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VAD bleeding

Thomas A Haglund, Namakkal S Rajasekaran, Benjamin Smood, Guruprasad A Giridharan, Charles W Hoopes, William L Holman, David C Mauchley, Sumanth D Prabhu, Salpy V Pamboukian, Jose A Tallaj, Indranee N Rajapreyar, James K Kirklin, Palaniappan Sethu
BACKGROUND: Continuous-flow ventricular assist devices (CF-VADs) produce non-physiologic flow with diminished pulsatility, which is a major risk factor for development of adverse events, including gastrointestinal (GI) bleeding and arteriovenous malformations (AVMs). Introduction of artificial pulsatility by modulating CF-VAD flow has been suggested as a potential solution. However, the levels of pulsatility and frequency of CF-VAD modulation necessary to prevent adverse events are currently unknown and need to be evaluated...
November 2, 2018: Journal of Heart and Lung Transplantation
Joanna Y Huang, Vera Ignjatovic, Bennett J Sheridan, Jacob Mathew, Yves D'Udekem, Johann Brink, Rebecca Barton, Gabrielle Callea, Dominique Morsman, Susan Donath, Stephen Opat, Paul Monagle
INTRODUCTION: Durable Ventricular Assist Devices (VADs) are increasingly used in children with end-stage heart failure. Major complications are bleeding and thromboembolism (TE). Our objective was to determine the timing, incidence and risk factors for bleeding and TE in children implanted with VADs. METHODS: This was a retrospective cohort of 8 years experience for children implanted with HeartWare HVAD and Berlin Heart EXCOR VADs at the Royal Children's Hospital, Melbourne...
November 22, 2018: Thrombosis Research
O Seguchi, K Kuroda, Y Kumai, S Nakajima, M Yanase, K Wada, Y Matsumoto, S Fukushima, T Fujita, J Kobayashi, N Fukushima
BACKGROUND: Left ventricular assist device (LVAD) therapy is the "gold standard" alternative therapy for patients with advanced heart failure. However, LVAD therapy is still uncommon in the Asia-Pacific region. Therefore, we aimed to elucidate the clinical outcomes of patients from Japan supported with the HeartMate II (HM-II) LVAD at our institution. METHODS: Ninety-two patients (mean 44.3 ± 12.1 years, 68 men, average body mass index 1.65 ± 0.28 m2 ; 81 with nonischemic cardiomyopathy) who underwent HM-II implantation for bridge to transplantation (n = 91) or for destination therapy in a clinical study (n = 1) at the National Cerebral and Cardiovascular Center between April 2013 and October 2017 were enrolled in this analysis...
November 2018: Transplantation Proceedings
Christina J VanderPluym, Iki Adachi, Robert Niebler, Eric Griffiths, Francis Fynn-Thompson, Sharon Chen, Matthew J O'Connor, Desiree Machado, Beth Hawkins, Mark S Bleiweis, Devin A Koehl, Ryan S Cantor, David Morales, Angela Lorts
BACKGROUND: Since 2012, there has been growing use of the HeartWare (Medtronic, Mounds View, MN) intracorporeal continuous flow (CF) ventricular assist device (VAD) in children, despite it not being labeled for use in pediatric patients. We sought to describe the use and outcomes of children with HeartWare VADs. METHODS: We identified all patients aged < 19 years and young adults aged 19 to 30 years supported with HeartWare who were entered into the pediatric portion (Pedimacs) of the Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) and the Intermacs registries, respectively, between September 2012 and June 2017...
September 25, 2018: Journal of Heart and Lung Transplantation
Jennifer J Chung, Robert Stetson, Jonathan Gordon, Carol W Chen, Ann C Gaffey, Jesus Eduardo Rame, Michael Acker, Pavan Atluri
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. This was a single institution, retrospective cost analysis of patients who received a Heartmate II or HeartWare LVAD between November 2005 and October 2015. Payments for hospitalization for device implantation and subsequent readmissions were represented as the institution's 2015 Medicare reimbursement rate...
October 9, 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
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