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Luise Holzhauser, Jonathan R Rosenberg, Nir Uriel, Atman P Shah
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September 11, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Colleen K McIlvennan, Daniel D Matlock, Jocelyn S Thompson, Shannon M Dunlay, Laura Blue, Shane J LaRue, Eldrin F Lewis, Chetan B Patel, Diane L Fairclough, Erin C Leister, Keith M Swetz, Vicie Baldridge, Mary Norine Walsh, Larry A Allen
OBJECTIVES: This study aims to characterize caregivers of patients considering destination therapy left ventricular assist device (DT-LVAD) and evaluate the effectiveness of a shared decision-making (SDM) intervention. BACKGROUND: Caregivers play an integral role in the care of patients with chronic illness. At the extreme, pursuing a DT-LVAD is a major preference-sensitive decision that requires high-level caregiver engagement. Yet, little is known about caregivers of patients considering DT-LVAD, and there is a paucity of research on the involvement of caregivers in medical decision-making...
October 4, 2018: JACC. Heart Failure
Alexandros Briasoulis, Chakradhari Inampudi, Emmanuel Akintoye, Oluwole Adegbala, Jay Bhama, Paulino Alvarez
BACKGROUND: We sought to evaluate the effects of hospital ownership, classified into three tiers (nonfederal government, not-for-profit, and for-profit hospitals) on in-hospital outcomes after implantation of continuous-flow left ventricular assist devices (LVADs) in the United States from 2009 to 2014. METHODS: Using data from the National Inpatient Sample and the U.S. Census Bureau, annual national estimates in utilization, in-hospital mortality, major complications length-of-stay, cost of hospitalization, and disposition at discharge were estimated for years 2009-2014...
October 11, 2018: Annals of Thoracic Surgery
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
Lucman A Anwer, Salvatore Poddi, Vakhtang Tchantchaleishvili, Richard C Daly, Hadi Toeg, Jacob J Strand, John M Stulak, Simon Maltais
Despite the growing acceptance of left ventricular assist device (LVAD) therapy to improve survival and quality of life in heart failure (HF) patients, uncertainties persist regarding the definition of a successful implant. We sought to define an innovative approach to assess success and subsequently compare preoperative variables affecting outcomes. From January 2007 to 2015, 278 patients underwent LVAD implantation. Median age at implant was 62 years and 81% patients were males. Indication for support was bridge-to-transplantation in 36% patients and the etiology of HF was ischemic in 49% patients...
October 9, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Sadeer G Al-Kindi, Jassim Al-Suwaidi, Amin Jayyousi, Guilherme H Oliveira, Charbel Abi Khalil
Diabetes mellitus (DM) is associated with increased mortality in advanced heart failure and in patients undergoing cardiac surgery. However, its impact on outcomes in patients supported with left ventricular assist devices (LVAD) is not well established. We queried the United Network for Organ Sharing (UNOS) for all adults listed for heart transplantation and bridged with continuous-flow LVAD in the United States from 2000 to 2015. We compared the pre- and post-transplant mortality of patients with and without DM...
October 9, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Sung-Min Cho, Tiffany Lee, Randall C Starling, Nicolas R Thompson, Ken Uchino
Despite the common occurrence left ventricular assist device (LVAD)-associated intracranial hemorrhage, the etiology of intracranial hemorrhage is uncertain. We aim to explore the impact of infection and international normalized ratio (INR) on intracranial hemorrhage in a case-crossover study. We reviewed consecutive patients with intracranial hemorrhage in a prospectively collected data of LVAD patients from a single, tertiary center from October 2004 to December 2016. Information on infection and INR values were collected at the time and 1 month before the intracranial hemorrhage as controls...
October 9, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Michael Salna, Yasuhiro Shudo, Jeffrey J Teuteberg, Dipanjan Banerjee, Richard V Ha, Y Joseph Woo, William Hiesinger
INTRODUCTION: The planned use of a temporary right ventricular assist device (RVAD) at the time of left ventricular assist device (LVAD) implantation may prevent the need for a permanent biventricular assist device (BiVAD). Herein we describe our RVAD weaning protocol that was effectively employed in 4 patients to prevent the need for permanent BiVAD. METHODS: Four patients in refractory cardiogenic shock underwent planned RVAD insertion during LVAD implantation due to severely depressed right ventricular function with dilation preoperatively...
October 1, 2018: Heart Surgery Forum
Pavol Sajgalik, Chul-Ho Kim, John M Stulak, Sudhir S Kushwaha, Simon Maltais, David L Joyce, Lyle D Joyce, Bruce D Johnson, John A Schirger
AIM: The lungs-and particularly the alveolar-capillary membrane-may be sensitive to continuous flow (CF) and pulmonary pressure alterations in heart failure (HF). We aimed to investigate long-term effects of CF pumps on respiratory function. METHODS AND RESULTS: We conducted a retrospective study of patients with end-stage HF at our institution. We analysed pulmonary function tests [e.g. forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1 )] and diffusing capacity of the lung for carbon monoxide (DLCO ) from before and after left ventricular assist device (LVAD) implantation and compared them with invasive haemodynamic studies...
October 12, 2018: ESC Heart Failure
Roland Graefe, Christof Beyel, Andreas Henseler, Reiner Körfer, Ulrich Steinseifer, Gero Tenderich
Current left ventricular assist devices (LVADs) differ with respect to their pump characteristics as described by the pump characteristic curve (also called HQ-curve). Pressure sensitive LVADs depict a flat characteristic curve while most available LVADs have a steep, less pressure sensitive characteristic curve. This in vitro study investigated the effect of LVAD pressure sensitivity with a focus on the afterload of the right ventricle (RV) which is one out of many factors influencing right heart failure (RHF)...
October 11, 2018: Artificial Organs
Behnam Ghadimi, Amir Nejat, Seyed Ahmad Nourbakhsh, Nasim Naderi
A centrifugal blood pump is a common type of pump used as a left ventricular assist device in the medical industries. Therefore, the improvement of the device bio-compatibility to reduce the blood damage and to increase the efficiency has become a major challenge. In the current work, a metamodel-assisted genetic algorithm is employed to simultaneously optimize the impeller and volute geometries of a typical centrifugal blood pump. The overall shape of the base design is inspired from HeartMate3 LVAD, and the main dimensions of the base design including inlet and outlet radius, blade angle distribution, volute cross-section area distribution, etc...
October 11, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
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
Mario Naranjo, Kevin Bryan Lo, Kenechukwu Mezue, Janani Rangaswami
Pulmonary hypertension is not uncommon in patients with renal disease and vice versa; therefore, influences treatments and outcomes. There is a large body of literature on pulmonary hypertension in patients with kidney disease, its prognostic implications, economic burden, and management strategies. However, the converse, namely the hemodynamic effects of pulmonary hypertension on kidney function (acute and chronic kidney injury) is less studied and described. There is also increasing interest in the effects of pulmonary hypertension on kidney transplant outcomes...
October 8, 2018: Current Cardiology Reviews
Ioannis Loumiotis, Snehal R Patel, Daniel J Goldstein, Stephen J Forest
Cardiac recovery after left ventricular assist device (LVAD) implantation is rare. Recurrent heart failure after device explantation is also rare. We describe a patient who is the recipient of a third-generation LVAD due to recurrent heart failure nearly one decade after successfully being bridged to recovery after implantation of a first-generation LVAD.
October 10, 2018: Journal of Cardiac 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
Yoshiaki Uda, Leonid Minkovich, Maral Ouzounian, Massimiliano Meineri
Aortic valve (AV) or aortic root thrombus related to a left ventricular assist device (LVAD) is a relatively uncommon but potentially life-threatening complication. In the present report, we describe a complex case where echocardiographic diagnosis of AV thrombosis was obscured by the presence of mediastinal packing in a patient who underwent valve-sparing aortic root replacement and insertion of the CentriMag™ LVAD for postcardiotomy cardiogenic shock. A large AV thrombus may develop rapidly in patients with LVADs...
July 2018: Journal of Cardiovascular Echography
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
Binh N Pham, Sandra V Chaparro
Heart failure is a widespread condition in the United States that is predicted to significantly increase in prevalence in the next decade. Many heart failure patients are given a left ventricular assist device (LVAD) while they wait for a heart transplant, while those that are not able to undergo a heart transplant may be given an LVAD permanently. However, past studies have observed a small subset of heart failure patients that recovered cardiac function of their native heart after being placed on an LVAD...
October 9, 2018: Heart Failure Reviews
Mário Santos, Erin West, Hicham Skali, Daniel E Forman, Wilson Nadruz, Amil M Shah
BACKGROUND: We studied the relationship between resting HR, chronotropic response to exercise, and clinical outcomes in patients with HF across the spectrum of left ventricle ejection fraction (LVEF). METHODS: Resting HR and chronotropic index (CIx) were assessed in 718 patients with HF (53±14 years, 66% male) referred for exercise testing. Associations with the composite outcome of LVAD implantation, transplantation, or death (151 events; 4.4 [3.0-5.8] years of follow-up) were assessed by Cox models adjusted for age, sex, HF etiology, diabetes, LVEF, beta-blocker use, device therapy, eGFR and peak VO2 ...
October 6, 2018: Journal of Cardiac Failure
Massimiliano Carrozzini, Jonida Bejko, Antonio Gambino, Vincenzo Tarzia, Corrado Lanera, Dario Gregori, Gino Gerosa, Tomaso Bottio
AIMS: We analysed the outcomes with the use of a new-generation continuous-flow left ventricular assist device (CF-LVAD) as a bridge-to-transplant (BTT). MATERIALS AND METHODS: We included all patients implanted with an intrapericardial CF-LVAD as BTT, between January 2012 and December 2016. Primary outcomes were overall survival, survival on waiting list and postheart transplant (HTx) survival. The outcomes after HTx were compared with those of a contemporary cohort of patients transplanted without previous CF-LVAD (No-LVAD group, n = 73)...
October 8, 2018: Journal of Cardiovascular Medicine
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