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https://www.readbyqxmd.com/read/29473181/bridging-to-a-long-term-ventricular-assist-device-with-short-term-mechanical-circulatory-support
#1
Chitaru Kurihara, Masashi Kawabori, Tadahisa Sugiura, Andre C Critsinelis, Suwei Wang, William E Cohn, Andrew B Civitello, O H Frazier, Jeffrey A Morgan
Implanting short-term mechanical circulatory support (MCS) devices as a bridge-to-decision is increasingly popular. However, outcomes have not been well studied in patients who receive short-term MCS before receiving long-term left ventricular assist device (LVAD) support. We analyzed outcomes in our single-center experience with long-term continuous-flow (CF)-LVAD recipients with pre-implantation short-term MCS. From November 2003 through March 2016, 526 patients (mean age, 54.7 ± 13.5 years) with chronic heart failure (mean ejection fraction, 21...
February 23, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29470280/blood-pressure-response-during-cardiopulmonary-exercise-testing-in-heart-failure
#2
Zachary J Il'Giovine, Nicole Solomon, Adam D DeVore, Daniel Wojdyla, Chetan B Patel, Joseph G Rogers
INTRODUCTION: The prognostic value of peak VO2 and VE/VCO2 slope measured during cardiopulmonary exercise (CPX) testing has been well established in patients with advanced heart failure, but blood pressure response to exercise is less well characterized. METHODS: We retrospectively studied 151 outpatients who underwent CPX testing as part of an advanced heart failure (HF) evaluation. The outcome of interest was failure of medical management, defined by death, cardiac transplantation, or left ventricular assist device placement...
February 21, 2018: Medicine and Science in Sports and Exercise
https://www.readbyqxmd.com/read/29470245/intra-aortic-balloon-pump-use-before-left-ventricular-assist-device-implantation-insights-from-the-intermacs-registry
#3
Adam D DeVore, Bradley G Hammill, Chetan B Patel, Manesh R Patel, Joseph G Rogers, Carmelo A Milano, Adrian F Hernandez
Use of durable, continuous-flow left ventricular assist devices (LVADs) has expanded rapidly, although data are limited regarding optimization strategies before LVAD implantation. We examined current use of intra-aortic balloon pumps (IABPs) before LVAD implantation and compared outcomes of patients with IABP use to those without. We analyzed data from the Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) on patients who underwent LVAD implantation between 2006 and 2014. We limited the analysis to patients with an admitting diagnosis of LVAD placement...
March 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29467331/pten-deficiency-promotes-pathological-vascular-remodeling-of-human-coronary-arteries
#4
Karen S Moulton, Marcella Li, Keith Strand, Shawna Burgett, Penn McClatchey, Rebecca Tucker, Seth B Furgeson, Sizhao Lu, Bruce Kirkpatrick, Joseph C Cleveland, Raphael A Nemenoff, Amrut V Ambardekar, Mary Cm Weiser-Evans
Phosphatase and tensin homolog (PTEN) is an essential regulator of the differentiated vascular smooth muscle cell (SMC) phenotype. Our goal was to establish that PTEN loss promotes SMC dedifferentiation and pathological vascular remodeling in human atherosclerotic coronary arteries and nonatherosclerotic coronary arteries exposed to continuous-flow left ventricular assist devices (CF-LVADs). Arteries were categorized as nonatherosclerotic hyperplasia (NAH), atherosclerotic hyperplasia (AH), or complex plaque (CP)...
February 22, 2018: JCI Insight
https://www.readbyqxmd.com/read/29465496/a-systematic-review-of-exercise-training-in-patients-with-cardiac-implantable-devices
#5
Afnan Hamad Alswyan, Ana Carolina Sauer Liberato, Cynthia M Dougherty
PURPOSE: This systematic review identified exercise-based intervention studies in patients with cardiac implantable devices (CIDs): implantable cardioverter defibrillator (ICD), cardiac resynchronization pacemaker or defibrillator (cardiac resynchronization therapy [CRT]), or ventricular assist device (VAD) and assessed evidence for the safety and efficacy of exercise-based interventions alone or in combination with psychoeducational components. METHODS: PubMed, EMBASE, CINAHL Plus, Web of Science, Cochrane, and PEDro databases were searched from database inception to September 2016...
March 2018: Journal of Cardiopulmonary Rehabilitation and Prevention
https://www.readbyqxmd.com/read/29465438/the-evolving-role-of-percutaneous-ventricular-assist-devices-in-high-risk-cardiac-patients
#6
Ilan A Marcuschamer, Aryeh Abelow, Ran Kornowski
The Impella is a mechanical circulatory support device that supports ventricular function. Since 2008, when the first Impella device received Food and Drug Administration clearance, its use has become increasingly prevalent. A variety of Impella devices are available, and are differentiated by size, power, and insertion techniques. These versions of the Impella have been used in a multitude of clinical scenarios, both emergent and elective, including high-risk coronary interventions, acute myocardial infarction complicated by cardiogenic shock, decompensated left and right heart failure, high-risk ventricular tachycardia ablations, and aortic valvuloplasty...
February 20, 2018: Coronary Artery Disease
https://www.readbyqxmd.com/read/29464441/left-heart-pressures-can-be-the-key-to-know-the-limitation-of-left-ventricular-assist-device-support-against-progression-of-aortic-insufficiency
#7
Kei Iizuka, Tomohiro Nishinaka, Noritsugu Naito, Daichi Akiyama, Yoshiaki Takewa, Kenji Yamazaki, Eisuke Tatsumi
Aortic insufficiency (AI) is a worrisome complication under left ventricular assist device (LVAD) support. AI progression causes LVAD-left ventricular (LV) recirculation and can require surgical intervention to the aortic valve. However, the limitations of LVAD support are not well known. Using an animal model of LVAD with AI, the effect of AI progression on hemodynamics and myocardial oxygen metabolism were investigated. Five goats (Saanen 48 ± 2 kg) underwent centrifugal type LVAD, EVAHEART, implantation...
February 20, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/29461305/transcatheter-aortic-valve-replacement-as-a-bridge-to-left-ventricular-assist-device-implantation
#8
Adham Elmously, Berhane Worku, Evelyn M Horn, Shing-Chiu Wong, Arash Salemi
We describe a case of the pre-emptive use of transcatheter aortic valve replacement in a patient with end-stage ischemic cardiomyopathy and native aortic stenosis/aortic insufficiency as a bridge to left ventricular assist device implantation. The use of this strategy can not only medically optimize patients before left ventricular assist device implantation but also provide a minimally invasive bridge to left ventricular assist device support, avoiding concomitant surgical aortic valve replacement or closure...
February 14, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29461279/individualized-antithrombotic-therapy-in-heartware-hvad-recipients
#9
Erik N Sorensen, Hannah J Voorhees, Lynn M Dees, Si M Pham, Zachary N Kon, Bartley P Griffith, Erika D Feller
There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and PFA-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29461278/home-inotropes-in-patients-supported-with-left-ventricular-assist-devices
#10
Emeka C Anyanwu, Viktoriya Kagan, Ankit Bhatia, David M Tehrani, Sirtaz Adatya, Gene Kim, Nitasha Sarswat, Valluvan Jeevanandam, Gabriel Sayer, Nir Uriel
There is little data outlining the use of outpatient inotropic medications in patients with existing left ventricular assist devices (LVADs). This case series explores this patient population and seeks to define the indications, complications, and safety of dual support. A retrospective chart review was conducted for all patients on LVAD and then subsequently started on home inotropes post device implant. Eight patients met inclusion criteria. The indications for inotropes were right ventricular failure, aortic insufficiency with biventricular failure, LVAD thrombosis with contraindication to device exchange, and cannula malposition with elevated pulmonary vascular resistance...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29461277/clinical-relevance-of-histopathologic-analysis-of-heartmate-ii-thrombi
#11
Lisa Baumann Kreuziger, Mark S Slaughter, Kartik Sundareswaran, Alan E Mast
Left ventricular assist device (LVAD) thrombosis is a devastating complication that occurs in about 10% of patients despite anticoagulation and antiplatelet treatment. How the thrombus initiates and propagates is unknown. We pathologically and immunohistochemically examined 28 thrombi removed from 17 HeartMate II LVADs. Two groups of thrombi were found: those formed in the inlet/outlet and those on the rotor. The four thrombi found at the inlet (three inlet conduit and one inlet tube) and outlet (three at outlet elbow and one outlet graft) appeared similar and were composed of a loose meshwork of fibrin(ogen), von Willebrand factor, leukocytes, and aggregated platelets...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29455273/updates-on-device-based-therapies-for-patients-with-heart-failure
#12
REVIEW
Jad Al Danaf, Javed Butler, Amin Yehya
PURPOSE OF REVIEW: Heart failure is a growing epidemic. Optimal medical therapy remains the cornerstone of heart failure management but device-based therapies have been shown to contribute to morbidity and mortality reduction. RECENT FINDINGS: Multiple investigational trials had been conducted in the past decade that helped us better understand and manage heart failure. In this manuscript, we will discuss the major device related trials of year 2017 in the fields of defibrillators, hemodynamic monitoring, remote monitoring, autonomic nervous system modulation, ventricular assist devices, and device-based valvular heart disease management...
February 17, 2018: Current Heart Failure Reports
https://www.readbyqxmd.com/read/29453695/temporary-assist-device-support-for-the-right-ventricle-pre-implant-and-post-implant-challenges
#13
REVIEW
Michael Dandel, Roland Hetzer
Severe right ventricular (RV) failure is more likely reversible than similar magnitudes of left ventricular (LV) failure and, because reversal of both adaptive remodeling and impaired contractility require most often only short periods of support, the use of temporary RV assist devices (t-RVADs) can be a life-saving therapy option for many patients. Although increased experience with t-RVADs and progresses made in the development of safer devices with lower risk for complications has improved both recovery rate of RV function and patient survival, the mortality of t-RVAD recipients can still be high but it depends mainly on the primary cause of RV failure (RVF), the severity of end-organ dysfunction, and the timing of RVAD implantation, and much less on adverse events and complications related to RVAD implantation, support, or removal...
February 17, 2018: Heart Failure Reviews
https://www.readbyqxmd.com/read/29452273/3d-bioprinted-functional-and-contractile-cardiac-tissue-constructs
#14
Zhan Wang, Sang Jin Lee, Heng-Jie Cheng, James J Yoo, Anthony Atala
Bioengineering of a functional cardiac tissue composed of primary cardiomyocytes has great potential for myocardial regeneration and in vitro tissue modeling. However, its applications remain limited because the cardiac tissue is a highly organized structure with unique physiologic, biomechanical, and electrical properties. In this study, we undertook a proof-of-concept study to develop a contractile cardiac tissue with cellular organization, uniformity, and scalability by using three-dimensional (3D) bioprinting strategy...
February 13, 2018: Acta Biomaterialia
https://www.readbyqxmd.com/read/29450594/position-paper-for-the-organization-of-ecmo-programs-for-cardiac-failure-in-adults
#15
Darryl Abrams, A Reshad Garan, Akram Abdelbary, Matthew Bacchetta, Robert H Bartlett, James Beck, Jan Belohlavek, Yih-Sharng Chen, Eddy Fan, Niall D Ferguson, Jo-Anne Fowles, John Fraser, Michelle Gong, Ibrahim F Hassan, Carol Hodgson, Xiaotong Hou, Katarzyna Hryniewicz, Shingo Ichiba, William A Jakobleff, Roberto Lorusso, Graeme MacLaren, Shay McGuinness, Thomas Mueller, Pauline K Park, Giles Peek, Vin Pellegrino, Susanna Price, Erika B Rosenzweig, Tetsuya Sakamoto, Leonardo Salazar, Matthieu Schmidt, Arthur S Slutsky, Christian Spaulding, Hiroo Takayama, Koji Takeda, Alain Vuylsteke, Alain Combes, Daniel Brodie
Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy for some of these indications, but there remains a need for additional evidence to guide best practices...
February 15, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29446208/study-rationale-design-and-pre-transplant-alloantibody-status-a-first-report-of-clinical-trials-in-organ-transplantation-in-children-04-ctotc-04-in-pediatric-heart-transplantation
#16
Warren A Zuckerman, Adriana Zeevi, Kristen L Mason, Brian Feingold, Carol Bentlejewski, Linda J Addonizio, Elizabeth D Blume, Charles E Canter, Anne I Dipchand, Daphne T Hsu, Robert E Shaddy, William T Mahle, Anthony J Demetris, David M Briscoe, Thalachallour Mohanakumar, Joseph M Ahearn, David N Iklé, Brian D Armstrong, Yvonne Morrison, Helena Diop, Jonah Odim, Steven A Webber
Anti-HLA donor-specific antibodies are associated with worse outcomes following organ transplantation. Among sensitized pediatric heart candidates, requirement for negative donor-specific cytotoxicity crossmatch increases wait times and mortality. However, transplantation with positive crossmatch may increase post-transplant morbidity and mortality. We address this clinical challenge in a prospective, multi-center, observational cohort study of children listed for heart transplantation (CTOTC-04). Outcomes were compared among sensitized recipients who underwent transplant with positive crossmatch, non-sensitized recipients, and sensitized recipients without positive crossmatch...
February 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29444276/extracorporeal-resuscitation-as-a-further-modifier-of-clinical-outcome-in-patients-with-left-ventricular-assist-device-implantation-and-interagency-registry-for-mechanically-assisted-circulatory-support-level-1
#17
Edis Ljajikj, Armin Zittermann, Andreas Koster, Jochen Börgermann, Michael Schönbrodt, Kavous Hakim-Meibodi, Jan Gummert, Michiel Morshuis
In cardiogenic shock patients with Interagency Registry for Mechanical Circulatory Support (INTERMACS) level 1, the need for temporary circulatory support is a predictor and modifier of patient outcome. Because this group includes patients with and without cardiopulmonary resuscitation (CPR) and is thus very heterogeneous, we investigated whether a further subclassification is useful. We compared 30-day and 1-year mortality of patients who underwent left ventricular assist device implantation after extracorporeal CPR with the aid of an extracorporeal life support system (CPR+ group; n = 40) with cardiogenic shock patients in which the extracorporeal life support system was implanted under non-CPR conditions (CPR- group, n = 68)...
February 12, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29444250/are-elevated-serum-haemolysis-markers-a-harbinger-of-adverse-events-in-heartmate-ii-patients
#18
Rashad Zayat, Mohamed Shoaib, Mohammad Amen Khattab, Usaama Ahmad, Andreas Goetzenich, Christian Stoppe, Ann Christina Foldenauer, Ajay Moza, Heike Schnoering, Rüdiger Autschbach, Lachmandath Tewarie
OBJECTIVES: Haemolysis during left ventricular assist device support is associated with thrombosis. In this retrospective study, we analysed whether low-level haemolysis (LLH) as defined by simultaneously elevated lactate dehydrogenase (LDH) and free haemoglobin (fHb) levels had an impact on thromboembolic and bleeding events and on von Willebrand factor levels in HeartMate II patients. METHODS: After exclusion of patients with LDH >700 U/l and fHb >40 mg/dl at hospital discharge, 79 HeartMate II patients were included...
February 12, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29443352/levitronix-bilateral-ventricular-assist-device-a-bridge-to-recovery-in-a-patient-with-acute-fulminant-myocarditis-and-concomitant-cerebellar-infarction
#19
Yi-Fan Huang, Po-Shun Hsu, Chien-Sung Tsai, Yi-Ting Tsai, Chih-Yuan Lin, Hong-Yan Ke, Yi-Chang Lin, Hsiang-Yu Yang
We report on the case of a 27-year-old male who presented to our emergency room with chest tightness, dyspnoea and cold sweats. The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. The coronary angiogram showed good patency of all three coronary vessels, and acute fulminant myocarditis was suspected. The patient underwent cardiopulmonary resuscitation in the catheter room and high-dose inotropic support was initiated to stabilise his haemodynamic status...
February 7, 2018: Cardiovascular Journal of Africa
https://www.readbyqxmd.com/read/29439593/bleeding-risks-in-patients-on-percutaneous-ventricular-assist-devices-receiving-two-different-dextrose-concentrations-of-heparinized-purge-solution-a-case-series
#20
Jenna N Dietrich, Hasan Kazmi
BACKGROUND: The Impella manufacturer has changed its recommendation for the diluent of the heparinized purge solution from 20% dextrose (D20) to 5% dextrose (D5). This reduced viscosity may result in increased purge solution infusion rates and unfractionated heparin (UFH) exposure. Increased UFH exposure could potentially cause increased bleeding events and may necessitate reduction in UFH concentration in the purge solution. Our objective was to evaluate anticoagulation for patients on Impella pumps receiving heparinized purge solution with D20 or D5 diluents...
January 1, 2018: Journal of Pharmacy Practice
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