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VAD bleeding

Jennifer J Chung, Robert Stetson, Jonathan Gordon, Carol W Chen, Ann C Gaffey, J Eduardo Rame, Michael Acker, Pavan Atluri
OBJECTIVE: This study aims to identify the major components of left ventricular assist device (LVAD) -related costs in a population on long term mechanical circulatory support to gain insight into opportunities for improvements in quality, safety, and efficiency of care for end stage heart failure patients. METHODS: This was a single institution, retrospective cost analysis of patients who received a Heartmate II or HeartWare LVAD between November 2005 - October 2015...
October 8, 2018: Seminars in Thoracic and Cardiovascular Surgery
Saman Setareh-Shenas, Felix Thomas, Robert M Cole, Alejandro Lemor, Eyal Herzog, Francisco Arabia, Jaime Moriguchi
Ventricular assist device (VAD) implantation has improved quality of life and short-term survival for advanced heart failure patients. There are limited data from single-center studies addressing the characteristics and etiologies of 30 day readmissions after VAD implant. We used the Nationwide Readmissions Database (NRD) 2014 to identify insertion of implantable heart assist system during index admission. Primary and secondary outcomes were 30 day readmissions and leading etiologies, respectively. We analyzed 1,481 patients who received VAD during the primary admission of whom 1,315 patients survived to hospital discharge (mortality rate 11...
October 3, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Nuccia Morici, Marisa Varrenti, Dario Brunelli, Enrico Perna, Manlio Cipriani, Enrico Ammirati, Maria Frigerio, Marco Cattaneo, Fabrizio Oliva
Platelets play a key role in the pathogenesis of ventricular assist device (VAD) thrombosis; therefore, antiplatelet drugs are essential, both in the acute phase and in the long-term follow-up in VAD management. Aspirin is the most used agent and still remains the first-choice drug for lifelong administration after VAD implantation. Anticoagulant drugs are usually recommended, but with a wide range of efficacy targets. Dual antiplatelet therapy, targeting more than one pathway of platelet activation, has been used for patients developing a thrombotic event, despite an increased risk of bleeding complications...
September 2018: IJC Heart & Vasculature
Stephen J Forest, Rongbing Xie, James K Kirklin, Jennifer Cowger, Yu Xia, Anne I Dipchand, Cumara Sivathasan, Chris Merry, Lars H Lund, Robert Kormos, Margaret M Hannan, Takeshi Nakatani, Ulrich Jorde, Daniel J Goldstein
BACKGROUND: Limited data exist describing impact of body mass index (BMI) on post‒left ventricular assist device (post-LVAD) outcomes. We sought to define the relationship between body mass index (BMI) and adverse events (AEs) after LVAD implantation by examining the ISHLT Mechanically Assisted Circulatory Support (IMACS) registry. METHODS: Patients implanted with a contemporary continuous flow (CF)-LVAD were stratified into 4 groups using pre-operative BMI: underweight (UW; BMI ≤18...
October 2018: Journal of Heart and Lung Transplantation
Lena Wiegmann, Bente Thamsen, Diane de Zélicourt, Marcus Granegger, Stefan Boës, Marianne Schmid Daners, Mirko Meboldt, Vartan Kurtcuoglu
Ventricular assist devices (VADs), among which the HeartMate 3 (HM3) is the latest clinically approved representative, are often the therapy of choice for patients with end-stage heart failure. Despite advances in the prevention of pump thrombi, rates of stroke and bleeding remain high. These complications are attributed to the flow field within the VAD, among other factors. One of the HM3's characteristic features is an artificial pulse that changes the rotor speed periodically by 4000 rpm, which is meant to reduce zones of recirculation and stasis...
August 21, 2018: Artificial Organs
Yorihiko Matsumoto, Tomoyuki Fujita, Satsuki Fukushima, Osamu Seguchi, Masanobu Yanase, Yumiko Hori, Takako Nakaya, Norihide Fukushima, Junjirou Kobayashi
From 2005, 124 patients have received implantable left ventricular assist device (iVAD) in our institute, including HeartMate II (84), EVAHEART (17), Jarvik2000 (13), DuraHeart (9), HVAD (1). At February 2018, 60 patients were waiting for heart transplant with iVAD support. Multi-specialist team consisted of clinical engineer, VAD management specialist, nurse, transplant coordinator for recipient and physicians provide patients care. Thirty one percents returned to their social activity after iVAD implantation...
July 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Leonhard Wert, Jasmin S Hanke, Günes Dogan, Marcel Ricklefs, Anamika Chatterjee, Christina Feldmann, Issam Ismail, L Christian Napp, Axel Haverich, Jan D Schmitto
Background: Device thrombosis is one of the main complications in left ventricular assist devices (LVAD) therapy and remains a challenging issue. Data on device thrombosis management, especially on the application of direct thrombin inhibitors such as argatroban, is limited and a consensus on thrombosis management has not yet been established. Methods: In this study we analysed retrospective clinical data obtained from 26 patients on VAD therapy who received argatroban for suspected VAD thrombosis, between April, 2012 and February, 2017...
June 2018: Journal of Thoracic Disease
Leonhard Wert, Anamika Chatterjee, Günes Dogan, Jasmin S Hanke, Dietmar Boethig, Kirstin A Tümler, L Christian Napp, Dominik Berliner, Christina Feldmann, Christian Kuehn, Andreas Martens, Malakh L Shrestha, Axel Haverich, Jan D Schmitto
Background: Left ventricular assist device (LVAD) (HVAD, Medtronic, Minneapolis, MN, USA) implantation is already a widely accepted treatment option for end-stage heart failure (HF) but also still considered as a rescue therapy for patients suffering from cardiogenic shock. Standard LVAD implantation techniques are often associated with high mortality rates and can result in severe complications, like bleeding or right heart failure (RHF). The aim of our study was to assess the outcome of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 patients (so called "crash and burn" patients) undergoing a LVAD implantation by standard or less invasive surgery...
June 2018: Journal of Thoracic Disease
Robert F Riley, James M McCabe, Sanjog Kalra, Mohamad Lazkani, Ashish Pershad, Darshan Doshi, Ajay J Kirtane, William Nicholson, Katherine Kearney, Tony Demartini, J Aaron Grantham, Jeffrey Moses, William Lombardi, Dimitri Karmpaliotis
INTRODUCTION: Patients with coronary chronic total occlusions (CTO) often have concurrent higher-risk anatomy and physiology (significant calcium, left ventricular dysfunction, multivessel disease) that increase their procedural risk. We present a retrospective multicenter case series describing use of the Impella percutaneous ventricular assist device (p-VAD) during CTO PCI. METHODS: We performed a retrospective analysis of self-reported data from five large referral centers from 2013 to 2017 and identified patients that underwent elective, hemodynamically supported CTO PCI with the Impella p-VAD device (2...
July 18, 2018: Catheterization and Cardiovascular Interventions
Phillip A Coghill, Suren Kanchi, Zheila J Azartash-Namin, James W Long, Trevor A Snyder
Gastrointestinal bleeding occurs in 20-30% of patients receiving ventricular assist devices (VADs) due, in part, to acquired von Willebrand syndrome. We examined factors to optimize a benchtop method to quantify changes in von Willebrand Factor (VWF) multimer distribution and function in VADs, then applied them to evaluate commercially available devices. Human plasma was circulated through flow loops with VADs. Several experimental conditions were examined, including temperature, viscosity, and enzyme inhibition...
July 12, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Anastasios Petrou, Menelaos Kanakis, Stefan Boes, Panagiotis Pergantis, Mirko Meboldt, Marianne Schmid Daners
OBJECTIVE: We present a novel machine learning model to accurately predict the blood-analog viscosity during support of a pathological circulation with a rotary ventricular assist device (VAD). The aim is the continuous monitoring of the hematocrit (HCT) of VAD patients with the benefit of a more reliable pump flow estimation and a possible early detection of adverse events, such as bleeding or pump thrombosis. METHODS: A large dataset was generated with a blood pump connected to a hybrid mock circulation by varying the pump speed, the physiological requirements of the modeled circulation, and the viscosity of the blood-analog...
October 2018: IEEE Transactions on Bio-medical Engineering
S Buchholz, S P W Guenther, S Michel, R Schramm, C Hagl
End-stage heart failure is associated with significant morbidity and mortality. Heart transplantation has the potential to offer a return to daily activities for critically ill patients and is the gold standard therapy. However, heart transplantations are decreasing yearly with a historic low in Germany in 2017. By striking contrast, both waiting list numbers and waiting time have increased owing to a lack of acceptable donor organs. Ventricular assist devices (VAD) represent a reasonable therapeutic alternative for patients on heart transplantation waiting lists...
August 2018: Herz
Olutosin J Akanni, Koji Takeda, Lauren K Truby, Paul A Kurlansky, Codruta Chiuzan, Jiho Han, Veli K Topkara, Melana Yuzefpolskaya, Paolo C Colombo, Dimitrios Karmpaliotis, Jeffery W Moses, Yoshifumi Naka, A Reshad Garan, Ajay J Kirtane, Hiroo Takayama
Combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and a percutaneous microaxial left ventricular assist device (pLVAD), or "EC-VAD," has been reported in cases of left ventricular decompression with mixed results. We conducted a retrospective review of patients who received EC-VAD (n = 29) or isolated VA-ECMO therapy (ECMO-only; n = 196) for refractory cardiogenic shock between February 2011 and October 2014. Fourteen patients received VA-ECMO and then Impella pLVAD (E→EC-VAD), and 15 received the Impella pump then VA-ECMO (I→EC-VAD)...
April 19, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Grant W Rowlands, Bryan C Good, Steven Deutsch, Keefe B Manning
Ventricular assist devices (VADs) are implanted in patients with a diseased ventricle to maintain peripheral perfusion as a bridge-to-transplant or as destination therapy. However, some patients with continuous flow VADs (e.g., HeartMate II (HMII)) have experienced gastrointestinal (GI) bleeding, in part caused by the proteolytic cleavage or mechanical destruction of von Willebrand factor (vWF), a clotting glycoprotein. in vitro studies were performed to measure the flow located within the HMII outlet cannula under both steady and physiological conditions using particle image velocimetry (PIV)...
July 1, 2018: Journal of Biomechanical Engineering
V Cestari, V L Pessoa, J D de Souza Neto, T Moreira, R Florêncio, G G de Vasconcelos, L Souza, A Braga, M G Sobral
OBJECTIVE: To evaluate the clinical evolution of patients with implantation of ventricular assist device (VAD) and identify the intervening factors for death. METHODS: This analytical, retrospective study was carried out in a public reference hospital in cardiopulmonary diseases located in northeastern Brazil. The study population encompassed the medical records of 16 patients who underwent VAD implantation. Data collection took place from January to August 2016, through the consultation of medical records...
April 2018: Transplantation Proceedings
Nathan McClane, Walter Jeske, Jeanine M Walenga, Vicki Escalante, Debra Hoppensteadt, Jeffrey Schwartz, Mamdouh Bakhos
Heart failure affects over 5 million people in the United States. Its rising prevalence and the limited supply of donor hearts is increasing the use of mechanical cardiac support with the implantation of continuous-flow ventricular assist devices (CF-VAD). Patients with CF-VAD implants are at risk of complications, specifically adverse hemostatic events such as nonsurgical bleeding and thrombosis. Development of a pump thrombus requires clinical intervention and/or surgical replacement significantly increasing the risk of patient morbidity and mortality...
September 2018: Clinical and Applied Thrombosis/hemostasis
Ina Laura Pieper, Gemma Radley, Abigail Christen, Sabrina Ali, Owen Bodger, Catherine A Thornton
Ventricular assist devices (VADs) are a life-saving form of mechanical circulatory support in heart failure patients. However, VADs have not yet reached their full potential due to the associated side effects (thrombosis, bleeding, infection) related to the activation and damage of blood cells and proteins caused by mechanical stress and foreign materials. Studies of the effects of VADs on leukocytes are limited, yet leukocyte activation and damage including microparticle generation can influence both thrombosis and infection rates...
June 2018: Artificial Organs
Joanna Y Huang, Paul Monagle, M Patricia Massicotte, Christina J VanderPluym
INTRODUCTION: Ventricular Assist Devices (VADs) are increasingly utilised in children with end-stage heart failure, and experience high bleeding and clotting rates. In particular, pediatric VAD patients are more challenging than adults to anticoagulate due to developmental hemostasis, lack of suitable drug preparations, and difficult anticoagulation monitoring often due to poor vascular access; in addition to difficulties of VAD design in smaller children. This review aims to summarize the current evidence related to antithrombotic therapy in pediatric VAD patients...
February 28, 2018: Thrombosis Research
Roland Hetzer, Mariano Francisco Del Maria Javier, Eva Maria Delmo Walter
Background: While heart transplantation has gained recognition as the gold standard therapy for advanced heart failure, the scarcity of donor organs has become an important concern. The evolution of surgical alternatives such as ventricular assist devices (VADs), allow for recovery of the myocardium and ensure patient survival until heart transplantation becomes possible. This report elaborates the role of VADs as a bridge to heart transplantation in infants and children (≤18 years old) with end-stage heart failure...
January 2018: Annals of Cardiothoracic Surgery
Ann C Gaffey, Carol W Chen, Jennifer J Chung, Jason Han, Christian A Bermudez, Joyce Wald, Pavan Atluri
BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVAD) have become the standard of care for patients with end stage heart failure. Device reliability has increased, bringing the potential for VAD, compared to transplant, into debate. However, complications continue to limit VADs as first line therapy. Bleeding is a major morbidity. A debate exists as to the difference in bleeding profile between the major centrifugal and axial flow devices. We hypothesized that there would be similar adverse bleeding event profiles between the 2 major CF-LVADs...
February 13, 2018: Journal of Cardiothoracic Surgery
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