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Mechanical circulatory support device

Guillaume Hékimian, Tamara Jovanovic, Nicolas Bréchot, Guillaume Lebreton, Pascal Leprince, Jean-Louis Trouillet, Matthieu Schmidt, Ania Nieszkowska, Sébastien Besset, Jean Chastre, Alain Combes, Charles-Edouard Luyt
PURPOSE: To describe patients with refractory cardiogenic shock related to influenza B virus myocarditis rescued by venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO). MATERIAL AND METHODS: Consecutive patients hospitalized in our unit for influenza-associated myocarditis were prospectively included. We also conducted a systematic MEDLINE database literature review through the PubMed search engine, between 1946 and 2017. RESULTS: We report the cases of 4 young patients with fulminant myocarditis requiring VA-ECMO for 6 [5-8] days...
June 9, 2018: Journal of Critical Care
Michael Goldfarb, Lawrence S Czer, Lee D Lam, Jaime Moriguchi, Francisco A Arabia, Oksana Volod
Acquired von Willebrand syndrome (VWS) due to loss of high-molecular-weight multimers (HMWMs) has been reported with longer term mechanical devices and is associated with mucosal bleeding, a primary hemostasis type of bleeding. However, little is known whether a similar defect occurs in patients with short-term mechanical circulatory support (STMCS) devices. We reviewed von Willebrand factor (VWF) profiles in patients with STMCS devices who underwent VWS workup from December 2015 to March 2017 at an academic quaternary care hospital...
June 2018: Journal of Extra-corporeal Technology
David Ouyang, Gunsagar Gulati, Richard Ha, Dipanjan Banerjee
BACKGROUND: Proposed changes to the United Network for Organ Sharing heart transplant allocation protocol will prioritize patients receiving temporary mechanical circulatory support (tMCS), including extracorporeal membrane oxygenation (ECMO), percutaneous ventricular assist devices (PVADs), and intra-aortic balloon pumps (IABPs). We sought to evaluate contemporary trends in the incidence and outcomes of patients who required tMCS during the hospitalization before heart transplantation...
April 26, 2018: Journal of Heart and Lung Transplantation
Mithun Chakravarthy, Masaki Tsukashita, Srinivas Murali
Cardiogenic shock is a clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death. In-hospital mortality rates range from 50% to 60%. Urgent diagnosis, timely transfer to a tertiary or quaternary medical facility with critical care management capabilities and multidisciplinary shock teams is a must to increase survival. Aggressive, hemodynamically guided medical management with careful monitoring of clinical and hemodynamic parameters with timely use of appropriate mechanical circulatory support devices is often necessary...
July 2018: Critical Care Clinics
Prashant N Mohite, Anton Sabashnikov, Achim Koch, Raj Binu, Ashok Padukone, Sundip Kaul, Olaf Maunz, Diana García-Sáez, Bartlomiej Zych, Mubassher Husain, Fabio De Robertis, Aron-Frederik Popov, André R Simon
OBJECTIVES: Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support (MCS). The aim of the study was to compare extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs) utilized in the management of PCCS. METHODS: In total, 56 consecutive patients who developed PCCS from 2005 to 2014 required MCS as a bridge to decision-24 were supported with a VAD and 32 with an ECMO...
June 13, 2018: Interactive Cardiovascular and Thoracic Surgery
Laurent Bonello, Clement Delmas, Guillaume Schurtz, Guillaume Leurent, Eric Bonnefoy, Nadia Aissaoui, Patrick Henry
Cardiogenic shock (CS) is a major challenge in contemporary cardiology. Despite a better understanding of the pathophysiology of CS, its management has only improved slightly. The prevalence of CS has remained stable over the past decade, but its outcome has seen few improvements, with the 1-month mortality rate still in the range of 40-60%. Inotropes and vasopressors are the first-line therapies for CS, but they are associated with significant hazards, and have well-known deleterious effects. Furthermore, a significant number of patients develop refractory CS with haemodynamic instability, causing critical organ hypoperfusion and/or pulmonary congestion, despite increasing doses of catecholamines...
June 11, 2018: Archives of Cardiovascular Diseases
Arif Albulushi, Andreas Giannopoulos, Nikolaos Kafkas, Stylianos Dragasis, Gregory Pavlides, Yiannis S Chatzizisis
Acute right ventricle myocardial infarction (RVMI) is observed in 30-50% of patients presenting with inferior wall myocardial infarction and, occasionally, with anterior wall myocardial infarction. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. Areas covered: The pathophysiological mechanisms, diagnostic steps and novel therapeutic approaches of acute RVMI are described. Expert commentary: Diagnosis of acute RVMI is based on physical examination, cardiac biomarkers, electrocardiography and coronary angiography, whereas non-invasive imaging modalities (echocardiography, cardiac magnetic resonance imaging) play a complementary role...
June 14, 2018: Expert Review of Cardiovascular Therapy
Marc Pineton de Chambrun, Nicolas Bréchot, Alain Combes
PURPOSE OF REVIEW: Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of recent case series and trials. RECENT FINDINGS: Percutaneous active MCS devices (Impella, TandemHeart…) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are utilized as a bridge to 'decision' that includes weaning after cardiac function recovery, transplantation, long-term MCS and withdrawal in case of futility...
June 8, 2018: Current Opinion in Critical Care
M Chadi Alraies, Ian C Gilchrist
Mechanical circulatory support using Impella for high risk PCI is associated with better procedural and hemodynamic outcome compared with IABP although mortality benefit has been elusive. Limited evidence is available to study the effectiveness and safety of mechanical circulatory support in high risk PCI patients and much of it is confounded by underpowered and heterogeneous sample sizes. Lack of randomized trials studying contemporary percutaneous left ventricular assist devices is attributed to difficulty in randomizing high risk patients into trials of hemodynamic support...
June 2018: Catheterization and Cardiovascular Interventions
Syed Yaseen Naqvi, Ibrahim G Salama, Ayhan Yoruk, Leway Chen
Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery...
May 2018: Cardiac Failure Review
Joanna M Joly, Ashraf El-Dabh, Ramey Marshell, Arka Chatterjee, Michelle G Smith, Margaret Tresler, James K Kirklin, Deepak Acharya, Indranee N Rajapreyar, José A Tallaj, Salpy V Pamboukian
Right heart failure (RHF) after left ventricular assist device (LVAD) is associated with poor outcomes. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) defines RHF as elevated right atrial pressure (RAP) plus venous congestion. The purpose of this study was to examine the diagnostic performance of the noninvasive INTERMACS criteria using RAP as the gold standard. We analyzed 108 patients with LVAD who underwent 341 right heart catheterizations (RHC) between January 1, 2006, and December 31, 2013...
June 1, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Kevin L Sack, Yaghoub Dabiri, Thomas Franz, Scott D Solomon, Daniel Burkhoff, Julius M Guccione
Predictive computation models offer the potential to uncover the mechanisms of treatments whose actions cannot be easily determined by experimental or imaging techniques. This is particularly relevant for investigating left ventricular mechanical assistance, a therapy for end-stage heart failure, which is increasingly used as more than just a bridge-to-transplant therapy. The high incidence of right ventricular failure following left ventricular assistance reflects an undesired consequence of treatment, which has been hypothesized to be related to the mechanical interdependence between the two ventricles...
2018: Frontiers in Physiology
Bastian Schmack, Leonie Grossekettler, Alexander Weymann, Joel Schamroth, Anton Sabashnikov, Philip W Raake, Aron F Popov, Ashham Mansur, Matthias Karck, Vedat Schwenger, Arjang Ruhparwar
End-stage heart failure (HF) is associated with renal failure (RF). This study aimed to determine the prognostic influence of RF and post-operative hemodialysis on short-term survival following left ventricular assist device (LVAD) implantation. This retrospective study includes 68 patients undergoing LVAD treatment. Kidney function was recorded prior to LVAD implantation, immediately afterwards and after 30 days, noting the need for hemodialysis. Median pre-operative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) classification was 3...
June 4, 2018: Scientific Reports
Jay K Bhama, Utsav Bansal, Daniel G Winger, Jeffrey J Teuteberg, Christian Bermudez, Robert L Kormos, Aditya Bansal
OBJECTIVES: This study sought to determine if indication for support affects the outcomes after temporary right ventricular mechanical circulatory support after postcardiotomy cardiogenic shock, cardiac transplant, or left ventricular assist device placement. METHODS: A retrospective review was performed on 80 patients receiving a right ventricular assist device. Data were collected from a prospectively maintained database. Kaplan-Meier survival analysis was performed to compare survival between groups...
May 1, 2018: Journal of Thoracic and Cardiovascular Surgery
David Couto-Mallón, Francisco González-Vílchez, Luis Almenar-Bonet, Beatriz Díaz-Molina, Javier Segovia-Cubero, José González-Costello, Juan Delgado-Jiménez, María A Castel-Lavilla, María G Crespo-Leiro, Diego Rangel-Sousa, Manuel Martínez-Sellés, Gregorio Rábago-Juan-Aracil, Luis De-la-Fuente-Galán, Teresa Blasco-Peiró, Daniela Hervás-Sotomayor, Iris P Garrido-Bravo, Sonia Mirabet-Pérez, Javier Muñiz, Eduardo Barge-Caballero
INTRODUCTION AND OBJECTIVES: To study the prognostic value of serum lactate in patients under temporary preoperative mechanical circulatory support who underwent urgent heart transplant. METHODS: We conducted a subanalysis of a Spanish multicenter registry recording data on patients under temporary mechanical circulatory support listed for highly urgent heart transplant from 2010 to 2015. Participants selected for the present study were those who received a transplant and who had known preoperative serum lactate levels...
May 30, 2018: Revista Española de Cardiología
Joseph W Rossano, Ryan S Cantor, Dingwei Dai, Pirouz Shamszad, Yuan-Shung Huang, Matthew Hall, Kimberly Y Lin, R Erik Edens, P Eugene Parrino, James K Kirklin
BACKGROUND: Few data exist on resource utilization with pediatric ventricular assist devices (VADs). We tested the hypothesis that device type and adverse events are associated with increased resource utilization in pediatric patients supported with VADs. METHODS AND RESULTS: The Pediatric Interagency Registry for Mechanically Assisted Circulatory Support, a national registry of VADs in patients <19 years old, and the Pediatric Health Information System, an administrative database, were merged...
June 1, 2018: Journal of the American Heart Association
Christian Stoppe, Ekaterina Nesterova, Gunnar Elke
PURPOSE OF REVIEW: Extracorporeal life support (ECLS) including venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD) provide mechanical pulmonary and circulatory support, respectively, in patients with acute pulmonary or cardiovascular failure. This review discusses recently published data regarding specific topics of nutritional support in patients with ECLS and VAD. RECENT FINDINGS: ECLS may aggravate loss of endogenous and exogenous micronutrients and macronutrients...
May 29, 2018: Current Opinion in Critical Care
Joshua L Chan, Deven C Patel, Dominick Megna, Sadia J Dimbil, Ryan Levine, Jaime Moriguchi, Lawrence S Czer, Jon A Kobashigawa, Francisco Arabia, Fardad Esmailian
OBJECTIVES: Previous studies have demonstrated that preheart transplant mechanical circulatory support (MCS) can lead to a small but significant increase in mortality. However, data on outcomes of patients with MCS who require simultaneous heart-kidney transplant are limited. METHODS: A retrospective review of simultaneous heart-kidney transplantations (HKTxs) performed at a single institution over a 5-year period was performed. Patients were divided based on the preoperative use of durable MCS...
May 24, 2018: Interactive Cardiovascular and Thoracic Surgery
Andrew C W Baldwin, William E Cohn, Jeffrey A Morgan, O H Frazier
We describe the successful use of long-term biventricular continuous-flow mechanical circulatory support as a bridge to transplantation in a small-framed 63-year-old woman with long-standing nonischemic cardiomyopathy. After placement of a left-sided HeartWare HVAD, persistent right-sided heart failure necessitated implantation of a second HeartWare device for long-term right ventricular support. After 262 days, the patient underwent successful orthotopic heart transplantation and was discharged from the hospital...
April 2018: Texas Heart Institute Journal
Kurtis Poole, Keith Couper, Michael A Smyth, Joyce Yeung, Gavin D Perkins
In cardiac arrest, high quality cardiopulmonary resuscitation (CPR) is a key determinant of patient survival. However, delivery of effective chest compressions is often inconsistent, subject to fatigue and practically challenging.Mechanical CPR devices provide an automated way to deliver high-quality CPR. However, large randomised controlled trials of the routine use of mechanical devices in the out-of-hospital setting have found no evidence of improved patient outcome in patients treated with mechanical CPR, compared with manual CPR...
May 29, 2018: Critical Care: the Official Journal of the Critical Care Forum
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