the possibility of using ventricular assist devices as a bridge to myocardial recovery and removal. Herein, we review the current issues and approaches to transforming myocardial recovery to a practical reality.
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9
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Kashiyama N, Toda K, Miyagawa S, Nishi H, Yoshikawa Y, Fukushima S, Yoshioka D, Saito T, Sawa Y. Initial experience of EVAHEART explantation after continuous-flow LVAD off test with percutaneous occlusion balloon. J Artif Organs 2014; 17:366-9. [PMID: 25060344 DOI: 10.1007/s10047-014-0784-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/01/2014] [Indexed: 11/27/2022]
Abstract
In contrast to a pulsatile-flow left ventricular assist device (LVAD), an LVAD off test for evaluation of cardiac recovery with a continuous-flow device is difficult because of intra-circuit backflow from the outflow graft when a device is stopped. We report a case of reliable evaluation of cardiac recovery using balloon occlusion of the outflow graft, followed by successful removal of a continuous-flow EVAHEART LVAD using a minimally invasive approach.
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Affiliation(s)
- Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Yamadaoka, 2-2, Suita City, Osaka, 565-0087, Japan,
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10
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Lenneman AJ, Birks EJ. Treatment strategies for myocardial recovery in heart failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:287. [PMID: 24492922 DOI: 10.1007/s11936-013-0287-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OPINION STATEMENT Heart failure is a progressive disorder characterized by adverse left ventricular remodeling. Until recently, this has been thought to be an irreversible process. Mechanical unloading with a left ventricular assist device (LVAD), particularly if combined with neurohormonal blockade with heart failure medications, can lead to a reversal of the heart failure phenotype, a process called "reverse remodeling." Reverse remodeling refers to the regression of pathologic myocardial hypertrophy and improvement in LV chamber size that can occur in response to treatment. Myocardial recovery is the sustained normalization of structural, molecular, and hemodynamic changes sufficient to allow explant of the LVAD. Despite the fact that reverse remodeling is commonly seen in LVAD patients in clinical practice, myocardial recovery sufficient to allow device explantation is still rare. Previous experience suggests that young patients with short duration of heart failure and less myocardial fibrosis may be more likely to recover. Alternatively, it may just be that clinicians make a greater effort to recover these subgroups. A combined approach of mechanical unloading with LVADs and pharmacological management, together with regular testing of underlying myocardial function with the pump reduced to a speed at which it is not contributing, can increase the frequency of sustained recovery from heart failure. The goal is to achieve optimal unloading of the myocardium, combined with pharmacologic therapy aimed at promoting reverse remodeling. Myocardial recovery must be considered as a therapeutic target. Clinical variables such as pump speed and blood pressure must be optimized to promote maximal unloading, leading to reverse remodeling and myocardial recovery. Frequent echocardiographic and hemodynamic evaluation of underlying myocardial function must be performed. The combination of LVAD therapy with optimal neurohormonal blockade appears promising as an approach to myocardial recovery. In addition, there is a growing body of translational research which, when combined with LVADs, may further promote more durable recovery. Strategies to thicken the myocardium to enhance the durability of recovery prior to explantation, such as clenbuterol (which induces "physiological hypertrophy"), or intermittently reducing the pump speed to increase myocardial load may be beneficial. Emergence of cardiac stem cells and alternative biologic agents, when added to current therapies, may have a complementary role in promoting and maintaining myocardial recovery. This review will summarize both current strategies and emerging therapies.
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Affiliation(s)
- Andrew J Lenneman
- Division of Cardiovascular Medicine, University of Louisville, Rudd Heart and Lung Center, 201 Abraham Flexner Way, Suite 1001, Louisville, KY, 40202, USA,
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11
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Sabashnikov A, Mohite PN, Simon AR, Popov AF. HeartWare miniaturized intrapericardial ventricular assist device: advantages and adverse events in comparison to contemporary devices. Expert Rev Med Devices 2014; 10:441-52. [DOI: 10.1586/17434440.2013.811851] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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Nienaber JJC, Kusne S, Riaz T, Walker RC, Baddour LM, Wright AJ, Park SJ, Vikram HR, Keating MR, Arabia FA, Lahr BD, Sohail MR. Clinical manifestations and management of left ventricular assist device-associated infections. Clin Infect Dis 2013; 57:1438-48. [PMID: 23943820 DOI: 10.1093/cid/cit536] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infection is a serious complication of left ventricular assist device (LVAD) therapy. Published data regarding LVAD-associated infections (LVADIs) are limited by single-center experiences and use of nonstandardized definitions. METHODS We retrospectively reviewed 247 patients who underwent continuous-flow LVAD implantation from January 2005 to December 2011 at Mayo Clinic campuses in Minnesota, Arizona, and Florida. LVADIs were defined using the International Society for Heart and Lung Transplantation criteria. RESULTS We identified 101 episodes of LVADI in 78 patients (32%) from this cohort. Mean age (± standard deviation [SD]) was 57±15 years. The majority (94%) underwent Heartmate II implantation, with 62% LVADs placed as destination therapy. The most common type of LVADIs were driveline infections (47%), followed by bloodstream infections (24% VAD related, and 22% non-VAD related). The most common causative pathogens included gram-positive cocci (45%), predominantly staphylococci, and nosocomial gram-negative bacilli (27%). Almost half (42%) of the patients were managed by chronic suppressive antimicrobial therapy. While 14% of the patients had intraoperative debridement, only 3 underwent complete LVAD removal. The average duration (±SD) of LVAD support was 1.5±1.0 years. At year 2 of follow-up, the cumulative incidence of all-cause mortality was estimated to be 43%. CONCLUSION Clinical manifestations of LVADI vary on the basis of the type of infection and the causative pathogen. Mortality remained high despite combined medical and surgical intervention and chronic suppressive antimicrobial therapy. Based on clinical experiences, a management algorithm for LVADI is proposed to assist in the decision-making process.
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13
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García Sáez D, Mohite PN, Zych B, Sabashnikov A, Hards R, Simon AR, Bahrami T. Minimally invasive access for off-pump HeartWare left ventricular assist device explantation. Interact Cardiovasc Thorac Surg 2013; 17:581-2. [PMID: 23788197 DOI: 10.1093/icvts/ivt239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The implantation of a left ventricular assist device as a bridge to transplantation is a well-established treatment of end-stage heart failure in selected patients. Device-related infection is a well-known complication that may require the removal of the device. We describe a minimally invasive explantation approach with complete removal of all components of a HeartWare left ventricular assist device in a patient with persistent infection related to the device.
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Affiliation(s)
- Diana García Sáez
- Department of Cardiothoracic Transplantation & Mechanical Support, Harefield Hospital, Harefield, Hertfordshire, UK.
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14
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Nishimura T, Ota T, Takayama H, Naka Y. Subcostal to rib-cross incision for HeartMate II explantation: A case report. J Thorac Cardiovasc Surg 2013; 145:e16-7. [DOI: 10.1016/j.jtcvs.2012.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 10/03/2012] [Accepted: 10/22/2012] [Indexed: 11/28/2022]
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15
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Sajjad M, Butt T, Oezalp F, Siddique A, Wrightson N, Crawford D, Pillay T, Schueler S. An alternative approach to explantation and exchange of the HeartWare left ventricular assist device. Eur J Cardiothorac Surg 2012; 43:1247-50. [DOI: 10.1093/ejcts/ezs585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Cheung A, Soon JL. Minimal-Access Left Ventricular Assist Device Explantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anson Cheung
- Division of Cardiac Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Jia-Lin Soon
- Division of Cardiac Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC Canada
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17
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Minimal-Access Left Ventricular Assist Device Explantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:300-2. [DOI: 10.1097/imi.0b013e3182746a6e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients on left ventricular assist device (LVAD) support can be successfully bridged to recovery. A novel explantation technique is reviewed. Six HeartMate II patients were successfully explanted off-pump through a combination of a left anterior minithoracotomy and a subxiphoid incision. A retrospective review of the institutional LVAD database was performed. The median LVAD support duration was 191 days (range, 69–307 days). There was no procedural or 30-day mortality associated with the LVAD explantation, and all patients are in New York Heart Association I to II at a median follow-up of 688 days (range, 127–1033 days). This procedure was associated with minimal blood transfusion and short intensive care unit stay (median, 1 day; range, 1–5 days) and hospitalization (median, 4.5 days; range, 3–19 days). One postexplant embolic cerebral infarct occurred. The HeartMate II LVAD can be safely explanted through a less conventional minimal-access approach.
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18
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Appel JM, Sander K, Hansen PB, Møller JE, Krarup-Hansen A, Gustafsson F. Left ventricular assist device as bridge to recovery for anthracycline-induced terminal heart failure. ACTA ACUST UNITED AC 2012; 18:291-4. [PMID: 22521037 DOI: 10.1111/j.1751-7133.2012.00291.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anthracycline treatments are hampered by dose-related cardiotoxicity, frequently leading to heart failure (HF) with a very poor prognosis. The authors report a case of a 19-year-old man developing HF after anthracycline treatment for Ewing sarcoma. Despite medical treatment, his condition deteriorated to terminal HF, leading to implantation of a mechanical left ventricular assist device (LVAD). His heart function recovered, allowing explantation of the device 14 months after implantation. Heart transplantation is often contraindicated in the first years after treatment for cancers, and LVAD as "bridge to recovery" may be warranted in similar patients.
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Affiliation(s)
- Jon M Appel
- Departments of CardiologyThoracic Surgery Thoracic Anesthesiology Oncology, Rigshopitalet, Copenhagen, Denmark.
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19
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Birks EJ, George RS, Hedger M, Bahrami T, Wilton P, Bowles CT, Webb C, Bougard R, Amrani M, Yacoub MH, Dreyfus G, Khaghani A. Reversal of Severe Heart Failure With a Continuous-Flow Left Ventricular Assist Device and Pharmacological Therapy. Circulation 2011; 123:381-90. [DOI: 10.1161/circulationaha.109.933960] [Citation(s) in RCA: 314] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We have previously shown that a specific combination of drug therapy and left ventricular assist device unloading results in significant myocardial recovery, sufficient to allow pump removal, in two thirds of patients with dilated cardiomyopathy receiving a Heartmate I pulsatile device. However, this protocol has not been used with nonpulsatile devices.
Methods and Results—
We report the results of a prospective study of 20 patients who received a combination of angiotensin-converting enzymes, β-blockers, angiotensin II inhibitors, and aldosterone antagonists followed by the β
2
-agonist clenbuterol and were regularly tested (echocardiograms, exercise tests, catheterizations) with the pump at low speed. Before left ventricular assist device insertion, patient age was 35.2±12.6 years (16 male patients), patients were on 2.0±0.9 inotropes, 7 (35) had an intra-aortic balloon pump, 2 were hemofiltered, 2 were ventilated, 3 had a prior Levitronix device, and 1 had extracorporeal membrane oxygenation. Cardiac index was 1.39±0.43 L · min
−1
· m
−2
, pulmonary capillary wedge pressure was 31.5±5.7 mm Hg, and heart failure history was 3.4±3.5 years. One patient was lost to follow-up and died after 240 days of support. Of the remaining 19 patients, 12 (63.2) were explanted after 286±97 days. Eight had symptomatic heart failure for ≤6 months and 4 for >6 months (48 to 132 months). Before explantation, at low flow for 15 minutes, ejection fraction was 70±7, left ventricular end-diastolic diameter was 48.6±5.7 mm, left ventricular end-systolic diameter was 32.3±5.7 mm, mV̇
o
2
was 21.6±4 mL · kg
−1
· min
−1
, pulmonary capillary wedge pressure was 5.9±4.6 mm Hg, and cardiac index was 3.6±0.6 L · min
−1
· m
−2
. Estimated survival without heart failure recurrence was 83.3 at 1 and 3 years. After a 430.7±337.1-day follow-up, surviving explants had an ejection fraction of 58.1±13.8, left ventricular end-diastolic diameter of 59.0±9.3 mm, left ventricular end-systolic diameter of 42.0±10.7 mm, and mV̇
o
2
of 22.6±5.3 mL · kg
−1
· min
−1
.
Conclusions—
Reversal of end-stage heart failure secondary to nonischemic cardiomyopathy can be achieved in a substantial proportion of patients with nonpulsatile flow through the use of a combination of mechanical and pharmacological therapy.
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Affiliation(s)
- Emma J. Birks
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Robert S. George
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Mike Hedger
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Toufan Bahrami
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Penny Wilton
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Christopher T. Bowles
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Carole Webb
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Robert Bougard
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Mohammed Amrani
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Magdi H. Yacoub
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Gilles Dreyfus
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
| | - Asghar Khaghani
- From the Royal Brompton and Harefield NHS Foundation Trust (E.J.B., R.S.G., M.H., T.B., P.W., C.T.B., C.W., R.B., M.A., G.D., A.K.) and Heart Science Centre, Imperial College (E.J.B., R.S.G., C.T.B., M.H.Y.), Harefield, Middlesex, UK, and University of Louisville, Louisville, KY (E.J.B.)
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Cheung A, Bashir J, Kaan A, Kealy J, Moss R, Shayan H. Minimally invasive, off-pump explant of a continuous-flow left ventricular assist device. J Heart Lung Transplant 2010; 29:808-10. [DOI: 10.1016/j.healun.2010.01.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/10/2010] [Accepted: 01/12/2010] [Indexed: 11/16/2022] Open
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