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LVAD DESTINATION THERAPY

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https://www.readbyqxmd.com/read/28323195/left-ventricular-assist-device-related-infections-a-multicentric-study
#1
S Siméon, E Flécher, M Revest, M Niculescu, J-C Roussel, M Michel, P Leprince, P Tattevin
OBJECTIVES: Implantable left ventricular assist device (LVAD) is a major therapeutic progress for end-stage heart failure in selected patients. As their use is expanding, infectious complications are emerging, with limited data available to guide their management. We aimed to better characterize LVAD-related infections. METHODS: We enrolled all consecutive patients diagnosed with LVAD-related infections in 3 referral centers in France, using standardized definition of infections in patients with LVAD...
March 18, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28299353/safety-and-efficacy-of-single-balloon-enteroscopy-in-management-of-gastrointestinal-bleeding-in-patients-with-a-left-ventricular-assist-device
#2
Abhinav Koul, Donald M Pham, Arjun Nanda, Kevin E Woods, Steven D Keilin
Background and study aims Left ventricular assist devices (LVADs) are currently the standard of care in treatment of patients with end-stage heart failure waiting for heart transplant as well as destination therapy for non-transplant candidates. However, patients with LVADs are at increased risk of gastrointestinal bleeding due to the device's unique effects on hemodynamics. A major source of gastrointestinal bleeding in these patients are gastrointestinal angioectasias located within the small bowel that can only be reached with deep enteroscopy...
March 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28283496/physical-activity-guided-by-pulse-pressure-in-patients-with-continuous-flow-left-ventricular-assist-devices-a-pilot-study
#3
Sven Haufe, Christoph Bara, Julian Eigendorf, Kristine Chobanyan-Jürgens, Sebastian V Rojas, Jan D Schmitto, Uwe Tegtbur, Jens Jordan, Jens Tank
Continuous flow left ventricular assist devices (cfLVADs) are increasingly used as bridge to cardiac transplantation or destination therapy in patients with end-stage heart failure.(1) Patients implanted with cfLVADs exhibit marked arterial pulse pressure (PP) reductions which could adversely affect cardiovascular health. Indeed, a pulsatile blood pressure provides stimuli for vascular smooth muscle cell growth and arterial baroreceptor functions.(2, 3) LVAD designs attempting to simulate PP have been developed recently with the hope to improve clinical outcomes...
March 10, 2017: Circulation
https://www.readbyqxmd.com/read/28208117/percutaneous-transcatheter-therapies-for-the-management-of-left-ventricular-assist-device-complications
#4
Rohan J Kalathiya, Jonathan Grinstein, Nir Uriel, Atman P Shah
Heart failure is a growing epidemic in the United States and throughout the world. The utilization of continuous-flow left ventricular assist devices (LVADs) has greatly increased over the last decade. In addition, a limited supply of organ donors has led to a rise in the use, and duration, of LVADs for destination therapy. The increased use of LVAD therapy has led to the observation of mechanical complications such as device thrombosis, de novo aortic insufficiency, and outflow graft stenosis, all of which are associated with prolonged LVAD support...
February 15, 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28198133/left-ventricular-assist-device-therapy-in-advanced-heart-failure-patient-selection-and-outcomes
#5
REVIEW
Finn Gustafsson, Joseph G Rogers
Despite improvements in pharmacological therapy and pacing, prognosis in advanced heart failure (HF) remains poor, with a 1-year mortality of 25-50%. While heart transplantation provides excellent survival and quality of life for eligible patients, only a few can be offered this treatment due to shortage of donor organs. Implantable left ventricular assist device (LVAD) technology has improved considerably, and the currently used continuous flow devices may last >10 years in a patient. LVADs are being used increasingly both as bridge-to-transplantation and as destination therapy...
February 15, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28191682/aortic-root-thrombus-complicated-by-left-main-coronary-artery-occlusion-visualized-by-3d-echocardiography-in-a-patient-with-continuous-flow-left-ventricular-assist-device
#6
Monique S Tanna, Alex Reyentovich, Leora B Balsam, John A Dodson, Alan F Vainrib, Ricardo J Benenstein, Barry P Rosenzweig, Muhamed Saric
Aortic root thrombus is an uncommon complication of continuous-flow left ventricular assist devices (LVAD). We present the case of a 71-year-old man with ischemic cardiomyopathy who underwent destination therapy HeartMate II LVAD placement. Eighteen months later, he presented with a cerebrovascular accident followed by myocardial infarction. Transesophageal echocardiography revealed an aortic root thrombus spanning the left and noncoronary cusps and obliterating the left main coronary artery. We discuss the incidence, risk factors, and management of aortic root thrombus in LVAD patients...
February 2017: Echocardiography
https://www.readbyqxmd.com/read/28168962/changes-in-end-organ-function-in-patients-with-prolonged-continuous-flow-left-ventricular-assist-device-support
#7
Daisuke Yoshioka, Hiroo Takayama, Paolo C Colombo, Melana Yuzefpolskaya, Arthur R Garan, Veli K Topkara, Jiho Han, Paul Kurlansky, Yoshifumi Naka, Koji Takeda
BACKGROUND: Few studies have evaluated the long-term effects of continuous blood flow with reduced pulsatility on end-organ function. METHODS: Between May 2004 and December 2015, 469 patients underwent continuous-flow left ventricular assist device (LVAD) implantation at our center. Our study included 59 (13%) patients who were supported with an LVAD for a minimum of 3 years. We evaluated postoperative renal function and hepatic function at 1 and 6 months, and 1, 2, and 3 years after implantation in those 59 patients...
March 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28161817/curative-surgery-for-gastric-cancer-in-a-patient-with-an-implantable-left-ventricular-assist-device
#8
Yuki Nakamura, Koichi Toda, Teruya Nakamura, Shigeru Miyagawa, Yasushi Yoshikawa, Satsuki Fukushima, Shunsuke Saito, Daisuke Yoshioka, Keitaro Domae, Tsuyoshi Takahashi, Tadayoshi Hashimoto, Yuichiro Doki, Yoshiki Sawa
The number of patients with end-stage heart failure treated by a left ventricular assist device (LVAD) is dramatically increasing, because the LVAD has been widely accepted for its clinical results. According to the initiation of destination therapy, the prevalence of malignancy in patients with an LVAD is estimated to increase. In patients with LVADs, abdominal surgery for visceral malignancy is associated with technical difficulties because of the presence of an LVAD pump or the driveline which is located transversely in the preperitoneal space...
February 4, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28160976/global-outcome-in-patients-with-left-ventricular-assist-devices
#9
Timothy J Fendler, Michael E Nassif, Kevin F Kennedy, Susan M Joseph, Scott C Silvestry, Gregory A Ewald, Shane J LaRue, Justin M Vader, John A Spertus, Suzanne V Arnold
Left ventricular assist devices (LVADs) improve survival and quality of life (QOL) for most, but not all, patients with advanced heart failure. We described a broader definition of poor outcomes after LVAD, using a novel composite of death, QOL, and other major adverse events. We evaluated the frequency of poor global outcome at 1 year after LVAD among 164 patients (86% Interagency Registry for Mechanically Assisted Circulatory Support profile 1 to 2; shock or declining despite inotropes) at a high-volume center...
April 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28125463/percutaneous-driveline-fracture-following-implantation-of-the-heartmate-ii-left-ventricular-assist-device-how-durable-is-driveline-repair
#10
John M Stulak, Sarah Schettle, Nicholas Haglund, Shannon Dunlay, Jennifer Cowger, Palak Shah, Keith D Aaronson, Francis D Pagani, Simon Maltais
Durability of the percutaneous driveline is critical for the optimal long-term support of patients after left ventricular assist device (LVAD) implantation. There are no data specifically examining the durability of major repair for driveline fracture or its effect on patient outcomes.Between May 2004 and August 2014, 560 patients underwent implantation with the HeartMate II LVAD at our respective institutions. Median age at LVAD implantation was 59 years (range, 18-82 years) and 465 patients (83%) were male...
January 23, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28112620/destination-lvad-therapy-and-the-trappings-of-metaphor
#11
Nicholas Braus, Paul Mueller
No abstract text is available yet for this article.
February 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/28112612/lvad-dt-culture-of-rescue-and-liminal-experience-in-the-treatment-of-heart-failure
#12
Frances K Barg, Katherine Kellom, Tali Ziv, Sarah C Hull, Selena Suhail-Sindhu, James N Kirkpatrick
The purpose of this article is to investigate how cultural meanings associated with the left ventricular assist device (LVAD) inform acceptance and experience of this innovative technology when it is used as a destination therapy. We conducted open-ended, semistructured interviews with family caregivers and patients who had undergone LVAD-DT procedures at six U.S. hospitals. A grounded theory approach was used for the analysis. Thirty-nine patients and 42 caregivers participated. Participants described a sense of obligation to undergo the procedure because of its promise for salvation...
February 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/28093312/palliative-medicine-and-preparedness-planning-for-patients-receiving-left-ventricular-assist-device-as-destination-therapy-challenges-to-measuring-impact-and-change-in-institutional-culture
#13
Brandon P Verdoorn, Angela J Luckhardt, Sara E Wordingham, Shannon M Dunlay, Keith M Swetz
CONTEXT: Although left ventricular assist devices as destination therapy (DT-LVAD) can improve survival, quality of life, and functional capacity in well-selected patients with advanced heart failure, there remain unique challenges to providing quality end-of-life care in this population. Palliative care involvement is universally recommended, but how to best operationalize this care and measure success is unknown. OBJECTIVES: To characterize the process of preparedness planning (PP) for patients receiving DT-LVAD at our institution and better understand opportunities for quality improvement or procedural transferability...
January 16, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28073849/caregivers-of-patients-with-left-ventricular-assist-devices-possible-impacts-on-patients-mortality-and-interagency-registry-for-mechanically-assisted-circulatory-support-defined-morbidity-events
#14
Courtenay R Bruce, Charles G Minard, L A Wilhelms, Mackenzie Abraham, Javier Amione-Guerra, Linda Pham, Sherry D Grogan, Barry Trachtenberg, Martin L Smith, Brian A Bruckner, Jerry D Estep, Kristin M Kostick
BACKGROUND: How caregivers contribute to positive or negative outcomes for left ventricular assist device (LVAD) patients remains unclear. Our primary study objectives were to (1) identify caregiver support attributes through a retrospective chart review of social workers' psychosocial assessments for LVAD patients and (2) determine how these attributes associated with patients' post-LVAD placement mortality and Interagency Registry for Mechanically Assisted Circulatory Support-defined morbidity events...
January 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28043445/a-decade-of-experience-with-continuous-flow-left-ventricular-assist-devices
#15
Ranjit John, Christopher T Holley, Peter Eckman, Samit S Roy, Rebecca Cogswell, Laura Harvey, Sara Shumway, Kenneth Liao
The use of continuous-flow left ventricular assist devices (CF-LVADs) has revolutionized the landscape of mechanical circulatory support for patients with heart failure. Clinical trials are already testing the next generation of CF-LVADs. In this study, our objective was to review our long-term experience with the current generation of CF-LVADs, specifically, the HeartMate (HM) II (Thoratec Corp, Pleasanton, CA). In this single-center retrospective analysis, we evaluated the records of 278 consecutive patients who underwent a total of 302 HM II placements from June 2005 through June 2014...
July 2016: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28017351/cost-effectiveness-of-left-ventricular-assist-devices-in-ambulatory-patients-with-advanced-heart-failure
#16
Jacqueline Baras Shreibati, Jeremy D Goldhaber-Fiebert, Dipanjan Banerjee, Douglas K Owens, Mark A Hlatky
OBJECTIVES: This study assessed the cost-effectiveness of left ventricular assist devices (LVADs) as destination therapy in ambulatory patients with advanced heart failure. BACKGROUND: LVADs improve survival and quality of life in inotrope-dependent heart failure, but data are limited as to their value in less severely ill patients. METHODS: We determined costs of care among Medicare beneficiaries before and after LVAD implantation from 2009 to 2010...
February 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28008413/gastrointestinal-symptoms-from-left-ventricular-assist-device-external-compression-of-the-gastric-lumen
#17
Jorge Suarez, Dennis Yang
A 74-year-old man with a left-ventricular assist device (LVAD) as destination therapy for end-stage ischemic cardiomyopathy presented with acute upper gastrointestinal bleeding. Other symptoms included chronic early satiety, intermittent nausea, and non-specific abdominal discomfort since LVAD implantation 3 years ago. An actively bleeding duodenal arteriovenous malformation was successfully treated with endoscopic coagulation. There was also evidence of moderate external compression of the anterior gastric wall from the LVAD pump with luminal narrowing in the antrum...
August 2016: ACG Case Reports Journal
https://www.readbyqxmd.com/read/27922889/pump-speed-optimization-in-stable-patients-with-a-left-ventricular-assist-device
#18
Lotte E Couperus, Victoria Delgado, Mand J H Khidir, Marijke P M Vester, Meindert Palmen, Marta Fiocco, Eduard R Holman, Laurens F Tops, Robert J M Klautz, Harriëtte F Verwey, Martin J Schalij, Saskia L M A Beeres
Optimal left ventricular assist device (LVAD) functioning and preservation of right ventricular (RV) function are major survival determinants in destination therapy (DT)-LVAD recipients. Currently, the indication for routine pump speed optimization in stable patients and its effect on RV function at follow-up remain underexplored. Hemodynamically stable patients (N=17, age 61 [interquartile range {IQR} 51-66]years; 13 [77%] male) underwent a routine speed ramp test. Echocardiographic images were obtained at incremental speed settings to determine optimal pump speed...
December 2, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27903010/heartmate-ii-left-ventricular-assist-device-pump-exchange-a-single-institution-experience
#19
Asad F Shaikh, Susan M Joseph, Brian Lima, Shelley A Hall, Rajasekhar Malyala, Aldo E Rafael, Gonzalo V Gonzalez-Stawinski, Themistokles Chamogeorgakis
Background Left ventricular assist devices (LVADs) have revolutionized the treatment of patients with end-stage heart failure. These devices are replaced when pump complications arise if heart transplant is not possible. We present our experience with HeartMate II (HMII (Thoratec, Plesanton, California, United States)) LVAD pump exchange. Materials and Methods We retrospectively reviewed all cases that required pump exchange due to LVAD complication from November 2011 until June 2016 at a single high-volume institution...
November 30, 2016: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/27837385/roads-maps-and-destinations-the-journey-of-left-ventricular-assist-device-implantation-in-ambulatory-patients-with-advanced-heart-failure
#20
REVIEW
Barry H Trachtenberg, Jerry D Estep
PURPOSE OF REVIEW: The benefit of left ventricular assist devices in patients dependent on inotropes or temporary mechanical support is clear. There is a large population of advanced heart failure patients who are ambulatory and not dependent on inotropes, but in whom mortality remains high. We review the limited evidence regarding the benefits and risks of LVADs in this population. RECENT FINDINGS: The REVIVE-IT trial, which aimed to study the use of LVADs in patients who are less sick and do not meet current FDA-indications, was suspended due to lack of equipoise in the setting of a spike in pump thromboses...
December 2016: Current Cardiology Reports
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