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Optimal Patient Selection on Extra-Corporeal Life Support for Durable Mechanical Circulatory Support: Validation Study on Behalf of Durable MCS after ECLS Study Group. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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C15 DOES THE DISTANCE BETWEEN RESIDENCY AND IMPLANTING CENTER AFFECT THE OUTCOME OF PATIENTS SUPPORTED BY LEFT VENTRICULAR ASSIST DEVICE? A MULTICENTER ITALIAN STUDY ON RADIAL MECHANICALLY ASSISTED CIRCULATORY SUPPORT (MIRAMACS) ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Patients with LVAD require continuous monitoring and care, and since Implanting Centers (IC) are more experienced in managing LVAD patients than other health care facilities, the distance between patient residency and IC could negatively affect the outcomes.
Methods
Data of patients discharged after receiving a LVAD implantation between 2010 and 2021 collected into the MIRAMACS database were retrospectively analyzed. The population was divided into two groups: A (n = 175) and B (n = 141), according to a distance between patient residency and IC ≤ or >of 90 miles. The primary end–point was freedom form Adverse Events (AEs), a composite outcome composed by death, cerebrovascular accident, hospital admission because of GI bleeding, infection, pump thrombosis or right ventricular failure. Secondary end–points were incidences of mortality and complications. All patients were followed–up regularly, according to participating centers protocols, by means of clinical visits, telemonitoring and local care–sharing.
Results
Baseline clinical characteristics and indications for LVAD did not differ between the two groups (Figure 1). Mean duration of support was 25.5±21 months for Group A and 25.7±20 months for Group B (p = 0.79). At 3 years, freedom from AEs was similar between Group A and B (p = 0.32, Figure 2), and there were no differences in rates of mortality and LVAD–related complications (Figure 2).
Conclusions
Distance from the IC does not represent a barrier to successful outcome, as long as regular and continuous follow–up is provided. Telemonitoring could offer several benefits, including early detection of complications and continuous evaluation of patient conditions and data of the pump. Moreover, it seemed to reduce the patient anxiety related to the device, increasing direct communication with the VAD–team. On the other hand, shared health programs with local facilities remains an attractive way to follow–up patient, provided that LVAD specific resources and trained staff are available. The dissemination of LVAD–specific care knowledge is also important to face urgent or emergent needs in the rapidly enlarging population of LVAD patients, by empowering local healthcare facilities.
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Using Hemodynamics to Define Graft Function: Do We Need It? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Impact of Concomitant Cardiac Valvular Surgery During Implantation of Continuous-Flow Left Ventricular Assist Devices: A European Registry for Patients with Mechanical Circulatory Support (EUROMACS) Analysis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Living at Distance from the Implanting Center: Any Impact on LVAD Patients Outcome? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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A Multi-Center Evaluation of Outflow Graft Obstruction with a Fully Magnetically Levitated Left Ventricular Assist Device. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Medium-Long Term Results of Cardiac Transplantation from Donors Assessed with the “Aged Donor Heart Rescue by Stress Echo” (ADONHERS) Protocol. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Impact of Recipients Pre-Operative Right Ventricular Dysfunction on Heart Transplantation Outcomes. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cardiac Transplantation Italian Allocation System Analysis: Single Center Results. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Impact of Major Surgical Procedures on Quality of Life of Patients with Advanced Heart Failure. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Role of Scoring Systems Calculation in Predicting Extracorporeal Life Support Patients’ Outcomes: A Single Centre Experience. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Prior Sternotomy Does Not Adversely Impact Survival or Allograft Function after Heart Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Impact of Predicted Heart Mass−Based Size Matching for Donor-Recipient Selection on Transplant Outcomes. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Neurological Complications in Patients Requiring Durable VAD Systems after ECLS Support. On Behalf of ECLS- Durable MCS Study Group. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Multicenter Italian Study on Radial Mechanically Assisted Circulatory Support (MIRAMACS): Preliminary Results. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Telemedicine (TM) during SARS-CoV-2 Outbreak. J Heart Lung Transplant 2021. [PMCID: PMC7979407 DOI: 10.1016/j.healun.2021.01.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose As Italy faced SARS-CoV-2 outbreak as first country outside China, and our hospital converted most of activities into the ones for COVID-19 patients (pts), we had to manage the need for continuing care of advanced heart failure (HF), heart transplant (HT) and LVAD pts. TM was a possible strategy, but its role in this very sick cohort is unknown. Methods During the lockdown (03-05/2020), we decided to make either a phone (PV) or an in presence (IV) visit, selecting for IV pts listed for HT, with LVAD, recently HT, scheduled for a biopsy within 6 months after HT or a RHC for listing eligibility. In PV, we assessed symptoms, blood pressure, drugs, and programmed a subsequent IV. All pts in IV group were triaged by phone for COVID-19 symptoms or contacts and if scheduled for RHC or biopsy received SARS-CoV-2 swab 48 h before the procedure. Study endpoints were: combined incidence at 6 months of MACE (HF hospitalization, CV death and need for anticipated IV) in HF/VAD group, and MACE, rejection and any cause- hospitalization in HT group. Results Among 448 pts (57±12y, 240 HT, 191 HF, 17 LVAD), 52% were managed by PV and a subsequent IV was scheduled after 3±2 months. Pts managed by PV were healthier: in HF-VAD group they were less frequently listed, had less Afib, LVAD (2/17) (p<0.01 all); post-capillary PH (pC-PH) was similarly distributed; in HT group there were less pts transplanted in the last 5 years (15% vs 52%, p<0.01) and numerically less with 2R rejection in the previous 6 months (8.3% vs 27.1%, p=0.13).The PV group had a lower incidence of the endpoints in both HF/VAD and HT cohorts (92.3±2.3% vs 70.3±4.4%; 97.0±1.7%vs82.5±4.1%, p<0.01). Overall, the predictors of the endpoints at multivariate analysis were pC-PH and PV (HR: 5.2 and 0.1, p<0.03 both) and a recent 2R rejection (HR: 3.6, p=0.05) in the HF/VAD and HT group respectively.There were no cases of COVID-19 in IV; 5 pts got infected at home in a context of infection prevalence of 6/1000 inhabitants in our region and of 40% of hospital beds dedicated to COVID-19 pts. Conclusion In this retrospective study, by reporting an organization set up in a emergency situation, we show that TM can be safely used to manage stable HF, LVAD and HT patients, whereas pC-PH and a recent rejection may identify those needing IV. These data suggest that the availability of devices for monitoring pulmonary pressures may improve safety of PV in HF pts and that TM could be useful not only in a pandemic outbreak but also subsequently.
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Extracorporeal Membrane Oxygenation for Patients with Severe COVID-19-Related ARDS: A European Multicenter Analysis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stroke Complications in Patients Requiring Durable VAD Systems after VA-ECMO Support. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Open surgery versus TEVAR in complicated type B acute aortic syndromes: outcomes of a single referral center. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
While patients with uncomplicated acute Type B aortic syndromes (ATBAS) are usually managed with optimal medical therapy, complicated ATBAS require a quick intervention to prevent life-threatening complications. If anatomical features are favorable, TEVAR is the preferred treatment option. Nevertheless, open surgery still plays a significant role in selected cases. The optimal approach to complicated ATBAS remains matter of debate.
Purpose
We retrospectively evaluated our seventeen-years' experience as regional referral center for acute aortic syndromes to analyze the outcomes of TEVAR and open surgery in cases of complicated ATBAS.
Methods
Between January 2000 and December 2016, 199 patients with ATBAS were referred to our hospital: 133 aortic dissections, 53 intramural hematomas, 13 penetrating ulcers. All patients were evaluated by a multidisciplinary aortic team. 113 patients (56.8%) received the optimal medical therapy being uncomplicated, while 86 (43.2%) patients admitted with or developing a complicated form of ATBAS underwent TEVAR or open surgery during the same hospital admission. Open surgical repair was performed in cases of unsuitable anatomy for TEVAR, retrograde involvement of the arch, ascending aorta ectasia or aneurysm. In-hospital outcomes, long term survival and freedom from reoperation were analyzed and compared between the groups.
Results
No differences were observed in terms of in-hospital mortality between uncomplicated and complicated ATBAS (13.3% versus 14.0% respectively [p=0.890]). Complicated ATBAS were treated for unstable anatomical evolution (34 patients), refractory pain or uncontrollable hypertension (19 patients), visceral or peripheral malperfusion (18 patients) or impending rupture in 15 patients. Sixty-eight patients (79%) underwent TEVAR while 18 underwent open surgery (16 frozen elephant trunk [FET] and 2 descending thoracic aorta replacement). Operative timing from the onset of symptoms did not differ between two groups (9+10 (TEVAR) versus 14+16 (Open) days [p=0.233]). In-hospital mortality was 13.2% in TEVAR group versus 16.7% in open surgery (p=0.709). Postoperative myocardial infarction, visceral and peripheral ischemia and neurological outcomes were similar in two groups (p>0.05), but acute kidney injury was higher in open surgery cohort (p=0.027). One, 5 and 10-years survival of uncomplicated ATBAS (medical therapy) were 75%, 58%, 34% vs. 76%, 65%, 58% in TEVAR and 83%, 76%, 76% in open surgery groups (Log rank p=0.329). Comparing TEVAR and open surgery, freedom from endovascular reoperation at 1 and 5 years was 86%, 78% vs. 66%, 60% respectively (Log rank p=0.091).
Conclusions
Surgical treatment options (open and TEVAR) modify the natural history of complicated acute type B aortic syndromes. Open surgery represents a good option in selected cases with in-hospital and long-term survival at least comparable to TEVAR.
Funding Acknowledgement
Type of funding source: None
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Concomitant Cardiac Procedures during Implantation of Long-Term Continuous-Flow LVADs: A European Registry for Patients with Mechanical Circulatory Support (EUROMACS) Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Impact of Severe Pulmonary Hypertension on Right Heart Hemodynamics and Outcomes Following Cardiac Transplantation: A Single Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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ICD Therapy Confers No Survival Advantage in a Global LVAD Population: Insights from the Trans-Atlantic Registry on VAD and Transplant (TRAViATA). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pulmonary Vascular Resistances among Heart Transplant Candidates: Are We Looking to the Right Player? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Implanting Durable VAD Systems in Patients on VA-ECMO: Comparing Less Invasive to Sternotomy Approach—On Behalf of ECMO-VAD Study Group. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Transition from VA-ECMO to Durable VAD Systems. Do We Need Cardiopulmonary Bypass Machine? On Behalf of ECMO-VAD Study Group. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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PH in Heart Transplant (HT) Candidates: Don't Look at Ghosts, Search the Evil in the Details. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Transition from Short Term to Durable Mechanical Circulatory Support Systems. Outcome and Patient Selection. On Behalf of ECMO-VAD Study Group. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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OC30 HEMOCOMPATIBILITY-RELATED ADVERSE EVENTS AND PHYSIOLOGICAL CIRCULATORY INTERFACE OF DIFFERENT GENERATION LEFT VENTRICULAR ASSIST DEVICES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549899.48487.fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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OC31 HOW TO IDENTIFY THE APPROPRIATE LEFT VENTRICULAR ASSIST DEVICE CANDIDATE AMONG PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549875.87567.cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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VD19 TRANS-FEMORAL IMPLANT OF A BALLOON EXPANDABLE AORTIC VALVE IN A LEAKING SUTURELESS SELF-EXPANDABLE VALVE. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549937.84819.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Identifying Appropriate Durable VAD Candidates in Patients with Veno-Arterial Extracorporeal Membrane Oxygenation: Can We Identify the “Point of No Return”? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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32
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Hemocompatibility Related Adverse Events and Competitive Outcomes of Different Generation of Left Ventricular Assist Devices. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Outcomes of Extended Criteria Cardiac Transplantation versus Destination Left Ventricular Assist Device Therapy. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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A Novel Risk Model to Predict Right Ventricular Failure after Continuous Flow Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Results of Unplanned Right Ventricular Assist Device for Severe Right Ventricular Failure after Continuous Flow Left Ventricular Assist Device Insertion. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Selecting Ideal VAD Candidates in Patients on Venoarterial Membrane Oxygenation: Can We Identify the “Point of No Return”? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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37
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Predicting Right Ventricular Failure in the Current Continuous Flow Left Ventricular Assist Device Era. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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38
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Influence of the MELD-XI (Model of End-Stage Liver Disease Excluding INR) on Heart Transplant Outcomes. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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39
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Pediatric Extracorporeal Membrane Oxygenation Support as Treatment for Refractory Cardiogenic Shock. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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40
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Impact of Recipient Body Mass Index on Orthotopic Heart Transplantation Outcomes. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mechanical circulatory support in advanced heart failure: single-center experience. Transplant Proc 2014; 46:1476-80. [PMID: 24935316 DOI: 10.1016/j.transproceed.2014.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 01/08/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Currently, ventricular assist device (VAD) or total artificial heart (TAH) mechanical support provides an effective treatment of unstable patients with advanced heart failure. We report our single-center experience with mechanical circulatory support therapy. METHODS From March 2002 to December 2012, 107 adult patients (mean age, 56.8 ± 9.9 y; range, 31-76 y) were primarly supported on temporary or long-term VAD or TAH support as treatment for refractory heart failure at our institution. Temporary extracorporeal radial VAD support (group A) was established in 49 patients (45.7%), and long-term paracorporeal and intracorporeal VAD or TAH (group B) in 58 patients (54.2%). Left ventricular (LVAD) support was established in 55 patients (51.4%; n = 33, Heartmate II; n = 6, Heartmate I XVE; n = 4, Heartware HVAD; and n = 12, Centrimag) and biventricular (BVAD/TAH) support (group B) in 28 patients (26.1%; n = 10, Thoratec paracorporeal; n = 2, Heartware HVAD, n = 1, Thoratec implantable; n = 1, Syncardia TAH; and n = 14, Centrimag). The temporary Centrimag was the only device adopted as isolated right ventricular (RVAD) support, and it was inserted in 24 patients (22.4%). RESULTS In group A, overall mean support time was 10.2 ± 6.6 days (range, 3-43 d). In group B, LVAD mean support time was 357 ± 352.3 days (range, 1-902 d) and BVAD/TAH support time was 98 ± 82.6 days (range, 8-832 d). In group A, the overall success rate was 55.1% (27 patients). In group B, LVAD overall success rate was 74.4% (32 patients) and BVAD/TAH success rate was 50% (7 patients). Overall heart transplantation rate for both groups was 27.1% (n = 2, group A; n = 27, group B). Overall 1-year and 5-year survivals after heart transplantation were 72.4% (n = 21) and 58.6% (n = 17), respectively. CONCLUSIONS Mechanical circulatory support is an effective strategy even in cases of end-stage heart failure according to our experience. Further improvement of VAD and TAH technologies may support their adoption as an encouraging alternative to heart transplantation in the near future.
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028 * EXTRACORPOREAL MEMBRANE OXYGENATION SYSTEM AS SALVAGE TREATMENT FOR PATIENTS WITH REFRACTORY CARDIOGENIC SHOCK. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Long Term Results with Total Artificial Heart: Is It Prime Time for Destination Therapy? J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Extracorporeal Membrane Oxygenation Support System as Bridge to Solution in Refractory Cardiogenic Shock. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Role of Donor-Recipient Match in Determining the Risk for Primary Graft Failure after Heart Transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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468 Temporary Right Ventricular Support in Left Ventricular Assist Device Recipients. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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47
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HeartWare third-generation implantable continuous flow pump as biventricular support: mid-term follow-up. Interact Cardiovasc Thorac Surg 2011; 12:458-460. [DOI: 10.1510/icvts.2010.250654] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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48
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49
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Extracorporeal Membrane Oxygenation for Primary Allograft Failure. Transplant Proc 2008; 40:3596-7. [DOI: 10.1016/j.transproceed.2008.06.079] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
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50
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Levitronix CentriMag short-term ventricular assist device as a „bridge-to-bridge“ solution. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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