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ventricular assist device bleeding

Abby W Hickman, Nick W Lonardo, Mary C Mone, Angela P Presson, Chong Zhang, Richard G Barton, Craig H Selzman, Stavros G Drakos, Antigone Koliopoulou, Stephen H McKellar
BACKGROUND: The high incidence of gastrointestinal bleeding (GIB) in patients with ventricular assist devices (VAD) is well known, but there is limited evidence to support the use of proton pump inhibitors (PPIs) or histamine receptor antagonists (H2RA) for preventing GIB in patients with VAD. MATERIALS AND METHODS: The surgical ICU and VAD databases within a large regional academic cardiac mechanical support and transplant center were queried for patients who underwent VAD implantation between 2010 and 2014...
February 2019: Journal of Surgical Research
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No abstract text is available yet for this article.
November 2018: Circulation. Heart Failure
Anthony P Carnicelli, Anjali Thakkar, David J Deicicchi, Andrew C Storm, Jessica Rimsans, Jean M Connors, Mandeep R Mehra, John D Groarke, Michael M Givertz
Gastrointestinal bleeding (GIB) occurs in up to 40% of patients with continuous-flow (CF) left ventricular assist devices (LVADs). We sought to identify targets to improve hospital resource utilization and decrease readmissions after GIB. We performed a single-center, retrospective analysis of LVAD-associated GIB resulting in hospital admission between July 2011 and April 2014. Follow-up data were collected through March 2015. We analyzed 57 admissions for GIB in 23 patients. One or more diagnostic imaging study was performed in 47% of admissions, with a definite or probable source of GIB identified in 23%...
December 6, 2018: Journal of Thrombosis and Thrombolysis
Brendan P Chou, Harveen K Lamba, Faisal H Cheema, Andrew B Civitello, Reynolds M Delgado, Leo Simpson, Ajith P Nair, Selby Oberton, Ziad A Taimeh, Todd K Rosengart, O H Frazier, Jeffrey A Morgan
Implantable continuous-flow left ventricular assist devices (CF-LVADs) are used for long-term LV support in bridging patients to heart transplantation or as destination therapy. With prolonged support times, some patients will have repeat complications necessitating multiple device exchanges. To elucidate the safety and efficacy of repeat device exchange, we retrospectively reviewed data from 25 patients who underwent two or more CF-LVAD implantations between July 2005 and August 2017. Indications for exchange were thrombus/hemolysis (n = 8, 32%), electromechanical device malfunction (n = 14, 56%), and infection (n = 3, 12%)...
November 28, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Rachel Sara Bercovitz
There is a delicate balance between bleeding and clotting in patients on circuits such as ventricular assist devices or extracorporeal membrane oxygenation. Traditional coagulation tests, prothrombin time, activated partial thromboplastin time, and anti-factor Xa levels, are used to monitor patients on these devices. However, turnaround times and inability to assess global hemostasis, including platelets and fibrinogen have contributed to a recognition that faster, accurate, and more informative coagulation tests are needed...
November 30, 2018: Hematology—the Education Program of the American Society of Hematology
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
Katherine L Wood, Brian Ayers, Fabio Sagebin, Himabindu Vidula, Sabu Thomas, Jeffrey Alexis, Bryan Barrus, Peter Knight, Sunil Prasad, Igor Gosev
BACKGROUND: Left ventricular assist device (LVAD) therapy has been the standard of care for selected patients with advance heart failure. Even though considerable strides have been achieved with the introduction of the newest centrifugal pump, therapy is still burdened with significant perioperative complications. Smaller devices along with improved techniques and instruments have encouraged the adoption of minimally invasive cardiac surgery (MICS) techniques for LVAD implantation to improve perioperative outcomes...
November 13, 2018: Annals of Thoracic Surgery
Prashant N Mohite, Anton Sabashnikov, Binu Raj, Rachel Hards, Gemma Edwards, Diana García-Sáez, Bartlomiej Zych, Mubassher Husain, Anand Jothidasan, Javid Fatullayev, Mohamed Zeriouh, Alexander Weymann, Aron-Frederik Popov, Fabio De Robertis, André R Simon
Left ventricular assist device (LVAD) is now a routine therapy for advanced heart failure. Minimally invasive approach via thoracotomy for LVAD implantation is getting popular due to its potential advantage over the conventional sternotomy approach in terms of reduced risk at re-operation due to sternal sparing. We compared the approaches (thoracotomy and sternotomy) to determine the superiority. Minimally invasive approach involved fitting of the LVAD inflow cannula into left ventricle apex via left anterior thoracotomy and anastomosis of outflow graft to ascending aorta via right anterior thoracotomy...
November 15, 2018: Artificial Organs
Ryan P McKillip, Anand Gopalsami, Magdeline Montoya, Gene Kim, James J Walter, Colleen Juricek, Eric Shappell
Introduction: Left ventricular assist device (LVAD) insertion is an increasingly common intervention for patients with advanced heart failure; however, published literature on the emergency department (ED) presentation of this population is limited. The objective of this study was to characterize ED presentations of patients with LVADs with a focus on device-specific complications to inform provider education and preparation initiatives. Methods: This was a retrospective chart review of all patients with LVADs followed at an urban academic medical center presenting to the ED over a five-year period (July 1, 2009, to June 30, 2014)...
November 2018: Western Journal of Emergency Medicine
Alana M Ciolek, Audrey J Littlefield, Douglas L Jennings
Continuous-flow left-ventricular assist devices (CF-LVADs) are an option for patients with end-stage heart failure requiring durable mechanical circulatory support. Two of the older-generation CF-LVADs have been associated with multiple device-related complications, including bleeding and thrombosis. The newest generation CF-LVAD, the HeartMate 3, was engineered specifically to prevent device-related thrombosis. As more data enhance our understanding of the burden of bleeding and thrombotic adverse events, patients with durable mechanical circulatory support may require less-aggressive antithrombotic therapy...
November 8, 2018: Annals of Pharmacotherapy
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
Rushikesh Shah, Emad Qayed
OBJECTIVES: Gastrointestinal (GI) bleeding is a major comorbidity in patients with left ventricular assist devices (LVADs). The study aim was to estimate the rate of hospital readmissions for GI bleeding in patients with LVADs using a nationally representative database. Additionally, we evaluated the etiologies, costs, endoscopy utilization, mortality, and predictors of GI bleeding readmissions in these patients. METHODS: We analyzed data from the National Readmissions Database (NRD) from 2010 through 2014...
November 2018: Southern Medical Journal
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
Badr Al-Bawardy, Sarah D Schettle, Emmanuel Gorospe, Louis M Wong Kee Song, Naveen L Pereira, Jeffrey A Alexander, David H Bruining, Nayantara Coelho-Prabhu, Jeff L Fidler, William J Mauermann, David W Barbara, Ross Dierkhising, Elizabeth Rajan
Background: Small bowel bleeding (SBB) accounts for 30% of gastrointestinal bleeding (GIB) episodes in patients with a left ventricular assist device (LVAD). The aim of this study was to determine the outcomes of conservative therapy (CT) compared to balloon-assisted enteroscopy (BAE) in the management of SBB in LVAD patients. Methods: A retrospective review was performed of a prospectively maintained LVAD database from January 2003 to July 2015. LVAD patients with SBB were classified into a BAE group or a CT group according to whether they did or did not undergo BAE...
November 2018: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Teruhiko Imamura, Koichiro Kinugawa, Nir Uriel
Left ventricular assist device (LVAD) technology has improved the survival of advanced heart failure patients. However, readmission rates following LVAD implantation remain high and are an unsolved matter. Currently, gastrointestinal bleeding is one of the major causes of readmission and has recently been demonstrated to mainly result from increased angiogenesis. In addition to the conventional therapeutic strategies, including a reduction in antiplatelet and anticoagulation therapies and blood products administration, several therapeutic tools have recently been proposed: octreotide, thalidomide, hemodynamic optimization by the ramp test, and fish oil therapy...
October 27, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Yalini Vigneswaran, Victoria Wang, Monika Krezalek, Vivek Prachand, Stephen Wyers, Colleen Juricek, Nir Uriel, Valluvan Jeevanandam, Mustafa Hussain
BACKGROUND: Cardiac left ventricular assist device (LVAD) placement is a common therapy for heart failure. Non-cardiac surgical care of these patients can be complex given the need for anticoagulation, perioperative monitoring, comorbidities, and anatomical considerations due to the device itself. There are no guidelines or significant patient series reported to date for laparoscopic procedures in this population. We herein report the techniques and outcomes for commonly performed laparoscopic procedures in patients with LVADs at a high volume center...
October 26, 2018: Surgical Endoscopy
Dana Berg, Edward Lebovics, Masashi Kai, David Spielvogel
Heart failure affects over 5 million Americans, with numbers expected to rise. While heart transplantation is the most effective long-term strategy for end-stage heart failure, there is a limited cardiac donor pool, and these organs are often unavailable at the time of need. Left ventricular assist devices (LVADs), therefore, continue to be used to bridge this gap. Originally implanted as a bridge to transplant, these devices are now additionally utilized as destination therapy for patients ineligible for transplant...
October 25, 2018: Cardiology in Review
Sohaib A Virk, Arieh Keren, Roy M John, Pasquale Santagelli, Adam Eslick, Saurabh Kumar
Mapping of scar-related ventricular tachycardia (VT) in structural heart disease is fundamentally driven by identifying the critical isthmus of conduction that supports re-entry in and around myocardial scar. Mapping can be performed using activation and entrainment techniques during VT, or by substrate mapping performed in stable sinus or paced rhythm. Activation and entrainment mapping requires the patient to be in continuous VT, which may not be haemodynamically tolerated, or, if tolerated, may lead to adverse sequelae related to impaired end organ perfusion...
October 17, 2018: Heart, Lung & Circulation
Sasa Vukelic, Peter P Vlismas, Snehal R Patel, Xiaonan Xue, Sanyog G Shitole, Omar Saeed, Daniel B Sims, Thiru Chinnadurai, Julia J Shin, Stephen J Forest, Daniel J Goldstein, Ulrich P Jorde
BACKGROUND: Gastrointestinal bleeding (GIB) is one of the principal adverse events affecting patients with continuous-flow left ventricular assist devices (CF-LVADs). Despite the early recognition that GIB is commonly because of gastrointestinal angiodysplasia (GIAD), the exact pathophysiology of this process remains elusive. It has been postulated that the abnormal hemodynamic profile in CF-LVAD patients may activate the angiogenesis signaling cascade via the HIF (hypoxia-inducible factor)-1α/angiopoietin-2 pathway leading to formation of GIADs...
August 2018: Circulation. Heart Failure
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