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LVAD DESTINATION THERAPY

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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
#1
Brandon P Verdoorn, Angela J Luckhardt, Sara E Wordingham, Shannon M Dunlay, Keith M Swetz
CONTEXT: While 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 13, 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
#2
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
#3
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
#4
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...
November 30, 2016: JACC. Heart Failure
https://www.readbyqxmd.com/read/28008413/gastrointestinal-symptoms-from-left-ventricular-assist-device-external-compression-of-the-gastric-lumen
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/27836022/the-nhlbi-revive-it-study-understanding-its-discontinuation-in-the-context-of-current-left-ventricular-assist-device-therapy
#9
EDITORIAL
Francis D Pagani, Keith D Aaronson, Robert Kormos, Douglas L Mann, Cathie Spino, Neal Jeffries, Wendy C Taddei-Peters, Donna M Mancini, Dennis M McNamara, Kathleen L Grady, John Gorcsan, Ralph Petrucci, Allen S Anderson, Henry A Glick, Michael A Acker, J Eduardo Rame, Daniel J Goldstein, Salpy V Pamboukian, Marissa A Miller, J Timothy Baldwin
The National Institutes of Health National Heart, Lung, and Blood Institute convened a working group in March 2008 to discuss how therapies for heart failure (HF) might be best advanced using clinical trials involving left ventricular assist devices (LVAD). This group opined that the field was ready for a trial to assess the use of long-term ventricular assist device therapy in patients who are less ill than patients currently eligible for destination therapy, which resulted in the Randomized Evaluation of VAD InterVEntion before Inotropic Therapy (REVIVE-IT) pilot study...
November 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27801308/how-i-do-it-temporary-rvad-placed-at-the-time-of-implantation-of-a-heartmate-ii-lvad
#10
William Zachary Chancellor, Curt Tribble
Left ventricular assist devices (LVAD) are increasingly used to support patients as they await heart transplantation and as destination therapy for patients with end-stage cardiac failure. While the methods of LVAD implantation have become fairly standardized, early postoperative management of patients receiving these devices remains challenging. One issue that has plagued surgeons, cardiologists, and intensivists caring for patients after LVAD implantation is right heart dysfunction. While many scoring systems have been developed to try to anticipate RV failure, the accuracy of these predictive tools remains low...
October 31, 2016: Heart Surgery Forum
https://www.readbyqxmd.com/read/27785136/monitoring-hemostasis-parameters-in-left-ventricular-assist-device-recipients-a-preliminary-report
#11
Bartosz Hudzik, Jacek Kaczmarski, Jerzy Pacholewicz, Michał Zakliczyński, Mariusz Gąsior, Marian Zembala
INTRODUCTION: Mechanical circulatory support (MCS) therapy is associated with the improvement of long-term prognosis in patients with end-stage heart failure. For years it has been used as a bridge to transplant. However, more recently it is even being used as a destination therapy. Recently, clinicians have identified common MCS therapy-associated complications: pump thrombosis, bleeding, and hemolysis. These complications are very challenging with regard to both diagnosis and management...
September 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/27774264/initial-3-year-outcomes-with-left-ventricular-assist-devices-in-a-country-with-a-nascent-heart-transplantation-program
#12
Yuriy Pya, Makhabbat Bekbossynova, Saltanat Jetybayeva, Serik Bekbossynov, Saltanat Andossova, Roman Salov, Assel Medressova, Svetlana Novikova, Muradym Murzagaliyev
AIMS: The need for the left ventricular assist devices (LVAD) in patients with end-stage heart failure is well established, but prior to 2011, this was not available to patients in Kazakhstan. We describe the development of the sole LVAD programme in the context of a nascent heart transplantation programme and clinical outcomes for the first three years. METHODS AND RESULTS: From November 2011 to November 2014, 146 patients underwent implantation of 152 VADs (approximately 50 devices implanted per year)...
March 2016: ESC Heart Failure
https://www.readbyqxmd.com/read/27758809/dying-with-a-left-ventricular-assist-device-as-destination-therapy
#13
Shannon M Dunlay, Jacob J Strand, Sara E Wordingham, John M Stulak, Angela J Luckhardt, Keith M Swetz
BACKGROUND: Despite the ability of left ventricular assist device as destination therapy (DT-LVAD) to prolong survival for many patients with advanced heart failure, little is known about the eventual end-of-life care that patients with DT-LVAD receive. METHODS AND RESULTS: All patients undergoing DT-LVAD at the Mayo Clinic in Rochester, Minnesota, from January 1, 2007, to September 30, 2014, who subsequently died before July 1, 2015, were included. Information about end-of-life care was obtained from documentation in the electronic medical record...
October 2016: Circulation. Heart Failure
https://www.readbyqxmd.com/read/27746085/the-incidence-risk-factors-and-outcomes-associated-with-late-right-sided-heart-failure-in-patients-supported-with-an-axial-flow-left-ventricular-assist-device
#14
Jonathan D Rich, Igor Gosev, Chetan B Patel, Susan Joseph, Jason N Katz, Peter M Eckman, Sangjin Lee, Kartik Sundareswaran, Ahmet Kilic, Brian Bethea, Behzad Soleimani, Brian Lima, Nir Uriel, Michael Kiernan
BACKGROUND: Early right-sided heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with increased mortality, but little is known about patients who develop late RHF (LRHF). We evaluated the incidence, risk factors, and clinical impact of LRHF in patients supported by axial-flow LVADs. METHODS: Data were analyzed from 537 patients enrolled in the HeartMate II (HM II; Thoratec/St. Jude) destination therapy clinical trial. LRHF was defined as the development of clinical RHF accompanied by the need for inotropic support occurring more than 30 days after discharge from the index LVAD implant hospitalization...
August 20, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27692952/left-ventricular-assist-device-as-destination-therapy-in-cardiac-end-stage-dystrophinopathies-midterm-results
#15
Gianluigi Perri, Sergio Filippelli, Rachele Adorisio, Roberta Iacobelli, Francesca Iodice, Giuseppina Testa, Maria Giovanna Paglietti, Domenico D'Amario, Massimo Massetti, Antonio Amodeo
OBJECTIVE: We report our experience with the use of a left ventricular assist device (LVAD) as destination therapy (DT) for the management of patients with cardiac end-stage dystrophinopathies. METHODS: From February 2011 to February 2016, 7 patients with dystrophinopathies and dilated cardiomyopathy (DCM) were treated with LVADs at our institution. Median age at surgery was 16.5 years (range, 14.2-23.4 years). All patients were preoperatively evaluated by a multidisciplinary team approach...
August 28, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27685648/transcriptional-patterns-of-reverse-remodeling-with-left-ventricular-assist-devices-a-consistent-signature
#16
Van-Khue Ton, Gordana Vunjak-Novakovic, Veli K Topkara
Left ventricular assist device (LVAD) therapy has revolutionized the treatment of patients with advanced heart failure. Although originally intended for bridge-to-transplantation and destination therapy indications, a small subset of patients supported with LVADs exhibit complete myocardial recovery leading to device explanation. However, genetic and molecular determinants of partial and/or complete myocardial recovery remain largely unknown. Areas covered: We summarize current knowledge on alterations in heart failure transcriptome in response to LVAD support, as well as discuss common gene signatures potentially responsible for the reverse remodeling phenotype in the failing human heart...
November 2016: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/27672540/endocarditis-in-left-ventricular-assist-device
#17
REVIEW
Braghadheeswar Thyagarajan, Monisha Priyadarshini Kumar, Rutuja R Sikachi, Abhinav Agrawal
Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality...
August 2016: Intractable & Rare Diseases Research
https://www.readbyqxmd.com/read/27660575/mechanical-circulatory-support-for-the-failing-heart-continuous-flow-left-ventricular-assist-devices
#18
REVIEW
Joseph A R Englert, Jennifer A Davis, Selim R Krim
BACKGROUND: Heart transplantation remains the definitive therapy for patients with advanced heart failure; however, owing to limited donor organ availability and long wait times, continuous-flow left ventricular assist devices (LVADs) have become standard therapy. METHODS: This review summarizes the history, progression, function, and basic management of LVADs. Additionally, we provide some clinical pearls and important caveats for managing this unique patient population...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27659884/exploring-cognitive-bias-in-destination-therapy-left-ventricular-assist-device-decision-making-a-retrospective-qualitative-framework-analysis
#19
Molly Magid, Colleen K Mcllvennan, Jaqueline Jones, Carolyn T Nowels, Larry A Allen, Jocelyn S Thompson, Dan Matlock
BACKGROUND: Cognitive biases are psychological influences, which cause humans to make decisions, which do not seemingly maximize utility. For people with heart failure, the left ventricular assist device (LVAD) is a surgically implantable device with complex tradeoffs. As such, it represents an excellent model within which to explore cognitive bias in a real-world decision. We conducted a framework analysis to examine for evidence of cognitive bias among people deciding whether or not to get an LVAD...
October 2016: American Heart Journal
https://www.readbyqxmd.com/read/27623098/aortic-insufficiency-in-continuous-flow-left-ventricular-assist-device-support-patients-is-common-but-does-not-impact-long-term-mortality
#20
Christopher T Holley, Megan Fitzpatrick, Samit S Roy, M Chadi Alraies, Rebecca Cogswell, Laura Souslian, Peter Eckman, Ranjit John
BACKGROUND: Aortic insufficiency (AI) is a significant long-term complication of continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate its impact on clinical outcomes and mortality in CF-LVAD recipients. METHODS: We retrospectively analyzed 237 patients implanted with HeartMate II CF-LVADs at our institution from June 2005 through June 2013. We evaluated recipients' baseline characteristics and annual echocardiograms, grading AI severity as either none, trace, mild, moderate or severe...
July 28, 2016: Journal of Heart and Lung Transplantation
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