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Gallone G, Ibero J, Morley-Smith A, Monteagudo Vela M, Fiorelli F, Konicoff M, Edwards G, Raj B, Shanmuganathan M, Pidello S, Frea S, De Ferrari GM, Panoulas V, Stock U, Bowles C, Dunning J, Riesgo Gil F. Association of Renin-Angiotensin-Aldosterone System Inhibitors With Clinical Outcomes, Hemodynamics, and Myocardial Remodeling Among Patients With Advanced Heart Failure on Left Ventricular Assist Device Support. J Am Heart Assoc 2024; 13:e032617. [PMID: 38686903 DOI: 10.1161/jaha.123.032617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND We evaluated the potential benefits of renin-angiotensin-aldosterone system inhibitors (RAASi) in patients with left ventricular assist device support. METHODS AND RESULTS A total of 165 consecutive patients undergoing left ventricular assist device implant and alive at 6-month on support were studied. RAASi status after 6-month visit along with clinical reasons for nonprescription/uptitration were retrospectively assessed. The primary outcome was a composite of heart failure hospitalization or cardiovascular death between 6 and 24 months after left ventricular assist device implant. Remodeling and hemodynamic outcomes were explored by studying the association of RAASi new prescription/uptitration versus unmodified therapy at 6-month visit with the change in echocardiographic parameters and hemodynamics between 6 and 18 months. After the 6-month visit, 76% of patients were on RAASi. Patients' characteristics among those receiving and not receiving RAASi were mostly similar. Of 85 (52%) patients without RAASi new prescription/uptitration at 6-month visit, 62% had no apparent clinical reason. RAASi were independently associated with the primary outcome (adjusted hazard ratio, 0.31 [95% CI, 0.16-0.69]). The baseline rates of optimal echocardiographic profile (neutral interventricular septum, mitral regurgitation less than mild, and aortic valve opening) and hemodynamic profile (cardiac index ≥2.2 L/min per m2, wedge pressure <18 mm Hg, and right atrial pressure <12 mm Hg) were similar between groups. At 18 months, patients receiving RAASi new prescription/uptitration at 6 months had higher rates of optimal hemodynamic profile (57.5% versus 37.0%; P=0.032) and trends for higher rates of optimal echocardiographic profile (39.6% versus 22.9%; P=0.055) compared with patients with 6-month unmodified therapy. Optimal 18-month hemodynamic and echocardiographic profiles were associated with the primary outcome (log-rank=0.022 and log-rank=0.035, respectively). CONCLUSIONS RAASi are associated with improved outcomes and improved hemodynamics among mechanically unloaded patients.
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Affiliation(s)
- Guglielmo Gallone
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
- Division of Cardiology, Cardiovascular and Thoracic Department Città della Salute e della Scienza Hospital Turin Italy
| | - Javier Ibero
- Department of Medical Sciences University of Turin Turin Italy
| | - Andrew Morley-Smith
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Maria Monteagudo Vela
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Francesca Fiorelli
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Mailen Konicoff
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Gemma Edwards
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Binu Raj
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Mayooran Shanmuganathan
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Stefano Pidello
- Division of Cardiology, Cardiovascular and Thoracic Department Città della Salute e della Scienza Hospital Turin Italy
| | - Simone Frea
- Division of Cardiology, Cardiovascular and Thoracic Department Città della Salute e della Scienza Hospital Turin Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department Città della Salute e della Scienza Hospital Turin Italy
| | - Vasileios Panoulas
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
- Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London United Kingdom
| | - Ulrich Stock
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Christopher Bowles
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - John Dunning
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Fernando Riesgo Gil
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
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Fiorelli F, Panoulas V, Riesgo Gil F, Era C, Rosenberg A. The challenge of advanced therapies in the contemporary era: first in Europe ECPELLA long-distance transfer-a case report. Eur Heart J Case Rep 2024; 8:ytae151. [PMID: 38751900 PMCID: PMC11095555 DOI: 10.1093/ehjcr/ytae151] [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: 02/10/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 05/18/2024]
Abstract
Background The use of mechanical circulatory support (MCS) has markedly increased over the last decade, so have the inter-hospital transfers, with the aim of being able to offer advanced heart failure (AHF) therapies and centralizing patients to tertiary centres. Case summary In this article, we present the first in Europe long-distance air transfer of a patient supported by veno-arterial extracorporeal membrane oxygenator and Impella (ECPELLA), as a bridge to successful heart transplant. In our case report, a foreign young patient with AHF due to familiar cardiomyopathy required multiple MCS devices to achieve cardiovascular stability. After appropriate planning and multidisciplinary discussion, the patient was transferred on MCS to his country of origin via a fixed-wing airplane, in order to be assessed for heart transplantation. During take-off, the Impella flows temporarily dropped and a suction alarm was displayed; however, this rectified without intervention, and the rest of the flight was uneventful. One month after transfer, the patient underwent successful heart transplantation and remained clinically stable during the 12-month follow-up. Discussion Our experience links together the current challenges in the evolving AHF strategies and the increased need for inter-facility cooperation. Both these clinical and logistic challenges appear to lead to possible improved outcomes, after appropriate assessment, training, and accurate planning. Our experience provides useful information on feasibility of long-distance transport of patients supported by ECPELLA in Europe.
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Affiliation(s)
- Francesca Fiorelli
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK
| | - Fernando Riesgo Gil
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
| | - Carl Era
- Capital Air Ambulance, Bristol, BS48 3DP, UK
| | - Alexander Rosenberg
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
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Akhtar W, Baston VR, Berman M, Bhagra S, Chue C, Deakin CD, Dalzell JR, Dunning J, Dunning J, Gardner RS, Kiff K, Kore S, Lim S, MacGowan G, Naldrett I, Ostermann M, Pinto S, Pettit S, Gil FR, Rosenberg A, Rubino A, Sayeed R, Sequeira J, Swanson N, Tsui S, Walker C, Webb S, Woods A, Ventkateswaran R, Bowles CT. British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres. Intensive Care Med 2024; 50:493-501. [PMID: 38526578 PMCID: PMC11018667 DOI: 10.1007/s00134-024-07382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation focus but are widely applicable to professionals regularly managing patients with implantable LVADs.
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Affiliation(s)
- Waqas Akhtar
- Harefield Hospital, London, UK.
- Faculty of Intensive Care Medicine, London, UK.
| | | | | | | | - Colin Chue
- University Hospitals Birmingham, Birmingham, UK
| | | | | | - Joel Dunning
- Cardiac Advanced Resuscitation Education, Festus, MO, USA
| | | | - Roy S Gardner
- Golden Jubilee National Hospital, Glasgow, UK
- British Society of Heart Failure, London, UK
| | | | | | - Sern Lim
- University Hospitals Birmingham, Birmingham, UK
| | | | - Ian Naldrett
- British Association of Critical Care Nurses, Newcastle, UK
| | | | | | | | | | | | | | - Rana Sayeed
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
| | | | | | - Steven Tsui
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
| | | | | | | | - Rajamiyer Ventkateswaran
- Wythenshawe Hospital, Manchester, UK
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
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Gil FR, Brida M. Response to Letter Regarding Article 'Heart failure in adults with congenital heart disease'. Int J Cardiol 2022; 367:26. [PMID: 36029848 DOI: 10.1016/j.ijcard.2022.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Fernando Riesgo Gil
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys and St Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK
| | - Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys and St Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK; Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Ul. Braće Branchetta 20/1, Rijeka 51000, Croatia.
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Akhtar W, Butcher C, Morley‐Smith A, Riesgo Gil F, Dar O, Baston V, Dunning J, Lyster H. Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices. ESC Heart Fail 2022; 9:4340-4343. [PMID: 35906098 PMCID: PMC9773711 DOI: 10.1002/ehf2.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS We present a single-centre retrospective experience using oral milrinone in patients with a left ventricular assist device (LVAD) and concurrent refractory right ventricular failure. METHODS AND RESULTS All patients implanted with LVAD between January 2013 and July 2021 from a high-volume advanced heart failure service were reviewed. Eight patients were initiated on oral milrinone during this period. Oral milrinone was started 1.5 [inter-quartile range (IQR) 1-2.3] years after LVAD implantation and continued for 1.2 (IQR 0.5-2.8) years. Therapeutic milrinone levels were achieved (232.2 ± 153.4 ng/mL) with 62.4 ± 18% of time within the therapeutic range. Two patients had adverse events (non-sustained ventricular tachycardia and ventricular fibrillation effectively treated by internal cardioverter defibrillator) but did not require milrinone discontinuation. Four deaths occurred, one after transplant and three from disease progression determined to be unrelated to oral milrinone use. Three patients continue oral milrinone therapy in the community. There was no significant difference found after the initiation of oral milrinone on any of the physiological measures; however, there were trends in reduction of New York Heart Association class from 3.4 ± 0.5 to 3.0 ± 0.8 (P = 0.08), reduction of right atrial/wedge pressure from 0.9 ± 0.3 to 0.5 ± 0.2 (P = 0.08), and improvement of right ventricular stroke work index from 3.8 ± 2 to 5.8 ± 2.7 (P = 0.16). CONCLUSIONS Oral milrinone appears safe for long-term use in the outpatient setting when combined with therapeutic monitoring in this complex medical cohort with limited management options. Further study is needed to ascertain whether this treatment is effective in reducing heart failure symptoms and admissions.
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Affiliation(s)
- Waqas Akhtar
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Charles Butcher
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Andrew Morley‐Smith
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Fernando Riesgo Gil
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Owais Dar
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Veronica Baston
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - John Dunning
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Haifa Lyster
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK,King's College LondonLondonUK
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Akhtar W, Gamble B, Kiff K, Wypych-Zych A, Raj B, Takata J, Gil FR, Hurtado A, Rosenberg A, Bowles CT. Mechanical life support algorithm developed by simulation for inpatient emergency management of recipients of implantable left ventricular assist devices. Resusc Plus 2022; 10:100254. [PMID: 35669526 PMCID: PMC9162943 DOI: 10.1016/j.resplu.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Published guidance concerning emergency management of left ventricular assist device (LVAD) recipients is both limited and lacking in consensus which increases the risk of delayed and/or inappropriate actions. Methods In our specialist tertiary referral centre we developed, by iteration, a novel in-hospital resuscitation algorithm for LVAD emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to restart LVAD function) and a multiple-choice question (MCQ) examination. Results The mean baseline staff confidence score in management of LVAD emergencies was 2.4 ± 1.2 out of a maximum of 5 (n = 29). After training with simulation, mean confidence score increased to 3.5 ± 0.8 (n = 13). Clinical personnel who were provided with the novel resuscitation algorithm were able to reduce time taken to restart LVAD function from a mean value of 49 ± 8.2 seconds (pre-training) to 20.4 ± 5 seconds (post-training) (n = 42, p < 0.0001). The Mechanical Life Support course increased mean confidence from 2.5 ± 1.2 to 4 ± 0.6 (n = 44, p < 0.0001) and mean MCQ score from 18.7 ± 3.4 to 22.8 ± 2.6, out of a maximum of 28 (n = 44, p < 0.0001). Conclusion We present a simplified LVAD Advanced Life Support algorithm to aid the crucial first minutes of resuscitation where basic interventions are likely to be critical in assuring good patient outcomes.
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Key Words
- ALS, Advanced Life Support
- Advanced life support
- CALS, Cardiac Advanced Life Support
- CPR, Cardio-Pulmonary Resuscitation
- Cardiac arrest
- DNAR, do not attempt resuscitation order
- ECMO, Extracorporeal Membrane Oxygenation
- ETCO2, End Tidal Carbon Dioxide, kPa Kilopascal
- LVAD
- LVAD, Left Ventricular Assist Device
- Left ventricular assist device
- MAP, Mean Arterial Pressure
- MCQ, multiple-choice exam
- MDT, multi-disciplinary team
- MLS, Mechanical Life Support
- Mechanical circulatory support
- Resuscitation
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
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Affiliation(s)
- Waqas Akhtar
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Brigitte Gamble
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Kristine Kiff
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | | | - Binu Raj
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Junko Takata
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Fernando Riesgo Gil
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Ana Hurtado
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Alex Rosenberg
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
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Brida M, Lovrić D, Griselli M, Gil FR, Gatzoulis MA. Heart failure in adults with congenital heart disease. Int J Cardiol 2022; 357:39-45. [DOI: 10.1016/j.ijcard.2022.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/11/2022]
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Monteagudo Vela M, Rial Bastón V, Panoulas V, Riesgo Gil F, Simon A. A detailed explantation assessment protocol for patients with left ventricular assist devices with myocardial recovery. Interact Cardiovasc Thorac Surg 2021; 32:298-305. [PMID: 33236054 DOI: 10.1093/icvts/ivaa259] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/08/2020] [Accepted: 10/04/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Left ventricular assist device (LVAD) implantation for end-stage heart failure patients has been on the rise, providing a reliable long-term option. For some LVAD patients, longer term LV unloading leads to recovery; hence, the need for evaluating potential myocardial recovery and weaning eligibility has emerged. METHODS All patients who underwent contemporary LVAD explantation at our institution between 2009 and 2020 were included in the study. Patients in New York Heart Association I, left ventricular ejection fraction >40%, a cardiac index >2.4 l/min and a peak oxygen intake >50% predicted underwent a 4-phase weaning assessment. A minimally invasive approach using a titanium plug was the surgery of choice in the most recent explants. Kaplan-Meier curves were used to estimate the survival at 1 and 5 years. RESULTS Twenty-six patients (17 HeartMate II, 9 HeartWare) underwent LVAD explantation after a median 317 days of support [IQ (212-518)], range 131-1437. Mean age at explant was 35.8 ± 12.7 years and 85% were males. Idiopathic dilated cardiomyopathy was the underlying diagnosis in 70% of cases. Thirteen (48%) patients were on short-term mechanical circulatory support and 60% required intensive care unit admission prior to the LVAD implantation. At 1 year, Kaplan-Meier estimated survival was 88%, whereas at 6 years, it was 77%. The average left ventricular ejection fraction at 1 year post-explant was 44.25% ± 8.44. CONCLUSIONS The use of a standardized weaning protocol (echocardiographic and invasive) and a minimally invasive LVAD explant technique minimizes periprocedural complications and leads to good long-term device-free survival rates.
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Affiliation(s)
- María Monteagudo Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Verónica Rial Bastón
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Fernando Riesgo Gil
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andre Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Monteagudo Vela M, Simon A, Riesgo Gil F, Rosenberg A, Dalby M, Kabir T, García Saez D, Panoulas V. Clinical Indications of IMPELLA Short-Term Mechanical Circulatory Support in a Tertiary Centre. Cardiovascular Revascularization Medicine 2020; 21:629-637. [DOI: 10.1016/j.carrev.2019.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/15/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
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Risse PA, Kachmar L, Matusovsky OS, Novali M, Gil FR, Javeshghani S, Keary R, Haston CK, Michoud MC, Martin JG, Lauzon AM. Ileal smooth muscle dysfunction and remodeling in cystic fibrosis. Am J Physiol Gastrointest Liver Physiol 2012; 303:G1-8. [PMID: 22538405 DOI: 10.1152/ajpgi.00356.2011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patients with cystic fibrosis (CF) often suffer from gastrointestinal cramps and intestinal obstruction. The CF transmembrane conductance regulator (CFTR) channel has been shown to be expressed in vascular and airway smooth muscle (SM). We hypothesized that the absence of CFTR expression alters the gastrointestinal SM function and that these alterations may show strain-related differences in the mouse. The aim of this study was to measure the contractile properties of the ileal SM in two CF mouse models. CFTR(-/-) and CFTR(+/+) mice were studied on BALB/cJ and C57BL/6J backgrounds. Responsiveness of ileal strips to electrical field stimulation (EFS), methacholine (MCh), and isoproterenol was measured. The mass and the cell density of SM layers were measured morphometrically. Finally, the maximal velocity of shortening (Vmax) and the expression of the fast (+)insert myosin isoform were measured in the C57BL/6J ileum. Ileal hyperreactivity was observed in response to EFS and MCh in CFTR(-/-) compared with CFTR(+/+) mice in C57BL/6J background. This latter observation was not reproduced by acute inhibition of CFTR with CFTR(inh)172. BALB/cJ CFTR(-/-) mice exhibited a significant increase of SM mass with a lower density of cells compared with CFTR(+/+), whereas no difference was observed in the C57BL/6J background. In addition, in this latter strain, ileal strips from CFTR(-/-) exhibited a significant increase in Vmax compared with control and expressed a greater proportion of the fast (+)insert SM myosin isoform with respect to total myosin. BALB/cJ CFTR(-/-) ilium had a greater relaxation to isoproterenol than the CFTR(+/+) mice when precontracted with EFS, but no difference was observed in response to exogeneous MCh. In vivo, the lack of CFTR expression induces a different SM ileal phenotype in different mouse strains, supporting the importance of modifier genes in determining intestinal SM properties.
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Affiliation(s)
- P-A Risse
- Meakins-Christie Laboratories, McGill University, 3626 St.-Urbain St., Montréal, Québec, Canada.
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