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LVAD DESTINATION THERAPY

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https://www.readbyqxmd.com/read/29774592/risk-factors-for-stroke-on-left-ventricular-assist-devices
#1
Muath Bishawi, Jeremy Joseph, Chetan Patel, Jacob Schroder, Mani Daneshmand, Dawn Bowles, Joseph Rogers, Carmelo Milano
BACKGROUND: Patients with end-stage heart failure on left ventricular assist devices (LVADs) are predisposed to a high incidence of stroke. Preoperative factors associated with increased stroke risk are poorly understood. METHODS: We performed a single-center retrospective review of all patients from 2009 to 2014 in whom a rotary flow LVAD was implanted. All patients with symptoms of a cerebrovascular event underwent a non-contrast head computed tomography scan...
May 17, 2018: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29759673/characterization-of-ventricular-tachycardia-after-left-ventricular-assist-device-implantation-as-destination-therapy-a-single-center-ablation-experience
#2
Joshua D Moss, Erin E Flatley, Andrew D Beaser, John H Shin, Hemal M Nayak, Gaurav A Upadhyay, Martin C Burke, Valluvan Jeevanandam, Nir Uriel, Roderick Tung
OBJECTIVES: This study sought to report mechanisms of ventricular tachycardia (VT) and outcomes of VT ablation in patients with a left ventricular assist device (LVAD) as destination therapy. BACKGROUND: Continuous flow LVAD implantation plays a growing role in the management of end-stage heart failure, and VT is common. There are limited reports of VT ablation in patients with a destination LVAD. METHODS: Patients with a continuous-flow LVAD referred for VT ablation from 2010 to 2016 were analyzed retrospectively...
December 11, 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29750405/heartmate-3-implantation-via-left-antero-lateral-thoracotomy-to-avoid-resternotomy-in-high-risk-patients
#3
Raymond Pfister, Piergiorgio Tozzi, Roger Hullin, Patrick Yerly, Fritz-Patrick Jahns, René Prêtre, Matthias Kirsch
Left ventricular assist devices (LVADs) are currently the best alternative to cardiac transplantation for patients with end-stage heart failure (HF) as a bridge to transplant or to decision, or as destination therapy. Full median sternotomy or minimally invasive techniques are the more standard approaches used at present.  LVADs are usually implanted between the left ventricle apex and the ascending aorta. An implantation through a left thoracotomy with an outflow graft connected to the descending aorta is much less performed nowadays due to the longer times to extubation, higher incidence of postoperative pain, and poorer hemodynamics in the ascending aorta, which may lead to thrombosis...
April 25, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
https://www.readbyqxmd.com/read/29746312/calculation-of-the-alma-risk-of-right-ventricular-failure-after-left-ventricular-assist-device-implantation
#4
Antonio Loforte, Andrea Montalto, Francesco Musumeci, Cristiano Amarelli, Carlo Mariani, Vincenzo Polizzi, Paola Lilla Della Monica, Francesco Grigioni, Roberto Di Bartolomeo, Giuseppe Marinelli
Right ventricular failure after continuous-flow left ventricular assist device (LVAD) implantation is still an unsolved issue and remains a life-threatening event for patients. We undertook this study to determine predictors of the patients who are candidates for isolated LVAD therapy as opposed to biventricular support (BVAD). We reviewed demographic, echocardiographic, hemodynamic, and laboratory variables for 258 patients who underwent both isolated LVAD implantation and unplanned BVAD because of early right ventricular failure after LVAD insertion, between 2006 and 2017 (LVAD = 170 and BVAD = 88)...
May 8, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29688916/gastrointestinal-bleeding-with-left-ventricular-assist-devices-lvad-locating-the-leak-and-identifying-outcomes
#5
Sarah Malik, Shahbaz A Malik, Laura L Ulmer, Lokesh K Jha, Michael S Strupp, Eugenia Raichlin, Elizabeth R Lyden, Alexander T Hewlett
BACKGROUND AND GOALS: Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients. STUDY: Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28%) and non-GIB (n=148; 72%) groups. RESULTS: Median time to GIB was 55 (range, 3 to 730) days...
April 23, 2018: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/29643259/cerebrovascular-accidents-during-mechanical-circulatory-support-new-predictors-of-ischemic-and-hemorrhagic-strokes-and-outcome
#6
Saef Izzy, Daniel B Rubin, Firas S Ahmed, Feras Akbik, Simone Renault, Katelyn W Sylvester, Henrikas Vaitkevicius, Jennifer A Smallwood, Michael M Givertz, Steven K Feske
BACKGROUND AND PURPOSE: Left ventricular assist devices (LVADs) have emerged as an effective treatment for patients with advanced heart failure refractory to medical therapy. Post-LVAD strokes are an important cause of morbidity and reduced quality of life. Data on risks that distinguish between ischemic and hemorrhagic post-LVAD strokes are limited. The aim of this study was to determine the incidence of post-LVAD ischemic and hemorrhagic strokes, their association with stroke risk factors, and their effect on mortality...
May 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29550312/fdg-pet-ct-for-early-detection-and-localization-of-left-ventricular-assist-device-infection-impact-on-patient-management-and-outcome
#7
Jongho Kim, Erika D Feller, Wengen Chen, Yuanyuan Liang, Vasken Dilsizian
OBJECTIVES: The feasibility of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis of left ventricular assist device (LVAD) infection has been demonstrated. Beyond the diagnoses of LVAD infection, the authors hypothesized that the pattern and site of the infection along its various components may significantly impact clinical management and patient outcome. BACKGROUND: In patients with end-stage heart failure, the clinical use of LVAD for destination therapy is on the rise, accompanied by a higher prevalence of infections and serious complications...
March 9, 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29540471/outcomes-after-continuous-flow-left-ventricular-assist-device-implantation-as-destination-therapy-at-transplant-versus-nontransplant-centers
#8
D Marshall Brinkley, David DeNofrio, Robin Ruthazer, Amanda R Vest, Navin K Kapur, Gregory S Couper, Michael S Kiernan
BACKGROUND: Since Food and Drug Administration's approval of the HeartMate II left ventricular assist device (LVAD) as destination therapy, the number of hospitals offering LVAD therapy has grown rapidly. A rising number are performed at centers without internal transplant programs. We sought to determine whether outcomes after destination therapy LVAD implantation are similar at transplant and nontransplant centers. METHODS AND RESULTS: Adult recipients of a primary, continuous-flow LVAD as destination therapy between January 2012 and March 2014 from the Interagency Registry for Mechanically Assisted Circulatory Support were included...
March 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29532509/successful-placement-of-nasointestinal-feeding-tubes-using-an-electromagnetic-sensor-guided-enteral-access-system-in-patients-with-left-ventricular-assist-devices
#9
Kay Lash, Rachelle Oppel, Jeanette Hasse
Technology advances have made it possible to prolong life for patients with heart failure who are not transplant candidates or while awaiting transplant. Many different cardiac devices are available that can be used as a bridge to transplant (temporary support) or as a destination therapy (permanent support). Placement of these devices can cause complications that, if not addressed, could negatively impact the nutrition status of patients. Placement of nasointestinal feeding tubes using an electromagnetic sensor-guided enteral access system (EMS-EAS) has been difficult in patients with implantable devices because of the potential for interference with the EMS-EAS and the left ventricular assist device (LVAD)...
April 2018: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/29492379/heart-transplantation-versus-left-ventricular-assist-devices-as-destination-therapy-or-bridge-to-transplantation-for-1-year-mortality-a-systematic-review-and-meta-analysis
#10
REVIEW
Christina A Theochari, George Michalopoulos, Evangelos K Oikonomou, Stefanos Giannopoulos, Ilias P Doulamis, M Alvarez Villela, Damianos G Kokkinidis
Background: The optimal treatment for advanced heart failure (HF) patients with regards to mortality remains unknown. Heart transplantation (HTx) and left ventricular assist devices (LVAD) used either as a bridge to transplant (BTT) or destination therapy (DT) have been compared in a number of studies, without definite conclusions with regards to mortality benefit. We sought to systematically review the pertinent literature and perform a meta-analysis of all the available studies presenting head-to-head comparisons between HTx and LVAD BTT or LVAD DT for late (>6 months) all-cause mortality...
January 2018: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29482542/matters-to-address-prior-to-introducing-new-life-support-technology-in-japan-three-serious-ethical-concerns-related-to-the-use-of-left-ventricular-assist-devices-as-destination-therapy-and-suggested-policies-to-deal-with-them
#11
Atsushi Asai, Sakiko Masaki, Taketoshi Okita, Aya Enzo, Yasuhiro Kadooka
BACKGROUND: Destination therapy (DT) is the permanent implantation of a left ventricular assist device (LVAD) in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications...
February 27, 2018: BMC Medical Ethics
https://www.readbyqxmd.com/read/29482225/effectiveness-of-an-intervention-supporting-shared-decision-making-for-destination-therapy-left-ventricular-assist-device-the-decide-lvad-randomized-clinical-trial
#12
Larry A Allen, Colleen K McIlvennan, Jocelyn S Thompson, Shannon M Dunlay, Shane J LaRue, Eldrin F Lewis, Chetan B Patel, Laura Blue, Diane L Fairclough, Erin C Leister, Russell E Glasgow, Joseph C Cleveland, Clifford Phillips, Vicie Baldridge, Mary Norine Walsh, Daniel D Matlock
Importance: Shared decision making helps patients and clinicians elect therapies aligned with patients' values and preferences. This is particularly important for invasive therapies with considerable trade-offs. Objective: To assess the effectiveness of a shared decision support intervention for patients considering destination therapy left ventricular assist device (DT LVAD) placement. Design, Setting, and Participants: From 2015 to 2017, a randomized, stepped-wedge trial was conducted in 6 US LVAD implanting centers including 248 patients being considered for DT LVAD...
April 1, 2018: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29380144/contemporary-perspectives-in-durable-mechanical-circulatory-support-what-did-we-learn-in-the-last-3-years
#13
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/29360282/left-ventricular-assist-device-patient-maintained-on-home-hemodialysis-a-novel-class-of-patients-to-the-home-dialysis-population
#14
Ramy M Hanna, Daniel Cruz, Umut Selamet, Huma Hasnain, Murray Kwon, Arnold Baas, James Wilson
Severe heart failure is increasingly being managed by cardiac transplantation, and in some cases mechanical support devices serve as destination therapies. Left ventricular assist devices (LVADs) were approved for destination therapy for end stage heart failure patients before the more advanced total artificial heart modality became available. One common complication of mechanical assist device placement is acute kidney injury. Historically, patients with mechanical support devices have had to have inpatient hemodialysis until combined heart kidney transplant...
January 23, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29319565/left-ventricular-assist-device-as-destination-therapy-for-end-stage-heart-failure-the-right-time-for-the-right-patients
#15
Naoto Fukunaga, Vivek Rao
PURPOSE OF REVIEW: Cardiac transplantation is the gold standard treatment for patients with end-stage heart failure. Unfortunately, the demand for donor organs far outstrips the number of available hearts. Therefore, not all patients who can benefit from this therapy are even listed for transplant. Once destination therapy was approved for the long-term support of nontransplant eligible patients, it was felt that the number of durable ventricular assist device (VAD) implants would increase...
March 2018: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29235399/reviewing-the-use-of-ventricular-assist-devices-in-the-elderly-where-do-we-stand-today
#16
Nandini Nair, Enrique Gongora
Implantation of left ventricular assist devices (LVADS) in older patients appears to be an attractive option in the wake of donor shortage and increasing incidence and prevalence of end stage heart failure. Since the inception of the artificial heart program half a century ago tremendous progress in research and development has led to utilization of more sophisticated devices. VADs have therefore emerged as a successful therapy for extending life with meaningful quality. Areas covered: This review will address the use of LVADS as a bridge to transplantation, destination therapy and comparison of LVAD therapy with alternate list heart transplantation in the elderly population...
January 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29232736/-left-ventricular-assist-device-therapy-ways-to-improve-the-ambulatory-care
#17
Caspar Burkhard-Meier, Michiel Morshuis
The use of left-ventricular assist device therapy (LVAD) in terminal heart failure patients is increasing. Many patients are receiving LVAD-therapy as final solution (destination therapy). After discharge from the implanting heart center patient-centered care has to be implemented on an outpatient basis. A responsible ambulatory treatment of this severe heart failure population requires knowledge about LVAD specific problems (general medical care, long term complications, device management). The referring cardiologist as well as the private practitioner should be more involved in the care of patients with LVAD...
March 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29181740/impact-of-mitral-valve-intervention-with-left-ventricular-assist-device-implantation-on-postoperative-outcomes-and-morphologic-change
#18
Hiroki Hata, Tomoyuki Fujita, Hatsue Ishibashi-Ueda, Kensuke Kuroda, Osamu Seguchi, Yorihiko Matsumoto, Masanobu Yanase, Takuma Sato, Seiko Nakajima, Norihide Fukushima, Junjiro Kobayashi
Although mitral regurgitation (MR) is prevalent in patients with end-stage heart failure, the impact of mitral valve (MV) surgery on outcomes after left ventricular assist device (LVAD) implantation and morphologic changes of MV remains unclear. We retrospectively reviewed 74 patients who underwent LVAD implantation as a bridge to transplant. Of these, 11 (15%) underwent MV repair concomitant with or prior to LVAD implantation, while 27 patients with preoperative significant (moderate or greater) MR did not undergo concomitant MV surgery...
November 27, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/29179901/ct-imaging-of-complications-associated-with-continuous-flow-left-ventricular-assist-devices-lvads
#19
Girish S Shroff, Daniel Ocazionez, Bindu Akkanti, Daniel Vargas, Alheli Garza, Pushpender Gupta, Jayeshkumar A Patel, Manish K Patel, Igor D Gregoric
Heart failure is becoming increasingly prevalent, and more patients are being treated with left ventricular assist devices (LVADs), either as a bridge to transplant or as destination therapy. The use of continuous-flow LVADs is on the rise. LVAD therapy is associated with several classes of complications, including bleeding, thrombosis, and infection. CT imaging can be used effectively to diagnose LVAD complications, including mediastinal hematomas and pericardial, abdominal wall, and retroperitoneal hemorrhage, inflow and outflow graft and aortic thrombi, and driveline and pump pocket infections...
December 2017: Seminars in Ultrasound, CT, and MR
https://www.readbyqxmd.com/read/29141856/impact-of-diabetes-mellitus-on-outcomes-in-patients-supported-with-left-ventricular-assist-devices-a-single-institutional-9-year-experience
#20
Rabea Asleh, Alexandros Briasoulis, Sarah D Schettle, Vakhtang Tchantchaleishvili, Naveen L Pereira, Brooks S Edwards, Alfredo L Clavell, Simon Maltais, David L Joyce, Lyle D Joyce, Richard C Daly, Sudhir S Kushwaha, John M Stulak
BACKGROUND: Diabetes mellitus (DM) is a risk factor for morbidity and mortality in patients with heart failure. The effect of DM on post-left ventricular assist device (LVAD) implantation outcomes is unclear. This study sought to investigate whether patients with DM had worse outcomes than patients without DM after LVAD implantation and whether LVAD support resulted in a better control of DM. METHODS AND RESULTS: We retrospectively reviewed 341 consecutive adults who underwent implantation of LVAD from 2007 to 2016...
November 2017: Circulation. Heart Failure
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