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P Lukito, A Wong, J Jing, J F Arthur, S F Marasco, D A Murphy, P J Bergin, J A Shaw, M Collecutt, R K Andrews, E E Gardiner, A K Davis
BACKGROUND: Ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) are associated with bleeding, not fully explained by anti-coagulant or anti-platelet use. Exposure of platelets to elevated shear in vitro leads to increased shedding. OBJECTIVES: Here we investigated whether loss of platelet receptors occurs in vivo, and the relationship with acquired Von Willebrand Syndrome (AVWS) METHODS: Platelet counts, coagulation tests and Von Willebrand factor (VWF) analyses were performed on samples from 21 continuous flow VAD (CF-VAD), 20 ECMO, 12 heart failure and 7 aortic stenosis patients...
September 7, 2016: Journal of Thrombosis and Haemostasis: JTH
Felix Schoenrath, Dennis Hoch, Francesco Maisano, Christoph T Starck, Burkhardt Seifert, Urs Wenger, Frank Ruschitzka, Markus J Wilhelm
BACKGROUND: Mechanical circulatory support is increasingly used in acute cardiogenic shock. OBJECTIVE: To assess treatment strategies for cardiogenic shock. METHODS: Data of 57 patients in acute intrinsic cardiogenic shock treated with ECMO were analyzed. Different subsequent strategies (weaning, VAD, transplantation) were followed.​ RESULTS: Overall 1, 2, and 4-year survival was 36.8 ± 6.4%, 32.2 ± 6.4%, 29.8 ± 6...
September 2016: Heart & Lung: the Journal of Critical Care
Konstantinos Karatolios, Georgios Chatzis, Birgit Markus, Ulrich Luesebrink, Anette Richter, Bernhard Schieffer
BACKGROUND: Cardiogenic shock remains a clinical challenge with high mortality rate. Mechanical circulatory support (MCS) devices have become an integral component of the therapeutic armamentarium expanding the treatment options for refractory cardiogenic shock (RCS). METHODS: We included all consecutive patients with biventricular unloading with Impella-2.5 and VA-ECMO admitted for RCS between October 2013 and March 2015. Outcome data included survival to discharge, bridging to VAD and 28-day mortality...
November 1, 2016: International Journal of Cardiology
John R Spratt, Ganesh Raveendran, Kenneth Liao, Ranjit John
Temporary mechanical circulatory support (MCS) is a common supportive therapy in cardiogenic shock and high-risk coronary intervention. The proliferation of new percutaneous MCS devices allows support to be instituted rapidly without surgical cutdown. The recent literature exploring the indications, benefits, and risks of each is reviewed. Areas discussed: Current applications of percutaneous MCS devices, including intra-aortic balloon pumps (IAPB), Impella, TandemHeart, and VA ECMO are discussed. Studies investigating each were identified through a combination of online database queries and direct extraction of single studies cited in previously-identified papers...
October 2016: Expert Review of Cardiovascular Therapy
Michael C Mongé, Bradley T Kulat, Osama Eltayeb, Shyamasundar Balasubramanya, Anne E Sarwark, Neale R Zingle, Steven T Moss, Michael Alice Moga, Jeffrey G Gossett, Elfriede Pahl, John M Costello, Carl L Backer
BACKGROUND: A continuous-flow "adult" ventricular assist device (VAD) was modified to support infants and children waiting for heart transplantation. METHODS: A centrifugal VAD, designed to flow at 1.5 to 8 L/min, was used as a bridge to transplantation in pediatric patients. In smaller children and infants, a modified recirculation shunt permitted lower flow ranges. In hypoxic patients, an oxygenator was spliced into the circuit. RESULTS: From 2010 to 2015, the VAD was placed in 13 consecutive patients...
July 2016: Annals of Thoracic Surgery
M Ting, C-H Wang, C-I Tsao, S-C Huang, N-H Chi, N-K Chou, Y-S Chen, S-S Wang
BACKGROUND: Acute fulminant myocarditis with intractable cardiogenic shock is a fatal condition; its only therapeutic option is mechanical circulatory support. The use of mechanical circulatory support, either extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD), serves as a bridge to recovery or as a bridge to transplantation. OBJECTIVES: The aim of this research was to advance our understanding of the outcome of heart transplantation under mechanical support for acute myocarditis...
April 2016: Transplantation Proceedings
Antti Laine, Tomi Niemi, Raili Suojaranta-Ylinen, Peter Raivio, Leena Soininen, Karl Lemström, Pekka Hämmäinen, Alexey Schramko
BACKGROUND: We aimed to characterize the coagulation disturbances which may increase the risk of bleeding, thrombosis or death shortly after implantation of an extracorporeal membrane oxygenation (ECMO) or ventricular assist (VAD) device. METHODS: Antithrombotic treatment was started in 23 VAD and 24 ECMO patients according to the hospital protocol. Additionally, conventional laboratory testing, rotational thromboelastometry (ROTEM®) and platelet function analysis (Multiplate®) were performed at predetermined intervals...
April 28, 2016: Perfusion
Elizabeth D Blume, David N Rosenthal, Joseph W Rossano, J Timothy Baldwin, Pirooz Eghtesady, David L S Morales, Ryan S Cantor, Jennifer Conway, Angela Lorts, Christopher S Almond, David C Naftel, James K Kirklin
BACKGROUND: Use of mechanical circulatory support in children has increased as more options have become available. A national account of the use of mechanical support in children and adolescents is essential to understanding outcomes, refining patient selection and improving quality of care. METHODS: The Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) is a National Heart, Lung, and Blood Institute-supported nationwide registry for temporary and durable ventricular assist device (VAD) use in patients <19 years of age...
May 2016: Journal of Heart and Lung Transplantation
Jennifer Conway, Mohammed Al-Aklabi, Don Granoski, Sunjidatul Islam, Lyndsey Ryerson, Vijay Anand, Gonzalo Guerra, Andrew S Mackie, Ivan Rebeyka, Holger Buchholz
BACKGROUND: Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly being used in the pediatric population. However, little is known about the outcomes in patients supported with these devices. METHODS: All pediatric patients supported with a STCF-VAD, including the Thoratec PediMag or CentriMag, or the Maquet RotaFlow, between January 2005 and May 2014, were included in this retrospective single-center study. RESULTS: Twenty-seven patients (15 girls [56%]) underwent 33 STCF-VAD runs in 28 separate hospital admissions...
May 2016: Journal of Heart and Lung Transplantation
Muhammad S K M Abdeen, Alexander Albert, Bujar Maxhera, Till Hoffmann, Georgi Petrov, Stephan Sixt, Elisabeth Roussel, Ralf Westenfeld, Artur Lichtenberg, Diyar Saeed
OBJECTIVES: Selected patients who failed to be weaned off temporary veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support may be considered for long-term left ventricular assist devices (LVADs). Activation of the systemic inflammatory response due to the cardiopulmonary bypass (CPB) machine and its associated deleterious effects on the coagulation system have been well documented. The aim of the study was to compare the outcome of patients receiving VAD on VA-ECMO with patients who were converted to CPB at the time of VAD implantation...
September 2016: European Journal of Cardio-thoracic Surgery
Jon Kobashigawa, Jeffrey Teuteberg, Monica Colvin, Leah Edwards, Tiffany Daun, Minh Luu, Jignesh Patel, John David Vega, Dan Meyer
Ensuring fair and equitable allocation of donor hearts in the US is the charge of the Organ Procurement and Transplantation Network (OPTN). However, the recent increase of candidates waiting without a corresponding increase in available donors, higher waitlist mortality rates in higher status patients, the presence of disadvantaged subgroups, and the changing management of heart failure patients with increased VAD usage, has necessitated review of allocation policy. Therefore, the Heart Subcommittee of the OPTN/UNOS Thoracic Committee is exploring a further-tiered allocation system, devising a "straw man" model as a starting point for modeling analyses and public discussion...
May 2016: Clinical Transplantation
Brody Wehman, Kristen A Stafford, Gregory J Bittle, Zachary N Kon, Charles F Evans, Keshava Rajagopal, Nicholas Pietris, Sunjay Kaushal, Bartley P Griffith
BACKGROUND: Pediatric patients awaiting orthotopic heart transplantation frequently require bridge to transplantation (BTT) with mechanical circulatory support. Posttransplant survival outcomes and predictors of mortality have not been thoroughly described in the modern era using a large-scale analysis. METHODS: The United Network for Organ Sharing database was reviewed to identify pediatric heart transplant recipients from 2005 through 2012. Patients were stratified into three groups: extracorporeal membrane oxygenation (ECMO), ventricular assist device (VAD), and direct transplantation (DTXP)...
June 2016: Annals of Thoracic Surgery
Maziar Khorsandi, Kasra Shaikhrezai, Sai Prasad, Renzo Pessotto, William Walker, Geoffrey Berg, Vipin Zamvar
BACKGROUND: Post-cardiotomy cardiogenic shock (PCCS) has an incidence of 2-6 % after routine adult cardiac surgery. 0.5-1.5 % are refractory to inotropic and intra-aortic balloon pump (IABP) support. Advanced mechanical circulatory support (AMCS) can be used to salvage carefully selected number of such patients. High costs and major complication rates have lead to centralization and limited funding for such devices in the UK. We have looked the outcomes of such devices in a non-transplant, intermediate-size adult cardiothoracic surgery unit...
2016: Journal of Cardiothoracic Surgery
Noritaka Okada, Hiroomi Murayama, Hiroki Hasegawa, Satoru Kawai, Hiromitsu Mori, Kazushi Yasuda
It is essential to establish an appropriate initial treatment strategy for pediatric fulminant myocarditis. We reviewed eight cases of pediatric fulminant myocarditis that required extracorporeal membrane oxygenation (ECMO) from 2012 to 2015. The median age was 8 years (range 3 months-13 years), and the median body surface area was 0.89 m(2) (range 0.35-1.34 m(2) ). Peripheral veno-arterial ECMO was initially applied, and we evaluated whether heart decompression was sufficient. If the pump flow was insufficient, central cannulation was performed via median sternotomy (central ECMO)...
August 2016: Artificial Organs
Rizwan A Manji, Rakesh C Arora, Rohit K Singal, Brett Hiebert, Michael C Moon, Darren H Freed, Alan H Menkis
BACKGROUND: There are minimal data on long-term functional survival (alive and not institutionalized) in patients undergoing cardiac operations who require a prolonged intensive care unit length of stay (prICULOS). We sought to describe 1- and 5-year functional survival in patients who had a prICULOS (ICULOS ≥ 5 days) and determine predictors of functional survival at 1 year. METHODS: Data were obtained from linked clinical and administrative databases from January 1, 2000 to December 31, 2011 to conduct this retrospective single-region analysis...
January 2016: Annals of Thoracic Surgery
James R Neal, Eduard Quintana, Roxann B Pike, James D Hoyer, Lyle D Joyce, Gregory Schears
Patients supported with extracorporeal membrane oxygenation (ECMO) or short-term centrifugal ventricular assist devices (VADs) are at risk for potential elevation of plasma-free hemoglobin (pfHb) during treatment. The use of pfHb testing allows detection of subclinical events with avoidance of propagating injury. Among 146 patients undergoing ECMO and VAD from 2009 to 2014, five patients experienced rapid increases in pfHb levels over 100 mg/dL. These patients were supported with CardioHelp, Centrimag, or Pedimag centrifugal pumps...
June 2015: Journal of Extra-corporeal Technology
Awais Ashfaq, Alyssa B Chapital
INTRODUCTION: Emphysematous gastritis is a rare condition in which gas accumulates in the stomach lining usually due to an infectious source. CASE PRESENTATION: We present a 16 year old female with viral myocarditis and cardiogenic shock transferred to our hospital on extracorporeal membrane oxygenation (ECMO) who developed emphysematous gastritis. After listing the patient for heart transplant, patient underwent Bi-VAD placement requiring veno-venous ECMO support...
2015: International Journal of Surgery Case Reports
Mikiko Shimizu, Tomohiro Nishinaka, Kei Inai, Toshio Nakanishi
The Japanese organ transplant law was revised in July 2010 in order to enable children aged <15 years to donate organs. However, the waiting time for orthotopic heart transplantation (HTx) is as long as 636 days in children due to a shortage of organ donors. Ventricular assist devices (VADs) have been widely used as a bridge to transplantation in Western countries, whereas experience with VADs is limited in Japan due to a lack of device availability for small children. This study aimed to clarify the clinical profiles and outcomes of children with advanced heart failure in Japan and to investigate the importance of mechanical circulatory support (MCS), VADs, and extracorporeal membrane oxygenation (ECMO) in children...
July 2016: Heart and Vessels
F Schmidt, T Jack, M Sasse, T Kaussen, H Bertram, A Horke, K Seidemann, P Beerbaum, H Koeditz
In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients...
December 2015: Pediatric Cardiology
Timothy R Stidham, Scott R Auerbach, Max B Mitchell, Shannon M Buckvold
Respiratory failure after ventricular assist device (VAD) placement may threaten transplant candidacy and can be lethal. Refractory respiratory failure may require addition of extracorporeal membrane oxygenation (ECMO) support. Providing ECMO in a VAD-supported patient is uniquely challenging, particularly in the case of LVAD inflow cannula obstruction in a pediatric patient who may be more prone to cannula obstruction. Surgical intervention to alleviate obstruction may not be feasible. Here, we present a novel nonsurgical strategy for conversion to ECMO in a VAD-supported pediatric patient with respiratory failure because of LVAD inflow cannula obstruction...
July 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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