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mechanical circulatory assistance

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https://www.readbyqxmd.com/read/28329060/first-series-of-left-ventricular-assist-device-exchanges-to-heartmate-3
#1
Jasmin S Hanke, Sebastian V Rojas, Günes Dogan, Christina Feldmann, Erik Beckmann, Ezin Deniz, Bettina Wiegmann, Jana-Elena Michaelis, L Christian Napp, Dominik Berliner, Malakh Shrestha, Johann Bauersachs, Axel Haverich, Jan D Schmitto
OBJECTIVES: Left ventricular assist device (LVAD) exchange is becoming a standard surgical procedure. The exchange procedure is an opportunity to upgrade patients to a new generation pump that offers advanced reduction of adverse events or longer battery hours. METHODS: We performed an analysis of 6 consecutive patients who underwent LVAD exchange to HeartMate 3 either from a HeartWare or HeartMate (HM) II device. Minimally invasive operations were performed through a lateral thoracotomy...
March 13, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28321882/optical-dynamic-analysis-of-thrombus-inside-a-centrifugal-blood-pump-during-extracorporeal-mechanical-circulatory-support-in-a-porcine-model
#2
Tatsuki Fujiwara, Daisuke Sakota, Katsuhiro Ohuchi, Shu Endo, Tomoki Tahara, Tomotaka Murashige, Ryo Kosaka, Keiji Oi, Tomohiro Mizuno, Osamu Maruyama, Hirokuni Arai
Complications due to pump thrombus remain the weak point of mechanical circulatory support (MCS), such as the use of a left ventricular assist device (LVAD) or extracorporeal membrane oxygenation, leading to poor outcomes. Hyperspectral imaging (HSI) is an effective imaging method using a hyperspectral (HS) camera, which comprises a spectrophotometer and a charge-coupled device camera to discriminate thrombus from whole blood. Animal experiments were conducted to analyze dynamic imaging of thrombus inside a prototype of a hydrodynamically levitated centrifugal blood pump using an HSI system...
March 20, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28306593/current-concepts-for-sensitized-patients-before-transplantation
#3
Dael Geft, Jon Kobashigawa
PURPOSE OF REVIEW: Antibody allosensitization poses a major immunologic challenge for patients awaiting heart transplantation. It is associated with significant morbidity and mortality for both pretransplant and posttransplant patients by prolonging wait times to transplant and increasing posttransplant rejection and vasculopathy. Many questions remain regarding methods and interpretation of antibody detection, the relevance of sensitization in specific patient populations such as those with mechanical circulatory support and the ideal strategies for desensitization...
March 16, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28299615/remote-monitoring-in-heart-failure-the-current-state
#4
REVIEW
Rajeev C Mohan, J Thomas Heywood, Roy S Small
The treatment of congestive heart failure is an expensive undertaking with much of this cost occurring as a result of hospitalization. It is not surprising that many remote monitoring strategies have been developed to help patients maintain clinical stability by avoiding congestion. Most of these have failed. It seems very unlikely that these failures were the result of any one underlying false assumption but rather from the fact that heart failure is a progressive, deadly disease and that human behavior is hard to modify...
March 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28259366/mechanical-support-with-venoarterial-extracorporeal-membrane-oxygenation-ecmo-va-short-term-and-long-term-prognosis-after-a-successful-weaning
#5
R García-Gigorro, E Renes-Carreño, J L Pérez-Vela, H Marín-Mateos, J Gutiérrez, M A Corrés-Peiretti, J F Delgado, E Pérez-de la Sota, J M Cortina-Romero, J C Montejo-González
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. DESIGN: A single-center, retrospective cohort study was carried out...
March 2, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28243893/successful-management-of-antibody-mediated-rejection-after-cardiac-transplantation-in-a-patient-supported-by-a-left-ventricular-assist-device-for-more-than-3%C3%A2-years
#6
Masatoshi Akiyama, Shingo Takahara, Satoshi Kawatsu, Yoichi Endo, Junko Fujiwara, Osamu Adachi, Kiichiro Kumagai, Shunsuke Kawamoto, Yoshikatsu Saiki
Due to donor shortage, patients with refractory heart failure need to be supported on mechanical circulatory support (MCS). Critically, patients undergo several deployments of MCS in stages inevitably requiring blood products transfusion. MCSs per se along with blood products can trigger immune allosensitization. Antibody-mediated rejection (AMR) is associated with significant mortality after heart transplantation. Here, we present the case with high panel-reactive antibody over 95% who developed AMR early after heart transplantation...
February 27, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28222499/prediction-of-the-level-and-duration-of-shear-stress-exposure-that-induces-subhemolytic-damage-to-erythrocytes
#7
Michael J Simmonds, Herbert J Meiselman
BACKGROUND: Current generation mechanical circulatory assist devices are designed to minimize high shears to blood for prolonged durations to avoid hemolysis. However, red blood cells (RBC) demonstrate impaired capacity to deform when exposed to shear stress (SS) well below the "hemolytic threshold". OBJECTIVE: We endeavored to identify how changes in the magnitude and duration of SS exposure alter RBC deformability and subsequently develop a model to predict erythrocyte subhemolytic damage...
February 9, 2017: Biorheology
https://www.readbyqxmd.com/read/28212401/preload-based-starling-like-control-of-rotary-blood-pumps-an-in-vitro-evaluation
#8
Mahdi Mansouri, Shaun D Gregory, Robert F Salamonsen, Nigel H Lovell, Michael C Stevens, Jo P Pauls, Rini Akmeliawati, Einly Lim
Due to a shortage of donor hearts, rotary left ventricular assist devices (LVADs) are used to provide mechanical circulatory support. To address the preload insensitivity of the constant speed controller (CSC) used in conventional LVADs, we developed a preload-based Starling-like controller (SLC). The SLC emulates the Starling law of the heart to maintain mean pump flow ([Formula: see text]) with respect to mean left ventricular end diastolic pressure (PLVEDm) as the feedback signal. The SLC and CSC were compared using a mock circulation loop to assess their capacity to increase cardiac output during mild exercise while avoiding ventricular suction (marked by a negative PLVEDm) and maintaining circulatory stability during blood loss and severe reductions in left ventricular contractility (LVC)...
2017: PloS One
https://www.readbyqxmd.com/read/28209402/chemokine-receptor-patterns-and-right-heart-failure-in-mechanical-circulatory-support
#9
Aditi Nayak, Colin Neill, Robert L Kormos, Luigi Lagazzi, Indrani Halder, Charles McTiernan, Jennifer Larsen, Ana Inashvili, Jeffrey Teuteberg, Timothy N Bachman, Karen Hanley-Yanez, Dennis M McNamara, Marc A Simon
BACKGROUND: Right ventricular failure (RVF) complicates 9% to 44% of left ventricular assist device (LVAD) implants post-operatively. Current prediction scores perform only modestly in validation studies, and do not include immune markers. Chemokines are inflammatory signaling molecules with a fundamental role in cardiac physiology and stress adaptation. In this study we investigated chemokine receptor regulation in LVAD recipients who develop RVF. METHODS: Expression of chemokine receptor (CCR) genes 3 to 8 were examined in the peripheral blood of 111 LVAD patients, collected 24 hours before implant...
December 23, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28195883/long-term-pediatric-ventricular-assist-device-therapy-a-case-report-of-2100-days-of-support
#10
Neha J Purkey, Aileen Lin, Jenna M Murray, Maryalice Gowen, Paul Shuttleworth, Katsuhide Maeda, Christopher S Almond, David N Rosenthal, Sharon Chen
Ventricular assist devices (VADs) have been placed as destination therapy in adults for over twenty years but have only recently been considered an option in a subset of pediatric patients. A 2016 report from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) revealed only eight pediatric patients implanted as destination therapy. We report the case of an adolescent male with Becker Muscular Dystrophy (BMD) who underwent VAD placement in 2011 as bridge to candidacy. He subsequently decided to remain as destination therapy and so far has accrued over 2100 days on VAD support, the longest duration of pediatric VAD support reported in the literature to date...
February 9, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28179009/benefits-of-ultra-fast-track-anesthesia-in-left-ventricular-assist-device-implantation-a-retrospective-propensity-score-matched-cohort-study-of-a-four-year-single-center-experience
#11
Rashad Zayat, Ares K Menon, Andreas Goetzenich, Gereon Schaelte, Ruediger Autschbach, Christian Stoppe, Tim-Philipp Simon, Lachmandath Tewarie, Ajay Moza
BACKGROUND: The use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 h. after surgery is feasible in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 3 and 4 patients and might prevent postoperative complications...
February 8, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28163432/early-primary-graft-failure-after-a-pediatric-heart-transplant-and-successful-rescue-with-plasmapheresis-immunoglobulins-and-alemtuzumab
#12
Shashi Raj, Phillip Ruiz, Paolo Rusconi
Early primary graft failure after pediatric orthotopic heart transplantation (OHT) has a high mortality rate and can occur due to several causes including but not limited to prolonged graft ischemia time, suboptimal preimplant myocardial preservation, hyperacute rejection, and maladaptation of the graft to the host's hemodynamic status. Mechanical circulatory support with either extracorporeal membrane oxygenation (ECMO) or ventricular assist device has been used for the rescue of primary graft failure in pediatric patients after heart transplant...
January 2017: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/28160976/global-outcome-in-patients-with-left-ventricular-assist-devices
#13
Timothy J Fendler, Michael E Nassif, Kevin F Kennedy, Susan M Joseph, Scott C Silvestry, Gregory A Ewald, Shane J LaRue, Justin M Vader, John A Spertus, Suzanne V Arnold
Left ventricular assist devices (LVADs) improve survival and quality of life (QOL) for most, but not all, patients with advanced heart failure. We described a broader definition of poor outcomes after LVAD, using a novel composite of death, QOL, and other major adverse events. We evaluated the frequency of poor global outcome at 1 year after LVAD among 164 patients (86% Interagency Registry for Mechanically Assisted Circulatory Support profile 1 to 2; shock or declining despite inotropes) at a high-volume center...
April 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28159376/the-role-of-durable-left-ventricular-assist-devices-in-advanced-heart-failure-would-my-patient-benefit
#14
Natasha Aleksova, Sharon Chih
Mechanical circulatory support improves survival and quality of life in selected patients with advanced heart failure. The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) clinical profile (profiles 1-7) is a classification system of patients with American Heart Association stage D and New York Heart Association functional class IIIb-IV heart failure. Most left ventricular assist devices (LVADs) are implanted in patients dependent on inotropes (INTERMACS 3) or whose condition is deteriorating with inotropic support (INTERMACS 2)...
November 29, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28153356/mechanical-circulatory-support-for-end-stage-heart-failure
#15
Alain Combes
Mechanical circulatory assistance has become a frequent therapeutic option for patients with advanced heart failure. For patients with acute cardiogenic shock and impaired organ function, short-term assistance with venoarterial extracorporeal membrane oxygenation is the leading therapeutic option. It enables a "bridge to decision-making" i.e. withdrawal of the device after myocardial recovery or after recognition of therapeutic futility, or as a bridge-to-transplantation or to long-term mechanical support. For Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 2-6 patients, implantation of a long-term ventricular assist-device (VAD) should be considered before progression to multiple organ failure if heart transplantation is not a first-line option...
April 2017: Metabolism: Clinical and Experimental
https://www.readbyqxmd.com/read/28146651/intrapericardial-left-ventricular-assist-device-for-advanced-heart-failure
#16
RANDOMIZED CONTROLLED TRIAL
Joseph G Rogers, Francis D Pagani, Antone J Tatooles, Geetha Bhat, Mark S Slaughter, Emma J Birks, Steven W Boyce, Samer S Najjar, Valluvan Jeevanandam, Allen S Anderson, Igor D Gregoric, Hari Mallidi, Katrin Leadley, Keith D Aaronson, O H Frazier, Carmelo A Milano
Background Mechanical circulatory support with a left ventricular assist device (LVAD) is an established treatment for patients with advanced heart failure. We compared a newer LVAD design (a small intrapericardial centrifugal-flow device) against existing technology (a commercially available axial-flow device) in patients with advanced heart failure who were ineligible for heart transplantation. Methods We conducted a multicenter randomized trial involving 446 patients who were assigned, in a 2:1 ratio, to the study (centrifugal-flow) device or the control (axial-flow) device...
February 2, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28118264/in-vitro-examination-of-the-heartware-circulite-ventricular-assist-device-in-the-fontan-connection
#17
Michael Tree, Phillip M Trusty, Timothy C Slesnick, Ajit Yoganathan, Shriprasad Deshpande, Kevin Maher
The failing Fontan physiology may benefit from ventricular assist device (VAD) mechanical circulatory support, though a sub-pulmonary VAD placed at the Fontan connection has never successfully supported the Fontan circulation long term.The HeartWare CircuLite continuous flow VAD was examined for Fontan circulatory support in an in vitro mock circulation. The VAD was tested in three different scenarios: VAD in parallel, baffle restricted VAD in parallel, and VAD in series. Successful support was defined as simultaneous decrease in inferior vena cava (IVC) pressure of 5 mmHg or more and an increase in cardiac output (CO) to 4...
January 20, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28112765/a-microfluidic-circulatory-system-integrated-with-capillary-assisted-pressure-sensors
#18
Yangfan Chen, Ho Nam Chan, Sean A Michael, Yusheng Shen, Yin Chen, Qian Tian, Lu Huang, Hongkai Wu
The human circulatory system comprises a complex network of blood vessels interconnecting biologically relevant organs and a heart driving blood recirculation throughout this system. Recreating this system in vitro would act as a bridge between organ-on-a-chip and "body-on-a-chip" and advance the development of in vitro models. Here, we present a microfluidic circulatory system integrated with an on-chip pressure sensor to closely mimic human systemic circulation in vitro. A cardiac-like on-chip pumping system is incorporated in the device...
January 23, 2017: Lab on a Chip
https://www.readbyqxmd.com/read/28109452/erratum-to-adverse-events-in-children-implanted-with-ventricular-assist-devices-in-the-us-data-from-the-pediatric-interagency-registry-for-mechanical-circulatory-support-pedimacs
#19
David N Rosenthal
No abstract text is available yet for this article.
January 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28107271/perioperative-care-of-the-patient-with-the-total-artificial-heart
#20
Jill Yaung, Francisco A Arabia, Michael Nurok
Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns...
January 19, 2017: Anesthesia and Analgesia
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