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ventricular assist device bleeding

Yu Xia, Stephen Forest, Patricia Friedmann, Lin-Chiang Chou, Snehal Patel, Ulrich Jorde, Daniel Goldstein
BACKGROUND: Limited data exists on factors predicting prolonged survival in left ventricular assist device (LVAD) recipients. We sought to identify patient characteristics and complications associated with prolonged survival. METHODS: We conducted retrospective review of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), including primary continuous flow LVAD recipients between May 2012 and March 2013. Patients were identified as having survived with a device in place after three years or not conditional on having initially survived six months...
October 11, 2018: Annals of Thoracic Surgery
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
William Sage, Amulya Gottiparthy, Paul Lincoln, Steven S L Tsui, Stephen J Pettit
Patients supported with implantable left ventricular assist devices (LVAD) have a significant risk of bleeding and thromboembolic complications. All patients require anticoagulation with warfarin, aiming for a target international normalised ratio (INR) of 2.5 and most patients also receive antiplatelet therapy. We found marked variation in the frequency of INR measurements and proportion of time outside the therapeutic INR range in our LVAD-supported patients. As part of a quality improvement initiative, home INR monitoring and a networked electronic database for recording INR results and treatment decisions were introduced...
2018: BMJ Open Quality
Rashad Zayat, Usaama Ahmad, Christian Stoppe, Mohammad Amen Khattab, Fateh Arab, Ajay Moza, Lachmandath Tewarie, Andreas Goetzenich, Rüdiger Autschbach, Heike Schnoering
Low-level hemolysis (LLH) after left ventricular assist device implantation contributes to thromboembolic events (TE). Free plasma hemoglobin (fHb) scavenges nitric oxide (NO), which causes endothelial dysfunction and activates platelets. fHb also interacts with von Willebrand factor (vWF). We hypothesized that improved hemodynamic and enhanced NO signaling in HeartMate II (HMII) patients with LLH taking the phosphodiesterase-5 inhibitor sildenafil may reduce the risk of TE.From 2011 to 2015, 83 patients underwent HMII implantation...
October 10, 2018: International Heart Journal
Hisanori Horiuchi
The von Willebrand factors (VWFs) play critical role in hemostasis and thrombosis formation. VWFs are produced in and secreted as large multimers from endothelial cells, and shear stress-dependently cleaved into 2-80 multimers by their specific protease, ADATS13. Because high molecular weight VWFs play important roles in platelet aggregation, the loss of high molecular weight VWFs caused by pathological high-shear stress induces a hemostatic disorder known as acquired von Willebrand syndrome (AVWS) type IIA...
2018: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
John Hui, William J Mauermann, John M Stulak, Andrew C Hanson, Simon Maltais, David W Barbara
BACKGROUND: Previous studies on readmissions after left ventricular assist device (LVAD) implantation have focused on hospital readmissions after dismissal from the index hospitalization. Because few data exist, the purpose of this study was to examine intensive care unit (ICU) readmissions in patients during their initial hospitalization for LVAD implantation to determine reasons for, factors associated with, and incidence of mortality after ICU readmission. METHODS: A retrospective analysis was performed from February 2007 to March 2015 of patients at our institution receiving first-time LVAD implantation...
October 8, 2018: Anesthesia and Analgesia
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
Paul A Gurbel, Palak Shah, Shashank Desai, Udaya S Tantry
Despite improvements in left ventricular assist device (LVAD) technology, bleeding and thrombotic complications are major concerns that adversely influence morbidity and mortality. Current antithrombotic therapy recommendations for LVAD thrombosis prophylaxis are largely derived from clinical device trials that implement a one-size-fits-all strategy. Objective serial laboratory-based assessment of thrombogenicity is needed to balance the risk of bleeding and thrombotic complications. Finally, the newest-generation device, the HeartMate 3, has been associated with lower levels of shear and reduced hemolysis that may mitigate thrombotic event occurrences...
November 2018: Cardiology Clinics
Ju H Kim, Donald F Brophy, Keyur B Shah
Continuous-flow (CF) left ventricular assist devices (LVADs) are a safe and durable therapeutic option for patients with advanced heart failure as a bridge to transplant or as destination therapy. Despite the remarkable technological advances in device design and increasing familiarity with the physiologic effects of CF, major complications such as gastrointestinal bleeding (GIB) continue to cause significant morbidity. The causes underlying CF-LVAD-related GIB are multifactorial. Accordingly, management strategies for CF-LVAD-related GIB encompass a wide range of therapeutic modalities...
November 2018: Cardiology Clinics
Mat Goebel, Christopher Tainter, Christopher Kahn, James V Dunford, John Serra, Jodie Pierce, J Joelle Donofrio
BACKGROUND: Left ventricular assist devices (LVADs) are used with increasing frequency and left in place for longer periods of time. Prior publications have focused on the mechanics of troubleshooting the device itself. We aim to describe the epidemiology of LVAD patient presentations to emergency medical services (EMS), prehospital assessments and interventions, and hospital outcomes. METHODS: This is a retrospective chart review of known LVAD patients belonging to a single academic center's heart failure program who activated the 9-1-1 system and were transported by an urban EMS system to one of the center's two emergency departments between January 2012 and December 2015...
October 4, 2018: Prehospital Emergency Care
Lindsay J May, Angela Lorts, Christina VanderPluym, Jennifer Conway, M Patricia Massicotte, Morgan M Millar, Marie E Steiner, David N Rosenthal
Management of antithrombotic therapy (ATT) for pediatric ventricular assist devices is challenging, and the Berlin EXCOR remains the only FDA-approved option. Among those on the EXCOR, 28% have neurologic complications and major bleeding occurs in 50%. The Edmonton Protocol was developed to guide ATT, but the adverse event rate remains high, leading most centers to make modifications. The objective of this study is to characterize antithrombotic practice variation among North American pediatric ventricular assist device programs, in order to guide future research...
September 12, 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
Quan M Bui, Oscar O Braun, Michela Brambatti, Yan K Gernhofer, Holly Hernandez, Victor Pretorius, Eric Adler
BACKGROUND: The Stanford integrated psychosocial assessment for transplantation (SIPAT) is a validated psychosocial evaluation tool in the transplant population. OBJECTIVE: We evaluated SIPAT in predicting post-left ventricular assist device (LVAD) outcomes, including cumulative re-admissions, driveline infections, pump malfunction, pump thrombosis, gastrointestinal bleeding, major bleeding, stroke and right ventricular failure. METHODS: This retrospective study included 50 LVAD patients at an academic institution in the United States who had a pre-implant SIPAT score during the years 2015-2017...
September 15, 2018: Heart & Lung: the Journal of Critical Care
Cenk Oezpeker, Armin Zittermann, Daniela Baurichter, Michel Morshuis, Wolfgang Prohaska, Astrid Kassner, Gülsüm Erkilet, Jan Gummert, Hendrik Milting
BACKGROUND: The associations between mechanical circulatory support (MCS), acquired von Willebrand syndrome (AvWS), and clinical outcome are incompletely understood. METHODS: In 128 heart failure patients with pulsatile MCS implants (65 total artificial heart or biventricular assist device implants, 63 left ventricular assist device [LVAD] implants) and 76 patients with continuous flow LVAD implants, we analyzed the von Willebrand factor (vWF) profile before (≤24 h) and 17...
October 2018: Journal of Cardiac Surgery
Sarah Schettle, Thomas Schlöglhofer, Daniel Zimpfer, Heinrich Schima, Friedrich Kaufmann, Anthony Salimbangon, Jennifer Wolforth, Sarah Schroeder, Rachel Hards, Brianne Ritchie, Linda Staley, Naveen Pereira, Sudhir Kushwaha, Simon Maltais, John Stulak
International normalized ratio (INR) measurements manage risks of bleeding and clotting sequelae in the population with left ventricular assist device (LVAD). Studies suggest that point-of-care (POC) INR does not significantly differ from plasma INR (P-INR) values in other patient populations, although this has not been validated in a multicenter LVAD study. We sought to determine whether POC-INR and P-INR values differ significantly in the LVAD population and reviewed patients with permanent LVAD implantation at seven institutions internationally...
June 28, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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
Yan K Gernhofer, Oscar O Braun, Michela Brambatti, Quan M Bui, Silva E Jorge, Barry H Greenberg, Eric Adler, Victor Pretorius
BACKGROUND: The optimal advanced heart failure (HF) therapy strategy for patients aged 60 or older with end-stage HF refractory to optimal medical therapy remains uncertain. This study compares outcomes of three advanced HF therapy strategies in this patient population. METHODS: A single-center retrospective study was conducted in 95 patients between the age of 60-73 years who had undergone isolated heart transplantation (HTx) or continuous flow left ventricular assist device (LVAD) implantation from 2010 to 2017...
August 29, 2018: Journal of Cardiovascular Surgery
Finn Gustafsson, Steven Shaw, Jacob Lavee, Diyar Saeed, Yuriy Pya, Thomas Krabatsch, Jan Schmitto, Michiel Morshuis, Joyce Chuang, Laura Damme, Daniel Zimpfer, Jens Garbade
Aims: The ELEVATE registry was planned to study post-approval outcomes with HeartMate 3™ (HM3), a fully magnetically levitated continuous flow left ventricular assist device (LVAD). Methods and results: A total of 482 patients provided consent to participate in ELEVATE (enrolled cohort). Data collection included baseline demographics, survival, adverse events, quality of life (QOL) [EuroQoL-5 Dimensions visual analogue scale (VAS), and 6-minute walk distance (6MWD)]...
October 1, 2018: European Heart Journal
L Baumann Kreuziger, K Karkouti, J Tweddell, M P Massicotte
Despite the development of catheter-based interventions for ischemic and valvular heart disease, hundreds of thousands of people undergo open heart surgery annually for coronary artery bypass graft (CABG), valve replacement or cardiac assist device implantation. Cardiac surgery patients are unique because therapeutic anticoagulation is required during cardiopulmonary bypass. Developmental hemostasis and altered drug metabolism affect management in children. This narrative review summarizes the current evidence-based and consensus guidelines regarding perioperative, intraoperative and postoperative antithrombotic therapy in patients undergoing cardiac surgery...
August 28, 2018: Journal of Thrombosis and Haemostasis: JTH
Saul A Rios, Claudio A Bravo, Michael Weinreich, Wilman Olmedo, Pedro Villablanca, Miguel Alvarez Villela, Harish Ramakrishna, Sameer Hirji, Octavio A Robles, Poonam Mahato, Christian Gluud, Deepak L Bhatt, Ulrich P Jorde
The intra-aortic balloon pump (IABP) and percutaneous ventricular assist devices (pVAD) are commonly used in different clinical scenarios. The goal of this study was to carry out a meta-analysis and Trial Sequential Analysis (TSA) comparing the IABP versus pVAD (TandemHeart and the Impella) during high-risk percutaneous coronary intervention (PCI) or cardiogenic shock (CS). Using PubMed, Cochrane Central Register of Controlled Trials, and EMBASE we searched for randomized clinical trials (RCTs) and nonrandomized studies that compared pVAD versus IABP in patients who underwent high-risk PCI or with CS...
July 24, 2018: American Journal of Cardiology
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