1
|
Takla A, Eid F, Elbanna M, Eid MM, Joshi A, Bitar A, Lydon R, Feitell S. Percutaneous Intervention of LVAD Outflow Graft Obstruction and Thrombosis. Methodist Debakey Cardiovasc J 2024; 20:9-13. [PMID: 38618610 PMCID: PMC11011953 DOI: 10.14797/mdcvj.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 04/16/2024] Open
Abstract
Left ventricular assist devices serve as a salvage therapy for patients with advanced heart failure. Complications such as thrombosis and obstruction can lead to acute device malfunction, posing significant clinical risks. A multidisciplinary approach is crucial for management. Few cases in the literature have demonstrated the safety and efficacy of percutaneous intervention, which holds significant value due to its less invasive nature and minimal risk of morbidity, especially in high-risk surgical patients.
Collapse
Affiliation(s)
- Andrew Takla
- Rochester General Hospital, Rochester, New York, US
| | - Fahad Eid
- Unity Hospital, Rochester, New York, US
| | | | | | - Akshay Joshi
- Rochester General Hospital, Rochester, New York, US
| | | | - Ryan Lydon
- Rochester General Hospital, Rochester, New York, US
| | | |
Collapse
|
2
|
Zapletal B, Zimpfer D, Schlöglhofer T, Fritzer-Szekeres M, Szekeres T, Bernardi MH, Geilen J, Schultz MJ, Tschernko EM. Hemolysis Index Correlations with Plasma-Free Hemoglobin and Plasma Lactate Dehydrogenase in Critically Ill Patients under Extracorporeal Membrane Oxygenation or Mechanical Circulatory Support-A Single-Center Study. Diagnostics (Basel) 2024; 14:680. [PMID: 38611592 PMCID: PMC11011733 DOI: 10.3390/diagnostics14070680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Monitoring for thrombosis and hemolysis is crucial for patients under extracorporeal or mechanical circulatory support, but it can be costly. We investigated correlations between hemolysis index (HI) and plasma-free hemoglobin (PFH) levels on one hand, and between the HI and plasma lactate dehydrogenase (LDH) levels on the other, in critically ill patients with and without extracorporeal or mechanical circulatory support. Additionally, we calculated the cost reductions if monitoring through HI were to replace monitoring through PFH or plasma LDH. In a single-center study, HI was compared with PFH and plasma LDH levels in blood samples taken for routine purposes in critically ill patients with and without extracorporeal or mechanical circulatory support. A cost analysis, restricted to direct costs associated with each measurement, was made for an average 10-bed ICU. This study included 147 patients: 56 patients with extracorporeal or mechanical circulatory support (450 measurements) and 91 patients without extracorporeal or mechanical circulatory support (562 measurements). The HI correlated well with PFH levels (r = 0.96; p < 0.01) and poorly with plasma LDH levels (r = 0.07; p < 0.01) in patients with extracorporeal or mechanical circulatory support. Similarly, HI correlated well with PFH levels (r = 0.97; p < 0.01) and poorly with plasma LDH levels (r = -0.04; p = 0.39) in patients without extracorporeal or mechanical circulatory support. ROC analyses demonstrated a strong performance of HI, with the curve indicating excellent discrimination in the whole cohort (area under the ROC of 0.969) as well as in patients under ECMO or mechanical circulatory support (area under the ROC of 0.988). Although the negative predictive value of HI for predicting PFH levels > 10 mg/dL was high, its positive predictive value was found to be poor at various cutoffs. A simple cost analysis showed substantial cost reduction if HI were to replace PFH or plasma LDH for hemolysis monitoring. In conclusion, in this cohort of critically ill patients with and without extracorporeal or mechanical circulatory support, HI correlated well with PFH levels, but poorly with plasma LDH levels. Given the high correlation and substantial cost reductions, a strategy utilizing HI may be preferable for monitoring for hemolysis compared to monitoring strategies based on PFH or plasma LDH. The PPV of HI, however, is unacceptably low to be used as a diagnostic test.
Collapse
Affiliation(s)
- Bernhard Zapletal
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (D.Z.); (T.S.)
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (D.Z.); (T.S.)
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
| | - Monika Fritzer-Szekeres
- Department of Laboratory Medicine, Medical University Vienna, 1090 Vienna, Austria; (M.F.-S.); (T.S.)
| | - Thomas Szekeres
- Department of Laboratory Medicine, Medical University Vienna, 1090 Vienna, Austria; (M.F.-S.); (T.S.)
| | - Martin H. Bernardi
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Johannes Geilen
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Marcus J. Schultz
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
- Department of Intensive Care, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Edda M. Tschernko
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| |
Collapse
|
3
|
Wan S, Chen Y, Yuan X, Lin Y. Postoperative care of 14 patients with left ventricular assist devices: a case series. J Int Med Res 2024; 52:3000605231214943. [PMID: 38318647 PMCID: PMC10846282 DOI: 10.1177/03000605231214943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/30/2023] [Indexed: 02/07/2024] Open
Abstract
A left ventricular assist device is a mechanical device that is surgically implanted in the heart to partially or completely replace the function of the heart. Left ventricular assist devices are of vital importance in the treatment of patients with heart failure. There are different recommendations for the postoperative care of patients undergoing left ventricular assist device implantation in different countries, and no uniform standard has been developed. The first implantation of a left ventricular assist device in Eastern China was performed in February 2021; since that date, 14 patients underwent implantation until February 2023. This report describes the postoperative care of these 14 patients with end-stage heart failure who underwent left ventricular assist device placement, all of whom were discharged with a good prognosis.
Collapse
Affiliation(s)
| | | | - Xia Yuan
- Nursing Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Lin
- Nursing Department, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
4
|
Lin CF, Tsai CL, Chang YH, Lin DY, Chien LN. Sex-based differences in ischemic cardiovascular and bleeding outcomes following implantation of drug-eluting stent in patients at high bleeding risk. Hellenic J Cardiol 2024:S1109-9666(24)00001-0. [PMID: 38218375 DOI: 10.1016/j.hjc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/28/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Patients with high bleeding risk (HBR) may exhibit uncertain adherence to dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) implantation. The current population-based cohort study aimed to investigate the sex-based differences in adverse outcomes among the HBR population by analyzing the National Health Insurance Research Database in Taiwan. METHODS Patients who had HBR features defined by the Academic Research Consortium (ARC) and received DES implantation between January 1, 2007, and December 31, 2017, were enrolled. Propensity score matching was adopted to select 3,981 pairs with similar clinical cardiovascular risks but different sexes. A competing risk model was performed to evaluate the risk of adverse ischemic events (cardiac death, nonfatal myocardial infarction, and ischemic stroke) and any bleeding events in both sexes. Noncardiac death was considered a competing risk. RESULTS Within a 5-year follow-up, the incidence rates (per 1,000 person-year (95% confidence interval (CI)) of composite ischemic events and any bleeding events in males were respectively 44.09 (40.25-48.30) and 42.55 (38.79-46.68), while those in females were respectively 40.18 (36.51-44.23) and 42.35 (38.57-46.51). After adjustment for clinical variables, male patients had a marginally increased risk in the composite ischemic events (adjusted subdistribution hazard ratio (SHR) = 1.15 (1.00-1.31), p = 0.045) and a similar risk of any bleeding events (adjusted SHR = 1.00 (0.88-1.15), p = 0.946) compared with female patients. CONCLUSIONS Of the HBR population, males had an increased risk of ischemic outcomes but a similar risk of bleeding compared with females following DES implantation.
Collapse
Affiliation(s)
- Chao-Feng Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Ling Tsai
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ya-Hui Chang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan
| | - Dai-Yi Lin
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Li-Nien Chien
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
5
|
Kummerow M, von Dossow V, Pasero D, Martinez Lopez de Arroyabe B, Abrams B, Kowalsky M, Wilkey BJ, Subramanian K, Martin AK, Marczin N, de Waal EEC. PERSUADE Survey-PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States. J Cardiothorac Vasc Anesth 2024; 38:197-206. [PMID: 37980193 DOI: 10.1053/j.jvca.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To comprehensively assess relevant institutional variations in anesthesia and intensive care management during left ventricular assist device (LVAD) implantation. DESIGN The authors used a prospective data analysis. SETTING This was an online survey. PARTICIPANTS Participants were from LVAD centers in Europe and the US. INTERVENTIONS After investigating initial interest, 91 of 202 European and 93 of 195 US centers received a link to the survey targeting institutional organization and experience, perioperative hemodynamic monitoring, medical management, and postoperative intensive care aspects. MEASUREMENTS AND MAIN RESULTS The survey was completed by 73 (36.1%) European and 60 (30.8%) US centers. Although most LVAD implantations were performed in university hospitals (>5 years of experience), significant differences were observed in the composition of the preoperative multidisciplinary team and provision of intraoperative care. No significant differences in monitoring or induction agents were observed. Propofol was used more often for maintenance in Europe (p < 0.001). The choice for inotropes changed significantly from preoperatively (more levosimendan in Europe) to intraoperatively (more use of epinephrine in both Europe and the US). The use of quantitative methods for defining right ventricular (RV) function was reported more often from European centers than from US centers (p < 0.05). Temporary mechanical circulatory support for the treatment of RV failure was more often used in Europe. Nitric oxide appeared to play a major role only intraoperatively. There were no significant differences in early postoperative complications reported from European versus US centers. CONCLUSIONS Although the perioperative practice of care for patients undergoing LVAD implantation differs in several aspects between Europe and the US, there were no perceived differences in early postoperative complications.
Collapse
Affiliation(s)
- Maren Kummerow
- Department of Anesthesiology and Intensive Care Medicine, Mathias-Spital Rheine, Rheine, Germany
| | - Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center North Rhine-Westphalia, University Clinic of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Daniela Pasero
- Department of Anesthesiology and Intensive Care, University Hospital, Sassari, Italy
| | | | - Benjamin Abrams
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Markus Kowalsky
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Barbara J Wilkey
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathirvel Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, Pittsburgh, PA
| | - Archer K Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - Nandor Marczin
- Division of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, Royal Brompton & Harefield Hospitals, Guy's & St. Thomas' NHS, London, United Kingdom; Department of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
| | - Eric E C de Waal
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
6
|
Balestra N, Fredericks S, Silva AVCD, Rodrigues RCM, Nunes DP, Pedrosa RBDS. Driveline dressings used in heartmate patients and local complications: A retrospective cohort. Heart Lung 2023; 62:271-277. [PMID: 37633011 DOI: 10.1016/j.hrtlng.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Patients with long-term ventricular assist devices (VAD) are predisposed to infection, bleeding, and pressure injuries at the insertion of the driveline. There is no consensus on a driveline dressing protocol. Chlorhexidine is often used to clean the driveline exit site and has been associated with lower rates of infection. For driveline coverage, bacteriostatic agents and transparent film have shown good results, but are costly. The same issue was associated with anchorage devices. OBJECTIVES The purpose of this study was to evaluate the types of dressings used in the driveline of patients using HeartMate (HM) and to describe the incidence density of local complications (infection, bleeding, and pressure injury) within 30 days postoperatively. METHODS A retrospective cohort study was conducted and included 22 patients admitted to the Intensive Care Unit after implantation of HM II and III in a Brazilian private hospital. RESULTS Several types of dressings were used in the drivelines. There were 22 different types of dressings. Dressing type 6 (Chlorhexidine, Excilon, Gauze and IV3000) were the most used (45.4%). Subjects using the Flexi-Trak anchoring device had a higher rate of local bleeding (50.0%) and those who used the Hollister device had more infection (61.1%) and pressure injury associated with a medical device (11.1%), compared to others. Infection was the primary complication (45.4%), followed by local bleeding (27.7%). CONCLUSION Despite the high variability of products used in the driveline of patients using HeartMate, the dressing made with chlorhexidine, silver-impregnated absorbent foam and transparent film, and the use of anchoring devices was the most frequently used. Infection was the most common complication.
Collapse
Affiliation(s)
- Natalia Balestra
- Sírio-Libanês Hospital, 115 Dona Adma Jafet St, São Paulo, 01308-050, Brazil; Faculty of Nursing, University of Campinas (UNICAMP), 126 Tessália Vieira de Camargo St, Campinas, 13083-887, Brazil
| | - Suzanne Fredericks
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, 350 Victoria St, Toronto, M5B 2K3, Canada
| | | | | | - Daniella Pires Nunes
- Faculty of Nursing, University of Campinas (UNICAMP), 126 Tessália Vieira de Camargo St, Campinas, 13083-887, Brazil
| | | |
Collapse
|
7
|
Malhotra A, Dalia T, Zorn GL, Shah Z, Vidic A. Transcatheter aortic valve replacement for aortic insufficiency in a patient with aortic root Thrombus and left ventricular assist device: A risk worth taking? J Cardiol Cases 2023; 28:197-200. [PMID: 38024109 PMCID: PMC10658293 DOI: 10.1016/j.jccase.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 12/01/2023] Open
Abstract
A 61-year-old man with end-stage ischemic cardiomyopathy post HeartMate 3 (Abbott laboratories, Chicago, Illinois, USA) left ventricular assist device (LVAD) implant was hospitalized after he had recurrent ventricular tachycardia requiring implantable cardioverter-defibrillator shocks. His transthoracic echocardiogram and computed tomography angiography of the chest showed presence of trace aortic insufficiency (AI) and aortic root thrombus (ART) of non-coronary cusp without obstruction of right or left coronary artery ostium despite therapeutic international normalized ratio. He presented again 3 months later with worsening heart failure signs and symptoms. Transesophageal echocardiogram showed progression to severe AI and persistent ART. Despite hemodynamically guided LVAD speed optimization, inotropic support, and diuresis, the patient continued to deteriorate with worsening renal function. The patient was not a transplant candidate due to frailty. After multi-disciplinary discussion he underwent successful 29-Sapien S3 (Edwards Lifesciences, Irvine, CA, USA) transcatheter aortic valve replacement utilizing distal protection filters in bilateral internal carotid arteries for stroke prevention. This case provides novel insight to physicians treating LVAD patients regarding management of severe AI in the setting of ART. Learning objective We report a rare approach employed for management of aortic insufficiency (AI) in a patient who also had an aortic root thrombus and left ventricular assist device (LVAD) that traditionally requires cardiac transplantation. Our patient had a favorable outcome with a minimally invasive transcatheter aortic valve replacement. With this case, we hope to generate awareness amongst physicians treating patients about management alternatives and approach of a commonly encountered, life-threatening complication of AI in patients with LVAD.
Collapse
Affiliation(s)
- Anureet Malhotra
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - George L. Zorn
- Department of Cardiothoracic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrija Vidic
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
8
|
Shields A, Setlur Nagesh SV, Rajagopal K, Bednarek DR, Rudin S, Chivukula VK. Application of 1,000 fps High-Speed Angiography to In-Vitro Hemodynamic Evaluation of Left Ventricular Assist Device Outflow Graft Configurations. ASAIO J 2023; 69:756-765. [PMID: 37140988 PMCID: PMC10524133 DOI: 10.1097/mat.0000000000001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Left ventricular assist device (LVAD)-induced hemodynamics are characterized by fast-moving flow with large variations in velocity, making quantitative assessments difficult with existing imaging methods. This study demonstrates the ability of 1,000 fps high-speed angiography (HSA) to quantify the effect of the surgical implantation angle of a LVAD outflow graft on the hemodynamics within the ascending aorta in vitro . High-speed angiography was performed on patient-derived, three-dimensional-printed optically opaque aortic models using a nonsoluble contrast media, ethiodol, as a flow tracer. Outflow graft configuration angles of 45° and 90° with respect to the central aortic axis were considered. Projected velocity distributions were calculated from the high-speed experimental sequences using two methods: a physics-based optical flow algorithm and tracking of radio-opaque particles. Particle trajectories were also used to evaluate accumulated shear stress. Results were then compared with computational fluid dynamics (CFD) simulations to confirm the results of the high-speed imaging method. Flow patterns derived from HSA coincided with the impingement regions and recirculation zones formed in the aortic root as seen in the CFD for both graft configurations. Compared with the 45° graft, the 90° configuration resulted in 81% higher two-dimensional-projected velocities (over 100 cm/s) along the contralateral wall of the aorta. Both graft configurations suggest elevated accumulated shear stresses along individual trajectories. Compared with CFD simulations, HSA successfully characterized the fast-moving flow and hemodynamics in each LVAD graft configuration in vitro , demonstrating the potential utility of this technology as a quantitative imaging modality.
Collapse
Affiliation(s)
- Allison Shields
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Swetadri Vasan Setlur Nagesh
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Keshava Rajagopal
- Division of Cardiac Surgery, Department of Surgery, Sidney
Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania,
USA
| | - Daniel R. Bednarek
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Stephen Rudin
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Venkat Keshav Chivukula
- Department of Biomedical Engineering, Florida Institute of
Technology, Melbourne, Florida, USA
| |
Collapse
|
9
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
10
|
Del Rio-Pertuz G, Paz P, Argueta-Sosa E, Hirsch B, Nair N. Complete Pump Stop as the Presentation of Left Ventricular Recovery in a Patient With Left Ventricular Assist Device. Int J Heart Fail 2023; 5:169-171. [PMID: 37554689 PMCID: PMC10406558 DOI: 10.36628/ijhf.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/07/2023] [Accepted: 05/28/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Gaspar Del Rio-Pertuz
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Pablo Paz
- Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Erwin Argueta-Sosa
- Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Benjamin Hirsch
- Department of Surgery/Cardiothoracic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Nandini Nair
- Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Division of Cardiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
11
|
Weymann A, Foroughi J, Vardanyan R, Punjabi PP, Schmack B, Aloko S, Spinks GM, Wang CH, Arjomandi Rad A, Ruhparwar A. Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure. Adv Mater 2023; 35:e2207390. [PMID: 36269015 DOI: 10.1002/adma.202207390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/19/2022] [Indexed: 05/12/2023]
Abstract
Medical soft robotics constitutes a rapidly developing field in the treatment of cardiovascular diseases, with a promising future for millions of patients suffering from heart failure worldwide. Herein, the present state and future direction of artificial muscle-based soft robotic biomedical devices in supporting the inotropic function of the heart are reviewed, focusing on the emerging electrothermally artificial heart muscles (AHMs). Artificial muscle powered soft robotic devices can mimic the action of complex biological systems such as heart compression and twisting. These artificial muscles possess the ability to undergo complex deformations, aiding cardiac function while maintaining a limited weight and use of space. Two very promising candidates for artificial muscles are electrothermally actuated AHMs and biohybrid actuators using living cells or tissue embedded with artificial structures. Electrothermally actuated AHMs have demonstrated superior force generation while creating the prospect for fully soft robotic actuated ventricular assist devices. This review will critically analyze the limitations of currently available devices and discuss opportunities and directions for future research. Last, the properties of the cardiac muscle are reviewed and compared with those of different materials suitable for mechanical cardiac compression.
Collapse
Affiliation(s)
- Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Javad Foroughi
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Library Rd, Kensington, NSW, 2052, Australia
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, 72 Du Cane Rd, London, W12 0HS, UK
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Sinmisola Aloko
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Geoffrey M Spinks
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Chun H Wang
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Library Rd, Kensington, NSW, 2052, Australia
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| |
Collapse
|
12
|
Litvak M, Shamanaev A, Zalawadiya S, Matafonov A, Kobrin A, Feener EP, Wallisch M, Tucker EI, McCarty OJT, Gailani D. Titanium is a potent inducer of contact activation: implications for intravascular devices. J Thromb Haemost 2023; 21:1200-1213. [PMID: 36696212 PMCID: PMC10621279 DOI: 10.1016/j.jtha.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/07/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Titanium (Ti) and its alloys are widely used in manufacturing medical devices because of their strength and resistance to corrosion. Although Ti compounds are considered compatible with blood, they appear to support plasma contact activation and may be thrombogenic. OBJECTIVES The objective of this study was to compare Ti and titanium nitride (TiN) with known activators of contact activation (kaolin and silica) in plasma-clotting assays and to assess binding and activation of factor XII, (FXII), factor XI (FXI), prekallikrein, and high-molecular-weight kininogen (HK) with Ti/TiN. METHODS Ti-based nanospheres and foils were compared with kaolin, silica, and aluminum in plasma-clotting assays. Binding and activation of FXII, prekallikrein, HK, and FXI to surfaces was assessed with western blots and chromogenic assays. RESULTS Using equivalent surface amounts, Ti and TiN were comparable with kaolin and superior to silica, for inducing coagulation and FXII autoactivation. Similar to many inducers of contact activation, Ti and TiN are negatively charged; however, their effects on FXII are not neutralized by the polycation polybrene. Antibodies to FXII, prekallikrein, or FXI or coating Ti with poly-L-arginine blocked Ti-induced coagulation. An antibody to FXII reduced FXII and PK binding to Ti, kallikrein generation, and HK cleavage. CONCLUSION Titanium compounds induce contact activation with a potency comparable with that of kaolin. Binding of FXII with Ti shares some features with FXII binding to soluble polyanions but may have unique features. Inhibitors targeting FXII or FXI may be useful in mitigating Ti-induced contact activation in patients with titanium-based implants that are exposed to blood.
Collapse
Affiliation(s)
- Maxim Litvak
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aleksandr Shamanaev
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandip Zalawadiya
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anton Matafonov
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anton Kobrin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edward P Feener
- KalVista Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Michael Wallisch
- Aronora, Inc., Portland, Oregon, USA; Department of Biomedical Engineering, Oregon Health & Science University, Oregon, USA
| | - Erik I Tucker
- Aronora, Inc., Portland, Oregon, USA; Department of Biomedical Engineering, Oregon Health & Science University, Oregon, USA
| | - Owen J T McCarty
- Department of Biomedical Engineering, Oregon Health & Science University, Oregon, USA
| | - David Gailani
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| |
Collapse
|
13
|
Hanke JS, Merzah AS, Arfai J, Haverich A, Schmitto JD, Dogan G. Der Patient am linksventrikulären Assist Device. Z Herz- Thorax- Gefäßchir 2023. [DOI: 10.1007/s00398-023-00571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
14
|
Schaffer C, Gunga Z, Guillier D, Raffoul W, Kirsch M, di Summa PG. Pressure sore incidence and treatment in left ventricular assist device (LVAD)-equipped patients: Insights from a prospective series. J Plast Reconstr Aesthet Surg 2023; 77:388-396. [PMID: 36628855 DOI: 10.1016/j.bjps.2022.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/07/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A left ventricular assistance device (LVAD) is indicated in patients with end-stage heart failure. Due to the non-physiologic blood flow, a LVAD may favor pressure sores with a devastating risk of infection. This work shows the prevalence and treatment of pressure sores in LVAD patients, to optimize their management. MATERIAL AND METHODS We retrospectively investigated all LVAD implantations at the Lausanne University Hospital (CHUV) from 2015 to 2019. We detected patients who developed a pressure sore and evaluated the timeline, management, and outcomes. RESULTS Forty-two patients benefited from LVAD, among whom 5 (12%) developed a stage III/IV pressure sore, within a mean time of 25 days. Due to their poor overall condition, 4/5 patients were treated surgically and 1/5 conservatively. Half of the patients treated with surgery had major complications requiring reoperation. After flap coverage, the mean time to healing for patients was 6 weeks. DISCUSSION The rapid development of deep pressure sores seen in 12% of patients may be a manifestation of the maladaptive blood flow induced by LVADs, combined with their bedridden condition. Initial signs of pressure sores should be considered seriously, as they are rapidly evolving and needing an aggressive surgical treatment whenever possible (80%). Complication rate was similar compared to standard pressure sore flap treatment. All patients benefiting from flap surgery achieved effective coverage after a mean follow-up of 24 months. No patient developed a LVAD infection. CONCLUSION Surgery must be considered early in this population to prevent potential device infection.
Collapse
Affiliation(s)
- Clara Schaffer
- Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, Lausanne 1006, Switzerland
| | - Ziyad Gunga
- Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David Guillier
- Plastic and Reconstructive Surgery, Dijon University Hospital (CHU Dijon), Dijon, France
| | - Wassim Raffoul
- Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, Lausanne 1006, Switzerland
| | - Matthias Kirsch
- Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pietro G di Summa
- Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, Lausanne 1006, Switzerland.
| |
Collapse
|
15
|
Sato D, Koizumi S, Umekawa M, Kioyofuji S, Ando M, Ono M, Saito N. Controversies and challenges of coil embolization for intracranial aneurysm in a continuous-flow LVAD implanted patient: A case report. Surg Neurol Int 2023; 14:34. [PMID: 36895216 PMCID: PMC9990801 DOI: 10.25259/sni_1101_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Background Continuous-flow left ventricular assist device (CF-LVAD) technology has rapidly developed to support the failing heart refractory to standard medical treatments. Although the expected prognosis has improved dramatically, ischemic and hemorrhagic strokes are possible complications and the leading causes of death in the CF-LVAD population. Case Description We encountered a case of an unruptured large internal carotid aneurysm in a patient with a CF-LVAD. Following a detailed discussion of his expected prognosis, the risk of aneurysm rupture, and the inherited risk of aneurysm treatment, coil embolization was performed without adverse events. The patient remained recurrence-free for 2-year postoperatively. Conclusion This report illustrates the feasibility of coil embolization in a CF-LVAD recipient and emphasizes the necessity of vigilant consideration of whether to intervene in an intracranial aneurysm after CF-LVAD implantation. We confronted several challenges during the treatment: optimal endovascular technique, management of antithrombotic drugs, safe arterial access, desirable perioperative imaging modalities, and prevention of ischemic complications. This study aimed to share this experience.
Collapse
Affiliation(s)
- Daisuke Sato
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Kioyofuji
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Ando
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
16
|
Katapadi A, Umland M, Khandheria BK. Update on the Practical Role of Echocardiography in Selection, Implantation, and Management of Patients Requiring Left Ventricular Assist Device Therapy. Curr Cardiol Rep 2022; 24:1587-1597. [PMID: 35984555 DOI: 10.1007/s11886-022-01771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Echocardiography is a valuable tool for management of patients with a left ventricular assist device (LVAD). We present an updated review on the practical applications of the role of echocardiography for pre- and postoperative evaluation of patients selected. RECENT FINDINGS The LVAD is a temporary or permanent option for patients with advanced heart failure who are unresponsive to other therapy. Use of the device has its own risks, and implantation remains a complex procedure. Transthoracic and transesophageal echocardiography are useful tools for patient evaluation and monitoring both peri- and postoperatively, as we previously presented. Assessment of left and right ventricular function, complications such as thrombus formation or intracardiac shunting, and valvular disease are all important in this assessment. This also aids in predicting postoperative complications. Placement of the device is confirmed intraoperatively, and subsequent ramp studies are used to determine optimal device settings. Right ventricular (RV) failure is the most common postoperative complication and preoperative evaluation of its function is crucial. Studies suggest that tricuspid annular plane systolic excursion, RV fractional area change, and RV global longitudinal strain are strong predictors of RV failure; LV ejection fraction, size, and end-diastolic diameter are also important markers. Aortic regurgitation and mitral stenosis must always be corrected prior to LVAD placement. However, direct visualization before and after implantation, especially to rule out potential contraindications such as thrombi, cannot be overemphasized. Ramp studies remain an integral part of device optimization and may result in greater myocardial recovery than previously realized.
Collapse
Affiliation(s)
- Aashish Katapadi
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Matt Umland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA.
- School of Medicine and Public Health, University of Wisconsin, Milwaukee, WI, 53215, USA.
| |
Collapse
|
17
|
Cormican DS, Madden C, Rodrigue MF. Mechanical circulatory support: complications, outcomes, and future directions. Int Anesthesiol Clin 2022; 60:72-80. [PMID: 35960687 DOI: 10.1097/aia.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel S Cormican
- Cardiothoracic & Transplant Anesthesiology and Surgical Critical Care, Anesthesiology Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Claire Madden
- Surgical Critical Care, Surgery Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Marc F Rodrigue
- Cardiothoracic Anesthesiology, Anesthesiology Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| |
Collapse
|
18
|
Cameli M, Pastore MC, Mandoli GE, Landra F, Lisi M, Cavigli L, D'Ascenzi F, Focardi M, Carrucola C, Dokollari A, Bisleri G, Tsioulpas C, Bernazzali S, Maccherini M, Valente S. A multidisciplinary approach for the emergency care of patients with left ventricular assist devices: A practical guide. Front Cardiovasc Med 2022; 9:923544. [PMID: 36072858 PMCID: PMC9441753 DOI: 10.3389/fcvm.2022.923544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
The use of a left ventricular assist device (LVAD) as a bridge-to-transplantation or destination therapy to support cardiac function in patients with end-stage heart failure (HF) is increasing in all developed countries. However, the expertise needed to implant and manage patients referred for LVAD treatment is limited to a few reference centers, which are often located far from the patient's home. Although patients undergoing LVAD implantation should be permanently referred to the LVAD center for the management and follow-up of the device also after implantation, they would refer to the local healthcare service for routine assistance and urgent health issues related to the device or generic devices. Therefore, every clinician, from a bigger to a smaller center, should be prepared to manage LVAD carriers and the possible risks associated with LVAD management. Particularly, emergency treatment of patients with LVAD differs slightly from conventional emergency protocols and requires specific knowledge and a multidisciplinary approach to avoid ineffective treatment or dangerous consequences. This review aims to provide a standard protocol for managing emergency and urgency in patients with LVAD, elucidating the role of each healthcare professional and emphasizing the importance of collaboration between the emergency department, in-hospital ward, and LVAD reference center, as well as algorithms designed to ensure timely, adequate, and effective treatment to patients with LVAD.
Collapse
Affiliation(s)
- Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- *Correspondence: Maria Concetta Pastore
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Federico Landra
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Division of Cardiology, Department of Cardiovascular Diseases -AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Luna Cavigli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Marta Focardi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Chiara Carrucola
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Aleksander Dokollari
- Department of Cardiac Surgery, Cardiac Surgery, St. Michael Hospital, Toronto, ON, Canada
| | - Gianluigi Bisleri
- Department of Cardiac Surgery, Cardiac Surgery, St. Michael Hospital, Toronto, ON, Canada
| | - Charilaos Tsioulpas
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sonia Bernazzali
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimo Maccherini
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Serafina Valente
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| |
Collapse
|
19
|
Rivinius R, Gralla C, Helmschrott M, Darche FF, Ehlermann P, Bruckner T, Sommer W, Warnecke G, Kopf S, Szendroedi J, Frey N, Kihm LP. Pre-transplant Type 2 Diabetes Mellitus Is Associated With Higher Graft Failure and Increased 5-Year Mortality After Heart Transplantation. Front Cardiovasc Med 2022; 9:890359. [PMID: 35757347 PMCID: PMC9218221 DOI: 10.3389/fcvm.2022.890359] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Aims Cardiac transplant recipients often suffer from type 2 diabetes mellitus (T2DM) but its influence on graft failure and post-transplant mortality remains unknown. The aim of this study was to investigate the long-term effects of pre-transplant T2DM in patients after heart transplantation (HTX). Methods This study included a total of 376 adult patients who received HTX at Heidelberg Heart Center between 01/01/2000 and 01/10/2016. HTX recipients were stratified by diagnosis of T2DM at the time of HTX. Patients with T2DM were further subdivided by hemoglobin A1c (HbA1c ≥ 7.0%). Analysis included donor and recipient data, immunosuppressive drugs, concomitant medications, post-transplant mortality, and causes of death. Five-year post-transplant mortality was further assessed by multivariate analysis (Cox regression) and Kaplan–Meier estimator. Results About one-third of all HTX recipients had T2DM (121 of 376 [32.2%]). Patients with T2DM showed an increased 5-year post-transplant mortality (41.3% versus 29.8%; P = 0.027) and had a higher percentage of death due to graft failure (14.9% versus 7.8%; P = 0.035). Multivariate analysis showed T2DM (HR: 1.563; 95% CI: 1.053–2.319; P = 0.027) as an independent risk factor for 5-year mortality after HTX. Kaplan–Meier analysis showed a significantly better 5-year post-transplant survival of patients with T2DM and a HbA1c < 7.0% than patients with T2DM and a HbA1c ≥ 7.0% (68.7% versus 46.3%; P = 0.008) emphasizing the clinical relevance of a well-controlled T2DM in HTX recipients. Conclusion Pre-transplant T2DM is associated with higher graft failure and increased 5-year mortality after HTX.
Collapse
Affiliation(s)
- Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- Partner Site Heidelberg/Mannheim, German Center for Cardiovascular Research, Heidelberg, Germany
- *Correspondence: Rasmus Rivinius,
| | - Carolin Gralla
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabrice F. Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- Partner Site Heidelberg/Mannheim, German Center for Cardiovascular Research, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- Partner Site Heidelberg/Mannheim, German Center for Cardiovascular Research, Heidelberg, Germany
| | - Tom Bruckner
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Internal Medicine I and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Julia Szendroedi
- Department of Internal Medicine I and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- Partner Site Heidelberg/Mannheim, German Center for Cardiovascular Research, Heidelberg, Germany
| | - Lars P. Kihm
- Department of Internal Medicine I and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| |
Collapse
|
20
|
Gerrald JE, Ather A, Schadler A, Birks EJ, Kolodziej AR, Kuan W. Retrospective Review of Secondary Prevention Strategies for Gastrointestinal Bleeding and Associated Clinical Outcomes in Left Ventricular Assist Device Patients. Artif Organs 2022; 46:2423-2431. [PMID: 35578786 DOI: 10.1111/aor.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is one of the most common bleeding complications associated with Left Ventricular Assist Devices (LVAD). Currently, there is no strong evidence or clear guidance for which secondary GIB prophylaxis strategy should be implemented after the discontinuation of aspirin. METHODS Our single-center study describes the outcomes of 26 LVAD patients who experienced a total of 49 GIB events, these individuals were either in Group-1) lower INR target range or Group-2) lower INR target plus a hemostatic agent as the secondary prophylaxis strategy. Each GIB event was considered an independent event. Outcomes assessed were bleeding reoccurrence rates, time to next GIB, acute GIB strategies, GIB-free days, thromboembolic events, survival, coagulation, and hematologic parameters. RESULTS GIB reoccurrence rates were not statistically different, Group-1) 9 (40.9%) vs Group-2) 15 (55.6%), p = 0.308. Danazol was utilized 81.5% of the time as the designated hemostatic agent. Additionally, no significant differences were observed with all of our secondary outcome measures for bleeding, ischemic events, or survival. CONCLUSION While our study was not powered to assess the clinical outcomes related to survival and thromboembolic events, no discernable increased risk of ischemic events including pump thrombosis was observed. Our data suggest that a lower INR target range plus danazol does not confer any additional benefit over a lower INR target range only approach. The results of this report are hypothesis-generating and additional studies are warranted to elucidate the optimal antithrombotic strategy and role of hemostatic agents in reducing the risk of recurrent GIB events.
Collapse
Affiliation(s)
| | - Ayesha Ather
- Pharmacy Department, University of Kentucky Medical Center, Lexington, KY, USA
| | - Aric Schadler
- Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY, USA
| | - Emma Jane Birks
- Division of Cardiology, Gill Heart and Vascular Institute, Lexington, KY, USA
| | | | - William Kuan
- Pharmacy Department, University of Kentucky Medical Center, Lexington, KY, USA
| |
Collapse
|
21
|
Esmailian G, Patel N, Patel JK, Czer L, Rafiei M, Megna D, Emerson D, Ramzy D, Trento A, Chikwe J, Esmailian F, Kobashigawa JA. Heart transplant recipient 1-year outcomes during the COVID-19 pandemic. Clin Transplant 2022; 36:e14697. [PMID: 35543382 PMCID: PMC9348427 DOI: 10.1111/ctr.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 12/02/2022]
Abstract
The COVID‐19 pandemic initially brought forth considerable challenges to the field of heart transplantation. To prevent the spread of the virus and protect immunocompromised recipients, our center made the following modifications to post‐transplant outpatient management: eliminating early coronary angiograms, video visits for postoperative months 7, 9, and 11, and home blood draws for immunosuppression adjustments. To assess if these changes have impacted patient outcomes, the current study examines 1‐year outcomes for patients transplanted during the pandemic. Between March and September 2020, we assessed 50 heart transplant patients transplanted during the pandemic. These patients were compared to patients who were transplanted during the same months between 2011 and 2019 (n = 482). Endpoints included subsequent 1‐year survival, freedom from cardiac allograft vasculopathy, any‐treated rejection, acute cellular rejection, antibody‐mediated rejection, nonfatal major adverse cardiac events (NF‐MACE), and hospital and ICU length of stay. Patients transplanted during the pandemic had similar 1‐year endpoints compared to those of patients transplanted from years prior apart from 1‐year freedom from NF‐MACE which was significantly higher for patients transplanted during the pandemic. Despite necessary changes being made to outpatient management of heart transplant recipients, heart transplantation continues to be safe and effective with similar 1‐year outcomes to years prior.
Collapse
Affiliation(s)
- Gabriel Esmailian
- The George Washington University School of Medicine and Health Sciences, Washington DC, USA.,Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nikhil Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Jignesh K Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Lawrence Czer
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Matthew Rafiei
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Dominick Megna
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Dominic Emerson
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Danny Ramzy
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Alfredo Trento
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Joanna Chikwe
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Fardad Esmailian
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | | |
Collapse
|
22
|
Li Y, Xi Y, Wang H, Sun A, Deng X, Chen Z, Fan Y. A new way to evaluate thrombotic risk in failure heart and ventricular assist devices. Medicine in Novel Technology and Devices 2022. [DOI: 10.1016/j.medntd.2022.100135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
23
|
Whitehouse KR, Avula D, Kahlon T, Costelle D, Dunbar-Matos C, Pahwa S, Trivedi JR, Slaughter MS. Apixaban: Alternative Anticoagulation for HeartMate 3 Ventricular Assist Device. ASAIO J 2022; 68:318-322. [PMID: 35213879 DOI: 10.1097/mat.0000000000001650] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with left ventricular assist devices currently require long-term anticoagulation with warfarin. Warfarin requires frequent blood tests and is associated with adverse events when not in the therapeutic range. Apixaban is a possible alternative that is potentially better for compliance and requires no additional testing. The purpose of this study was to compare adverse events in patients with a HeartMate 3 LVAD receiving apixaban versus warfarin. Thirty-five patients underwent HM3 implantation between January 01, 2016 to January 31, 2021. The groups compared were apixaban (n = 15, 43%) and warfarin (n = 20, 57%). All patients received 325 mg aspirin daily. Stroke, bleeding, and death were identified as primary outcomes after LVAD implant. Univariate nonparametric statistical analysis was performed. The median duration of treatment with apixaban was 148 days (37-606 days). The groups were comparable in terms of age (56 vs. 54 years), gender (male, 85% vs. 75%), and renal function (Cr 1.5 vs. 1.4). The apixaban group had significantly higher mean pulmonary artery pressure (41 vs. 34, p = 0.03) and there were more (p < 0.05) ischemic cardiomyopathy and INTERMACS profile >3 in the warfarin group. At 6 months, thrombotic complications and death were not different between the groups. The two deaths in the apixaban group were from right heart failure. The apixaban group had clinically lower rates of bleeding complications (5% vs. 30%). The adverse events of bleeding, stroke, and death were similar in HM3 patients receiving warfarin or apixaban. Apixaban may be a safe alternative anticoagulant therapy in HM 3 LVAD patients.
Collapse
Affiliation(s)
- Katherine R Whitehouse
- From the Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, University of Louisville, Kentucky
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Sun W, Zhang J, Shah A, Arias K, Berk Z, Griffith BP, Wu ZJ. Neutrophil dysfunction due to continuous mechanical shear exposure in mechanically assisted circulation in vitro. Artif Organs 2022; 46:83-94. [PMID: 34516005 PMCID: PMC8688241 DOI: 10.1111/aor.14068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Leukocytes play an important role in the body's immune system. The aim of this study was to assess alterations in neutrophil phenotype and function in pump-assisted circulation in vitro. METHODS Human blood was circulated for four hours in three circulatory flow loops with a CentriMag blood pump operated at a flow of 4.5 L/min at three rotational speeds (2100, 2800, and 4000 rpm), against three pressure heads (75, 150, and 350 mm Hg), respectively. Blood samples were collected hourly for analyses of neutrophil activation state (Mac-1, CD62L, CD162), neutrophil reactive oxygen species (ROS) production, apoptosis, and neutrophil phagocytosis. RESULTS Activated neutrophils indicated by both Mac-1 expression and decreased surface expression of CD62L and CD162 receptors increased with time in three loops. The highest level of neutrophil activation was observed in the loop with the highest rotational speed. Platelet-neutrophil aggregates (PNAs) progressively increased in two loops with lower rotational speeds. PNAs peaked at one hour after circulation and decreased subsequently in the loop with the highest rotational speed. Neutrophil ROS production dramatically increased at one hour after circulation and decreased subsequently in all three loops with similar levels and trends. Apoptotic neutrophils increased with time in all three loops. Neutrophil phagocytosis capacity in three loops initially elevated at one hour after circulation and decreased subsequently. Apoptosis and altered phagocytosis were dependent on rotational speed. CONCLUSIONS Our study revealed that the pump-assisted circulation induced neutrophil activation, apoptosis, and functional impairment. The alterations were strongly associated with pump operating condition and duration.
Collapse
Affiliation(s)
- Wenji Sun
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jiafeng Zhang
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Katherin Arias
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA,Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Zachary Berk
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bartley P Griffith
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zhongjun J Wu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA,Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| |
Collapse
|
25
|
Castrodeza J, Ortiz-Bautista C, Fernández-Avilés F. Continuous-flow left ventricular assist device: Current knowledge, complications, and future directions. Cardiol J 2021; 29:293-304. [PMID: 34967940 PMCID: PMC9007493 DOI: 10.5603/cj.a2021.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
Long-term continuous-flow left ventricular assist devices have become a real alternative to heart transplantation in patients with advanced heart failure, achieving a promising 2-year event-free survival rate with new-generation devices. Currently, this technology has spread throughout the world, and any cardiologist or cardiac surgeon should be familiar with its fundamentals and its possible complications as well as the advances made in recent years. The aim of this review is to describe current knowledge, management of complications, and future directions of this novel heart-failure therapy.
Collapse
Affiliation(s)
- Javier Castrodeza
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain.
| | - Carlos Ortiz-Bautista
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain
- Universidad Complutense, Madrid, Spain
| |
Collapse
|
26
|
Alstott J, Jhagroo R. Acute Onset of Dark Urine in a Patient with LVAD Pump Dysfunction. Kidney360 2021; 2:1867-1868. [PMID: 35372999 PMCID: PMC8785837 DOI: 10.34067/kid.0003482021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 02/04/2023]
Affiliation(s)
- James Alstott
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Roy Jhagroo
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
27
|
Schmalz G, Zöbisch SP, Garbade J, Rast J, Eisner M, Wagner J, Kottmann T, Binner C, Eifert S, Ziebolz D. No Association between Clinical Periodontal Conditions and Microbiological Findings on Driveline of Patients with Left-Ventricular Assist Devices (LVAD). Antibiotics (Basel) 2021; 10:antibiotics10101219. [PMID: 34680800 PMCID: PMC8532916 DOI: 10.3390/antibiotics10101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this retrospective study was to investigate whether there would be an association between periodontal disease parameters and positive bacterial findings at the driveline of patients with a left ventricular assist device (LVAD). Patients with an LVAD, who underwent a full oral and microbiological examination between 2016 and 2018, were included. During oral examination, periodontitis severity (stage and grade) and the periodontal inflamed surface area (PISA) were evaluated. A microbiological analysis was performed from swabs of the driveline, whereby different bacterial species were cultivated and analyzed. A total of 73 patients were included in the current study. The majority of participants (80.8%) had at least one positive bacterial finding during the study period. Most patients had a periodontitis stage of III-IV (80.9%). The determined PISA of the total group was 284.78 ± 352.29 mm2. No associations were found between the periodontal disease parameters and the bacterial findings in general, the bacterial findings on the day of oral examination or the bacterial findings 12 months prior to/after the oral examination (p > 0.05). Periodontitis is not associated with cultivated microbiological findings at the driveline of patients with an LVAD and thus appears not to be a risk indicator for driveline colonization. Nevertheless, the high periodontal burden in LVAD patients underlines the need for their improved periodontal care.
Collapse
Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (S.-P.Z.); (J.R.); (M.E.); (J.W.)
| | - Sven-Paul Zöbisch
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (S.-P.Z.); (J.R.); (M.E.); (J.W.)
| | - Jens Garbade
- Department of Cardiac Surgery, Klinikum Links der Weser, 28277 Bremen, Germany;
| | - Josephine Rast
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (S.-P.Z.); (J.R.); (M.E.); (J.W.)
| | - Mirjam Eisner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (S.-P.Z.); (J.R.); (M.E.); (J.W.)
| | - Justus Wagner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (S.-P.Z.); (J.R.); (M.E.); (J.W.)
| | - Tanja Kottmann
- CRO Dr. med. Kottmann GmbH & Co. KG, 59077 Hamm, Germany;
| | - Christian Binner
- Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (S.E.)
| | - Sandra Eifert
- Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (S.E.)
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (S.-P.Z.); (J.R.); (M.E.); (J.W.)
- Correspondence: ; Tel.: +0049-341-9721211
| |
Collapse
|
28
|
Nishida H, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Jeevanandam V, Ota T. Proximal ascending aorta size is associated with the incidence of de novo aortic insufficiency with left ventricular assist device. Heart Vessels 2021; 37:647-653. [PMID: 34585275 DOI: 10.1007/s00380-021-01946-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
We sought to assess the impact of the aortic root geometry on developing de novo aortic insufficiency (AI) in patients undergoing left ventricular assist device (LVAD). In total, 114 patients underwent LVAD implantation between February 2016 and January 2020 were included in this study (HeartMate3 N = 68, HeartWare N = 46). Significant aortic insufficiency was defined as mild-to-moderate or greater in echocardiography. The cohort was divided into two groups; those who developed significant AI (Group AI: n = 13) and did not (Group non-AI: n = 101). The primary outcomes of interest included late survival and predictors for significant AI. The patients in Group AI were older than Group non-AI (62.6 ± 11.9 vs 51.3 ± 14.0 years, p < 0.01). The diameter of proximal ascending aorta in Group AI was larger than Group non-AI (31.0 ± 5.0 vs 27.4 ± 4.3 mm, p < 0.01). Aortic valve remained closed in 53.8% in Group AI and 36.6% in Group non-AI (p = 0.24). The late survival was not significantly different between the groups (67.1% vs 76.0% at 3 years, log rank = 0.97). The Cox hazard model showed that larger proximal ascending aortic diameter/BSA (HR 1.55, CI 1.19-2.04, p < 0.01) and not-opening aortic valve (HR 4.73, CI 1.43-16.9, p = 0.01) were independent risk factors for significant AI. The cutoff value of proximal ascending aortic diameter/BSA was 15.5 (area under curve: 0.770, sensitivity: 0.69, specificity: 0.79). Dilated proximal ascending aorta at the time of LVAD surgery and not-opening aortic valve during follow-up were associated with the incidence of de novo significant AI.
Collapse
Affiliation(s)
- Hidefumi Nishida
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Tae Song
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - David Onsager
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Ann Nguyen
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Jonathan Grinstein
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Bow Chung
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Bryan Smith
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Sara Kalantari
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Nitasha Sarswat
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Gene Kim
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Sean Pinney
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA.
| |
Collapse
|
29
|
Abstract
Left ventricular assist devices (LVADs) are indicated in inotrope-dependent heart failure (HF) patients with pure or predominant LV dysfunction. Survival benefit is less clear in ambulatory, advanced HF. Timing is crucial: early, unnecessary exposure to the risks of surgery, and device-related complications (infections, stroke, and bleeding) should be weighed against the probability of dying or developing irreversible right ventricular and/or end-organ dysfunction while deferring implant. The interplay between LVAD and heart transplantation depends largely on donor availability and allocation rules. Postoperatively, quality of life depends on patients' expectations and is influenced by complications. Patients' preferences, prognosis, and alternative options-including palliation-should be openly discussed and reviewed before and after the operation.
Collapse
Affiliation(s)
- Maria Frigerio
- 2nd Section of Cardiology, Heart Failure and Transplant Unit, DeGasperis CardioCenter, Niguarda Great Metropolitan Hospital, Milan, Italy.
| |
Collapse
|
30
|
Doğan Ö, Arslan Ş, Özyıldırım S, Abacı O. A stable patient with a left ventricular assist device was admitted to the outpatient clinic with ventricular fibrillation. Anatol J Cardiol 2021; 25:595-597. [PMID: 34369890 DOI: 10.5152/anatoljcardiol.2021.02009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ömer Doğan
- İstanbul University-Cerrahpaşa, Institute of Cardiology; İstanbul-Turkey
| | - Şükrü Arslan
- İstanbul University-Cerrahpaşa, Institute of Cardiology; İstanbul-Turkey
| | - Serhan Özyıldırım
- İstanbul University-Cerrahpaşa, Institute of Cardiology; İstanbul-Turkey
| | - Okay Abacı
- İstanbul University-Cerrahpaşa, Institute of Cardiology; İstanbul-Turkey
| |
Collapse
|
31
|
Toll AL, Hernandez Mejia L, Sidhu A, Carmona-rubio A. Troubleshooting Left Ventricular Assist Devices: Modern Technology and Its Limitations. Curr Treat Options Cardio Med 2021; 23. [DOI: 10.1007/s11936-021-00939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
32
|
Xu T, Huang Y, Liu Z, Bai Y, Ma Z, Cai X, Zhang Y, Zhang J. Heart Failure Is Associated with Increased Risk of Long-Term Venous Thromboembolism. Korean Circ J 2021; 51:766-780. [PMID: 34327882 PMCID: PMC8424458 DOI: 10.4070/kcj.2021.0213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
The risk of venous thromboembolism (VTE) in out-patients with heart failure (HF) in long-term period is still controversial, resulting in unclear recommendations for long-term treatment. In this analysis, we found that HF was an independent risk for VTE and pulmonary embolism but not deep vein thrombosis in long-term follow-up period. Patients with chronic HF were prone to have higher risk of VTE. This meta-analysis provided an evidence which is supportive for developing strategies for prevention of VTE in patients with HF. Background and Objectives Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE), is highly prevalent in in-hospital HF patients and contributes to worse prognoses. However, the risk of VTE in out-patients with HF in long-term period is controversial. This study aimed to evaluate the associations between HF and the risk of VTE in a long-term follow-up duration. Methods We searched for studies investigating the risk of VTE, PE, and DVT in patients with HF before April 15, 2020, in PubMed, MEDLINE, and Embase databases. Cohort studies and post hoc analysis of RCTs were eligible for inclusion if they reported relative risk of VTE, DVT or PE in patients with HF in more than 3-month follow-up period. Results We identified 31 studies that enrolled over 530,641 HF patients. Overall, patients with HF were associated with an increased risk of VTE (risk ratio [RR]=1.57, 95% confidence interval [CI]=1.34–1.84) and PE (RR=2.00, 95% CI=1.38–2.89). However, the risk of DVT was not significantly increased in HF patients (RR=1.33, 95% CI=0.67–2.63). Subgroup analysis showed that patients with chronic HF (RR=1.54, 95% CI=1.32–1.80) had a higher risk of VTE than those with acute HF (RR=0.95, 95% CI=0.68–1.32). Conclusions In conclusion, HF was an independent risk for VTE and PE but not DVT in a long-term follow-up period. Patients with chronic HF were prone to suffer from VTE than acute HF.
Collapse
Affiliation(s)
- Tianyu Xu
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuli Huang
- Department of Cardiology, The Affiliated Hospital at Shunde, Southern Medical University (the First People's Hospital of Shunde), Foshan, China
| | - Zuheng Liu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yujia Bai
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhuang Ma
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyan Cai
- Department of Cardiology, The Affiliated Hospital at Shunde, Southern Medical University (the First People's Hospital of Shunde), Foshan, China
| | - Yuhui Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jian Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
33
|
Smith ME, Moak JH. Asymptomatic ventricular fibrillation in continuous flow left-ventricular assist device. Am J Emerg Med 2021; 49:130-2. [PMID: 34102458 DOI: 10.1016/j.ajem.2021.05.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022] Open
Abstract
Left ventricular assist devices (LVADs) have increased survival for heart failure patients. Individuals with LVADs are a growing patient population with frequent complications and Emergency Department (ED) visits. A 50-year-old female presented to the ED due to a low flow alarm on her LVAD. Upon arrival in the ED she was noted to be in ventricular fibrillation. She was defibrillated with restoration to normal sinus rhythm and was started on amiodarone. An implantable cardiac defibrillator was placed during hospital admission. Amiodarone was continued as an outpatient. Patients with continuous flow LVADs can be in dysrhythmias including ventricular tachycardia and ventricular fibrillation and remain relatively asymptomatic. We present a rare case of a patient with an LVAD and ventricular fibrillation who was completely asymptomatic in the ED.
Collapse
|
34
|
Abstract
BACKGROUND Modern ventricular assist devices (VADs) use a continuous flow design. It has been suggested that a lack of pulsatility contributes to a range of adverse outcomes including pump thrombus, gastrointestinal bleeding and stroke. To better assess the role of pulsatility in these adverse events, we first require a clear definition of 'pulsatility' in the setting of a severely impaired ventricle and a modern continuous flow VAD. METHODS A literature review was conducted to elucidate the understanding of pulsatility in modern VAD literature. Search engines used included PUBMED, EMBASE and the Cochrane library. Articles were appraised on three aspects: Whether they mentioned pulsatility; whether they mentioned which pulsatility measure was used and finally which methodology was used to obtain the value. RESULTS Of 354 articles reviewed, only 13 met our broad inclusion criteria. Of these articles, the most cited measure was pulsatility index (PI) - used by 11 of the publications. The methodology used to obtain the value was not uniform and five articles did not clearly state it. Other measures included pulse pressure and surplus haemodynamic energy. The majority of articles did not directly discuss pulsatility in the setting of patient-pump interaction. CONCLUSION Most publications did not provide a definition for pulsatility. In those that did, the most common measure was PI. Measuring PI was not standardised. Few papers addressed the impact of intrinsic ventricular function and arterial compliance on pulsatility. We suggest that future publications adopt a uniform definition which encompasses both patient and pump characteristics.
Collapse
Affiliation(s)
- Sam Emmanuel
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Paul Jansz
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Christopher Hayward
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| |
Collapse
|
35
|
Barnicle R, Boaglio S, Fitzgerald J, Otterness K, Johnson S, Ahn C. Left Ventricular Assist Device Multialarm Emergency: A High-Fidelity Simulation Case for Emergency Medicine Residents. MedEdPORTAL 2021; 17:11156. [PMID: 34013023 PMCID: PMC8096883 DOI: 10.15766/mep_2374-8265.11156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION As left ventricular assist devices (LVADs) become more prevalent in the treatment of patients with end-stage heart failure, emergency physicians must become experts in the management and resuscitation of patients with LVADs. As with other high-acuity, low-occurrence scenarios, managing the unstable LVAD patient makes for an ideal topic for simulation-based resident education. METHODS By incorporating a high-fidelity HeartMate 3 LVAD task trainer, our program developed and executed a novel LVAD simulation activity for our emergency medicine resident physicians. In the scenario, a 65-year-old male with recent LVAD placement arrived at a community hospital with undifferentiated hypotension. Various device alarms activated during the scenario and required intervention. Ultimately, the patient was found to be in septic/hypovolemic shock and only survived with appropriate resuscitation. We implemented a postscenario survey to assess the effectiveness of the simulation activity and administered it to 27 residents. RESULTS Content and delivery of our simulation were found to be effective; all survey questions regarding content and delivery obtained a mean score of 4.5 or greater on a 5-point Likert scale. Residents reported an overall high level of confidence in achieving most of the skill-based learning objectives (most scores > 4.1). The two objectives with the lowest confidence ratings were troubleshooting an LVAD and its various alarms (3.8) and demonstrating the ability to assess an LVAD patient (3.9). DISCUSSION Our LVAD simulation activity was successful and also revealed several potential areas for future research and simulation improvement.
Collapse
Affiliation(s)
- Ryan Barnicle
- Clinical Instructor, Department of Emergency Medicine, Stony Brook University Hospital
| | - Sean Boaglio
- Clinical Instructor, Department of Emergency Medicine, Vanderbilt University Medical Center
| | - Jillian Fitzgerald
- LVAD Coordinator, Department of Cardiothoracic Surgery, Stony Brook University Hospital
| | - Karalynn Otterness
- Assistant Residency Program Director, Department of Emergency Medicine, Stony Brook University Hospital
| | - Scott Johnson
- Residency Program Director, Department of Emergency Medicine, Stony Brook University Hospital
| | - Christine Ahn
- Assistant Residency Program Director, Department of Emergency Medicine, Stony Brook University Hospital
| |
Collapse
|
36
|
Abstract
BACKGROUND Patients with isolated left ventricular failure may have positive outcomes after being implanted with a left ventricular assist device. Unfortunately, almost half of patients with heart failure and reduced ejection fraction also have evidence of right ventricular dysfunction. For a subset of this population with severe biventricular failure, or those who develop right ventricular dysfunction after left ventricular assist device implantation, patients may necessitate biventricular assist devices or the total artificial heart. OBJECTIVES This overview of mechanical circulatory support devices will enhance nurses' ability to differentiate criteria for implantation, current practice, and outcomes with a focus on durable ventricular assist devices and the total artificial heart. METHODS A review of the literature involved searching CINAHL and PubMed databases using keywords biventricular assist devices, total artificial heart, and durable mechanical circulatory support. Results were narrowed to articles based on adults, 18 years or older. Seventy-eight relevant articles were identified, and 8 articles compared the durable biventricular assist devices. RESULTS Similar patient outcomes were found when comparing the use of left ventricular assist devices as biventricular support versus the total artificial heart. DISCUSSION The decision to implant the appropriate durable mechanical circulatory support for a patient in biventricular failure is complex and dependent on patient factors.
Collapse
|
37
|
Neo SHS, Ku JSM, Tan JYT, Yoon S. Lived Experiences and Long-Term Challenges and Needs of Asian Left Ventricular Assist Device Caregivers. Palliat Med Rep 2021; 2:84-92. [PMID: 34223507 PMCID: PMC8241394 DOI: 10.1089/pmr.2021.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Caregivers are essential for improved outcomes in patients living with left ventricular assist device (LVAD). There is a paucity of research on a long-term LVAD caregivers' experiences and burdens. Objectives: The aim of this study was to explore long-term challenges and needs of LVAD caregivers in the Asian health care setting. Design: We conducted semistructured interviews with caregivers of patients who were currently or previously living with the LVAD. Settings/Subjects: Caregivers were recruited from the National Heart Centre Singapore. Measurements: Interviews were conducted in English and Chinese. All interviews were transcribed verbatim and analyzed based on grounded theory. Chinese interviews were translated to English before transcription. Results: A multiethnic and multireligious sample of 11 caregivers participated. Median caregiving duration was 45 months. Caregivers described long-term challenges that were multifaceted. Misaligned patient expectations, stigmatization and limited social resources within the family and society affected caregivers' coping. Existing gender roles and spiritual and cultural influences shaped how caregivers appraised, made meaning of caregiving, and assessed support. Long-term caregivers' needs included learning from role models, shifting perspectives, enhancing communication between patient and caregivers, advocacy efforts, and holistic medical care. Conclusions: Gender roles as well as cultural and spiritual influences affected coping and access to support in long-term Asian LVAD caregivers. Future interventions should consider culturally relevant approaches to improve well-being and quality of life of caregivers.
Collapse
Affiliation(s)
- Shirlyn Hui Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Jasmine Si Min Ku
- Department of Medical Social Services, National Heart Centre Singapore, Singapore, Singapore
| | - Jasmine Yun Ting Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | |
Collapse
|
38
|
Austin MA, Maynes EJ, Gadda MN, O'Malley TJ, Morris RJ, Shah MK, Pirlamarla PR, Alvarez RJ, Entwistle JW, Massey HT, Tchantchaleishvili V. Continuous-flow LVAD exchange to a different pump model: Systematic review and meta-analysis of the outcomes. Artif Organs 2021; 45:696-705. [PMID: 33350485 DOI: 10.1111/aor.13893] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/21/2020] [Accepted: 12/16/2020] [Indexed: 01/20/2023]
Abstract
Despite improved outcomes of modern continuous-flow left ventricular assist devices (CF-LVADs), device exchange is still needed for various indications. While the majority of CF-LVADs are exchanged to the same model, exchange to a different pump model is occasionally warranted. In this meta-analysis, we sought to consolidate the existing evidence to better elucidate the indications and outcomes in these cases. A comprehensive systematic search of adult patient cohorts who underwent CF-LVAD exchange to a different CF-LVAD model was performed. Study-level data from 10 studies comprising 98 patients were extracted and pooled for analysis. Mean patient age was 58 (95% CI: 48-65) and 81% were male. Indication for initial CF-LVAD was ischemic cardiomyopathy in 45% (34-57). Initial device was HeartMate II LVAD (HMII) in 93 (94.9%) and HeartWare HVAD (HW) in 5 (5.1%) patients. After mean CF-LVAD support time of 18.8 (15.2-22.4) months, exchange indications included thrombosis in 71% (43-89), infection in 21% (8-47) and device malfunction in 12% (7-21). HMII to HW exchange occurred in 53 (54.1%) patients, HMII to HeartMate III (HM3) in 32 (32.7%), and HM II to either HW or HM3 in 13 (13.2%) patients. Postoperatively, right ventricular assist device was required in 16% (8-32). Overall, 20% (8-40) of patients experienced a stroke, while HW patients had a significantly higher stroke incidence than HM3 patients (HW: 21% (8-47) vs. HM3: 5% (1-24), P < .01). Overall 30-day mortality was 10% (6-17), while HW had a significantly worse 30-day mortality than HM3 (HW: 13% (7-24) vs. HM3: 5% (1-24), P = .03). Following device exchange from a different CF-LVAD model, HM3 is associated with lower stroke and higher survival when compared to HW.
Collapse
Affiliation(s)
- Melissa A Austin
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Marc N Gadda
- Drexel University College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Thomas J O'Malley
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mahek K Shah
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Preethi R Pirlamarla
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rene J Alvarez
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John W Entwistle
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Howard Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | |
Collapse
|
39
|
Sorguven E, Bozkurt S, Baldock C. Computer simulations can replace in-vivo experiments for implantable medical devices. Phys Eng Sci Med 2021; 44:1-5. [PMID: 33559037 DOI: 10.1007/s13246-021-00978-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Esra Sorguven
- Thermo Fluid Mechanics Research Centre, University of Sussex, Brighton, BN1 9RH, UK
| | - Selim Bozkurt
- Institute of Cardiovascular Science, University College London, London, WC1E 6DD, UK
| | - Clive Baldock
- Research and Innovation Division, University of Wollongong, Wollongong, NSW, 2522, Australia.
| |
Collapse
|
40
|
Stio RE, Montalto A, Feccia M, Intorcia A, Buffa V, Cesario V, Petroni G, De Felice F, Musumeci F. Extracorporeal membrane oxygenation-assisted emergency percutaneous treatment of left ventricular assist device graft occlusion. ESC Heart Fail 2021; 8:1627-1630. [PMID: 33497518 PMCID: PMC8006740 DOI: 10.1002/ehf2.13205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/03/2020] [Accepted: 01/02/2021] [Indexed: 01/27/2023] Open
Abstract
End‐stage heart failure is more often treated with Implantable left ventricular assist device (LVAD), even if the prolonged use may increase the risk of complications. In this case, a 51‐year‐old male patient presented to our emergency department showing acute heart failure signs and symptoms and a dramatic reduction of LVAD flow. Laboratory tests ruled out significant haemolysis, usually associated with pump thrombosis. The echocardiogram and the computed tomography were not able to clarify the correct diagnosis. We immediately placed a veno‐arterial extracorporeal membrane oxygenation, followed by a selective retrograde angiography of the pump. The images showed stenosis of the LVAD‐outflow graft, suggesting a twist. Through a hand‐made J‐tip guidewire, we performed multiple dilatations of the occlusion using peripheral balloons. Finally, we implanted an aortic coarctation covered‐stent, re‐establishing an adequate cardiac output to the patient. Our case indicates that catheter‐based approach in extracorporeal membrane oxygenation assistance provides an important therapeutic alternative to treat outflow graft stenosis, especially in the case of acutely unstable patient.
Collapse
Affiliation(s)
- Rocco Edoardo Stio
- Division of Interventional Cardiology, Department of Heart and Vessels, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, Rome, 00152, Italy
| | - Andrea Montalto
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, San Camillo Forlanini Hospital, Rome, Italy
| | - Mariano Feccia
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, San Camillo Forlanini Hospital, Rome, Italy
| | - Alfredo Intorcia
- Division of Interventional Cardiology, Department of Heart and Vessels, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, Rome, 00152, Italy
| | - Vitaliano Buffa
- Division of Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Vincenzo Cesario
- Division of Interventional Cardiology, Department of Heart and Vessels, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, Rome, 00152, Italy
| | - Giulia Petroni
- Department of Legal and Forensic Medicine, Social Security and Forensic Toxicology, University of Rome Tor Vergata, Rome, Italy
| | - Francesco De Felice
- Division of Interventional Cardiology, Department of Heart and Vessels, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, Rome, 00152, Italy
| | - Francesco Musumeci
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, San Camillo Forlanini Hospital, Rome, Italy
| |
Collapse
|
41
|
Immohr MB, Boeken U, Mueller F, Prashovikj E, Morshuis M, Böttger C, Aubin H, Gummert J, Akhyari P, Lichtenberg A, Schramm R. Complications of left ventricular assist devices causing high urgency status on waiting list: impact on outcome after heart transplantation. ESC Heart Fail 2021; 8:1253-1262. [PMID: 33480186 PMCID: PMC8006689 DOI: 10.1002/ehf2.13188] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/19/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023] Open
Abstract
Aims Heart transplantation (HTx) represents optimal care for advanced heart failure. Left ventricular assist devices (LVADs) are often needed as a bridge‐to‐transplant (BTT) therapy to support patients during the wait for a donor organ. Prolonged support increases the risk for LVAD complications that may affect the outcome after HTx. Methods and results A total of 342 patients undergoing HTx after LVAD as BTT in a 10‐year period in two German high‐volume HTx centres were retrospectively analysed. While 73 patients were transplanted without LVAD complications and with regular waiting list status (T, n = 73), the remaining 269 patients were transplanted with high urgency status (HU) and further divided with regard to the observed leading LVAD complications (infection: HU1, n = 91; thrombosis: HU2, n = 32; stroke: HU3, n = 38; right heart failure: HU4, n = 41; arrhythmia: HU5, n = 23; bleeding: HU6, n = 18; device malfunction: HU7, n = 26). Postoperative hospitalization was prolonged in patients with LVAD complications. Analyses of perioperative morbidity revealed no differences regarding primary graft dysfunction, renal failure, and neurological events except postoperative infections. Short‐term survival, as well as Kaplan–Meier survival analysis, indicated comparable results between the different study groups without disadvantages for patients with LVAD complications. Conclusions Left ventricular assist device therapy can impair the outcome after HTx. However, the occurrence of LVAD complications may not impact on outcome after HTx. Thus, we cannot support the prioritization or discrimination of HTx candidates according to distinct mechanical circulatory support‐associated complications. Future allocation strategies have to respect that device‐related complications may define urgency but do not impact on the outcome after HTx.
Collapse
Affiliation(s)
- Moritz Benjamin Immohr
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Franziska Mueller
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| | - Emir Prashovikj
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| | - Charlotte Böttger
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| |
Collapse
|
42
|
Rao P, Katz D, Hieda M, Sabe M. How to Manage Temporary Mechanical Circulatory Support Devices in the Critical Care Setting: Translating Physiology to the Bedside. Heart Fail Clin 2020; 16:283-293. [PMID: 32503752 DOI: 10.1016/j.hfc.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The incidence of cardiogenic shock and the utilization of mechanical circulatory support devices are increasing in the US. In this review we discuss the pathophysiology of cardiogenic shock through basic hemodynamic and myocardial energetic principles. We also explore the commonly used platforms for temporary mechanical circulatory support, their advantages, disadvantages and practical considerations relating to implementation and management. It is through the translation of underlying physiological principles that we can attempt to maximize the clinical utility of circulatory support devices and improve outcomes in cardiogenic shock.
Collapse
Affiliation(s)
- Prashant Rao
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Daniel Katz
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michinari Hieda
- University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX 75231, USA
| | - Marwa Sabe
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
43
|
Al-Ani M, Gul SS, Khatri A, Chowdhury MAB, Drabin M, Murphy T, Allen B, Aranda JM, Vilaro J, Jeng EI, Arnaoutakis GJ, Parker AM, Meece LE, Ahmed MM. Patterns of emergency department utilization for LVAD patients compared with non-LVAD patients. Int J Cardiol Heart Vasc 2020; 30:100617. [PMID: 32904266 PMCID: PMC7452580 DOI: 10.1016/j.ijcha.2020.100617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
Abstract
Background Left ventricular assist device (LVAD) patients are vulnerable to over-utilization of resources. Methods and results We explored the pattern of emergency department (ED) presentations of LVAD patients and their costs compared with non-LVAD heart failure patients. ED visits between 7/2008 and 7/2017 were reviewed to identify 145 LVAD patients, and 435 patients with known heart failure were selected using propensity score matching for age and sex. ED evaluation metrics, hospitalization cost, and length of stay (LOS) were analyzed. Although the most common ED presentations and their frequency differed between groups, few were LVAD specific. LVAD patients were more likely to have taken personal vehicles or be flown to the ED. They had similar times to triage, rooming, and physician evaluation compared with non-LVAD patients. However, LVAD patients were noted to have a shorter time from physician assessment to disposition (109.8 min vs. 177.0 min, p < 0.001) and, overall, LVAD patients had shorter ED LOS (6.33 vs. 9.82 hrs, p = 0.0001). For patients admitted, no significant difference was found between groups in hospital LOS (6.67 vs 6.58 days, p = 0.928) or total cost ($28,766 vs $21,524, p = 0.087). Conclusion Shorter disposition times without increases in LOS or costs may identify a created healthcare disparity among LVAD patients.
Collapse
Affiliation(s)
- Mohammad Al-Ani
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | - Sarah S Gul
- Department of Surgery, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA, United States
| | - Abhishek Khatri
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | | | - Matthew Drabin
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - Travis Murphy
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - Brandon Allen
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States
| | - Juan M Aranda
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | - Juan Vilaro
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | - Eric I Jeng
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL, United States
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL, United States
| | - Alex M Parker
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | - Lauren E Meece
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| |
Collapse
|
44
|
Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Giacomo Bianchi
- Division of Adult Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| |
Collapse
|
45
|
Abstract
Left ventricular assist devices (LVADs) are implantable mechanical devices that pump blood from the apex of the left ventricle to the aorta in order to assist the forward flow of blood; they are most commonly used as a bridge to transplant for patients with heart failure. As of February 2019, a total of 25,145 patients with ventricular assist devices have been reported in the Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs). As this number continues to grow, more and more of these patients will inevitably be seen in the acute care setting outside of their defined LVAD center. Currently, however, LVAD emergencies represent a high-acuity low-occurrence event with limited opportunities for exposure and mastery for most physicians. Therefore, a growing need exists for emergency care providers to familiarize themselves with these devices and the management of LVAD emergencies. We present a novel model for the simulation of LVAD emergencies created through simple modifications of a Laerdal 3G Manikin.
Collapse
Affiliation(s)
- Wayne Lindsay
- Emergency Medicine, Brooke Army Medical Center, San Antonio, USA
| | - Tiffany Nelms
- Simulation, Brooke Army Medical Center, San Antonio, USA
| | - Sean O'Hara
- Emergency Medicine, Brooke Army Medical Center, San Antonio, USA
| | - Zachary Sletten
- Emergency Medicine, San Antonio Military Medical Center, San Antonio, USA
| |
Collapse
|
46
|
Chen Z, Sun A, Wang H, Fan Y, Deng X. Non-physiological shear stress-induced blood damage in ventricular assist device. Medicine in Novel Technology and Devices 2019; 3:100024. [DOI: 10.1016/j.medntd.2019.100024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|