1
|
Nordan T, Critsinelis AC, Vest A, Zhang Y, Chen FY, Couper GS, Kawabori M. Prolonged waitlisting is associated with mortality in extracorporeal membrane oxygenation-supported heart transplantation candidates. JTCVS Open 2022; 12:234-254. [PMID: 36590718 PMCID: PMC9801284 DOI: 10.1016/j.xjon.2022.09.010] [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] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/07/2022] [Accepted: 09/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Heart transplantation (HTx) candidates supported with venoarterial extracorporeal membrane oxygenation (ECMO) may be listed at highest status 1 but are at inherent risk for ECMO-related complications. The effect of waitlist time on postlisting survival remains unclear in candidates with ECMO support who are listed using the new allocation system. METHODS Adult candidates listed with ECMO for a first-time, single-organ HTx from October 18, 2018, to March 21, 2021, in the Scientific Registry of Transplant Recipients database were included and stratified according to waitlist time (≤7 vs ≥8 days). Postlisting outcomes were compared between cohorts. RESULTS Among 175 candidates waitlisted for ≤7 days, 162 (92.6%) underwent HTx whereas 13 (7.4%) died/deteriorated compared with 41 (57.8%) and 21 (29.6%) of the 71 candidates waitlisted for ≥8 days, respectively (P < .01). Blood type O candidates (odds ratio [OR], 2.94; 95% CI, 1.54-5.61) were more likely to wait ≥8 days whereas candidates with concurrent intra-aortic balloon pump were less likely (OR, 0.30; 95% CI, 0.10-0.89). Obesity was additionally associated among those listed at status 1 (OR, 2.04; 95% CI, 1.00-4.17). Waitlisting for ≥8 days was independently associated with 90-day postlisting mortality conditional on survival to day 8 postlisting (hazard ratio, 5.59; 95% CI, 2.59-12.1). Candidates listed at status 1 showed similar trends (hazard ratio, 5.49; 95% CI, 2.39-12.6). There was no significant difference in 90-day post-HTx survival depending on whether a candidate waited for ≥8 days versus ≤7 days (92.7 vs 92.0%; log rank P = .87). CONCLUSIONS Among ECMO-supported candidates, obtaining HTx within 1 week of listing might improve overall survival.
Collapse
Affiliation(s)
- Taylor Nordan
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | | | - Amanda Vest
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Yijing Zhang
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Frederick Y. Chen
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Gregory S. Couper
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Masashi Kawabori
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| |
Collapse
|
2
|
Kwiatkowski SG, Gertz ZM, Grizzard JD, Rezai Gharai L, Tchoukina I, Trankle CR. Right Atrial Compression From Biodebris Associated With Long-Term Left Ventricular Assist Device Support. JACC Case Rep 2022; 4:101656. [PMID: 36507294 PMCID: PMC9730033 DOI: 10.1016/j.jaccas.2022.08.047] [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: 01/19/2022] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022]
Abstract
Biodebris surrounding HVAD (Medtronic) intrapericardial centrifugal-flow left ventricular assist device outflow cannulas is common and appears to accumulate over time. We recently encountered 2 patients on long-term HVAD support with right atrial compression from such biodebris, prompting a review of our institution's HVAD cohort to better understand this phenomenon. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Sara G. Kwiatkowski
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M. Gertz
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John D. Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leila Rezai Gharai
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Inna Tchoukina
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cory R. Trankle
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA,Address for correspondence: Dr Cory R. Trankle, Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, PO Box 980036, 1200 E Broad Street, Richmond, Virginia 23298, USA. @Sarakwiat
| |
Collapse
|
3
|
Nieves J, Laslett DB, Basil A, Whitman IR, Cooper JM, Cronin EM. Simultaneous Leadless Pacemaker and Subcutaneous ICD Implantation With Intraoperative Screening: Workflow in Two Patients. JACC Case Rep 2022; 4:101535. [PMID: 36507298 PMCID: PMC9730143 DOI: 10.1016/j.jaccas.2022.06.018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Abstract
A communicating subcutaneous implantable cardioverter-defibrillator (ICD) and leadless pacemaker system is being developed for patients who require both pacing and ICD therapy. It is important to ensure that the paced morphology from the leadless pacemaker will be sensed appropriately by the subcutaneous ICD. We present 2 cases illustrating our approach and workflow. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
| | | | | | | | | | - Edmond M. Cronin
- Address for correspondence: Dr Edmond M. Cronin, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, 9th Floor, Parkinson Pavilion, Philadelphia, Pennsylvania 19140, USA.
| |
Collapse
|
4
|
Ruck JM, Zhou AL, Zeiser LB, Alejo D, Durand CM, Massie AB, Segev DL, Bush EL, Kilic A. Trends and three-year outcomes of hepatitis C virus-viremic donor heart transplant for hepatitis C virus-seronegative recipients. JTCVS Open 2022; 12:269-279. [PMID: 36590744 PMCID: PMC9801334 DOI: 10.1016/j.xjon.2022.10.007] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Objective Heart transplants (HTs) from hepatitis C virus (HCV)-viremic donors to HCV-seronegative recipients (HCV D+/R-) have good 6-month outcomes, but practice uptake and long-term outcomes overall and among candidates on mechanical circulatory support (MCS) have yet to be established. Methods Using the Scientific Registry of Transplant Recipients, we identified US adult HCV-seronegative HT recipients (R-) from 2015 to 2021. We classified donors as HCV-seronegative (D-) or HCV-viremic (D+). We used multivariable regression to compare post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, acute rejection, and risk of post-HT mortality between HCV D+/R- and HCV D-/R-. Models were adjusted for donor, recipient, and transplant characteristics and center HT volume. We performed subgroup analyses of recipients bridged with MCS. Results From 2015 to 2021, the number of HCV D+/R- HT increased from 1 to 181 and the number of centers performing HCV D+/R- HT increased from 1 to 60. Compared with HCV D-/R- recipients, HCV D+/R- versus D-/R- recipients overall and among patients bridged with MCS had similar odds of post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, and acute rejection; and mortality risk at 30 days, 1 year, and 3 years (all P > .05). High center HT volume but not HCV D+/R- volume (<5 vs >5 in any year) was associated with lower mortality for HCV D+/R- HT. Conclusions HCV D+/R- and D-/R- HT have similar outcomes at 3 years' posttransplant. These results underscore the opportunity provided by HCV D+/R- HT, including among the growing population bridged with MCS, and the potential benefit of further expanding use of HCV+ allografts.
Collapse
Key Words
- D+, HCV-viremic donor
- DAAs, direct-acting antivirals
- DCD, donation after circulatory death
- D–, HCV-seronegative donor
- ECMO, extracorporeal membranous oxygenation
- HCV, hepatitis C virus
- HT, heart transplant
- IABP, intra-aortic balloon pump
- IQR, interquartile range
- LVAD, left ventricular assist device
- MCS, mechanical circulatory support
- R–, HCV-seronegative recipient
- SRTR, Scientific Registry of Transplant Recipients
- aHR, adjusted hazard ratio
- aOR, adjusted odds ratio
- donor pool
- heart transplant
- hepatitis C
- outcomes
Collapse
Affiliation(s)
- Jessica M. Ruck
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Alice L. Zhou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Laura B. Zeiser
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Diane Alejo
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christine M. Durand
- Division of Infection Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Allan B. Massie
- Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Dorry L. Segev
- Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY,Scientific Registry of Transplant Recipients, Minneapolis, Minn
| | - Errol L. Bush
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md,Address for reprints: Ahmet Kilic, MD, Department of Surgery, Johns Hopkins Medical Institutions, Sheikh Zayed Tower, Suite 7107, 1800 Orleans St, Baltimore, MD 21287.
| |
Collapse
|
5
|
Schwartz B, Gjini P, Gopal DM, Fetterman JL. Inefficient Batteries in Heart Failure: Metabolic Bottlenecks Disrupting the Mitochondrial Ecosystem. JACC Basic Transl Sci 2022; 7:1161-1179. [PMID: 36687274 PMCID: PMC9849281 DOI: 10.1016/j.jacbts.2022.03.017] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023]
Abstract
Mitochondrial abnormalities have long been described in the setting of cardiomyopathies and heart failure (HF), yet the mechanisms of mitochondrial dysfunction in cardiac pathophysiology remain poorly understood. Many studies have described HF as an energy-deprived state characterized by a decline in adenosine triphosphate production, largely driven by impaired oxidative phosphorylation. However, impairments in oxidative phosphorylation extend beyond a simple decline in adenosine triphosphate production and, in fact, reflect pervasive metabolic aberrations that cannot be fully appreciated from the isolated, often siloed, interrogation of individual aspects of mitochondrial function. With the application of broader and deeper examinations into mitochondrial and metabolic systems, recent data suggest that HF with preserved ejection fraction is likely metabolically disparate from HF with reduced ejection fraction. In our review, we introduce the concept of the mitochondrial ecosystem, comprising intricate systems of metabolic pathways and dynamic changes in mitochondrial networks and subcellular locations. The mitochondrial ecosystem exists in a delicate balance, and perturbations in one component often have a ripple effect, influencing both upstream and downstream cellular pathways with effects enhanced by mitochondrial genetic variation. Expanding and deepening our vantage of the mitochondrial ecosystem in HF is critical to identifying consistent metabolic perturbations to develop therapeutics aimed at preventing and improving outcomes in HF.
Collapse
Key Words
- ADP, adenosine diphosphate
- ANT1, adenine translocator 1
- ATP, adenosine triphosphate
- CVD, cardiovascular disease
- DCM, dilated cardiomyopathy
- DRP-1, dynamin-related protein 1
- EET, epoxyeicosatrienoic acid
- FADH2/FAD, flavin adenine dinucleotide
- HETE, hydroxyeicosatetraenoic acid
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HIF1α, hypoxia-inducible factor 1α
- LV, left ventricle
- LVAD, left ventricular assist device
- LVEF, left ventricular ejection fraction
- NADH/NAD+, nicotinamide adenine dinucleotide
- OPA1, optic atrophy protein 1
- OXPHOS, oxidative phosphorylation
- PGC1-α, peroxisome proliferator-activated receptor gamma coactivator 1 alpha
- SIRT1-7, sirtuins 1-7
- cardiomyopathy
- heart failure
- iPLA2γ, Ca2+-independent mitochondrial phospholipase
- mPTP, mitochondrial permeability transition pore
- metabolism
- mitochondria
- mitochondrial ecosystem
- mtDNA, mitochondrial DNA
Collapse
Affiliation(s)
- Brian Schwartz
- Evans Department of Medicine, Section of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Petro Gjini
- Evans Department of Medicine, Section of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Deepa M Gopal
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Zhou AL, Etchill EW, Shou BL, Whitbread JJ, Barbur I, Giuliano KA, Kilic A. Outcomes after heart transplantation in patients who have undergone a bridge-to-bridge strategy. JTCVS Open 2022; 12:255-268. [PMID: 36590736 PMCID: PMC9801290 DOI: 10.1016/j.xjon.2022.08.011] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/04/2023]
Abstract
Objectives We compared posttransplant outcomes between patients bridged from temporary mechanical circulatory support to durable left ventricular assist device before transplant (bridge-to-bridge [BTB] strategy) and patients bridged from temporary mechanical circulatory support directly to transplant (bridge-to-transplant [BTT] strategy). Methods We identified adult heart transplant recipients in the Organ Procurement and Transplantation Network database between 2005 and 2020 who were supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device as a BTB or BTT strategy. Kaplan-Meier survival analysis and Cox regressions were used to assess 1-year, 5-year, and 10-year survival. Posttransplant length of stay and complications were compared as secondary outcomes. Results In total, 201 extracorporeal membrane oxygenation (61 BTB, 140 BTT), 1385 intra-aortic balloon pump (460 BTB, 925 BTT), and 234 temporary ventricular assist device (75 BTB, 159 BTT) patients were identified. For patients supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device, there were no differences in survival between BTB and BTT at 1 and 5 years posttransplant, as well as 10 years posttransplant even after adjusting for baseline characteristics. The extracorporeal membrane oxygenation BTB group had greater rates of acute rejection (32.8% vs 13.6%; P = .002) and lower rates of dialysis (1.6% vs 21.4%; P < .001). For intra-aortic balloon pump and temporary ventricular assist device patients, there were no differences in posttransplant length of stay, acute rejection, airway compromise, stroke, dialysis, or pacemaker insertion between BTB and BTT recipients. Conclusions BTB patients have similar short- and midterm posttransplant survival as BTT patients. Future studies should continue to investigate the tradeoff between prolonged temporary mechanical circulatory support versus transitioning to durable mechanical circulatory support.
Collapse
Key Words
- BTB, bridge-to-bridge
- BTT, bridge-to-transplant
- CO, cardiac output
- ECMO, extracorporeal membrane oxygenation
- IABP, intra-aortic balloon pump
- LVAD, left ventricular assist device
- MCS, mechanical circulatory support
- OPTN, Organ Procurement and Transplantation Network
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge pressure
- TAH, total artificial heart
- UNOS, United Network for Organ Sharing
- extracorporeal membrane oxygenation
- heart transplant
- intra-aortic balloon pump
- mPAP, mean pulmonary arterial pressure
- mechanical circulatory support
- tVAD, temporary ventricular assist device
- transplant outcomes
- ventricular assist devices
Collapse
Affiliation(s)
- Alice L. Zhou
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Eric W. Etchill
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | - Iulia Barbur
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Katherine A. Giuliano
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Address for reprints: Ahmet Kilic, MD, Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7107, 1800 Orleans St, Baltimore, MD 21287.
| |
Collapse
|
7
|
Wiechmann RJ, Lee LY, Yu Y, Prillinger JB, Gutfinger D, Blakeman B. Ten-year outcomes of surgical aortic valve replacement with a contemporary supra-annular porcine valve in a Medicare population. JTCVS Open 2022; 12:84-102. [PMID: 36590734 PMCID: PMC9801294 DOI: 10.1016/j.xjon.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 01/04/2023]
Abstract
Objective Bioprosthetic surgical aortic valve replacement remains an important treatment option in the era of transcatheter interventions. Real-world outcomes are not well characterized because of limited prospective follow-up studies. We present the 10-year clinical outcomes of Medicare beneficiaries undergoing surgical aortic valve replacement with a contemporary supra-annular porcine valve. Methods This is a single-arm observational study using Medicare fee-for-service claims data. De-identified patients undergoing surgical aortic valve replacement with the Epic Supra valve (Abbott) in the United States between January 1, 2008, and December 31, 2019, were selected by International Classification of Diseases 9th and 10th Revision procedure codes and then linked to a manufacturer device tracking database. All-cause mortality, heart failure rehospitalization, and aortic valve reintervention (surgical or transcatheter valve-in-valve) were evaluated at 10 years using the Kaplan-Meier method. Results Among 272,591 Medicare beneficiaries undergoing surgical aortic valve replacement during the study period, 11,685 received the Epic Supra valve, of whom 51.6% (6029) had underlying heart failure. Mean age was 76 ± 7 years. Survival at 10 years in patients without preoperative heart failure was 43.5% (95% confidence interval, 41.8-45.2) compared with 24.1% (95% confidence interval, 22.6-25.5) for patients with heart failure (P < .001). The 10-year freedom from heart failure rehospitalization was 64.0% (95% confidence interval, 62.6-65.3). Freedom from aortic valve reintervention was 94.6% (95% confidence interval, 93.8-95.3) at 10 years. Conclusions This real-world nationwide study of US Medicare beneficiaries receiving the Epic Supra valve demonstrates more than 94% freedom from all-cause valve reintervention and 64% freedom from heart failure rehospitalization at 10 years postimplant. Long-term survival and heart failure rehospitalization in this population with aortic valve disease undergoing surgical aortic valve replacement were found to be impacted by underlying heart failure.
Collapse
Key Words
- CABG, coronary artery bypass grafting
- CI, confidence interval
- CMS, Centers for Medicare & Medicaid Service
- FFS, fee-for-service
- HF, heart failure
- HR, hazard ratio
- ICD-10, International Classification of Diseases, Tenth Revision
- ICD-9, International Classification of Diseases, Ninth Revision
- LVAD, left ventricular assist device
- SAVR, surgical aortic valve replacement
- TAVI, transcatheter aortic valve implantation
- VIV, valve-in-valve
- aortic valve replacement
- durability
- heart failure
- porcine valve
- survival
Collapse
Affiliation(s)
- Robert J. Wiechmann
- Mayo Clinic Health System, Cardiothoracic Surgery, Eau Claire, Wis,Address for reprints: Robert J. Wiechmann, MD, Mayo Clinic Health System, 1400 Bellinger St, Eau Claire, WI 54702.
| | - Leonard Y. Lee
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | | | | |
Collapse
|
8
|
Brailovsky Y, Masoumi A, Bijou R, Oliveros E, Sayer G, Takeda K, Uriel N. Fulminant Giant Cell Myocarditis Requiring Bridge With Mechanical Circulatory Support to Heart Transplantation. JACC Case Rep 2022; 4:265-270. [PMID: 35257100 PMCID: PMC8897036 DOI: 10.1016/j.jaccas.2021.11.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
Giant cell myocarditis is a rare cause of cardiogenic shock requiring a high index of suspicion, rapid immunosuppressive therapy, and mechanical circulatory support. We present the case of a patient with giant cell myocarditis who underwent a successful bridge with four different types of mechanical circulatory support devices to heart transplantation. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Yevgeniy Brailovsky
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amirali Masoumi
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Rachel Bijou
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Estefania Oliveros
- Division of Cardiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Gabriel Sayer
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiovascular Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
9
|
Yang M, Houck KL, Dong X, Hernandez M, Wang Y, Nathan SS, Wu X, Afshar-Kharghan V, Fu X, Cruz MA, Zhang J, Nascimbene A, Dong JF. Hyperadhesive von Willebrand Factor Promotes Extracellular Vesicle-Induced Angiogenesis: Implication for LVAD-Induced Bleeding. JACC Basic Transl Sci 2022; 7:247-261. [PMID: 35411318 PMCID: PMC8993768 DOI: 10.1016/j.jacbts.2021.12.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022]
Abstract
VWF in patients on LVAD supports was hyperadhesive, activated platelets, and generated platelet-derived extracellular vesicles. Extracellular vesicles from LVAD patients and those from shear-activated platelets promoted aberrant angiogenesis in a VWF-dependent manner. The activated VWF exposed the A1 domain through the synergistic actions of oxidative stress and HSS generated in LVAD-driven circulation.
Bleeding associated with left ventricular assist device (LVAD) implantation has been attributed to the loss of large von Willebrand factor (VWF) multimers to excessive cleavage by ADAMTS-13, but this mechanism is not fully supported by the current evidence. We analyzed VWF reactivity in longitudinal samples from LVAD patients and studied normal VWF and platelets exposed to high shear stress to show that VWF became hyperadhesive in LVAD patients to induce platelet microvesiculation. Platelet microvesicles activated endothelial cells, induced vascular permeability, and promoted angiogenesis in a VWF-dependent manner. Our findings suggest that LVAD-driven high shear stress primarily activates VWF, rather than inducing cleavage in the majority of patients.
Collapse
Key Words
- ADAMTS-13:Ag, ADAMTS-13 antigen
- AVS, aortic vascular segment
- EC, endothelial cell
- EV, extracellular vesicle
- EVFP, extracellular vesicle–free plasma
- GI, gastrointestinal
- GOF, gain of function
- GP, glycoprotein
- GPM, growth factor-poor medium
- GRM, growth factor-rich medium
- HSS, high shear stress
- LVAD, left ventricular assist device
- PS, phosphatidylserine
- SIPA, shear-induced platelet aggregation
- ULVWF, ultra-large von Willebrand factor
- VEGF, vascular endothelial growth factor
- VWF, von Willebrand factor
- VWF:Ag, von Willebrand factor antigen
- VWF:CB, von Willebrand factor binding to collagen
- VWF:pp, von Willebrand factor propeptide
- aVWS, acquired von Willebrand syndrome
- angiogenesis
- extracellular vesicles
- left ventricular assist devices
- pEV, extracellular vesicle from von Willebrand factor-activated platelets
- platelets
- shear stress
- von Willebrand factor
Collapse
Affiliation(s)
- Mengchen Yang
- Bloodworks Research Institute, Seattle, Washington, USA.,Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Katie L Houck
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Xinlong Dong
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Maria Hernandez
- Center for Advanced Heart Failure, University of Texas at Houston, Houston, Texas, USA
| | - Yi Wang
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Sriram S Nathan
- Center for Advanced Heart Failure, University of Texas at Houston, Houston, Texas, USA
| | - Xiaoping Wu
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vahid Afshar-Kharghan
- Division of Internal Medicine, Department of Pulmonary Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Xiaoyun Fu
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Miguel A Cruz
- Cardiovascular Research Section, Department of Medicine, Baylor College of Medicine.,Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Angelo Nascimbene
- Center for Advanced Heart Failure, University of Texas at Houston, Houston, Texas, USA
| | - Jing-Fei Dong
- Bloodworks Research Institute, Seattle, Washington, USA.,Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
10
|
Adebo DA, Uppu SC, Aggarwal A, Salazar JD, LaPar DJ. Virtual Simulated Implantation of an Adult-Sized Left Ventricular Assist Device in a Pediatric Patient. JACC Case Rep 2022; 4:239-240. [PMID: 35199024 PMCID: PMC8855125 DOI: 10.1016/j.jaccas.2021.11.025] [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: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
There is very limited experience with simulated virtual implantation of left ventricular assist devices (LVADs) to assess device fitness in pediatric patients. In this clinical vignette, we report the case of a 9-year-old male patient with dilated cardiomyopathy who underwent successful placement of an LVAD after virtual simulated implantation was performed. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Dilachew A. Adebo
- Division of Pediatric Cardiology, Children’s Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Santosh C. Uppu
- Division of Pediatric Cardiology, Children’s Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Avichal Aggarwal
- Division of Pediatric Cardiology, Children’s Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Jorge D. Salazar
- Division of Cardiothoracic Surgery, Children’s Heart Institute, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Damien J. LaPar
- Division of Cardiothoracic Surgery, Children’s Heart Institute, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, Texas, USA
| |
Collapse
|
11
|
Ranard LS, Kaple R, Khalique OK, Agarwal V, Bellumkonda L, Bonde P, George I, Uriel N, Leon MB, Vahl TP. First Transfemoral Implantation of a Novel Transcatheter Valve in an LVAD Patient With Aortic Insufficiency. JACC Case Rep 2021; 3:1806-1810. [PMID: 34917959 PMCID: PMC8642726 DOI: 10.1016/j.jaccas.2021.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 06/14/2023]
Abstract
An 80-year-old man with a destination left ventricular assist device (LVAD) presented with decompensated heart failure. Evaluation demonstrated numerous LVAD high power spike events, significant aortic regurgitation, and hemolysis. He underwent successful aortic valve replacement with a novel transcatheter valve and LVAD pump exchange that resulted in an improvement in his clinical status. (Level of Difficulty: Advanced.).
Collapse
Key Words
- AR, aortic regurgitation
- CO, cardiac output
- CTA, computed tomography angiography
- LVAD, left ventricular assist device
- LVEDD, left ventricular end diastolic dimension
- NYHA, New York Heart Association
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge pressure
- RA, right atrial
- RV, right ventricular
- TAVR
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiogram
- THV, transcatheter heart valve
- TTE, transthoracic echocardiogram
- aortic regurgitation
Collapse
Affiliation(s)
- Lauren S. Ranard
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Ryan Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Omar K. Khalique
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Vratika Agarwal
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lavanya Bellumkonda
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Pramod Bonde
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isaac George
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Nir Uriel
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Martin B. Leon
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Torsten P. Vahl
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| |
Collapse
|
12
|
Pienta M, Shore S, Pagani FD, Likosky DS. Rates and types of infections in left ventricular assist device recipients: A scoping review. JTCVS Open 2021; 8:405-411. [PMID: 36004147 PMCID: PMC9390679 DOI: 10.1016/j.xjon.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/06/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Michael Pienta
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Supriya Shore
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Donald S. Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| |
Collapse
|
13
|
Deveza RC, Doyle MP, Schnegg B, Pearman M, Emmanuel S, Goh SSC, Robson D, Muthiah K, Watson A, Hayward CS. Intermittent Papillary Muscle Suction: A Rare Cause of Left Ventricular Assist Device Low Flow. JACC Case Rep 2021; 3:1680-1684. [PMID: 34766018 PMCID: PMC8571786 DOI: 10.1016/j.jaccas.2021.07.025] [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: 05/06/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022]
Abstract
Low flow alarms represent a management challenge in patients with left ventricular assist devices because they are often a consequence of complex patient-device interactions. We present a case of intermittent suction of the postero-medial papillary muscle into the left ventricular assist device inflow cannula during diastole, causing low flows. This case highlights the importance of a systematic approach and use of multiple investigation modalities in making an accurate diagnosis. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
| | - Mathew P. Doyle
- Department of Cardiothoracic Surgery, St Vincent’s Hospital, Sydney, Australia
| | - Bruno Schnegg
- Department of Cardiology, St Vincent’s Hospital, Sydney, Australia
| | | | - Sam Emmanuel
- Department of Cardiothoracic Surgery, St Vincent’s Hospital, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Siew SC. Goh
- Department of Cardiothoracic Surgery, St Vincent’s Hospital, Sydney, Australia
| | - Desiree Robson
- Department of Cardiology, St Vincent’s Hospital, Sydney, Australia
| | - Kavitha Muthiah
- Department of Cardiology, St Vincent’s Hospital, Sydney, Australia
| | - Alasdair Watson
- Department of Cardiothoracic Surgery, St Vincent’s Hospital, Sydney, Australia
| | | |
Collapse
|
14
|
Vaile JR, Rame JE, Alvarez RJ, Massey HT, Tchantchaleishvili V, Vishnevsky A, Rajapreyar IN, Brailovsky Y, Shah MK. 3 Cases of Superior Vena Cava Syndrome Following Percutaneous Right Ventricular Assist Device Placement. JACC Case Rep 2021; 3:1690-1693. [PMID: 34766020 PMCID: PMC8571785 DOI: 10.1016/j.jaccas.2021.09.005] [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: 04/27/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
Abstract
We present 3 cases of superior vena cava (SVC) syndrome following percutaneous right ventricular assist device (RVAD) placement. Each case underscores the importance of early recognition of SVC syndrome in patients with percutaneous RVAD insertion via the internal jugular vein and calls for heightened awareness of device-associated complications. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- John R Vaile
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J Eduardo Rame
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rene J Alvarez
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Howard T Massey
- Department of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Alec Vishnevsky
- Department of Interventional and Structural Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Indranee N Rajapreyar
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yevgeniy Brailovsky
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mahek K Shah
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
15
|
Emamaullee J, Khan S, Weaver C, Goldbeck C, Yanni G, Kohli R, Genyk Y, Zhou S, Shillingford N, Sullivan PM, Takao C, Detterich J, Kantor PF, Cleveland JD, Herrington C, Ram Kumar S, Starnes V, Badran S, Patel ND. Non-invasive biomarkers of Fontan-associated liver disease. JHEP Rep 2021; 3:100362. [PMID: 34693238 DOI: 10.1016/j.jhepr.2021.100362] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background & Aims Fontan-associated liver disease (FALD) has emerged as an important morbidity following surgical palliation of single ventricle congenital heart disease. In this study, non-invasive biomarkers that may be associated with severity of FALD were explored. Methods A retrospective cohort of paediatric patients post-Fontan who underwent liver biopsy at a high volume at a paediatric congenital heart disease centre was reviewed. Results Among 106 patients, 66% were male and 69% were Hispanic. The mean age was 14.4 ± 3.5 years, and biopsy was performed 10.8 ± 3.6 years post-Fontan. The mean BMI was 20.8 ± 5 kg/m2, with 27.4% meeting obesity criteria. Bridging fibrosis was observed in 35% of patients, and 10.4% of all patients had superimposed steatosis. Bridging fibrosis was associated with lower platelet counts (168.3 ± 58.4 vs. 203.9 ± 65.8 K/μl for congestive hepatic fibrosis score [CHFS] 0–2b, p = 0.009), higher bilirubin (1.7 ± 2.2 vs. 0.9 ± 0.7 mg/dl, p = 0.0090), higher aspartate aminotransferase-to-platelet ratio index [APRI] and fibrosis-4 [FIB-4] scores (APRI: 0.5 ± 0.3 vs. 0.4 ± 0.1, p <0.01 [AUC: 0.69] and FIB-4: 0.6 ± 0.4 vs. 0.4 ± 0.2, p <0.01 [AUC: 0.69]), and worse overall survival (median 2 years follow-up post-biopsy, p = 0.027). Regression modelling of temporal changes in platelet counts before and after biopsy correlated with fibrosis severity (p = 0.005). Conclusions In this large, relatively homogeneous adolescent population in terms of age, ethnicity, and Fontan duration, bridging fibrosis was observed in 35% of patients within the first decade post-Fontan. Bridging fibrosis was associated with worse survival. Changes in platelet counts, even years before biopsy, and APRI/FIB-4 scores had modest discriminatory power in identifying patients with advanced fibrosis. Steatosis may represent an additional risk factor for disease progression in obese patients. Further prospective studies are necessary to develop strategies to screen for FALD in the adolescent population. Lay summary In this study, the prevalence of Fontan-associated liver disease (FALD) in the young adult population and clinical variables that may be predictive of fibrosis severity or adverse outcomes were explored. Several lab-based, non-invasive markers of bridging fibrosis in FALD were identified, suggesting that these values may be followed as a prognostic biomarker for FALD progression in the adolescent population. FALD is universal within 10 years post-Fontan, with 35% of patients having bridging fibrosis. Of our adolescent patient population, 10% had concomitant hepatic steatosis, which was associated with obesity. Regression modelling demonstrates that temporal changes in platelet counts correlate with severity of fibrosis in FALD. AST-to-platelet ratio index and FIB-4 scores correlate with bridging fibrosis with a high specificity. Bridging fibrosis in FALD is associated with worse survival.
Collapse
Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- APRI, AST-to-platelet ratio index
- AST, aspartate aminotransferase
- BMI, body mass index
- BNP, brain natriuretic peptide
- BUN, blood urea nitrogen
- CBC, complete blood count
- CHFS, congestive hepatic fibrosis score
- CHLT, combined heart–liver transplantation
- CVP, central venous pressure
- Congenital heart disease
- Congestive hepatopathy
- ECMO, extracorporeal membrane oxygenation
- FALD, Fontan-associated liver disease
- FIB-4, fibrosis-4
- GFR, glomerular filtration rate
- GGT, gamma-glutamyl transferase
- INR, international normalised ratio
- IQR, interquartile range
- LVAD, left ventricular assist device
- MELD, model of end-stage liver disease
- MELD-Na, MELD-sodium
- MELD-XI, MELD without INR
- NAFLD, non-alcoholic fatty liver disease
- PELD, paediatric end-stage liver disease
- PT, prothrombin time
- PTT, partial thromboplastin time
- TTE, transthoracic echocardiograms
- Univentricular heart disease
Collapse
|
16
|
Sticchi A, Bartkowiak J, Brugger N, Weiss S, Windecker S, Praz F. Retrograde Retrieval of a Novel Large Mitral Clip After Embolization Into the Left Ventricle. JACC Case Rep 2021; 3:1561-1568. [PMID: 34729501 PMCID: PMC8543158 DOI: 10.1016/j.jaccas.2021.08.024] [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: 06/15/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/05/2022]
Abstract
We describe the successful retrieval of a novel large mitral clip, which embolized in a patient with severe secondary mitral regurgitation and left ventricular dysfunction, dilated left ventricle, and severely tethered mitral valve leaflets in the setting of a challenging anatomy for transcatheter edge-to-edge repair. The description highlights planning, technical issues, and possible adverse events of this bailout procedure. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Alessandro Sticchi
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro per la Lotta Contro L'Infarto Foundation, Rome, Italy.,Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Joanna Bartkowiak
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Salome Weiss
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
17
|
Garcia RA, Gaznabi S, Musoke L, Osnard M, Balakumaran K, Armitage KB, Al-Kindi SG, Ginwalla M, Abu-Omar Y, Elamm CA. LVAD Vasculitis Case Series: Suggestion of a New Fatal LVAD-Related Phenomenon. JACC Case Rep 2021; 3:1013-1017. [PMID: 34317675 PMCID: PMC8311371 DOI: 10.1016/j.jaccas.2021.03.030] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
Left ventricular assist devices (LVADs) are surgically implanted mechanical devices indicated for patients with advanced heart failure and are known to come with several complications. Here we present a case series, and review 1 documented report, of LVAD vasculitis, a presumed new LVAD immune/humoral related phenomenon. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Raul Angel Garcia
- Department of Advanced Heart Failure and Transplant, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
- Address for correspondence: Dr Raul Angel Garcia, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th Floor, Kansas City, Missouri 64111, USA.
| | - Safwan Gaznabi
- Department of Advanced Heart Failure and Transplant, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lewis Musoke
- Department of Infectious Disease, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael Osnard
- Department of Internal Medicine, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kathir Balakumaran
- Department of Advanced Heart Failure and Transplant, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Keith B. Armitage
- Department of Infectious Disease, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sadeer G. Al-Kindi
- Department of Cardiovascular Medicine, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mahazarin Ginwalla
- Department of Advanced Heart Failure and Transplant, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yasir Abu-Omar
- Department of Cardiothoracic Surgery, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chantal A. Elamm
- Department of Advanced Heart Failure and Transplant, University Hospital Cleveland Medical Center, Harrington Heart Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
18
|
Dreessens E, Cox J, Ramsey J, Uyeda E, Adamson R, Jaski B, Narula A. Transaxillary Stenting of LVAD Outflow Graft Obstruction. JACC Case Rep 2021; 3:1064-1068. [PMID: 34317685 PMCID: PMC8311358 DOI: 10.1016/j.jaccas.2021.02.038] [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: 11/10/2020] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/12/2022]
Abstract
An 82-year-old man with a HeartMate II left ventricular assist device presented with low-flow alarms and cardiogenic shock secondary to left ventricular assist device outflow graft obstruction. Given high risk for redo sternotomy, the heart team decided on percutaneous intervention with peripheral stents, a procedure that is currently limited to case reports. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Erin Dreessens
- Naval Medical Center San Diego, San Diego, California, USA
| | - Justin Cox
- Naval Medical Center San Diego, San Diego, California, USA.,Sharp Memorial Hospital, San Diego, California, USA
| | - Jack Ramsey
- Sharp Memorial Hospital, San Diego, California, USA
| | - Ensley Uyeda
- Sharp Memorial Hospital, San Diego, California, USA
| | | | - Brian Jaski
- Sharp Memorial Hospital, San Diego, California, USA
| | - Arvin Narula
- Sharp Memorial Hospital, San Diego, California, USA
| |
Collapse
|
19
|
Ramu B, Masotti M, Tedford RJ, Cogswell RJ. Heart Transplantation in Adriamycin-Associated Cardiomyopathy in the Contemporary Era of Advanced Heart Failure Therapies. JACC CardioOncol 2021; 3:294-301. [PMID: 34396337 PMCID: PMC8352281 DOI: 10.1016/j.jaccao.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/03/2022]
Abstract
Background Adriamycin-associated cardiomyopathy (ACM) can lead to end-stage heart failure requiring advanced heart failure therapies. Objectives This study sought to provide post-cardiac transplant survival data in patients with ACM in the contemporary era of mechanical circulatory support and cardiac transplantation. Methods Adults (≥18 years of age) who underwent first-time, single-organ heart transplantation were identified from the United Network for Organ Sharing between October 18, 2008, and October 18, 2018. Cardiomyopathy subtypes that could have been supported with a left ventricular assist device (LVAD) including ACM, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM) were included. A multivariable Cox regression analysis was performed to determine the association between cardiomyopathy subtype and post-cardiac transplant survival. Results This analysis included 18,270 patients (357 with ACM; 10,662 with DCM; and 7,251 with ICM). Heart transplant recipients with ACM were younger, included more women, and had higher pulmonary vascular resistance at the time of listing. Patients with ACM had a lower percentage of durable LVADs at the time of transplant across all years of the study period. Patients with ACM did not experience an increase in post-cardiac transplant mortality compared to those with DCM (adjusted hazard ratio: 0.96; 95% confidence interval: 0.79 to 1.40; p = 0.764) or ICM (adjusted hazard ratio: 0.85; 95% confidence interval: 0.6 to 1.2; p = 0.304). Conclusions Patients with ACM who received heart transplants between 2008 and 2018 had similar post-cardiac transplant survival to those with dilated and ischemic cardiomyopathy. Bridge-to-transplant LVAD use remains lower compared to other cardiomyopathy subtypes.
Collapse
Affiliation(s)
- Bhavadharini Ramu
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maria Masotti
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca J Cogswell
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
20
|
Schlam I, Lee AY, Li S, Sheikh FH, Zaghlol R, Basyal B, Gallagher C, Molina E, Mahr C, Cheng RK, Barac A. Left Ventricular Assist Devices in Patients With Active Malignancies. JACC CardioOncol 2021; 3:305-315. [PMID: 34396339 PMCID: PMC8352017 DOI: 10.1016/j.jaccao.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/14/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There are limited data to guide oncology and cardiology decision-making in patients with a left ventricular assist device (LVAD) and concurrent active malignancy. OBJECTIVES The goal of this study was to describe cancer treatment approaches, complications, and survival among patients with active cancer on LVAD support in 2 tertiary heart failure and oncology programs. METHODS In this retrospective cohort study, LVAD databases were reviewed to identify patients with a cancer diagnosis at the time of or after LVAD implantation. We created a 3:1 matched cohort based on age, sex, etiology of cardiomyopathy, LVAD implant strategy, and INTERMACS profile stratified by site. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival between patients with cancer and non-cancer comparators. RESULTS Among 1,123 patients who underwent LVAD implantation between 2005 and 2019, 22 patients with LVADs with active cancer and 66 matched non-cancer comparators were identified. Median age was 62 years (range 41 to 73 years); 50% of patients with cancer were African-American, and 27% were women. Prostate cancer, followed by renal cell cancer and hematologic malignancies were the most common diagnoses. There was no significant difference in unadjusted Kaplan-Meier median survival estimates from the time of LVAD placement between patients with cancer (3.53 years; 95% confidence interval [CI]: 1.41 to 5.33) and non-cancer comparators (3.03 years; 95% CI: 1.83 to 5.26; log-rank P = 0.99). In Cox proportional hazard models, cancer diagnosis as a time-varying variable was associated with a statistically significant increase in death (hazard ratio: 2.05; 95% CI: 1.03 to 4.12; P = 0.04). Patients with cancer had less gastrointestinal bleeding compared with matched non-cancer comparators (P = 0.016). Other complications were not significantly different. CONCLUSIONS Our study provides initial feasibility and safety data and set a framework for multidisciplinary team management of patients with cancer and LVADs.
Collapse
Affiliation(s)
- Ilana Schlam
- MedStar Washington Cancer Institute, Washington, DC, USA
- Department of Hematology-Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Andy Y. Lee
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Song Li
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Farooq H. Sheikh
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Raja Zaghlol
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Binaya Basyal
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Christopher Gallagher
- MedStar Washington Cancer Institute, Washington, DC, USA
- Department of Hematology-Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ezequiel Molina
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Claudius Mahr
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Richard K. Cheng
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| |
Collapse
|
21
|
Corona S, Naliato M, Tondo C, Casella M, Apostolo A, Agostoni P, Salvi L, Alamanni F. Successful Open Chest Epicardial Ablation for Refractory Ventricular Tachycardia in an LVAD Recipient. JACC Case Rep 2021; 3:1055-1060. [PMID: 34317683 PMCID: PMC8311376 DOI: 10.1016/j.jaccas.2021.02.007] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
A patient with history of dilated cardiomyopathy, a cardiac resynchronization therapy defibrillator, and endocardial ablation presented for refractory ventricular tachycardia 3 years after implantation of a Jarvik 2000 left ventricular assist device (Jarvik Heart, Inc., New York, New York). Open-chest epicardial ablation safely and effectively terminated the arrhythmia, without ventricular tachycardia recurrence at 9-month follow-up and in the absence of complications during the hospital stay. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Silvia Corona
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
- Address for correspondence: Dr Silvia Corona, IRCCS Centro Cardiologico Monzino, Via Parea 4, 20138 Milan, Italy. @SilviaCorona89
| | - Moreno Naliato
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
| | - Claudio Tondo
- Department of Electrophysiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Michela Casella
- Department of Electrophysiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Anna Apostolo
- Department of Heart Failure and Clinical Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Piergiuseppe Agostoni
- Department of Heart Failure and Clinical Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Anaesthesia and Intensive Care, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Luca Salvi
- Department of Anaesthesia and Intensive Care, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
- Department of Cardiovascular Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| |
Collapse
|
22
|
Bartoli CR, Hennessy-Strahs S, Dowling RD, Gaynor JW, Glatz AC. Abnormalities in the Von Willebrand-Angiopoietin Axis Contribute to Dysregulated Angiogenesis and Angiodysplasia in Children With a Glenn Circulation. JACC Basic Transl Sci 2021; 6:222-35. [PMID: 33778210 DOI: 10.1016/j.jacbts.2020.12.014] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 02/08/2023]
Abstract
Children with a bidirectional superior cavopulmonary connection (Glenn circulation) develop dysregulated angiogenesis and pulmonary angiodysplasia in the form of arteriovenous malformations (AVMs). No targeted therapy exists. The von Willebrand factor (vWF)–angiopoietin axis plays a major role in normal angiogenesis, angiodysplasia, and AVM formation in multiple diseases. vWF and angiopoietin-2 (which destabilizes vessel formation) were abnormal in children with a Glenn circulation versus control children. Within Glenn patients, angiopoietin-1 (which stabilizes vessel formation) and angiogenesis were different in the systemic versus pulmonary circulation. Plasma angiopoietin-1 was lower in the pulmonary circulation of Glenn patients with pulmonary AVMs than Glenn patients without AVMs. In parallel, differences in multiple angiogenic and inflammatory signaling peptides were observed between Glenn patients and controls, which indicated derangements in multiple angiogenic pathways in Glenn patients. These findings support the novel hypothesis that abnormal vWF metabolism and angiopoietin signaling dysregulate angiogenesis and contribute to pulmonary AVM formation in children with a Glenn circulation. The vWF-angiopoietin axis may be a target to correct angiogenic imbalance and reduce pulmonary angiodysplasia in Glenn patients.
Children with a bidirectional superior cavopulmonary (Glenn) circulation develop angiodysplasia and pulmonary arteriovenous malformations (AVMs). The von Willebrand factor (vWF)–angiopoietin axis plays a major role in AVM formation in multiple diseases. We observed derangements in global angiogenic signaling, vWF metabolism, angiopoietins, and in vitro angiogenesis in children with a Glenn circulation versus controls and within Glenn pulmonary versus systemic circulations. These findings support the novel hypothesis that abnormalities in the vWF-angiopoietin axis may dysregulate angiogenesis and contribute to Glenn pulmonary AVMs. The vWF-angiopoietin axis may be a target to correct angiogenic imbalance in Glenn patients, for whom no targeted therapy exists.
Collapse
Key Words
- ADAMTS-13, a disintegrin and metalloproteinase thrombospondin (motif) #13
- AVM, arteriovenous malformation
- EBM, endothelial basal media
- EGM, endothelial growth media
- Glenn
- HUVEC, human umbilical vein endothelial cell
- IVC, inferior vena cava
- LVAD, left ventricular assist device
- PA, pulmonary artery
- SVC, superior vena cava
- angiogenesis
- angiopoietin
- arteriovenous malformation
- vWF, von Willebrand factor
- von Willebrand factor
Collapse
|
23
|
Le Ruz R, Lande G, Lepoivre T, David CH, Michel M, Gourraud JB. Electrical Storm Ablation in a Patient in Cardiogenic Shock Supported by Impella 5.0. JACC Case Rep 2021; 3:486-490. [PMID: 34317564 PMCID: PMC8311017 DOI: 10.1016/j.jaccas.2020.12.032] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Abstract
Intra-axial pumps are increasingly used to support cardiogenic shock. The occurrence of electrical storms in this setting is a rising issue, and data remain scarce about optimal management. We report the feasibility of ventricular tachycardia ablation in the presence of a recent surgically inserted Impella 5.0 device (Abiomed, Danvers, Massachusetts). (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Robin Le Ruz
- Department of Cardiology, Nantes University Hospital Center, Saint-Herblain, France
- Address for correspondence: Robin Le Ruz, Department of Cardiology, Centre Hospitalo-Universitaire de Nantes, Boulevard Professeur Jacques Monod, 44800 Saint-Herblain, France. @CHUnantes
| | - Gilles Lande
- Department of Cardiology, Nantes University Hospital Center, Saint-Herblain, France
| | - Thierry Lepoivre
- Department of Cardiac Anesthesiology and Intensive Care, Nantes University Hospital Center, Saint-Herblain, France
| | - Charles-Henri David
- Department of Cardiac Surgery, Nantes University Hospital Center, Saint-Herblain, France
| | - Magali Michel
- Department of Cardiology, Nantes University Hospital Center, Saint-Herblain, France
| | | |
Collapse
|
24
|
Vlismas PP, Rochlani YM, Romero J, Scheinin S, Shin JJ, Goldstein D, Jorde UP. Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmia in Continuous-Flow Left Ventricular Assist Device. JACC Case Rep 2021; 3:443-446. [PMID: 34317554 PMCID: PMC8311031 DOI: 10.1016/j.jaccas.2020.12.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/12/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
Cardiac sympathetic denervation has been shown to reduce sustained ventricular arrhythmias and implantable cardioverter-defibrillator shocks by inhibiting sympathetic outflow to the heart. We describe the first case to our knowledge of cardiac sympathetic denervation in the left ventricular assist device population. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Peter P Vlismas
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Yogita M Rochlani
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Jorge Romero
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Scott Scheinin
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Jooyoung J Shin
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Daniel Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
25
|
Najjar E, Hallberg Kristensen A, Thorvaldsen T, Dalén M, Jorde UP, Lund LH. Electrostatic Discharge Causing Pump Shutdown in HeartMate 3. JACC Case Rep 2021; 3:459-463. [PMID: 34317558 PMCID: PMC8311034 DOI: 10.1016/j.jaccas.2020.12.036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 10/29/2022]
Abstract
Left ventricular assist devices (LVADs) improve symptoms and outcomes in advanced heart failure. Although device malfunction has decreased significantly with later generation LVADs, it has not been eliminated. We describe the clinical course of a patient with HeartMate 3 LVAD who experienced device malfunction, involving temporary pump shutdown suspected to be caused by electrostatic discharge. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Emil Najjar
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Tonje Thorvaldsen
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrich P Jorde
- Department of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
26
|
Hak JF, Moreau de Bellaing A, Boulouis G, Roux CJ, Kerleroux B, Bonnet D, Houyel L, Raisky O, Kossorotoff M, Naggara O. Late Pediatric Mechanical Thrombectomy for Embolic Stroke as Bridge Reinforcement From LVAD to Heart Transplantation. JACC Case Rep 2021; 3:686-9. [PMID: 34317604 DOI: 10.1016/j.jaccas.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 10/19/2020] [Indexed: 01/01/2023]
Abstract
Although the left ventricular assist device is an important bridge to heart transplantation for patients with end-stage heart failure, it can also be a source of embolic stroke. We present a case of late intracranial mechanical thrombectomy performed for embolic stroke beyond the recommended 6 h, thus allowing for heart transplantation 4 days after intracranial mechanical thrombectomy. (Level of Difficulty: Advanced.)
Collapse
|
27
|
Kiamanesh O, Rankin K, Billia F, Badiwala MV. Left Ventricular Assist Device With a Left Atrial Inflow Cannula for Hypertrophic Cardiomyopathy. JACC Case Rep 2020; 2:2090-2094. [PMID: 34317114 PMCID: PMC8299761 DOI: 10.1016/j.jaccas.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/07/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 10/26/2022]
Abstract
Patients with restrictive or hypertrophic cardiomyopathy (HCM) are often ineligible for a left ventricular assist device (LVAD) due to the risk of suction events with a small left ventricular cavity size and left ventricular inflow cannula. We describe an alternative LVAD configuration using a left atrial inflow cannula as a bridge to transplantation in an adult with HCM. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Omid Kiamanesh
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kate Rankin
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Mitesh V Badiwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Nandkeolyar S, Contractor T, Bhardwaj R, Mandapati R, Sakr A, Abudayyeh I, Razzouk A, Bharadwaj AS. A Multidisciplinary Approach to Electrical Instability and Cardiogenic Shock in Acute Myocardial Infarction. JACC Case Rep 2020; 2:2053-2059. [PMID: 34317107 PMCID: PMC8299773 DOI: 10.1016/j.jaccas.2020.07.059] [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: 04/29/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Abstract
New cardiogenic shock classifications allow prompt recognition and management of complications of acute coronary syndrome. A 59-year-old man presented after a delayed left anterior descending coronary artery ST-segment elevation myocardial infarction in Society of Cardiovascular Angiography and Interventions stage E cardiogenic shock and ventricular tachycardia storm. He underwent revascularization of the left anterior descending artery, percutaneous left ventricular assist device bridged to permanent assist device placement, epicardial and endocardial ventricular tachycardia ablation, and iatrogenic closure of an atrial septal defect. (Level of Difficulty: Beginner.)
Collapse
Key Words
- ASD closure
- CPO, cardiac power output
- CRT-D, cardiac resynchronization therapy defibrillator
- LAD, left anterior descending (coronary artery)
- LV, left ventricular
- LVAD, left ventricular assist device
- PCI, percutaneous coronary intervention
- RV, right ventricular
- STEMI, ST-segment elevation myocardial infarction
- TIMI, Thrombolysis In Myocardial Infarction
- VT, ventricular tachycardia
- cardiogenic shock
- delayed STEMI presentation
- mechanical assist devices
- ventricular tachycardia storm
Collapse
Affiliation(s)
- Shuktika Nandkeolyar
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Tahmeed Contractor
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Rahul Bhardwaj
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Ravi Mandapati
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Antoine Sakr
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Islam Abudayyeh
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Anees Razzouk
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Aditya Satish Bharadwaj
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| |
Collapse
|
29
|
Egolum UO, Parikh K, Lekavich C, Wosik J, Frazier-Mills C, Fudim M. Applications of the Multisensor HeartLogic Heart Failure Monitoring Algorithm During the COVID-19 Global Pandemic. JACC Case Rep 2020; 2:2265-2269. [PMID: 33073246 PMCID: PMC7550056 DOI: 10.1016/j.jaccas.2020.09.035] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023]
Abstract
In the COVID-19 era, the heart failure community has witnessed an unprecedented reduction in heart failure–related patient visits and hospitalizations. Social distancing measures present a dilemma for patients with heart failure who require frequent surveillance of volume status and vital signs to minimize heart failure–related symptoms and hospitalizations. With the rise of telemedicine comes an increased focus on remote monitoring technologies. This report describes use of a multisensor device algorithm in implantable cardioverter defibrillator devices by Boston Scientific, called HeartLogic. We present 2 cases of patients with advanced heart failure who were actively surveilled by the HeartLogic device algorithm to guide care. (Level of Difficulty: Beginner.)
Collapse
Affiliation(s)
- Ugochukwu O Egolum
- Advanced Heart Failure Section, The Heart Center of Northeast Georgia Medical Center, Gainesville, Georgia
| | - Kishan Parikh
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Carolyn Lekavich
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jedrek Wosik
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
30
|
Asawaeer M, Kadir S, Albulushi A, Castleberry AW, Chatzizisis YS. Left Ventricular Assist Device Outflow Cannula Obstruction: Importance of Multimodality Imaging. JACC Case Rep 2020; 2:1454-1456. [PMID: 34316995 PMCID: PMC8302100 DOI: 10.1016/j.jaccas.2020.05.065] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
One of the dreaded complications of left ventricular assist device implantation is mechanical obstruction of the device secondary to pump thrombosis or mechanical outflow cannula obstruction. We describe a case of outflow cannula obstruction caused by kinking and twisting of the outflow graft after surgical manipulation of the pump. (Level of Difficulty: Beginner.)
Collapse
Affiliation(s)
- Majid Asawaeer
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sajid Kadir
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Arif Albulushi
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Anthony W Castleberry
- Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Yiannis S Chatzizisis
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| |
Collapse
|
31
|
Chau VQ, Oliveros E, Mahmood K, Singhvi A, Lala A, Moss N, Gidwani U, Mancini DM, Pinney SP, Parikh A. The Imperfect Cytokine Storm: Severe COVID-19 With ARDS in a Patient on Durable LVAD Support. JACC Case Rep 2020; 2:1315-1320. [PMID: 32292915 PMCID: PMC7142699 DOI: 10.1016/j.jaccas.2020.04.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 03/27/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 04/30/2023]
Abstract
As health systems worldwide grapple with the coronavirus disease-2019 (COVID-19) pandemic, patients with durable LVAD support represent a unique population at risk for the disease. This paper outlines the case of such a patient who developed COVID-19 complicated by a "cytokine storm" with severe acute respiratory distress syndrome and myocardial injury and describes the challenges that arose during management.
Collapse
Affiliation(s)
| | | | | | | | - Anuradha Lala
- Address for correspondence: Dr. Anuradha Lala, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
| | | | | | | | | | | |
Collapse
|
32
|
Chaudhry SP, Salerno CT, Ravichandran AK, Walsh MN. Shared Decision Making in Cardiac Transplantation During the COVID-19 Pandemic: Patient Refusal of Transplantation. JACC Case Rep 2020; 2:1365-7. [PMID: 32835281 DOI: 10.1016/j.jaccas.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
Abstract
Shared decision making with patients in advanced heart failure is critical when making decisions on therapies such as left ventricular assist device implantation and cardiac transplantation. We describe a case wherein the risks of coronavirus disease-2019 affected the decision of a patient regarding proceeding with cardiac transplantation. (Level of Difficulty: Beginner.).
Collapse
|
33
|
Vilaro J, Al-Ani M, Manjarres DG, Lascano JE, Cherabuddi K, Elgendy AY, Bleiweiss MS, Parker AM, Ahmed MM, Aranda JM. Severe COVID-19 After Recent Heart Transplantation Complicated by Allograft Dysfunction. JACC Case Rep 2020; 2:1347-1350. [PMID: 32835277 PMCID: PMC7279732 DOI: 10.1016/j.jaccas.2020.05.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/26/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
A 50-year-old male presented with atrial flutter 25 days after heart and kidney transplantation. Rejection was excluded, but he developed severe COVID-19 infection with cardiac allograft dysfunction. Despite continued corticosteroid and tacrolimus therapy, he remained aviremic. Respiratory and myocardial functions recovered after a week of mechanical ventilation. The cardiomyopathy was stress induced. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Juan Vilaro
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
- Address for correspondence: Dr. Juan Vilaro, Division of Cardiovascular Medicine, University of Florida College of Medicine, 1329 SW 16th Street, P.O. Box 100288, Gainesville, Florida 32610.
| | - Mohammad Al-Ani
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Diana Gomez Manjarres
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Jorge E. Lascano
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Kartik Cherabuddi
- Division of Infectious Diseases, Department of Medicine, University of Florida, Gainesville, Florida
| | - Akram Y. Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Mark S. Bleiweiss
- Congenital Heart Center, University of Florida Health Shands Children's Hospital, University of Florida, Gainesville, Florida
| | - Alex M. Parker
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Mustafa M. Ahmed
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Juan M. Aranda
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
34
|
Mahmood K, Rashed ER, Oliveros E, Chau VQ, Hermle T, Jacobs S, Lala A, Singhvi A, Parikh A, Pinney SP. Predisposition or Protection?: COVID-19 in a Patient on LVAD Support With HIV/AIDS. JACC Case Rep 2020; 2:1337-1341. [PMID: 32835275 PMCID: PMC7236747 DOI: 10.1016/j.jaccas.2020.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Indexed: 01/19/2023]
Abstract
There is a desperate search to discover effective therapies against coronavirus disease-2019 (COVID-19). Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) comprise a unique population whose clinical course may provide insights into the effects of antiretroviral therapy on COVID-19. We describe the case of a patient with HIV/AIDS on left ventricular assist device support who was hospitalized and recovered from COVID-19. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Kiran Mahmood
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eman R Rashed
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Estefania Oliveros
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vinh Q Chau
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Taylor Hermle
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Jacobs
- Department of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aditi Singhvi
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aditya Parikh
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean P Pinney
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
35
|
Lara LF, Silva R, Thakkar S, Stanich PP, Mai D, Samarasena JB. Multicenter case series of patients with small-bowel angiodysplasias treated with a small-bowel radiofrequency ablation catheter. VideoGIE 2020; 5:162-167. [PMID: 32258850 PMCID: PMC7125393 DOI: 10.1016/j.vgie.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background and Aims GI angiodysplasia is the most common cause of small-bowel bleeding. Argon plasma coagulation (APC) is preferred for ablation because of its availability, ease of use, and perceived safety, but it has limitations. An instrument capable of repeated use through the enteroscope, which covers more area of intestinal mucosa per treatment with low risk of damage to healthy mucosa, and which improves ablation, is desirable. A series of patients treated with a through-the-scope radiofrequency ablation (RFA) catheter is reported. Methods Patients with a previous diagnosis of small-bowel angiodysplasia (SBA) and ongoing bleeding with melena, hematochezia, or iron-deficiency anemia were eligible for treatment. A small-bowel radiofrequency ablation (SBRFA) catheter was passed through the enteroscope instrument channel. The treatment paddle was pushed against the SBA, achieving coaptive coagulation, and the SBA was treated up to 2 times at standard settings of 10 J/cm2. The patients' demographics, pretreatment and posttreatment hemoglobin levels, time to recurrence of bleeding, and need for more therapy were recorded. This study was approved by the institutional review boards of the respective institutions. Results Twenty consecutive patients were treated from March until October 2018 and followed up until March 2019. There were 6 women (average age 68 years, standard deviation ± 11.1), and 14 men (average age 73 years, standard deviation ± 10.4). All had undergone at least 1 previous EGD and colonoscopy; 14 patients (70%) had SBA on video capsule endoscopy, and 14 patients had undergone previous endoscopic treatment of SBA with APC. A median of 23 treatments were applied (range, 2-99). The median follow-up time was 195 days (range, 30-240 days). Four patients, including 3 with a left ventricular assist device (LVAD), had recurrent bleeding between 45 and 210 days after treatment, and 2 patients received repeated blood transfusions. Three of those patients underwent repeated endoscopies, including a push enteroscopy and an upper endoscopy with no treatment, and a repeated enteroscopy with SBA treated with APC, respectively. One patient with LVAD underwent arterial embolization. Conclusions In this case series, bleeding recurred in 20% of patients in a follow-up time of ≤240 days. Notably, 3 of the 4 patients who had recurrent bleeding had an LVAD. These rates compare favorably with reported bleeding recurrence after APC of SBA. More studies on the benefits of SBRFA, which may include reduced risk of recurrent bleeding or prolonging the time to recurrent bleeding, resource utilization, and factors associated with bleeding recurrence are needed.
Collapse
Affiliation(s)
- Luis F Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rogelio Silva
- Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Shyam Thakkar
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Peter P Stanich
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel Mai
- University of California, Irvine, California USA
| | | |
Collapse
|
36
|
Ullah W, Sattar Y, Darmoch F, Al-Khadra Y, Mir T, Ajmal R, Moussa-Pacha H, Glazier J, Asfour A, Gardi D, Alraies MC. The impact of peripheral arterial disease on patients with mechanical circulatory support. Int J Cardiol Heart Vasc 2020; 28:100509. [PMID: 32300637 PMCID: PMC7150524 DOI: 10.1016/j.ijcha.2020.100509] [Citation(s) in RCA: 4] [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: 02/05/2020] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 01/05/2023]
Abstract
Patient having LVAD and history of PAD have a higher odd to develop acute myocardial infarction as compared to non-PAD. Major bleeding requiring transfusion, and thromboembolic complications were higher in patients with PAD disease. The LVAD placement in prior PAD can have high odds of surgical wound infections, and implant-related complications as compared to non-PAD. The odds of developing acute renal failure are high in LVAD with PAD as compared to non-PAD group. LVAD placement in history of PAD can have high in-hospital mortality are high as compared to non-PAD group.
Background Left ventricular assist devices (LVAD) are indicated as bridging or destination therapy for patients with advanced (Stage D) heart failure and reduced ejection fraction (HFrEF). Due to the clustering of the mutual risk factors, HFrEF patients have a high prevalence of peripheral arterial disease (PAD). This, along with the fact that continuous flow LVAD influence shear stress on the vasculature, can further deteriorate the PAD. Methods We queried the National Inpatient Sample (NIS) database (2002–2014) to identify the burden of pre-existing PAD cases, its association with LVAD, in-hospital mortality, and other complications of LVAD. The adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using the Cochran–Mantel–Haenszel test. Results A total of 20,817 LVAD patients, comprising of 1,625 (7.8%) PAD and 19,192 (91.2%) non-PAD patients were included in the study. The odds of in-hospital mortality in PAD patients were significantly higher compared to non-PAD group (OR 1.29, CI, 1.07–1.55, P = 0.007). The PAD group had significantly higher adjusted odds as compared to non-PAD group for acute myocardial infarction (aOR 1.29; 95% CI, 1.07–1.55, P = 0.007), major bleeding requiring transfusion (aOR, 1.286; 95% CI, 1.136–1.456, P < 0.001), vascular complications (aOR, 2.360; 95% CI, 1.781–3.126, P < 0.001), surgical wound infections (aOR, 1.50; 95% CI, 1.17–1.94, P = 0.002), thromboembolic complications (aOR, 1.69; 95% CI, 1.36–2.10, P < 0.001), implant-related complications (aOR, 1.47; 95% CI, 1.19–1.80, P < 0.001), and acute renal failure (aOR, 1.26; 95% CI, 1.12–1.43, P < 0.001). Conclusion PAD patients can have high LVAD associated mortality as compared to non-PAD.
Collapse
Key Words
- BiVAD, biventricular assist device
- CABG, coronary artery bypass surgery
- CAD, coronary artery disease
- CKD, chronic kidney disease
- End-stage heart failure
- LOS, length of stay
- LVAD, left ventricular assist device
- Left ventricular assist device
- MCS, mechanical circulatory support
- NIS, National Inpatient Sample
- OMT, optimal medical therapy
- PAD, peripheral arterial disease
- PCI, percutaneous coronary intervention
- Peripheral arterial disease
Collapse
Affiliation(s)
- Waqas Ullah
- Abington Hospital - Jefferson Health, United States
| | - Yasar Sattar
- Icahn School of Medicine at Mount Sinai-Elmhurst Hospital, United States
| | - Fahed Darmoch
- Beth Israel Hospital, Harvard University, United States
| | | | - Tanveer Mir
- Wayne State University, Detroit Medical Center, United States
| | - Rasikh Ajmal
- Wayne State University, Detroit Medical Center, United States
| | - Homam Moussa-Pacha
- University of Texas Health Science Center, McGovern Medical School, Memorial Hermann Heart & Vascular Institute, USA
| | - James Glazier
- Wayne State University, Detroit Medical Center, United States
| | | | - Delair Gardi
- Wayne State University, Detroit Medical Center, United States
| | - M Chadi Alraies
- Wayne State University, Detroit Medical Center, United States
| |
Collapse
|
37
|
Davila CD, Kiernan MS, Kapur NK. Percutaneous Management of Outflow Graft Obstruction in Patients With Continuous Flow Left Ventricular Assist Devices. JACC Case Rep 2020; 2:400-405. [PMID: 34317251 PMCID: PMC8311608 DOI: 10.1016/j.jaccas.2019.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/23/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 06/13/2023]
Abstract
Outflow graft obstruction (OGO) has been reported as a cause of left ventricular assist device dysfunction. The incidence, diagnosis, and treatment of OGO remains poorly understood. We present our experience with the diagnosis and management of OGO in the cardiac catheterization laboratory. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Carlos D. Davila
- Address for correspondence: Dr. Carlos D. Davila, Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts 02111.
| | | | | |
Collapse
|
38
|
Vaishnav J, Hsu S, Sharma K, Florido R, Lewsey S, Schulman SP, Chacko M, Kilic A, Choi CW, Gilotra NA. Crossing the Bridge to Heart Transplantation: Biventricular Impella to Support an Unstable LVAD Patient. JACC Case Rep 2020; 2:173-177. [PMID: 34317200 PMCID: PMC8298639 DOI: 10.1016/j.jaccas.2019.12.017] [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: 09/20/2019] [Revised: 11/04/2019] [Accepted: 12/07/2019] [Indexed: 06/13/2023]
Abstract
We report the first case of a patient with a durable left ventricular assist device admitted with cardiogenic shock and managed with biventricular Impella support as a successful bridge to heart transplantation. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Joban Vaishnav
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Roberta Florido
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sabra Lewsey
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven P. Schulman
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Matthews Chacko
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Chun-woo Choi
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nisha A. Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
39
|
Fatehi Hassanabad A, McBride SA, Hill MD, Kent WDT. Mechanical Circulatory Support for the Management of Complex Peripartum Cardiomyopathy. JACC Case Rep 2020; 2:154-158. [PMID: 34316985 PMCID: PMC8301704 DOI: 10.1016/j.jaccas.2019.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/12/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 10/28/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease. The management of PPCM is individualized, and an early diagnosis is instrumental in the institution of an appropriate management plan. Here, we present a dramatic case of PPCM that was managed with a period of mechanical circulatory support. (Level of Difficulty: Beginner.).
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Susan Ainslie McBride
- Section of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Section of Neurology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - William D T Kent
- Section of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
40
|
Pfeffer TJ, Schlothauer S, Pietzsch S, Schaufelberger M, Auber B, Ricke-Hoch M, List M, Berliner D, Abou Moulig V, König T, Arany Z, Sliwa K, Bauersachs J, Hilfiker-Kleiner D. Increased Cancer Prevalence in Peripartum Cardiomyopathy. JACC CardioOncol 2019; 1:196-205. [PMID: 34396183 PMCID: PMC8352111 DOI: 10.1016/j.jaccao.2019.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Abstract
Objectives This study was designed to analyze the prevalence and potential genetic basis of cancer and heart failure in peripartum cardiomyopathy (PPCM). Background PPCM manifests as heart failure late in pregnancy or postpartum in women without previous heart disease. Methods Clinical history and cancer prevalence were evaluated in a cohort of 236 PPCM patients from Germany and Sweden. Exome sequencing assessed variants in 133 genes associated with cancer predisposition syndromes (CPS) and in 115 genes associated with dilated/hypertrophic cardiomyopathy (DCM/HCM) in 14 PPCM patients with a history of cancer, and in 6 PPCM patients without a history of cancer. Results The prevalence of cancer was 16-fold higher (8.9%, 21 of 236 patients) in PPCM patients compared to age-matched women (German cancer registry, Robert-Koch-Institute: 0.59%; p < 0.001). Cancer before PPCM occurred in 12 of 21 patients of whom 11 obtained cardiotoxic cancer therapies. Of those, 17% fully recovered cardiac function by 7 ± 2 months of follow-up compared to 55% of PPCM patients without cancer (p = 0.015). Cancer occurred after PPCM in 10 of 21 patients; 80% had left ventricular ejection fraction of ≥50% after cancer therapy. Whole-exome sequencing in 14 PPCM patients with cancer revealed that 43% (6 of 14 patients) carried likely pathogenic (Class IV) or pathogenic (Class V) gene variants associated with DCM/HCM in CPT2, DSP, MYH7, TTN, and/or with CPS in ATM, ERCC5, NBN, RECQL4, and SLX4. All CPS variants affected DNA damage response genes. Conclusions Cardiotoxic cancer therapy before PPCM is associated with delayed full recovery. The high cancer prevalence in PPCM is linked to likely pathogenic/pathogenic gene variants associated with DCM/HCM and/or CPS/DNA damage response-related cancer risk. This may warrant genetic testing and screening for heart failure in pregnant women with a cancer history and screening for cancer in PPCM patients.
Collapse
Key Words
- ATM, ataxia telangiectasia mutated
- BMBF, Bundesministerium für Bildung und Forschung
- BRCA1, breast cancer 1
- CPS, cancer predisposition syndrome
- DCM, dilated cardiomyopathy
- DDR, DNA damage response
- DFG, Deutsche Forschungsgesellschaft
- ERCC5, excision repair cross-complementing rodent repair deficiency
- FANCA, Fanconi anemia, complementation group
- FKRP, fukutin-related protein
- HCM, hypertrophic cardiomyopathy
- HTX, heart transplantation
- LVAD, left ventricular assist device
- LVEF, left ventricular ejection fraction
- PPCM, peripartum cardiomyopathy
- RECQL4, ATP-dependent DNA helicase Q4
- RYR1, ryanodine receptor 1
- SLX4, structure-specific endonuclease subunit SLX4
- TXNRD2, thioredoxin reductase 2
- VUS, variants of unknown significance
- cancer
- cardiotoxicity
- genetics
- peripartum cardiomyopathy
- whole-exome sequencing
Collapse
Affiliation(s)
- Tobias J Pfeffer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stella Schlothauer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stefan Pietzsch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Manuel List
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Valeska Abou Moulig
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tobias König
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Zolt Arany
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
41
|
Ko T, Fujita K, Nomura S, Uemura Y, Yamada S, Tobita T, Katoh M, Satoh M, Ito M, Domoto Y, Hosoya Y, Amiya E, Hatano M, Morita H, Fukayama M, Aburatani H, Komuro I. Quantification of DNA Damage in Heart Tissue as a Novel Prediction Tool for Therapeutic Prognosis of Patients With Dilated Cardiomyopathy. ACTA ACUST UNITED AC 2019; 4:670-680. [PMID: 31709317 PMCID: PMC6834953 DOI: 10.1016/j.jacbts.2019.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/07/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
This study evaluated myocardial nuclear staining for the DNA damage markers poly(ADP-ribose) (PAR) and γ-H2A.X in 58 patients with dilated cardiomyopathy. Patients with left ventricular reverse remodeling (LVRR) showed a significantly smaller proportion of PAR-positive nuclei and γ-H2A.X-positive nuclei in biopsy specimens compared with those without LVRR. Propensity analysis showed that the proportion of both PAR-positive and γ-H2A.X-positive nuclei were independent prognostic factors for LVRR. In conclusion, we showed the utility of DNA damage-marker staining to predict the probability of LVRR, thus revealing a novel prognostic predictor of medical therapy for dilated cardiomyopathy.
Collapse
Key Words
- BMI, body mass index
- BNP, B-type natriuretic peptide
- CI, confidence interval
- DAPI, 4′,6-diamidino-2-phenylindole
- DCM, dilated cardiomyopathy
- DNA damage
- IQR, interquartile range
- LVAD, left ventricular assist device
- LVEF, left ventricular ejection fraction
- LVRR, left ventricular reverse remodeling
- NYHA, New York Heart Association
- PAR, poly(ADP-ribose)
- ROC, receiver-operating characteristic
- WGA, wheat germ agglutinin
- dilated cardiomyopathy
- left ventricular reverse remodeling
- poly ADP-ribose
Collapse
Affiliation(s)
- Toshiyuki Ko
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kanna Fujita
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Seitaro Nomura
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
| | - Shintaro Yamada
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takashige Tobita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Manami Katoh
- Genome Science Division, Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
| | - Masahiro Satoh
- Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masamichi Ito
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yukako Domoto
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yumiko Hosoya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Aburatani
- Genome Science Division, Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| |
Collapse
|
42
|
Mohammedzein A, Taha A, Salwan A, Nambiar R. Impella Use in Cardiogenic Shock Due to Takotsubo Cardiomyopathy With Left Ventricular Outflow Tract Obstruction. JACC Case Rep 2019; 1:161-165. [PMID: 34316775 PMCID: PMC8301524 DOI: 10.1016/j.jaccas.2019.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/08/2019] [Revised: 05/05/2019] [Accepted: 06/12/2019] [Indexed: 11/17/2022]
Abstract
Cardiogenic shock (CS) due to Takotsubo cardiomyopathy (TCM) is often managed with cautious fluid administration and inotropic support; however, the co-existence of a left ventricular outflow tract obstruction (LVOTO) can complicate this management approach. This report describes a case of CS due to TCM and LVOTO. It was successfully managed with the Impella 2.5. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Assad Mohammedzein
- Department of Internal Medicine, Texas Tech University Health Science Center, Amarillo, Texas
| | - Ahmed Taha
- Department of Internal Medicine, Texas Tech University Health Science Center, Amarillo, Texas
| | - Anu Salwan
- Department of Internal Medicine, Texas Tech University Health Science Center, Amarillo, Texas
| | - Rajesh Nambiar
- Department of Cardiology, Texas Tech University Health Science Center, Amarillo, Texas
| |
Collapse
|
43
|
Azuma K, Yamanaka S. Recent policies that support clinical application of induced pluripotent stem cell-based regenerative therapies. Regen Ther 2016; 4:36-47. [PMID: 31245486 PMCID: PMC6581825 DOI: 10.1016/j.reth.2016.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 11/07/2015] [Revised: 01/07/2016] [Accepted: 01/28/2016] [Indexed: 02/04/2023] Open
Abstract
In Japan, a research center network consisting of Kyoto University to provide clinical-grade induced Pluripotent Stem Cells (iPSC) and several major research centers to develop iPSC-based regenerative therapies was formed for the clinical application of iPSCs. This network is under the supervision of a newly formed funding agency, the Japan Agency for Medical Research and Development. In parallel, regulatory authorities of Japan, including the Ministry of Health, Labour and Welfare, and Pharmaceuticals and Medical Devices Agency, are trying to accelerate the development process of regenerative medicine products (RMPs) by several initiatives: 1) introduction of a conditional and time-limited approval scheme only applicable to RMPs under the revised Pharmaceuticals and Medical Devices Act, 2) expansion of a consultation program at the early stage of development, 3) establishment of guidelines to support efficient development and review and 4) enhancement of post-market safety measures such as introduction of patient registries and setting user requirements with cooperation from relevant academic societies and experts. Ultimately, the establishment of a global network among iPSC banks that derives clinical-grade iPSCs from human leukocyte antigens homozygous donors has been proposed. In order to share clinical-grade iPSCs globally and to facilitate global development of iPSC-based RMPs, it will be necessary to promote regulatory harmonization and to establish common standards related to iPSCs and differentiated cells based on scientific evidence.
Collapse
Key Words
- AMED, Japan Agency for Medical Research and Development
- BLA, Biological License Approval
- CFR, Code of Federal Regulations
- CiRA, Center for iPS Cell Research and Application
- DMF, Drug Master File
- ESC, embryonic stem cell
- FDA, Food and Drug Administration
- FY, fiscal year
- GAiT, Global Alliance for iPS Cell Therapies
- GCTP, Good Gene, Cell, Cellular and Tissue-based Products Manufacturing Practice
- GMP, good manufacturing practice
- HLA, human leukocyte antigen
- Haplobank
- IBRI, Institution of Biomedical Research and Innovation
- ICH, The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use
- IND, Investigational New Drug
- INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support
- IRB, Institutional Review Board
- J-MACS, Japanese Registry for Mechanically Assisted Circulatory Support
- JST, Japan Science and Technology Agency
- Japan
- LVAD, left ventricular assist device
- METI, Ministry of Economy, Trade and Industry
- MEXT, Ministry of Education, Culture, Sports, Science and Technology
- MHLW, Ministry of Health, Labour and Welfare
- NEDO, New Energy and Industrial Technology Development Organization
- NIBIO, National Institute of Biomedical Innovation
- NIHS, National Institute of Health Science
- PAL, Pharmaceutical Affairs Law
- PIC/S, The Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme
- PMD Act, Pharmaceuticals and Medical Devices Act
- PMDA, Pharmaceuticals and Medical Devices Agency
- Policy
- R&D, research and development
- RM Act, the Act on the Safety of Regenerative Medicine
- RMP, regenerative medicine product
- Regenerative medicine
- Regulation
- Riken CDB, Riken Center for Developmental Biology
- U.S., United States
- WHO, World Health Organization
- iPS cells
- iPSC, induced pluripotent stem cell
Collapse
Affiliation(s)
- Kentaro Azuma
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
| | - Shinya Yamanaka
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
- Gladstone Institute of Cardiovascular Disease, San Francisco, California 94158, USA
| |
Collapse
|
44
|
Mulukutla V, Lam W, Simpson L, Mathuria N. Successful catheter ablation of hemodynamically significant ventricular tachycardia in a patient with biventricular assist device support. HeartRhythm Case Rep 2015; 1:209-212. [PMID: 28491550 PMCID: PMC5419334 DOI: 10.1016/j.hrcr.2015.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Wilson Lam
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX
| | - Leo Simpson
- Section of Cardiology, Baylor College of Medicine, Houston, TX.,Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX
| | - Nilesh Mathuria
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX
| |
Collapse
|