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Mechanical circulatory support device

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https://www.readbyqxmd.com/read/29470245/intra-aortic-balloon-pump-use-before-left-ventricular-assist-device-implantation-insights-from-the-intermacs-registry
#1
Adam D DeVore, Bradley G Hammill, Chetan B Patel, Manesh R Patel, Joseph G Rogers, Carmelo A Milano, Adrian F Hernandez
Use of durable, continuous-flow left ventricular assist devices (LVADs) has expanded rapidly, although data are limited regarding optimization strategies before LVAD implantation. We examined current use of intra-aortic balloon pumps (IABPs) before LVAD implantation and compared outcomes of patients with IABP use to those without. We analyzed data from the Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) on patients who underwent LVAD implantation between 2006 and 2014. We limited the analysis to patients with an admitting diagnosis of LVAD placement...
March 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29465438/the-evolving-role-of-percutaneous-ventricular-assist-devices-in-high-risk-cardiac-patients
#2
Ilan A Marcuschamer, Aryeh Abelow, Ran Kornowski
The Impella is a mechanical circulatory support device that supports ventricular function. Since 2008, when the first Impella device received Food and Drug Administration clearance, its use has become increasingly prevalent. A variety of Impella devices are available, and are differentiated by size, power, and insertion techniques. These versions of the Impella have been used in a multitude of clinical scenarios, both emergent and elective, including high-risk coronary interventions, acute myocardial infarction complicated by cardiogenic shock, decompensated left and right heart failure, high-risk ventricular tachycardia ablations, and aortic valvuloplasty...
February 20, 2018: Coronary Artery Disease
https://www.readbyqxmd.com/read/29452978/the-management-of-antibodies-in-heart-transplantation-an-ishlt-consensus-document
#3
Jon Kobashigawa, Monica Colvin, Luciano Potena, Duska Dragun, Maria G Crespo-Leiro, Juan F Delgado, Michael Olymbios, Jayan Parameshwar, Jignesh Patel, Elaine Reed, Nancy Reinsmoen, E Rene Rodriguez, Heather Ross, Randall C Starling, Dolly Tyan, Simon Urschel, Andreas Zuckermann
Despite the successes from refined peri-operative management techniques and immunosuppressive therapies, antibodies remain a serious cause of morbidity and mortality for patients both before and after heart transplantation. Patients awaiting transplant who possess antibodies against human leukocyte antigen are disadvantaged by having to wait longer to receive an organ from a suitably matched donor. The number of pre-sensitized patients has been increasing, a trend that is likely due to the increased use of mechanical circulatory support devices...
January 31, 2018: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29451075/short-term-outcomes-of-preoperative-intra-aortic-balloon-pump-use-in-patients-undergoing-adjunctive-coronary-endarterectomy-a-retrospective-observational-study
#4
Liangshan Wang, Xing Hao, Xiaomeng Wang, Chengxiong Gu, Hong Wang, Xiaotong Hou
BACKGROUND: Coronary artery bypass grafting (CABG) combined with coronary endarterectomy (CE) can be associated with high operative mortality and morbidity. An intra-aortic balloon pump (IABP) has been the most widely used mechanical circulatory support device during perfusion treatment. However, the benefits of preoperative IABP in CABG combined with CE remain unknown. We conducted a retrospective observational study to evaluate the efficacy of preoperative IABP therapy in patients undergoing adjunctive right coronary artery (RCA) endarterectomy...
February 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29444276/extracorporeal-resuscitation-as-a-further-modifier-of-clinical-outcome-in-patients-with-left-ventricular-assist-device-implantation-and-interagency-registry-for-mechanically-assisted-circulatory-support-level-1
#5
Edis Ljajikj, Armin Zittermann, Andreas Koster, Jochen Börgermann, Michael Schönbrodt, Kavous Hakim-Meibodi, Jan Gummert, Michiel Morshuis
In cardiogenic shock patients with Interagency Registry for Mechanical Circulatory Support (INTERMACS) level 1, the need for temporary circulatory support is a predictor and modifier of patient outcome. Because this group includes patients with and without cardiopulmonary resuscitation (CPR) and is thus very heterogeneous, we investigated whether a further subclassification is useful. We compared 30-day and 1-year mortality of patients who underwent left ventricular assist device implantation after extracorporeal CPR with the aid of an extracorporeal life support system (CPR+ group; n = 40) with cardiogenic shock patients in which the extracorporeal life support system was implanted under non-CPR conditions (CPR- group, n = 68)...
February 12, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29432374/development-of-an-outpatient-guideline-for-optimal-anticoagulation-bridging-in-patients-with-durable-mechanical-circulatory-support
#6
Amy A Levesque, Jessica M Rimsans, Katelyn W Sylvester, Erin N Lyons, Katie A Frankel, Lara L Coakley, Maryclare Hickey, Krystin A Montoya, Mandeep R Mehra, Michael M Givertz, Garrick C Stewart, Jean M Connors
Patients with durable mechanical circulatory support are at increased risk of thromboembolic and bleeding complications. Current guidelines recommend that these patients receive chronic anticoagulation with warfarin to maintain a target international normalized ratio (INR) as specified by device manufacturers. Limited data exist regarding management of subtherapeutic INRs in this setting. To standardize clinical practice at our institution, we assembled a multidisciplinary task force including members from various specialties to develop a guideline for managing subtherapeutic INRs that incorporates published data and expert opinion...
March 2018: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29428715/routine-clinical-anti-platelet-agents-have-limited-efficacy-in-modulating-hypershear-mediated-platelet-activation-associated-with-mechanical-circulatory-support
#7
Lorenzo Valerio, Jawaad Sheriff, Phat L Tran, William Brengle, Alberto Redaelli, Gianfranco B Fiore, Federico Pappalardo, Danny Bluestein, Marvin J Slepian
INTRODUCTION: Continuous flow ventricular assist devices (cfVADs) continue to be limited by thrombotic complications associated with disruptive flow patterns and supraphysiologic shear stresses. Patients are prescribed complex antiplatelet therapies, which do not fully prevent recurrent thromboembolic events. This is partially due to limited data on antiplatelet efficacy under cfVAD-associated shear conditions. MATERIALS AND METHODS: We investigated the efficacy of antiplatelet drugs directly acting on three pathways: (1) cyclooxygenase (aspirin), (2) phosphodiesterase (dipyridamole, pentoxifylline, cilostazol), and (3) glycoprotein IIb-IIIa (eptifibatide)...
December 5, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29419538/percutaneous-mechanical-circulation-support-combined-with-extracorporeal-membrane-oxygenation-oxyrvad-in-secondary-right-heart-failure
#8
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/29412085/compliant-buckled-foam-actuators-and-application-in-patient-specific-direct-cardiac-compression
#9
Benjamin C Mac Murray, Chaim C Futran, Jeanne Lee, Kevin W O'Brien, Amir A Amiri Moghadam, Bobak Mosadegh, Meredith N Silberstein, James K Min, Robert F Shepherd
We introduce the use of buckled foam for soft pneumatic actuators. A moderate amount of residual compressive strain within elastomer foam increases the applied force ∼1.4 × or stroke ∼2 × compared with actuators without residual strain. The origin of these improved characteristics is explained analytically. These actuators are applied in a direct cardiac compression (DCC) device design, a type of implanted mechanical circulatory support that avoids direct blood contact, mitigating risks of clot formation and stroke...
February 2018: Soft Robotics
https://www.readbyqxmd.com/read/29409843/t-cell-dysfunction-and-patient-age-are-associated-with-poor-outcomes-after-mechanical-circulatory-support-device-implantation
#10
Joanna M Schaenman, Maura Rossetti, Yael Korin, Tiffany Sidwell, Victoria Groysberg, Emily Liang, Sitaram Vangala, Nicholas Wisniewski, Eleanor Chang, Maral Bakir, Galyna Bondar, Martin Cadeiras, Murray Kwon, Elaine F Reed, Mario Deng
Immunologic impairment may contribute to poor outcomes after implantation of mechanical circulatory support device (MCSD), with infection often as a terminal event. The study of immune dysfunction is of special relevance given the growing numbers of older patients with heart disease. The aim of the study was to define which immunologic characteristics are associated with development of adverse clinical outcomes after MCSD implantation. We isolated peripheral blood mononuclear cells (PBMC) from patients pre- and up to 20 days post-MCSD implantation and analyzed them by multiparameter flow cytometry for T cell dysfunction, including terminal differentiation, exhaustion, and senescence...
January 31, 2018: Human Immunology
https://www.readbyqxmd.com/read/29404355/when-more-is-not-better-appropriately-excluding-patients-from-mechanical-circulatory-support-therapy
#11
REVIEW
Mannu Nayyar, Kevin Michael Donovan, Rami N Khouzam
Mechanical circulatory support (MCS) devices are continually evolving and are providing greater hemodynamic support. This review was conducted to evaluate the prophylactic use of MCS in hemodynamically stable patients who were awaiting future coronary artery revascularization. A thorough review of published literature was conducted to evaluate for patients and clinical scenarios that are indicated for MCS, including hemodynamically stable and unstable patients awaiting revascularization. Although there have been several studies demonstrating the benefit of MCS use in hemodynamically unstable patients, there was limited trials in patients that were hemodynamically stable...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29400657/national-trends-predictors-of-use-and-in-hospital-outcomes-in-the-mechanical-circulatory-support-for-cardiogenic-shock
#12
Jordan B Strom, Yuansong Zhao, Changyu Shen, Mabel Chung, Duane S Pinto, Jeffrey J Popma, Robert W Yeh
AIMS: Despite rising rates of cardiogenic shock (CS), data on trends and in-hospital outcomes of shortterm non-durable mechanical circulatory support (MCS) are limited. METHODS AND RESULTS: Hospitalizations of US adults with a discharge diagnosis of CS, 1/1/2004- 12/31/2014, in the National Inpatient Sample, were included. Rates of MCS were stratified by device type and clinical presentation. Outcomes included in-hospital mortality, hospitalization costs, and number of procedures...
February 6, 2018: EuroIntervention
https://www.readbyqxmd.com/read/29395828/4-valve-heart-disease-and-right-heart-failure
#13
McKenzie Hollon, Kathyrn Glas, Michele Sumler
Carcinoid heart disease is a rare form of heart disease due to secretion of vasoactive compounds, including serotonin, from gastrointestinal tumors. This E-challenge examines the case of a patient with advanced carcinoid heart disease who presented to the operating room (OR) for a tricuspid valve replacement. Once the patient was in the OR, intraoperative transesophageal echocardiography was used to discover a patent foramen ovale and involvement of all 4 valves with regurgitant lesions. The patient underwent tricuspid valve replacement, pulmonic valve replacement, right ventricular outflow tract reconstruction, and patent foramen closure in the OR and experienced subsequent fulminant right heart failure...
October 13, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29384755/direct-echocardiographic-imaging-of-berlin-heart-valves-can-aid-in-early-detection-of-berlin-heart-valve-dysfunction
#14
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/29380144/contemporary-perspectives-in-durable-mechanical-circulatory-support-what-did-we-learn-in-the-last-3%C3%A2-years
#15
REVIEW
Jayant Raikhelkar, Nir Uriel
PURPOSE OF REVIEW: In this paper, we will review developments in the field of durable mechanical circulatory support over the past 3 years. RECENT FINDINGS: The role of left ventricular assist device (LVAD) placement in non-inotrope-dependent ambulatory heart failure patients remains controversial in light of recent clinical trials. New devices are on the horizon for destination therapy in advanced heart failure patients. The concept of hemocompatibility and the calculation of hemocompatibility scores represent a novel approach to common adverse events...
January 29, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29373985/reversal-of-end-stage-heart-failure-in-juvenile-hemochromatosis-with-iron-chelation-therapy-a-case-report
#16
Shamil D Cooray, Neel M Heerasing, Laura A Selkrig, V Nathan Subramaniam, P Shane Hamblin, Cameron J McDonald, Catriona A McLean, Elissa McNamara, Angeline S Leet, Stuart K Roberts
BACKGROUND: Juvenile hemochromatosis is the most severe form of iron overloading phenotype. Although rare, it should be suspected in patients who present with hypogonadotropic hypogonadism, diabetes mellitus, or cardiomyopathy without a clear cause. CASE PRESENTATION: A young Serbian male presenting with end-stage heart failure was referred for extracorporeal membrane oxygenation. An endomyocardial biopsy revealed cytoplasmic iron deposits in myocytes. His condition was stabilized with biventricular assist devices and he was listed for heart transplantation...
January 26, 2018: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29370923/the-role-of-mechanical-circulatory-support-during-percutaneous-coronary-intervention-in-patients-without-severely-depressed-left-ventricular-function
#17
Khaldoon Alaswad, Mir Babar Basir, Akshay Khandelwal, Theodore Schreiber, William Lombardi, William O'Neill
Currently, there are no data on the use of mechanical circulatory support (MCS) in patients without severely depressed left ventricular ejection fraction (LVEF) during high-risk percutaneous coronary intervention (PCI). We analyzed data from the global catheter-based ventricular assist device (cVAD) registry on the clinical use of MCS in high-risk PCI in patients without severely depressed LVEF, defined as LVEF > 35%. Patients without cardiogenic shock from the catheter-based ventricular assist device registry, who underwent elective or urgent PCI with an Impella 2...
December 25, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29366423/therapeutic-approach-to-patients-with-heart-failure-with-reduced-ejection-fraction-and-end-stage-renal-disease
#18
Chakradhari Inampudi, Paulino Alvarez, Rabea Asleh, Alexandros Briasoulis
Several risk factors including Ischemic heart disease, uncontrolled hypertension, high output heart failure (HF) from shunting through vascular hemodialysis access, and anemia, contribute to development of HF in patients with end-stage renal disease (ESRD). Guideline-directed medical and device therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) has not been extensively studied and may have limited safety and efficacy in patients with ESRD. Maintenance of interdialytic and intradialytic euvolemia is a key component of HF management in these patients but often difficult to achieve...
January 23, 2018: Current Cardiology Reviews
https://www.readbyqxmd.com/read/29365118/initial-in-vitro-testing-of-a-paediatric-continuous-flow-total-artificial-heart
#19
Kiyotaka Fukamachi, Jamshid H Karimov, David J Horvath, Gengo Sunagawa, Nicole A Byram, Barry D Kuban, Nader Moazami
OBJECTIVES: Mechanical circulatory support has become standard therapy for adult patients with end-stage heart failure; however, in paediatric patients with congenital heart disease, the options for chronic mechanical circulatory support are limited to paracorporeal devices or off-label use of devices intended for implantation in adults. Congenital heart disease and cardiomyopathy often involve both the left and right ventricles; in such cases, heart transplantation, a biventricular assist device or a total artificial heart is needed to adequately sustain both pulmonary and systemic circulations...
January 19, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29355988/variation-in-practice-patterns-and-outcomes-across-united-network-for-organ-sharing-allocation-regions
#20
Dushyanth Srinivasan, Benjamin Vaccaro, Pooja Rao, Rohit Ghosh, Prashant Warier, Tariq Ahmad, Nihar Desai
BACKGROUND: The number of heart transplants performed is limited by organ availability and is managed by the United Network for Organ Sharing (UNOS). Efforts are underway to make organ disbursement more equitable as demand increases. HYPOTHESIS: Significant variation exists in contemporary patterns of care, wait times, and outcomes among patients undergoing heart transplantation across UNOS regions. METHODS: We identified adult patients undergoing first, single-organ heart transplantation between January 2006 and December 2014 in the UNOS dataset and compared sociodemographic and clinical profiles, wait times, use of mechanical circulatory support (MCS), status at time of transplantation, and 1-year survival across UNOS regions...
January 22, 2018: Clinical Cardiology
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