1
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Movahedi F, Antaki JF. Improving the Prediction of 1-Year Right Ventricular Failure After Left Ventricular Assist Device Implantation. ASAIO J 2024; 70:495-501. [PMID: 38346283 PMCID: PMC11147739 DOI: 10.1097/mat.0000000000002152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Previous predictive models for postimplant right heart failure (RHF) following left ventricular assist device (LVAD) implantation have demonstrated limited performance on validation datasets and are susceptible to overfitting. Thus, the objective of this study was to develop an improved predictive model with reduced overfitting and improved accuracy in predicting RHF in LVAD recipients. The study involved 11,967 patients who underwent continuous-flow LVAD implantation between 2008 and 2016, with an RHF incidence of 9% at 1 year. Using an eXtreme Gradient Boosting (XGBoost) algorithm, the training data were used to predict RHF at 1 year postimplantation, resulting in promising area under the curve (AUC)-receiver operating characteristic (ROC) of 0.8 and AUC-precision recall curve (PRC) of 0.24. The calibration plot showed that the predicted risk closely corresponded with the actual observed risk. However, the model based on data collected 48 hours before LVAD implantation exhibited high sensitivity but low precision, making it an excellent screening tool but not a diagnostic tool.
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Affiliation(s)
- Faezeh Movahedi
- From the Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James F Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
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2
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Akbar AF, Zhou AL, Wang A, Feng ASN, Rizaldi AA, Ruck JM, Kilic A. Special Considerations for Advanced Heart Failure Surgeries: Durable Left Ventricular Devices and Heart Transplantation. J Cardiovasc Dev Dis 2024; 11:119. [PMID: 38667737 PMCID: PMC11050210 DOI: 10.3390/jcdd11040119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Heart transplantation and durable left ventricular assist devices (LVADs) represent two definitive therapies for end-stage heart failure in the modern era. Despite technological advances, both treatment modalities continue to experience unique risks that impact surgical and perioperative decision-making. Here, we review special populations and factors that impact risk in LVAD and heart transplant surgery and examine critical decisions in the management of these patients. As both heart transplantation and the use of durable LVADs as destination therapy continue to increase, these considerations will be of increasing relevance in managing advanced heart failure and improving outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 7107, Baltimore, MD 21287, USA; (A.F.A.); (A.L.Z.); (A.W.); (A.S.N.F.); (A.A.R.); (J.M.R.)
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3
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Mullens W, Dauw J, Gustafsson F, Mebazaa A, Steffel J, Witte KK, Delgado V, Linde C, Vernooy K, Anker SD, Chioncel O, Milicic D, Hasenfuß G, Ponikowski P, von Bardeleben RS, Koehler F, Ruschitzka F, Damman K, Schwammenthal E, Testani JM, Zannad F, Böhm M, Cowie MR, Dickstein K, Jaarsma T, Filippatos G, Volterrani M, Thum T, Adamopoulos S, Cohen-Solal A, Moura B, Rakisheva A, Ristic A, Bayes-Genis A, Van Linthout S, Tocchetti CG, Savarese G, Skouri H, Adamo M, Amir O, Yilmaz MB, Simpson M, Tokmakova M, González A, Piepoli M, Seferovic P, Metra M, Coats AJS, Rosano GMC. Integration of implantable device therapy in patients with heart failure. A clinical consensus statement from the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2024; 26:483-501. [PMID: 38269474 DOI: 10.1002/ejhf.3150] [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: 04/20/2023] [Revised: 10/27/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
Implantable devices form an integral part of the management of patients with heart failure (HF) and provide adjunctive therapies in addition to cornerstone drug treatment. Although the number of these devices is growing, only few are supported by robust evidence. Current devices aim to improve haemodynamics, improve reverse remodelling, or provide electrical therapy. A number of these devices have guideline recommendations and some have been shown to improve outcomes such as cardiac resynchronization therapy, implantable cardioverter-defibrillators and long-term mechanical support. For others, more evidence is still needed before large-scale implementation can be strongly advised. Of note, devices and drugs can work synergistically in HF as improved disease control with devices can allow for further optimization of drug therapy. Therefore, some devices might already be considered early in the disease trajectory of HF patients, while others might only be reserved for advanced HF. As such, device therapy should be integrated into HF care programmes. Unfortunately, implementation of devices, including those with the greatest evidence, in clinical care pathways is still suboptimal. This clinical consensus document of the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) describes the physiological rationale behind device-provided therapy and also device-guided management, offers an overview of current implantable device options recommended by the guidelines and proposes a new integrated model of device therapy as a part of HF care.
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Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
- UHasselt, Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Jeroen Dauw
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
- UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Finn Gustafsson
- The Heart Center, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Alexandre Mebazaa
- Université de Paris, UMR Inserm - MASCOT; APHP Saint Louis Lariboisière University Hospitals, Department of Anesthesia-Burn-Critical Care, Paris, France
| | - Jan Steffel
- Hirslanden Heart Clinic and University of Zurich, Zurich, Switzerland
| | - Klaus K Witte
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Hospital University Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Cecilia Linde
- Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Heart Vascular and Neurology Theme, Stockholm, Sweden
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Davor Milicic
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Gerd Hasenfuß
- University Medical Center Göttingen (UMG), Department of Cardiology and Pneumology, German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | | | - Friedrich Koehler
- Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Ruschitzka
- Clinic of Cardiology, University Heart Centre, University Hospital, Zurich, Switzerland
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ehud Schwammenthal
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, and Tel Aviv University, Ramat Aviv, Israel
| | - Jeffrey M Testani
- Division of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 14-33, Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Michael Böhm
- Universitatsklinikum des Saarlandes, Klinik fur Innere Medizin III, Saarland University, Kardiologie, Angiologie und Internistische Intensivmedizin, Homburg, Germany
| | - Martin R Cowie
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust, and School of Cardiovascular Medicine and Sciences, Faculty of Lifesciences & Medicine, King's College London, London, UK
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway; and Stavanger University Hospital, Stavanger, Norway
| | - Tiny Jaarsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany and Fraunhofer institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Alain Cohen-Solal
- Department of Cardiology, University Hospital Lariboisière, AP-HP, Paris, France; INSERM UMR-S 942, MASCOT, Université Paris Cité, Paris, France
| | - Brenda Moura
- Armed Forces Hospital, Porto, and Faculty of Medicine of Porto, Porto, Portugal
| | - Amina Rakisheva
- Cardiology Department, Scientific Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
| | - Arsen Ristic
- Universi Faculty of Medicine, University of Belgrade, and Serbian Academy of Arts and Sciences, Belgrade, Serbia
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Badalona, Spain
| | - Sophie Van Linthout
- Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | - Carlo Gabriele Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences (DISMET); Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center for Clinical and Translational Research (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA); Federico II University, Naples, Italy
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Hadi Skouri
- Division of Cardiology, Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Offer Amir
- Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | | | | | - Arantxa González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra, and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Massimo Piepoli
- Clinical Cardiac Unit, Policlinico San Donato, University of Milan, Milan, Italy
| | - Petar Seferovic
- Universi Faculty of Medicine, University of Belgrade, and Serbian Academy of Arts and Sciences, Belgrade, Serbia
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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4
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Arjomandi Rad A, Fleet B, Zubarevich A, Nanchahal S, Naruka V, Subbiah Ponniah H, Vardanyan R, Sardari Nia P, Loubani M, Moorjani N, Schmack B, Punjabi PP, Schmitto J, Ruhparwar A, Weymann A. Left ventricular assist device implantation and concomitant mitral valve surgery: A systematic review and meta-analysis. Artif Organs 2024; 48:16-27. [PMID: 37822301 DOI: 10.1111/aor.14659] [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] [Received: 06/16/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The management of concomitant valvular lesions in patients undergoing left ventricular assist device (LVAD) implantation remains a topic of debate. This systematic review and meta-analysis aimed to evaluate the existing evidence on postoperative outcomes following LVAD implantation, with and without concomitant MV surgery. METHODS A systematic database search was conducted as per PRISMA guidelines, of original articles comparing LVAD alone to LVAD plus concomitant MV surgery up to February 2023. The primary outcomes assessed were overall mortality and early mortality, while secondary outcomes included stroke, need for right ventricular assist device (RVAD) implantation, postoperative mitral valve regurgitation, major bleeding, and renal dysfunction. RESULTS The meta-analysis included 10 studies comprising 32 184 patients. It revealed that concomitant MV surgery during LVAD implantation did not significantly affect overall mortality (OR:0.83; 95% CI: 0.53 to 1.29; p = 0.40), early mortality (OR:1.17; 95% CI: 0.63 to 2.17; p = 0.63), stroke, need for RVAD implantation, postoperative mitral valve regurgitation, major bleeding, or renal dysfunction. These findings suggest that concomitant MV surgery appears not to confer additional benefits in terms of these clinical outcomes. CONCLUSION Based on the available evidence, concomitant MV surgery during LVAD implantation does not appear to have a significant impact on postoperative outcomes. However, decision-making regarding MV surgery should be individualized, considering patient-specific factors and characteristics. Further research with prospective studies focusing on specific patient populations and newer LVAD devices is warranted to provide more robust evidence and guide clinical practice in the management of valvular lesions in LVAD recipients.
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Affiliation(s)
- Arian Arjomandi Rad
- Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ben Fleet
- School of Medicine, Lancaster University, Lancaster, UK
| | - Alina Zubarevich
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sukanya Nanchahal
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vinci Naruka
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Robert Vardanyan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth NHS Trust, Cambridge, UK
| | - Bastian Schmack
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jan Schmitto
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Weymann
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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5
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Sennhauser S, Sridharan L. Left Ventricular Assist Device Emergencies: Diagnosis and Management. Crit Care Clin 2024; 40:159-177. [PMID: 37973352 DOI: 10.1016/j.ccc.2023.06.004] [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: 11/19/2023]
Abstract
Durable left ventricular assist devices (LVADs) are a virtually limitless advanced therapy option for an increasingly growing population of patients with end-stage advanced heart failure. As of 2019, 30% to 40% of all patients diagnosed with heart failure were categorized as New York Heart Association class III or IV. In 2018 more than 3.2 million office visits and 1.4 million emergency department visits carried a primary diagnosis of heart failure. Given the rapid growth of the LVAD population, facility in the diagnosis and management of common perioperative and outpatient LVAD emergencies has become of paramount importance in a variety of clinical settings.
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Affiliation(s)
- Susie Sennhauser
- Division of Cardiology, Department of Medicine, Emory University School of Medicine
| | - Lakshmi Sridharan
- Division of Cardiology, Department of Medicine, Emory University School of Medicine.
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6
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John R, Kanwar MK, Cleveland JC, Uriel N, Naka Y, Salerno C, Horstmanshof D, Hall SA, Cowger JA, Heatley G, Somo SI, Mehra MR. Concurrent valvular procedures during left ventricular assist device implantation and outcomes: A comprehensive analysis of the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 trial portfolio. J Thorac Cardiovasc Surg 2023; 166:1684-1694.e18. [PMID: 35643769 DOI: 10.1016/j.jtcvs.2022.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Correction of valvular disease is often undertaken during left ventricular assist device (LVAD) implantation with uncertain benefit. We analyzed clinical outcomes with HeartMate 3 (HM3; Abbott) LVAD implantation in those with various concurrent valve procedures (HM3+VP) with those with an isolated LVAD implant (HM3 alone). METHODS The study included 2200 patients with HM3 implanted within the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) trial portfolio who underwent 820 concurrent procedures among which 466 (21.8%) were HM3+VP. VPs included 101 aortic, 61 mitral, 163 tricuspid; 85 patients had multiple VPs. Perioperative complications, major adverse events, and survival were analyzed. RESULTS Patients who underwent HM3+VP had higher-acuity Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles (1-2: 41% vs 31%) compared with no VPs (P < .05). The cardiopulmonary bypass time (124 vs 76 minutes; P < .0001) and hospital length of stay (20 vs 18 days; P < .0001) were longer in HM3+VP. A higher incidence of stroke (4.9% vs 2.4%), bleeding (33.9% vs 23.8%), and right heart failure (41.5% vs 29.6%) was noted in HM3+VP at 0 to 30 days (P < .01), with no difference in 30-day mortality (3.9% vs 3.3%) or 2-year survival (81.7% vs 80.8%). Analysis of individual VP showed no differences in survival compared to HM3 alone. No differences were noted among patients with either significant mitral (moderate or worse) or tricuspid (moderate or worse) regurgitation with or without corrective surgery. CONCLUSIONS Concurrent VPs, commonly performed during LVAD implantation, are associated with increased morbidity during the index hospitalization, with no effect on short- and long-term survival. There is sufficient equipoise to consider a randomized trial on the benefit of commonly performed VPs (such as mitral or tricuspid regurgitation correction), during LVAD implantation.
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Affiliation(s)
- Ranjit John
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minn
| | - Manreet K Kanwar
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Joseph C Cleveland
- Surgery-Cardiothoracic, University of Colorado School of Medicine, Aurora, Colo
| | - Nir Uriel
- Advanced Heart Failure and Cardiac Transplantation, Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY
| | - Yoshifumi Naka
- Cardiac Surgery, Weill Cornell Medical College, New York, NY
| | | | | | - Shelley A Hall
- Transplant Cardiology and Mechanical Support/Heart Failure, Baylor University Medical Center, Dallas, Tex
| | - Jennifer A Cowger
- Mechanical Circulatory Support Team, Henry Ford Health System, Detroit, Mich
| | | | | | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
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7
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Masarone D, Houston B, Falco L, Martucci ML, Catapano D, Valente F, Gravino R, Contaldi C, Petraio A, De Feo M, Tedford RJ, Pacileo G. How to Select Patients for Left Ventricular Assist Devices? A Guide for Clinical Practice. J Clin Med 2023; 12:5216. [PMID: 37629257 PMCID: PMC10455625 DOI: 10.3390/jcm12165216] [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: 07/22/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, a significant improvement in left ventricular assist device (LVAD) technology has occurred, and the continuous-flow devices currently used can last more than 10 years in a patient. Current studies report that the 5-year survival rate after LVAD implantation approaches that after a heart transplant. However, the outcome is influenced by the correct selection of the patients, as well as the choice of the optimal time for implantation. This review summarizes the indications, the red flags for prompt initiation of LVAD evaluation, and the principles for appropriate patient screening.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Brian Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC 158155, USA (R.J.T.)
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Maria L. Martucci
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Marisa De Feo
- Cardiac Surgery Unit, Department of Cardiac Surgery and Transplant, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Ryan J. Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC 158155, USA (R.J.T.)
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
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8
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Arjomandi Rad A, Zubarevich A, Shah V, Yilmaz O, Vardanyan R, Naruka V, Moorjani N, Ruhparwar A, Punjabi PP, Weymann A. Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta-analysis. Artif Organs 2023; 47:1250-1261. [PMID: 37086154 DOI: 10.1111/aor.14549] [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] [Received: 03/16/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear. METHODS A systematic database search with meta-analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0-I) versus moderate-severe MR (Grade II-III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection. RESULTS Our search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate-severe MR (grade II-III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate-severe MR. An increased rate of right heart failure was seen among patients with moderate-severe MR, while lower rates of neurological events were also observed. CONCLUSION LVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.
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Affiliation(s)
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Ogulcan Yilmaz
- School of Postgraduate Studies, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Royal Papworth Hospital NHS Trust, Cambridge, UK
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, National Heart and Lung Institute, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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9
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Dagher O, Santaló-Corcoy M, Perrin N, Dorval JF, Duggal N, Modine T, Ducharme A, Lamarche Y, Noly PE, Asgar A, Ben Ali W. Transcatheter valvular therapies in patients with left ventricular assist devices. Front Cardiovasc Med 2023; 10:1071805. [PMID: 36993995 PMCID: PMC10040555 DOI: 10.3389/fcvm.2023.1071805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
Aortic, mitral and tricuspid valve regurgitation are commonly encountered in patients with continuous-flow left ventricular assist devices (CF-LVADs). These valvular heart conditions either develop prior to CF-LVAD implantation or are induced by the pump itself. They can all have significant detrimental effects on patients' survival and quality of life. With the improved durability of CF-LVADs and the overall rise in their volume of implants, an increasing number of patients will likely require a valvular heart intervention at some point during CF-LVAD therapy. However, these patients are often considered poor reoperative candidates. In this context, percutaneous approaches have emerged as an attractive “off-label” option for this patient population. Recent data show promising results, with high device success rates and rapid symptomatic improvements. However, the occurrence of distinct complications such as device migration, valve thrombosis or hemolysis remain of concern. In this review, we will present the pathophysiology of valvular heart disease in the setting of CF-LVAD support to help us understand the underlying rationale of these potential complications. We will then outline the current recommendations for the management of valvular heart disease in patients with CF-LVAD and discuss their limitations. Lastly, we will summarize the evidence related to transcatheter heart valve interventions in this patient population.
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Affiliation(s)
- Olina Dagher
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Departmentof Cardiac Sciences, Libin Cardiovascular Institute, Calgary, AB, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Marcel Santaló-Corcoy
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Nils Perrin
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-François Dorval
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Neal Duggal
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, United States
| | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévêque, CHU Bordeaux, Bordeaux, France
| | - Anique Ducharme
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
| | | | - Anita Asgar
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Walid Ben Ali
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Correspondence: Walid Ben Ali
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10
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Vriz O, Mushtaq A, Shaik A, El-Shaer A, Feras K, Eltayeb A, Alsergnai H, Kholaif N, Al Hussein M, Albert-Brotons D, Simon AR, Tsai FW. Reciprocal interferences of the left ventricular assist device and the aortic valve competence. Front Cardiovasc Med 2023; 9:1094796. [PMID: 36698950 PMCID: PMC9870593 DOI: 10.3389/fcvm.2022.1094796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Patients suffering from end-stage heart failure tend to have high mortality rates. With growing numbers of patients progressing into severe heart failure, the shortage of available donors is a growing concern, with less than 10% of patients undergoing cardiac transplantation (CTx). Fortunately, the use of left ventricular assist devices (LVADs), a variant of mechanical circulatory support has been on the rise in recent years. The expansion of LVADs has led them to be incorporated into a variety of clinical settings, based on the goals of therapy for patients ailing from heart failure. However, with an increase in the use of LVADs, there are a host of complications that arise with it. One such complication is the development and progression of aortic regurgitation (AR) which is noted to adversely influence patient outcomes and compromise pump benefits leading to increased morbidity and mortality. The underlying mechanisms are likely multifactorial and involve the aortic root-aortic valve (AV) complex, as well as the LVAD device, patient, and other factors, all of them alter the physiological mechanics of the heart resulting in AV dysfunction. Thus, it is imperative to screen patients before LVAD implantation for AR, as moderate or greater AR requires a concurrent intervention at the time of LVADs implantation. No current strict guidelines were identified in the literature search on how to actively manage and limit the development and/or progression of AR, due to the limited information. However, some recommendations include medical management by targeting fluid overload and arterial blood pressure, along with adjusting the settings of the LVADs device itself. Surgical interventions are to be considered depending on patient factors, goals of care, and the underlying pathology. These interventions include the closure of the AV, replacement of the valve, and percutaneous approach via percutaneous occluding device or transcatheter aortic valve implantation. In the present review, we describe the interaction between AV and LVAD placement, in terms of patient management and prognosis. Also it is provided a comprehensive echocardiographic strategy for the precise assessment of AV regurgitation severity.
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Affiliation(s)
- Olga Vriz
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia,*Correspondence: Olga Vriz,
| | - Ali Mushtaq
- School of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Shaik
- School of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed El-Shaer
- School of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Khalid Feras
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdalla Eltayeb
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hani Alsergnai
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Naji Kholaif
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mosaad Al Hussein
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dimpna Albert-Brotons
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Andre Rudiger Simon
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Felix Wang Tsai
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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11
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Si MS, Sood V, Biniwale R, Peng D. Considerations of valvular heart disease in children with ventricular assist devices. Front Cardiovasc Med 2023; 10:1056663. [PMID: 37034354 PMCID: PMC10075362 DOI: 10.3389/fcvm.2023.1056663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Ventricular assist devices have become a valuable tool in the treatment of heart failure in children. The use of ventricular assist devices has decreased mortality in children with end-stage heart failure awaiting transplant. It is not uncommon for children with end-stage heart failure associated with cardiomyopathy or congenital heart disease to have significant systemic semilunar and atrioventricular valve regurgitation, which can impact the efficiency and efficacy of hemodynamic support provided by a ventricular assist device. Therefore, implanting clinicians should carefully assess for valve abnormalities that may need repair and impact device selection and cannulation strategy to effectively support this diverse population. The purpose of this review is to provide an overview of this important and relevant topic and to discuss strategies for managing these patients.
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Affiliation(s)
- Ming-Sing Si
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, MI, United States
- Correspondence: Ming-Sing Si
| | - Vikram Sood
- Department of Cardiac Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - Reshma Biniwale
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, MI, United States
| | - David Peng
- Department of Cardiac Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, Mattel Children’s Hospital, Los Angeles, CA, United States
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12
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Acharya D, Kazui T, Al Rameni D, Acharya T, Betterton E, Juneman E, Loyaga-Rendon R, Lotun K, Shetty R, Chatterjee A. Aortic valve disorders and left ventricular assist devices. Front Cardiovasc Med 2023; 10:1098348. [PMID: 36910539 PMCID: PMC9996073 DOI: 10.3389/fcvm.2023.1098348] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Aortic valve disorders are important considerations in advanced heart failure patients being evaluated for left ventricular assist devices (LVAD) and those on LVAD support. Aortic insufficiency (AI) can be present prior to LVAD implantation or develop de novo during LVAD support. It is usually a progressive disorder and can lead to impaired LVAD effectiveness and heart failure symptoms. Severe AI is associated with worsening hemodynamics, increased hospitalizations, and decreased survival in LVAD patients. Diagnosis is made with echocardiographic, device assessment, and/or catheterization studies. Standard echocardiographic criteria for AI are insufficient for accurate diagnosis of AI severity. Management of pre-existing AI includes aortic repair or replacement at the time of LVAD implant. Management of de novo AI on LVAD support is challenging with increased risks of repeat surgical intervention, and percutaneous techniques including transcatheter aortic valve replacement are assuming greater importance. In this manuscript, we provide a comprehensive approach to contemporary diagnosis and management of aortic valve disorders in the setting of LVAD therapy.
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Affiliation(s)
- Deepak Acharya
- Division of Cardiovascular Diseases, University of Arizona, Tucson, AZ, United States
| | - Toshinobu Kazui
- Division of Cardiovascular Surgery, University of Arizona, Tucson, AZ, United States
| | - Dina Al Rameni
- Division of Cardiovascular Surgery, University of Arizona, Tucson, AZ, United States
| | - Tushar Acharya
- Division of Cardiovascular Diseases, University of Arizona, Tucson, AZ, United States
| | - Edward Betterton
- Artificial Heart Program, University of Arizona, Tucson, AZ, United States
| | - Elizabeth Juneman
- Division of Cardiovascular Diseases, University of Arizona, Tucson, AZ, United States
| | | | - Kapildeo Lotun
- Division of Cardiology, Carondelet Medical Center, Tucson, AZ, United States
| | - Ranjith Shetty
- Division of Cardiology, Carondelet Medical Center, Tucson, AZ, United States
| | - Arka Chatterjee
- Division of Cardiovascular Diseases, University of Arizona, Tucson, AZ, United States
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Calin E, Ducharme A, Carrier M, Lamarche Y, Ben Ali W, Noly PE. Key questions about aortic insufficiency in patients with durable left ventricular assist devices. Front Cardiovasc Med 2022; 9:1068707. [PMID: 36505355 PMCID: PMC9729243 DOI: 10.3389/fcvm.2022.1068707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
The development of the latest generation of durable left ventricular assist devices (LVAD) drastically decreased adverse events such as pump thrombosis or disabling strokes. However, time-related complications such as aortic insufficiency (AI) continue to impair outcomes following durable LVAD implantation, especially in the context of long-term therapy. Up to one-quarter of patients with durable LVAD develop moderate or severe AI at 1 year and its incidence increases with the duration of support. The continuous regurgitant flow within the left ventricle can compromise left ventricular unloading, increase filling pressures, decrease forward flow and can thus lead to organ hypoperfusion and heart failure. This review aims to give an overview of the epidemiology, pathophysiology, and clinical consequences of AI in patients with durable LVAD.
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Affiliation(s)
- Eliza Calin
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Michel Carrier
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Walid Ben Ali
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Pierre-Emmanuel Noly
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada,*Correspondence: Pierre-Emmanuel Noly,
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14
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Selection and management considerations to enhance outcomes in patients supported by left ventricular assist devices. Curr Opin Cardiol 2022; 37:502-510. [PMID: 36094516 DOI: 10.1097/hco.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Left ventricular assist devices (LVADs) are life-saving therapies for patients in end-stage heart failure (HF) with reduced ejection fraction regardless of candidacy for heart transplantation. Multiple clinical trials have demonstrated improved morbidity and mortality with LVADs when compared to medical therapy alone. However, the uptake of LVADs as a therapeutic option in a larger section of end-stage HF patients remains limited, partly due to associated adverse events and re-hospitalization. RECENT FINDINGS Accurate assessment and staging of HF patients is crucial to guide appropriate use of LVADs. Innovative methods to risk stratify patients and manage cardiac and noncardiac comorbidities can translate to improved outcomes in LVAD recipients. Inclusion of quality of life metrics and measurements of adverse events can better inform heart failure cardiologists to help identify ideal LVAD candidates. Addition of machine learning algorithms to this process may guide patient selection to improve outcomes. SUMMARY Patient selection and assessment of reversible medical comorbidities are critical to the postoperative success of LVAD implantation. Identifying patients most likely to benefit and least likely to experience adverse events should be a priority.
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15
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Noly PE, Duggal N, Jiang M, Nordsletten D, Bonini M, Lei I, Ela AAE, Haft JW, Pagani FD, Cascino TM, Tang PC. Role of the mitral valve in left ventricular assist device pathophysiology. Front Cardiovasc Med 2022; 9:1018295. [PMID: 36386343 PMCID: PMC9649705 DOI: 10.3389/fcvm.2022.1018295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/29/2022] [Indexed: 08/27/2023] Open
Abstract
Functional mitral regurgitation (MR) in the setting of heart failure results from progressive dilatation of the left ventricle (LV) and mitral annulus. This leads to leaflet tethering with posterior displacement. Contrary to common assumptions, MR often does not resolve with LVAD decompression of the LV alone. The negative impact of significant (moderate-severe) mitral regurgitation in the LVAD setting is becoming better recognized in terms of its harmful effect on right heart function, pulmonary vascular resistance and hospital readmissions. However, controversies remain regarding the threshold for intervention and management. At present, there are no consensus indications for the repair of significant mitral regurgitation at the time of LVAD implantation due to the conflicting data regarding potential adverse effects of MR on clinical outcomes. In this review, we summarize the current understanding of MR pathophysiology in patients supported with LVAD and potential future management strategies.
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Affiliation(s)
- Pierre-Emmanuel Noly
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Neal Duggal
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Mulan Jiang
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - David Nordsletten
- Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | - Mia Bonini
- Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | - Ienglam Lei
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ashraf Abou El Ela
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jonathan W. Haft
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Francis D. Pagani
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Thomas M. Cascino
- Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Paul C. Tang
- Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
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16
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Rapp ES, Pawar SR, Longoria RG. Hybrid Mock Circulatory Loop Simulation of Extreme Cardiac Events. IEEE Trans Biomed Eng 2022; 69:2883-2892. [PMID: 35254970 PMCID: PMC9466991 DOI: 10.1109/tbme.2022.3156963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This paper presents preliminary methods of incorporating the pathological conditions of cardiac arrhythmias and valvular stenosis in hybrid mock circulation loop (hMCL) operation for the enhanced verification and validation of mechanical circulatory support devices such as VADs. METHODS The MGH/MF Waveform datasets from PhysioNet database (including both nominal and clinically diagnosed arrhythmic ECG measurements) as well as cardiovascular system model updates are used to recreate arrhythmic events and valvular stenosis in vitro. RESULTS Preliminary results show the hMCL can recreate each tested cardiac event within 2% and 4% mean error for reference pressure tracking in the aortic and left ventricular pressure chambers, respectively. Further, frequency spectrum analysis comparisons using the magnitude-squared coherence analysis shows close alignment between measured arrhythmic and hMCL realized pressure frequency content. CONCLUSION The generation of cardiac arrhythmias and valvular stenosis around a VAD via both model and acute measurement based methods was achieved. SIGNIFICANCE Pathological conditions such as cardiac arrhythmias and valvular stenosis are limited in documentation despite the large percentage of patients who experience these events. This paper provides a means to begin incorporating these events into hardware-in-the-loop mock circulatory systems for next generation VAD validation and verification.
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17
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Patel NH, Guerrero-Miranda C, Hall S, Rafael AE, Brown WM, Bindra AS. Fusion of Bovine Tissue Aortic Valve Leaflets in a Patient With Left Ventricular Assist Device. JACC Case Rep 2022; 4:604-609. [PMID: 35615220 PMCID: PMC9125526 DOI: 10.1016/j.jaccas.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 10/29/2022]
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Rate of thromboembolic and bleeding events in patients undergoing concomitant aortic valve surgery with left ventricular assist device implantation. Int J Cardiol 2022; 359:39-45. [DOI: 10.1016/j.ijcard.2022.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 01/14/2023]
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McMullen L, Barker K, Fried J, Wagener G. Clinical considerations for the evaluation of patients with left ventricular assist devices. JAAPA 2022; 35:37-42. [PMID: 34939589 DOI: 10.1097/01.jaa.0000803636.43190.eb] [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: 11/25/2022]
Abstract
ABSTRACT A left ventricular assist device (LVAD) provides mechanical circulatory support for patients with end-stage heart failure. As these devices become more prevalent, clinicians must be familiar with the device's function, common complications, and management strategies when evaluating this patient population.
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Affiliation(s)
- Leah McMullen
- At Columbia University Medical Center in New York, N.Y., Leah McMullen and Kelly Barker practice in the cardiothoracic ICU. Justin Fried is an assistant professor of medicine in the division of cardiology at Columbia University Medical Center. Gebhard Wagener is a professor of anesthesiology at Columbia University Medical Center and chief of the division of vascular anesthesiology. The authors have disclosed no potential conflicts of interest, financial or otherwise
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20
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Loforte A, de By TMMH, Gliozzi G, Schönrath F, Mariani C, Netuka I, Pya Y, Zimpfer D, Cavalli GG, Gummert J, Meyns B, Pacini D, Potapov E. Impact of concomitant cardiac valvular surgery during implantation of continuous-flow left ventricular assist devices: A European registry for patients with mechanical circulatory support (EUROMACS) analysis. Artif Organs 2021; 46:813-826. [PMID: 34904255 DOI: 10.1111/aor.14143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/22/2021] [Accepted: 12/08/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND We investigated the clinical outcomes after cardiac valvular surgery procedures concomitant (CCPs) with left ventricular assist device (LVAD) implantation compared to propensity score (PS) matched controls using the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data. METHODS Between 2006 and 2018, 2760 continuous-flow LVAD patients were identified. Of these, 533 underwent a CCP during the LVAD implant. RESULTS Cardiopulmonary bypass time (p < 0.001) and time for implant (p < 0.001) were both significantly longer in the LVAD+CCP group. Hospital mortality was comparable between the two groups from the unmatched population (15.7% vs. 14.1%, p = 0.073). Similarly, short-to-mid-term survival was similar in both groups, with 1-year, 3-year, and 5-year survival rates of 67.9%, 48.2%, and 27.7% versus 66.4%, 46.1%, and 26%, respectively (log-rank, p = 0.25). The results were similar in the PS-matched population. Hospital mortality was comparable between the two groups (18.9% vs. 17.4%, p = 0.074). The short-to-mid-term Kaplan-Meier survival analysis was similar for both groups, with 1-year, 3-year, and 5-year survival rates of 63.4%, 49.2%, and 24.7% versus 66.5%, 46%, and 25.1%, respectively (log-rank, p = 0.81). In the unmatched population, LVAD+CCP patients had longer intensive care unit (ICU) stays (p < 0.0001), longer mechanical ventilation time (p = 0.001), a higher rate of temporary right ventricular assist device (RVAD) support (p = 0.033), and a higher rate of renal replacement therapy (n = 35, 6.6% vs. n = 89, 4.0%, p = 0.014). In the PS-matched population, the LVAD+CCP patients had longer ICU stays (p = 0.019) and longer mechanical ventilation time (p = 0.002). CONCLUSIONS The effect of additive valvular procedures (CCPs) does not seem to affect short-term survival, significantly, based on our registry data analysis. However, the decision to perform CCPs should be balanced with the projected type of surgery and preoperative characteristics. LVAD+CCP patients remain a delicate population and adverse device-related events should be strictly monitored and managed.
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Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | | | - Gregorio Gliozzi
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | | | - Carlo Mariani
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Yuriy Pya
- National Research Cardiac Surgery Center, Astana Kazakhstan, Kazakhstan
| | | | - Giulio Giovanni Cavalli
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Jan Gummert
- Heart and Diabetes Center North-Rhine Westphalia, Ruhr-Un, Bad Oeynhausen, Germany
| | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
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21
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Troubleshooting Left Ventricular Assist Devices: Modern Technology and Its Limitations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Bhagra SK, Pettit S, Parameshwar J. Implantable left ventricular assist device: indications, eligibility and current outcomes. Heart 2021; 108:233-241. [PMID: 34099466 DOI: 10.1136/heartjnl-2020-317886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sai Kiran Bhagra
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Stephen Pettit
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Jayan Parameshwar
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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23
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Mitral and aortic valve surgery during left ventricular assist device implantation. J Thorac Cardiovasc Surg 2021; 164:970-977. [PMID: 33865571 DOI: 10.1016/j.jtcvs.2021.01.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022]
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Tanoue Y, Sonoda H, Ushijima T, Yamashita Y, Matsuyama S, Fujita S, Kimura S, Oishi Y, Tatewaki H, Shiose A. Successful papillary muscle approximation for severe mitral regurgitation via apical cuff hole in HeartMate 3 implantation via left anterior thoracotomy. J Artif Organs 2021; 24:368-371. [PMID: 33392862 DOI: 10.1007/s10047-020-01227-3] [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: 04/04/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022]
Abstract
We herein report a case of successful papillary muscle approximation for severe mitral regurgitation and HeartMate 3 left ventricular assist device implantation via left anterior thoracotomy in a 39-year-old man diagnosed with dilated cardiomyopathy. He underwent papillary muscle approximation in the mitral valve for severe functional regurgitation via the apical cuff hole. The postoperative course was uneventful. Echocardiography revealed that mitral regurgitation has disappeared. He was awaiting heart transplantation while working.
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Affiliation(s)
- Yoshihisa Tanoue
- Department of Advanced Cardiopulmonary Failure, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Tomoki Ushijima
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Yamashita
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Sho Matsuyama
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Satoshi Fujita
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Satoshi Kimura
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Yasuhisa Oishi
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Hideki Tatewaki
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
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Pagani FD. Understanding the impact of mitral regurgitation at the time of LVAD implantation. J Heart Lung Transplant 2020; 39:538-540. [DOI: 10.1016/j.healun.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/25/2022] Open
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Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D'Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Thorac Cardiovasc Surg 2020; 159:865-896. [DOI: 10.1016/j.jtcvs.2019.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Fujino T, Imamura T, Nitta D, Kim G, Smith B, Kalantari S, Nguyen A, Chung B, Narang N, Holzhauser L, Juricek C, Rodgers D, Song T, Ota T, Jeevanandam V, Burkhoff D, Sayer G, Uriel N. Effect of Concomitant Tricuspid Valve Surgery With Left Ventricular Assist Device Implantation. Ann Thorac Surg 2020; 110:918-924. [PMID: 32035052 DOI: 10.1016/j.athoracsur.2019.12.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/24/2019] [Accepted: 12/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is common in advanced heart failure (HF) patients. However, the effect of concomitant tricuspid valve repair or replacement (tricuspid valve intervention [TVI]) with left ventricular assist device (LVAD) implantation is controversial. The aim of this study was to investigate the longitudinal trend of TR after LVAD implantation and the effect of TVI on the TR trend and clinical outcomes. METHODS We retrospectively reviewed patients at our institution who underwent LVAD implantation between April 2014 and August 2018. We evaluated the grade of TR by echocardiography before and after LVAD implantation. Moderate or greater TR was defined as significant. RESULTS Among 199 consecutive patients, 194 had at least 2 echocardiographic TR assessments before and after LVAD implantation. Of these patients, 108 were included in the TVI-positive (TVI+) group and 86 in the TVI-negative (TVI-) group. In the TVI+ group, the prevalence of significant TR decreased from 52% to about 20% in the first 6 months after implantation (P < .01). Overall survival and HF readmission-free survival were comparable between the TVI+ and TVI- patients. In contrast, patients in both groups who had significant postoperative TR during early follow-up had worse 2-year HF readmission-free survival (36% in patients with significant postoperative TR vs 55% in those without significant postoperative TR; P = .028). CONCLUSIONS Concomitant TVI with LVAD implantation improved TR in most patients but did not have an impact on clinical outcomes. Significant postoperative TR after LVAD implantation, in patients with and without TVI, was associated with worse HF-free outcomes.
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Affiliation(s)
- Takeo Fujino
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Teruhiko Imamura
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Daisuke Nitta
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Gene Kim
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Bryan Smith
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Sara Kalantari
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Ann Nguyen
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Ben Chung
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Nikhil Narang
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Luise Holzhauser
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Colleen Juricek
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Daniel Rodgers
- Departments of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Tae Song
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | | | - Daniel Burkhoff
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | - Gabriel Sayer
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York.
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Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D'Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Heart Lung Transplant 2020; 39:187-219. [PMID: 31983666 DOI: 10.1016/j.healun.2020.01.1329] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
| | | | - Daniel J Goldstein
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | | | | - Anson Cheung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - William Holman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Charles Hoopes
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | | | - Ulrich P Jorde
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | - Nader Moazami
- Langone Medical Center, New York University, New York, NY
| | - Yoshifumi Naka
- Columbia University College of Physicians & Surgeons, New York, NY
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Salpy V Pamboukian
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | | | | | | | | | - John Stulak
- Mayo Clinic College of Medicine and Science, Rochester, Minn
| | | | | | | | - Stephan Schueler
- Department for Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - David A D'Alessandro
- Department of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Mass
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Gao B, Zhang Q, Chang Y. Hemodynamic effects of support modes of LVADs on the aortic valve. Med Biol Eng Comput 2019; 57:2657-2671. [PMID: 31707689 DOI: 10.1007/s11517-019-02058-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 11/02/2019] [Indexed: 12/11/2022]
Abstract
As the alternative treatment for heart failure, left ventricular assist devices (LVADs) have been widely applied to clinical practice. However, the effects of the support modes of LVADs on the biomechanical states of the aortic valve are still poorly understood. Hence, the present study investigates such effects and proposes a novel fluid-structure interaction (FSI) approach that combines the lattice Boltzmann method (LBM) and finite element (FE) method. Two support modes of LVADs, namely constant speed mode and constant flow mode, which have been widely applied to clinical practice, are also designed. Results demonstrate that the support modes of LVADs could significantly affect the biomechanical states of the aortic valve and the blood flow pattern of the ascending aorta. Compared with those in the constant flow mode, the leaflets in the constant speed mode could achieve better dynamic performance and lower stress during the systolic phase. The max radial displacement of the leaflets in the constant speed mode is at 8 mm, whereas that in the constant flow mode is at 0.8 mm. Furthermore, the outflow of LVADs directly impacts the aortic surfaces of the leaflets during the diastolic phase by increasing the level of wall shear stress of the leaflets. The leaflets in the constant speed mode receive less impact than those in the constant flow mode. The condition with such minimal impact is conducive to maintaining the normal structure of leaflets and benefits the reduction of the risk of valvular diseases. In sum, the support modes of LVADs exert a crucial effect on the biomechanical environment of the aortic valve. The constant speed mode is better than the constant flow mode in terms of providing a good hemodynamic environment for the aortic valve.
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Affiliation(s)
- Bin Gao
- School of Life Science and BioEngineering, Beijing University of Technology, Beijing, 100124, People's Republic of China.
| | - Qi Zhang
- School of Life Science and BioEngineering, Beijing University of Technology, Beijing, 100124, People's Republic of China
| | - Yu Chang
- School of Life Science and BioEngineering, Beijing University of Technology, Beijing, 100124, People's Republic of China
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Medical Management of Left Ventricular Assist Device Patients: A Practical Guide for the Nonexpert Clinician. Can J Cardiol 2019; 36:205-215. [PMID: 31879052 DOI: 10.1016/j.cjca.2019.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 01/09/2023] Open
Abstract
Left ventricular assist devices (LVADs) provide short- or long-term circulatory support to improve survival and reduce morbidity in selected patients with advanced heart failure. LVADs are being used increasingly and now have expanded indications. Health care providers across specialties will therefore not only encounter LVAD patients but play an integral role in their care. To accomplish that, they need to understand the elements of LVAD function, physiology and clinical use. This article provides a concise overview of the medical management of LVAD patients for nonexpert clinicians. Our presentation includes the basics of LVAD physiology, design, and operation, patient selection and assessment, medical management, adverse event identification and management, multidisciplinary care, and management of special circumstances, such as noncardiac surgery, cardiac arrest, and end-of-life care. The clinical examination of LVAD patients is unique in terms of blood pressure and heart rate assessment, LVAD "hum" auscultation, driveline and insertion site inspection, and device parameter recording. Important potential device-related adverse events include stroke, gastrointestinal bleeding, hematologic disorders, device infection, LVAD dysfunction, arrhythmias, and heart failure. Special considerations include the approach to the unconscious or pulseless patient, noncardiac surgery, and palliative care. An understanding of the principles presented in this paper will enable the nonexpert clinician to be effective in collaborating with an LVAD center in the assessment, medical management, and follow-up of LVAD patients. Future opportunities and challenges include the improvement of device designs, greater application of minimally invasive surgical implantation techniques, and management of health economics in cost-constrained systems like those of Canada and many other jurisdictions.
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Cluster analysis of preoperative echocardiographic findings and outcomes following left ventricular device implantation. J Thorac Cardiovasc Surg 2019; 157:1851-1860.e1. [DOI: 10.1016/j.jtcvs.2018.11.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/23/2018] [Accepted: 11/14/2018] [Indexed: 11/22/2022]
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Commentary: Mitral valve repair with left ventricular assist device implantation: Yes! But who? J Thorac Cardiovasc Surg 2019; 157:1849-1850. [DOI: 10.1016/j.jtcvs.2018.12.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
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Gomes B, Bekeredjian R, Leuschner F, Ehlermann P, Schmack B, Ruhparwar A, Raake PW, Katus HA, Kreusser MM. Transfemoral aortic valve replacement for severe aortic valve regurgitation in a patient with a pulsatile-flow biventricular assist device. ESC Heart Fail 2018; 6:217-221. [PMID: 30479049 PMCID: PMC6351890 DOI: 10.1002/ehf2.12384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022] Open
Abstract
Severe aortic regurgitation (AR) is a rare but significant complication of ventricular assist device therapy. Experience with transcatheter aortic valve replacement (TAVR) in this setting of patients is very limited, while the scarcely reported cases exclusively refer to TAVR under continuous‐flow left ventricular assist devices. Here, we present the first successful TAVR while running a pulsatile‐flow biventricular assist device (PF‐BiVAD). Clinical data were collected based on the patient's electronic medical records after the patient's consent was obtained. We describe the case of a 57‐year‐old man in whom a PF‐BiVAD (EXCOR, Berlin Heart, Berlin, Germany) had been initially inserted after fulminant myocarditis with subsequent severe dilated cardiomyopathy as bridge‐to‐transplantation therapy. Over the following 2 years, the patient developed severe de novo AR under PF‐BiVAD therapy. This, along with progressive cardiac decompensation, led to the decision for TAVR by our heart team as a minimal invasive approach for severe AR. TAVR using two Edwards SAPIEN 3 bioprostheses as a valve‐in‐valve procedure resulted in a significant reduction of AR from severe to mild, with trace paravalvular leakage and without significant pressure gradients. The patient underwent total orthotopic heart transplantation afterwards. This is the first report of successful TAVR in a patient with severe de novo AR while running a PF‐BiVAD.
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Affiliation(s)
- Bruna Gomes
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Florian Leuschner
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.,Department of Internal Medicine, Kurpfalzkrankenhaus, Heidelberg, Germany
| | - Bastian Schmack
- Department of Internal Medicine, Kurpfalzkrankenhaus, Heidelberg, Germany
| | - Arjang Ruhparwar
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.,Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
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Robertson JO, Naftel DC, Myers SL, Tedford RJ, Joseph SM, Kirklin JK, Silvestry SC. Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis. J Heart Lung Transplant 2018; 37:79-88. [DOI: 10.1016/j.healun.2017.09.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 11/28/2022] Open
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Impact of mitral valve intervention with left ventricular assist device implantation on postoperative outcomes and morphologic change. J Artif Organs 2017; 21:164-171. [DOI: 10.1007/s10047-017-1010-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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Medical Management of Patients With a Left Ventricular Assist Device for the Non-Left Ventricular Assist Device Specialist. JACC-HEART FAILURE 2017; 5:621-631. [DOI: 10.1016/j.jchf.2017.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/11/2017] [Accepted: 06/11/2017] [Indexed: 11/24/2022]
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Fukuhara S, Takeda K, Chiuzan C, Han J, Kurlansky PA, Takayama H, Naka Y. Concomitant mitral repair and continuous-flow left ventricular assist devices: Is it warranted? J Thorac Cardiovasc Surg 2017; 154:1303-1312.e4. [PMID: 28800891 DOI: 10.1016/j.jtcvs.2017.04.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/19/2017] [Accepted: 04/10/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pre-existing mitral pathology is common in patients undergoing continuous-flow left ventricular assist device implantation. We sought to investigate whether concurrent mitral repair confers any advantage. METHODS From March 2004 to October 2014, 374 patients received a continuous-flow left ventricular assist device. Of these, a total of 115 patients with pre-existing mitral regurgitation (MR) greater than moderate were identified and included in the analysis. Outcomes were compared between patients with concurrent mitral repair (n = 52 [45.2%]; Group A) and without repair (n = 63 [54.8%]; Group B). RESULTS The mean age was 56.8 years and 25 (21.5%) were women. Patients in Group A were more likely to have undergone destination therapy (48.1% vs 11.1%; P < .001) and had a greater cardiopulmonary bypass time (125 vs 89 minutes; P < .001) than did patients in Group B. Longitudinal analysis using a generalized mixed-effects model demonstrated the odds of developing moderate or severe MR during device support were 86% lower for Group A patients (P < .001). Among those who were discharged alive, 9 (8.6%)-consisting of 1 (2.2%) in Group A and 8 (13.6%) in Group B (P = .039)-developed late right heart failure requiring a total of 13 readmissions (0.03 vs 0.15 readmissions per patient-year; P = .011). Multivariable competing risks regression revealed mitral repair to be a protective factor (hazard ratio, 0.16; 95% confidence interval, 0.03-0.94; P = .042) for late right heart failure occurrence. CONCLUSIONS Concurrent mitral repair appears to be efficacious in controlling MR after device implant. The fact that repaired patients developed late right heart failure less frequently than did patients without repair challenges the notion that concurrent mitral repair is unwarranted.
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Affiliation(s)
- Shinichi Fukuhara
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Codruta Chiuzan
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Jiho Han
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Kurlansky
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY.
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Butterfield M, Derr C, Keffeler J, Jelic T. Organized cardiac activity in an awake LVAD patient during ventricular fibrillation. Am J Emerg Med 2017; 35:1041.e1-1041.e3. [PMID: 28291704 DOI: 10.1016/j.ajem.2017.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mike Butterfield
- Tampa General Hospital, University of South Florida, Emergency Medicine Residency Program, Tampa, FL, United States.
| | - Charlotte Derr
- Tampa General Hospital, University of South Florida, Emergency Medicine Residency Program, Tampa, FL, United States
| | - Jotham Keffeler
- Aeromed Transport, Tampa General Hospital, Tampa, FL, United States
| | - Tom Jelic
- Tampa General Hospital, University of South Florida, Emergency Medicine Residency Program, Tampa, FL, United States
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Kassis H, Cherukuri K, Agarwal R, Kanwar M, Elapavaluru S, Sokos GG, Moraca RJ, Bailey SH, Murali S, Benza RL, Raina A. Significance of Residual Mitral Regurgitation After Continuous Flow Left Ventricular Assist Device Implantation. JACC-HEART FAILURE 2017; 5:81-88. [DOI: 10.1016/j.jchf.2016.09.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
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Fierro MA, Welsby IJ. Identification of Severe Mitral Stenosis Using Real-Time Three-Dimensional Transesophageal Echocardiography During an Left Ventricular Assist Device Insertion. Anesth Analg 2016; 123:1089-1093. [DOI: 10.1213/ane.0000000000001551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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41
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Technology for Diagnosis, Treatment, and Prevention of Cardiometabolic Disease in India. Prog Cardiovasc Dis 2016; 58:620-9. [DOI: 10.1016/j.pcad.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 02/28/2016] [Indexed: 12/26/2022]
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Gregory SD, Stevens MC, Wu EL, Pauls JP, Kleinheyer M, Fraser JF. Mitral Valve Regurgitation with a Rotary Left Ventricular Assist Device: The Haemodynamic Effect of Inlet Cannulation Site and Speed Modulation. Ann Biomed Eng 2016; 44:2674-82. [PMID: 26932840 DOI: 10.1007/s10439-016-1579-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
Mitral valve regurgitation (MVR) is common in patients receiving left ventricular assist device (LVAD) support, however the haemodynamic effect of MVR is not entirely clear. This study evaluated the haemodynamic effect of MVR with LVAD support and the influence of inflow cannulation site and LVAD speed modulation. Left atrial (LAC) and ventricular (LVC) cannulation was evaluated in a mock circulation loop with no, mild, moderate and severe MVR with constant speed and speed modulation (±600 RPM) modes. The use of an LVAD relieved pulmonary congestion during severe MVR, by reducing left atrial pressure from 20.5 to 10.8 (LAC) and 11.5 (LVC) mmHg. However, LAC resulted in decreased left ventricular stroke work (-0.08 J), ejection fraction (-7.9%) and higher MVR volume (+12.7 mL) and pump speed (+100 RPM) compared to LVC. This suggests that LVC, in addition to reducing MVR severity, also improves ventricular washout over LAC. LVAD speed modulation in synchrony with ventricular systole reduced MVR volume and increased ejection fraction with LAC and LVC, thus demonstrating the potential benefits of this mode, despite a reduction in cardiac output.
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Affiliation(s)
- Shaun D Gregory
- School of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Michael C Stevens
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Eric L Wu
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Jo P Pauls
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Engineering, Griffith University, Southport, QLD, Australia
| | - Matthias Kleinheyer
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Engineering, Griffith University, Southport, QLD, Australia
| | - John F Fraser
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
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Goldraich L, Kawajiri H, Foroutan F, Braga J, Billia P, Misurka J, Stansfield WE, Yau T, Ross HJ, Rao V. Tricuspid Valve Annular Dilation as a Predictor of Right Ventricular Failure After Implantation of a Left Ventricular Assist Device. J Card Surg 2016; 31:110-6. [PMID: 26748904 DOI: 10.1111/jocs.12685] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tricuspid annular (TA) dilation has been suggested as a more reliable marker of concomitant advanced right ventricular failure (RVF) than severity of tricuspid regurgitation (TR). Our objective was to examine the impact of TA dilation on occurrence of RVF and in-hospital mortality following left ventricular assist device (LVAD) implant. METHODS Consecutive patients undergoing implantation of a continuous-flow LVAD implant were grouped according to the presence or absence of preoperative dilated TA. Clinical characteristics, hemodynamics, and short-term postoperative outcomes were compared between groups. RVF was defined as unplanned right ventricular assist device (RVAD) or postoperative use of inotropes for >14 days. Linear and logistic regressions were used to explore associations of TA with occurrence of RVF and duration of inotrope use. RESULTS We included 69 patients who had continuous-flow LVAD implanted between 2006 and 2013 (50 ± 13 years old; 69% males; 37% ischemic etiology; 69% bridge-to-transplant LVAD; 18% INTERMACS 1-2; 48% with significant TR). RVF occurred in nine cases, and overall in-hospital mortality rate was 14%. Tricuspid valve repair was performed in ten cases. Dilated TA (OR 4.86; 95% CI 1.05-22.33; p = 0.04) was associated with RVF. In an adjusted multivariable analysis, indexed TA was an independent predictor of increased days of inotrope use (0.8-day increase in inotrope use for every 1 mm/m2 increase; p = 0.04). CONCLUSION In this cohort, TA dilation was a predictor of RVF after LVAD implant. The potential benefit of concomitant TVR in selected patients with a dilated TA undergoing LVAD implantation remains to be determined.
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Affiliation(s)
- Livia Goldraich
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Hiroyuki Kawajiri
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Farid Foroutan
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Juarez Braga
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Phyllis Billia
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Echocardiography Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Jimmy Misurka
- Echocardiography Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - William E Stansfield
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Terrence Yau
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Heather J Ross
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Vivek Rao
- Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Jarvik 2000 axial-flow ventricular assist device placement to a systemic morphologic right ventricle in congenitally corrected transposition of the great arteries. J Artif Organs 2015; 19:97-9. [DOI: 10.1007/s10047-015-0866-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
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Subramaniam K. Mechanical circulatory support. Best Pract Res Clin Anaesthesiol 2015; 29:203-27. [DOI: 10.1016/j.bpa.2015.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 12/29/2022]
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Adatya S, Holley CT, Roy SS, Yarmohammadi H, Feng A, Eckman P, Colvin-Adams M, John R, Masri C. Echocardiographic Ramp Test for Continuous-Flow Left Ventricular Assist Devices. JACC-HEART FAILURE 2015; 3:291-9. [DOI: 10.1016/j.jchf.2014.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/03/2014] [Indexed: 10/23/2022]
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Halbreiner MS, Soltesz E, Starling R, Moazami N. Current Practice in Patient Selecting for Long-Term Mechanical Circulatory Support. Curr Heart Fail Rep 2014; 12:120-9. [DOI: 10.1007/s11897-014-0243-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Medical management of patients with continuous-flow left ventricular assist devices. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:283. [PMID: 24398802 DOI: 10.1007/s11936-013-0283-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OPINION STATEMENT The prevalence of patients living with advanced heart failure continues to rise. For a subset of these patients, continuous-flow left ventricular assist devices (LVADs) are a life-saving therapy. Given the efficacy and durability of contemporary LVAD devices, their use has increased exponentially in recent years. The medical management of patients with an LVAD is an area of expertise for advanced heart failure clinicians, but a general understanding of the initial approach to, and stabilization of, LVAD patients is an important skillset for many health care providers. The rapidly changing field of the medical management of LVAD patients is largely based on clinical experience and limited published data. In this manuscript, we integrate the available published data on the medical management of LVAD patients with the growing clinical experience.
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