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ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs

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https://www.readbyqxmd.com/read/29461279/individualized-antithrombotic-therapy-in-heartware-hvad-recipients
#1
Erik N Sorensen, Hannah J Voorhees, Lynn M Dees, Si M Pham, Zachary N Kon, Bartley P Griffith, Erika D Feller
There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and PFA-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29461278/home-inotropes-in-patients-supported-with-left-ventricular-assist-devices
#2
Emeka C Anyanwu, Viktoriya Kagan, Ankit Bhatia, David M Tehrani, Sirtaz Adatya, Gene Kim, Nitasha Sarswat, Valluvan Jeevanandam, Gabriel Sayer, Nir Uriel
There is little data outlining the use of outpatient inotropic medications in patients with existing left ventricular assist devices (LVADs). This case series explores this patient population and seeks to define the indications, complications, and safety of dual support. A retrospective chart review was conducted for all patients on LVAD and then subsequently started on home inotropes post device implant. Eight patients met inclusion criteria. The indications for inotropes were right ventricular failure, aortic insufficiency with biventricular failure, LVAD thrombosis with contraindication to device exchange, and cannula malposition with elevated pulmonary vascular resistance...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29461277/clinical-relevance-of-histopathologic-analysis-of-heartmate-ii-thrombi
#3
Lisa Baumann Kreuziger, Mark S Slaughter, Kartik Sundareswaran, Alan E Mast
Left ventricular assist device (LVAD) thrombosis is a devastating complication that occurs in about 10% of patients despite anticoagulation and antiplatelet treatment. How the thrombus initiates and propagates is unknown. We pathologically and immunohistochemically examined 28 thrombi removed from 17 HeartMate II LVADs. Two groups of thrombi were found: those formed in the inlet/outlet and those on the rotor. The four thrombi found at the inlet (three inlet conduit and one inlet tube) and outlet (three at outlet elbow and one outlet graft) appeared similar and were composed of a loose meshwork of fibrin(ogen), von Willebrand factor, leukocytes, and aggregated platelets...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29432298/ventricular-assist-device-patients-have-different-clinical-outcomes-and-altered-patterns-of-bleeding-with-intracranial-hemorrhage
#4
Mustafa M Ahmed, Maryam Rahman, Dan Neal, Juan M Aranda, Charles T Klodell
Intracranial hemorrhage (ICH) is one of the most feared complications of left ventricular assist device (LVAD) support. However, outcomes in this group have not been well described. We therefore sought to examine clinical outcomes in this patient population in comparison to those with heart failure (HF) and no LVAD, as well as those without HF or LVAD. The National Inpatient Sample database, years 2002-2012, was queried to classify patients into 3 groups: any ICH (group 1), any HF with any ICH (group 2), and any LVAD with any ICH (group 3)...
February 9, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29419538/percutaneous-mechanical-circulation-support-combined-with-extracorporeal-membrane-oxygenation-oxyrvad-in-secondary-right-heart-failure
#5
Philipp M Lepper, Sabrina I Hörsch, Frederik Seiler, Annegret Kamp, Sören L Becker, Christian Lensch, Lars O Conzelmann, Hendrik Haake, Ralf M Muellenbach, Robert Bals, Markus Kredel, Frank Langer, Heinrike Wilkens, Franziska C Trudzinski
Right heart failure (RHF) because of pulmonary hypertension (PH) is a frequently encountered clinical problem with high mortality. The last resort, if pharmacological therapy fails, is mechanical circulatory support. There is a lack of percutaneous systems to support the right ventricle (RV). Venoarterial extracorporeal membrane oxygenation is widely used as a bailout in acute RHF in non-left ventricular assist device patients. Venoarterial extracorporeal membrane oxygenation does not unload the left ventricle and may cause failure of the left ventricle if used for a longer period of time...
February 6, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29419537/modification-of-a-ventricular-assistance-device-for-a-hemiplegic-left-ventricular-assist-device-patient
#6
Rahatullah Muslem, Yunus C Yalçin, Kadir Caliskan, Cees van der Heiden, Hans van Rhijn, Ad J J C Bogers, Olivier C Manintveld
Neurologic events occur in up to 18% of patients with continuous-flow left ventricular assist devices (LVAD) and is associated with significant morbidity and mortality. The current form of the LVAD equipment is not suited to serve patients who are impaired by a stroke. By creating an assistance device for the LVAD equipment, we have been able to greatly improve the quality of life and self-dependence of a hemiplegic LVAD patient.
February 6, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29419536/extracorporeal-membrane-oxygenation-in-a-patient-with-biliary-atresia-case-and-review-of-extracorporeal-life-support-organization-data
#7
Inna N Lobeck, Alexander Bondoc, Heather Nolan, Jason S Frischer, Kathleen M Campbell, Thomas D Ryan, Stuart L Goldstein, Jaimie D Nathan, Maria H Alonso, Greg M Tiao
Biliary atresia is a newborn cholangiopathy that may lead to portopulmonary hypertension and cirrhosis-induced cardiomyopathy while awaiting liver transplantation. Extracorporeal life support and hepatic toxin filtration are life-saving interventions that provide cardiopulmonary support and hepatic dialysis to allow resolution of a child's illness. We utilized a combination of these extreme measures to bridge an infant with biliary atresia to transplantation. We reviewed cases of extracorporeal life support utilization in transplantation recipients in the Extracorporeal Life Support Organization database and determined that ours was the only use of pretransplant extracorporeal life support in biliary atresia...
February 6, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29419535/electromagnetic-interference-between-left-ventricular-assist-device-and-a-three-dimensional-mapping-system-overcome-by-hot-mapping
#8
Christian Blockhaus, Hans-Peter Waibler, Jan-Erik Gülker, Florian Meyer, Heinrich Klues, Alexander Bufe, Dong-In Shin
The number of patients with implanted left ventricular assist devices is constantly increasing. Numerous patients suffer from drug-resistant ventricular tachycardias. Only a few studies and reports about ablation therapy in this cohort of patients are available. Electromagnetic interferences between the left ventricular assist device and the three-dimensional mapping system which is used for ablation has been described as disabling the investigator to create a proper map of the left ventricle. We observed that this interference is interrupted by "hot mapping" meaning that one pretends an ablation with only 5 W, permitting the creation of a clear map in areas of interference...
February 6, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29406356/gastrointestinal-bleeding-in-left-ventricular-assist-device-octreotide-and-other-treatment-modalities
#9
Tara L Molina, Jill Krisl, Kevin Donahue, Sara Varnado
Left ventricular assist devices (LVADs) offer a therapeutic strategy for patients with end-stage heart failure. Increased device utilization has also increased the incidence of device-related complications including gastrointestinal bleeding (GIB). Multiple mechanisms have been proposed in the pathophysiology of continuous-flow LVAD-associated GIB including physiologic changes associated with high shear and nonpulsatile flow such as gastrointestinal arteriovenous malformations and acquired von Willebrand syndrome...
February 5, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29384755/direct-echocardiographic-imaging-of-berlin-heart-valves-can-aid-in-early-detection-of-berlin-heart-valve-dysfunction
#10
Gary S Beasley, Kristen Nelson-McMillan, Luca Vricella, William R Thompson, William Ravekes
Mechanical circulatory support options remain limited for pediatric patients, especially neonates. The only FDA-approved pediatric device remains the Berlin Heart EXCOR, which unfortunately carries with it a 20-30% risk of neurologic complications, such as strokes. We demonstrate a new technique of direct echocardiographic color-Doppler imaging of the Berlin Heart valves to detect valve regurgitation. Increases in valve regurgitation could indicate issues with pump-valve thrombosis or increased afterload leading to valve insufficiency...
January 30, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29356690/bacterial-biofilms-on-extracorporeal-membrane-oxygenation-catheters
#11
Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Woo Hyun Cho, Dohyung Kim, Doosoo Jeon, Kyung-Hwa Shin, Yun Seong Kim
Despite the advantages of extracorporeal membrane oxygenation (ECMO), secondary catheter infection remains a major concern during ECMO support. In this study, to clarify the mechanism of ECMO catheter-related infection, we evaluated the impact of infection on biofilm formation on the surfaces of ECMO catheters, and we investigated clinical factors associated with biofilm formation. Catheters used for ECMO were prospectively collected aseptically from the femoral vein, internal jugular vein, and femoral artery of 81 patients with acute cardiorespiratory failure between January 2015 and October 2016...
January 18, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29324515/acute-cor-pulmonale-in-veno-venous-extracorporeal-membrane-oxygenation-three-case-reports
#12
Erik R Dong, David G Ng, Danny Ramzy, Joshua S Chung, Oren Friedman, Alain Combes, Francisco A Arabia, Michael Nurok
A retrospective review of three patients with acute respiratory distress syndrome (ARDS) and normal baseline right ventricular function admitted to the Cardiac Surgery Intensive Care Unit whom developed acute cor pulmonale while on veno-venous extracorporeal membrane oxygenation. These patients were diagnosed with ARDS using Berlin Criteria definitions and cannulated with a dual lumen (Avalon) cannula. Despite variations in history, presentation, and course, findings of acute cor pulmonale were encountered 4 to 6 weeks after extracorporeal membrane oxygenation cannulation...
January 10, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29324514/anticoagulant-bridge-comparison-in-mechanical-circulatory-support-patients
#13
Richard H Cosgrove, Robyn L Basken, Richard G Smith, Chiu-Hsieh Hsu, Toshinobu Kazui, Brandon K Martinez, Richard W Burt, Eric S Crawford, Scott D Lick, Zain Khalpey
Maintaining mechanical circulatory support (MCS) device patients in a specified therapeutic range for anticoagulation remains challenging. Subtherapeutic international normalized ratios (INRs) occur frequently while on warfarin therapy. An effective anticoagulant bridge strategy may improve the care of these patients. This retrospective review of MCS patients with subtherapeutic INRs compared an intravenous unfractionated heparin (UFH) strategy with a subcutaneous enoxaparin or fondaparinux strategy. Native thromboelastography (n-TEG) was used to evaluate anticoagulant effect with coagulation index (CI) as the primary outcome measure...
January 10, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29324513/the-functional-immune-response-of-patients-on-extracorporeal-life-support
#14
Asaad G Beshish, Jeffrey D Bradley, Kelli L McDonough, Nadine L N Halligan, Walker M McHugh, Julie Sturza, Mark W Hall, Timothy T Cornell, Mary K Dahmer
Extracorporeal life support (ECLS) is a widely used lifesaving technology. Whether ECLS results in immune dysregulation is unclear. This study's aim was to examine whether ECLS affected innate immune response. All patients placed on ECLS were eligible. Blood was obtained before, during, and after ECLS. Function of the innate immune system was measured by ex vivo lipopolysaccharide (LPS)-induced tumor necrosis factor-α (TNF-α) and plasma cytokine levels (interleukin [IL]-6, IL-8, IL-10, and TNF-α). Immunoparalysis was defined as ex vivo TNF-α levels less than 200 pg/ml...
January 10, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29324512/exercise-capacity-in-patients-with-the-total-artificial-heart
#15
Justin M Canada, Ronald K Evans, Antonio Abbate, Ross Arena, Daniel G Tang, Vigneshwar Kasirajan, Keyur B Shah
There is a dearth of information regarding the functional abilities of patients with the total artificial heart (TAH). Increased utilization of the TAH and patient discharge to home with the portable unit necessitates a shift in focus to quality of life, which includes quantifying and ultimately optimizing functional capacity. To date, only single-patient case studies have described the exercise response of the TAH patient. Fourteen patients with the TAH underwent cardiopulmonary exercise testing with concurrent analysis of TAH device function...
January 10, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29324511/evolutionary-improvements-in-the-jarvik-2000-left-ventricular-assist-device
#16
Craig H Selzman, Antigone Koliopoulou, Jason P Glotzbach, Stephen H McKellar
Mechanical circulatory support devices experience a wide range of operating conditions during patient use. Since its first implant in June 2000, the Jarvik 2000 left ventricular assist device has witnessed systematic stepwise modifications to reduce the risk of serious adverse events and improve patient outcomes. Over time, clinical experience revealed a number of low-incidence failure modes that presented opportunities for improvement. Design changes have included, but are not limited to, a Y cable to permit battery changes without pump stoppage, increased pull strength of external cables from 35 to 200 lbs, an intermittent low-speed controller to improve aortic root washout, sintered titanium microsphere surface on the pump housing to prevent apical thrombus, and novel cone bearings to reduce thrombus formation...
January 10, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29309280/numerical-investigation-of-the-influence-of-blade-radial-gap-flow-on-axial-blood-pump-performance
#17
Guang-Mao Liu, Dong-Hai Jin, Jian-Ye Zhou, Yan Zhang, Hai-Bo Chen, Han-Song Sun, Sheng-Shou Hu, Xing-Min Gui
The gaps between the blades and the shroud (or hub) of an axial blood pump affect the hydraulics, efficiency, and hemolytic performance. These gaps are critical parameters when a blood pump is manufactured. To evaluate the influence of blade gaps on axial blood pump performance, the flow characteristics inside an axial blood pump with different radial blade gaps were numerically simulated and analyzed with special attention paid to the hydraulic characteristics, gap flow, hydraulic efficiency, and hemolysis index (HI)...
January 5, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29251634/the-clinical-implication-of-transcranial-doppler-detection-of-microembolic-signals-in-patients-with-heartmate-ii
#18
Kazuki Fukuma, Osamu Seguchi, Kozue Saito, Kensuke Kuroda, Seiko Nakajima, Takuma Sato, Masanobu Yanase, Yorihiko Matsumoto, Satsuki Fukushima, Tomoyuki Fujita, Junjiro Kobayashi, Kazuyuki Nagatsuka, Norihide Fukushima
We aimed to elucidate the clinical relevance of transcranial Doppler (TCD) in the detection of microembolic signals in patients with Heartmate II (HM-II). Twenty patients with HM-II underwent TCD examinations, and microembolic signals were rarely detected in stable patients. However, they were detected in patients with hemolysis and/or thromboembolic events. Further, TCD examination under oxygen inhalation revealed that, both, solid emboli and gaseous emboli exist in patients with HM-II.
December 14, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29251633/prevalence-of-anemia-and-iron-deficiency-in-pediatric-patients-on-ventricular-assist-devices
#19
Kriti Puri, Aamir Jeewa, Iki Adachi, Susan W Denfield, Antonio G Cabrera, Jack F Price, Timothy J Humlicek, Sarah Burki, William J Dreyer, Mona D Shah
The prevalence and characteristics of anemia and iron deficiency in children supported by a ventricular assist device (VAD) are unknown. Patients <21 years of age on durable VAD support for ≥7 days at Texas Children's Hospital from 2006 to 2015 were retrospectively reviewed. Red blood cell (RBC) and iron deficiency indices in pulsatile VAD (P-VAD) and continuous-flow VAD (CF-VAD) were evaluated. Anemia, iron deficiency, and iron therapy regimens were identified. Seventy-six VAD implants in 74 patients were included: 45 P-VAD and 31 CF-VAD...
December 14, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29251632/ventricular-assist-device-self-management-issues-the-patient-and-caregiver-perspectives
#20
Jesus M Casida, Pamela Combs, Sarah E Schroeder, Kathleen T Hickey
Despite technological advancements, ventricular assist device (VAD) self-management (SM) remains complex. Using a descriptive mixed-method research, we examined the VAD care issues reported by nondyadic sample of 102 patients and 116 caregivers in the United States. Participants (mean age, 50.0 ± 13.1 years) were predominantly white (80%), female (59%), and married (77%). Quantitative and qualitative data revealed the patients/caregivers' need for competency assessment and reassessment of VAD care after discharge...
December 14, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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