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mechanical circulatory assistance

Matteo Di Nardo, Graeme MacLaren, Marco Marano, Corrado Cecchetti, Paola Bernaschi, Antonio Amodeo
Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children...
2016: Frontiers in Pediatrics
Colleen K McIlvennan, JoAnn Lindenfeld, David P Kao
BACKGROUND: Mechanical circulatory support (MCS) is a widely available management strategy. No studies have described sex differences in both extracorporeal and durable MCS. We analyzed sex-related differences of in-hospital outcomes for extracorporeal and durable MCS using administrative hospital data. METHODS: In total, 134.5 million hospital records between 1994 and 2012 were screened for placement of MCS using procedure codes of the International Classification of Diseases-9, Clinical Modification...
August 20, 2016: Journal of Heart and Lung Transplantation
Jessica Rimsans, Katelyn W Sylvester, Jean M Connors
Available options for the treatment of advanced heart failure have expanded to include the use of mechanical circulatory assist devices to improve quality of life in those both eligible and ineligible for heart transplant. Although there have been significant advancements in device technologies, anticoagulation protocols, and multidisciplinary team management, bleeding and thrombosis are the most common adverse effects. Management strategies for pump thrombosis and their outcomes vary considerably among mechanical circulatory support centers and include intensification of antithrombotic therapy (medical) and device exchange (surgical)...
October 7, 2016: Clinical and Applied Thrombosis/hemostasis
Ju H Kim, Ramesh Singh, Francis D Pagani, Shashank S Desai, Nicholas A Haglund, Shannon M Dunlay, Simon Maltais, Keith D Aaronson, John M Stulak, Mary E Davis, Christopher T Salerno, Jennifer A Cowger, Palak Shah
BACKGROUND: Limited data exist on outcomes in patients greater than 70 years of age supported with continuous flow left ventricular assist devices (LVAD). METHODS: Data on 1,149 continuous-flow LVAD recipients was queried from the Mechanical Circulatory Support Research Network. Groups were assigned based on age: ≥70 years ("older patients") and <70 years. The primary outcome was survival at one-year based on age grouping. RESULTS: Compared with younger patients, (54...
October 17, 2016: Journal of Cardiac Failure
O P Sanjay
The use of mechanical circulatory support for patients with severe heart failure is on the rist. The poeoperative, intraoperative and postoperative challenges the anaesthesiologists skills. These are discussed in this review.
October 2016: Annals of Cardiac Anaesthesia
Henrik Vase, Steffen Christensen, Aage Christiansen, Christian Juhl Therkelsen, Evald Høj Christiansen, Hans Eiskjær, Steen Hvidtfeldt Poulsen
INTRODUCTION: Mechanical circulatory support may be considered as a therapeutic option in selected patients with refractory cardiac arrest (rCA). Animal studies suggest a potential role for the Impella(®) left ventricular assist device in this setting, but so far no human data have been published. METHODS: Eight patients with rCA were treated with the Impella CP(®) device at our institution from November 2014 to October 2015. The Impella CP(®) was used at the discretion of the treating physicians in patients with rCA and pulseless electrical activity with presumed primary left ventricular failure...
October 14, 2016: Resuscitation
Ivan Netuka, Pierre-Yves Litzler, Michael Berchtold-Herz, Erwan Flecher, Daniel Zimpfer, Laura Damme, Kartik S Sundareswaran, David J Farrar, Jan D Schmitto
BACKGROUND: Current recommendations of antithrombotic therapy for HeartMate II (HMII) patients include the use of both an anticoagulant and an antiplatelet agent. Because bleeding is still the most frequent adverse event, the TRACE (STudy of Reduced Anti-Coagulation/Anti-platelet Therapy in Patients with the HeartMatE II) study was initiated to evaluate the incidence of adverse events in HMII patients on reduced antithrombotic (RT) therapy. METHODS: HMII patients (n = 101) from nine centers were enrolled in the European arm of TRACE and were managed on a single anticoagulant (vitamin K antagonist) with no antiplatelet agents...
October 12, 2016: Annals of Thoracic Surgery
M Hirschvogel, M Bassilious, L Jagschies, S M Wildhirt, M W Gee
A model for patient-specific cardiac mechanics simulation is introduced, incorporating a 3-dimensional finite element model of the ventricular part of the heart which is coupled to a reduced-order 0-dimensional closed-loop vascular system, heart valve and atrial chamber model.The ventricles are modeled by a nonlinear orthotropic passive material law. The electrical activation is mimicked by a prescribed parametrized active stress acting along a generic muscle fiber orientation. Our activation function is constructed such that the start of ventricular contraction and relaxation as well as the active stress curve's slope are parameterized...
October 15, 2016: International Journal for Numerical Methods in Biomedical Engineering
Omar Wever-Pinzon, Stavros G Drakos, Stephen H McKellar, Benjamin D Horne, William T Caine, Abdallah G Kfoury, Dean Y Li, James C Fang, Josef Stehlik, Craig H Selzman
BACKGROUND: The number of centers with left ventricular assist device (LVAD) research programs focused on cardiac recovery is very small. Therefore, this phenomenon has been reported in real-world multi-center registries as a rare event. OBJECTIVES: This study evaluated the incidence of cardiac recovery with an a priori LVAD implantation strategy of bridge-to-recovery (BTR) and constructed a recovery predictive model. METHODS: The study included LVAD recipients registered in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)...
October 4, 2016: Journal of the American College of Cardiology
Gardner Yost, Christine Rachel Joseph, Thomas Royston, Antone Tatooles, Geetha Bhat
Despite increasing use of left ventricular assist devices (LVADs) as a surgical treatment for advanced heart failure in an era of improved outcomes with LVAD support, the mechanical interactions between these pumps and the cardiovascular system are not completely understood. We utilized an in vitro mock circulatory loop to analyze the heat production incurred by operation of an axial flow and centrifugal flow LVAD.A HeartMate II and a HeartWare HVAD were connected to an abbreviated flow loop and were implanted in a viscoelastic gel...
September 20, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Roosevelt Bryant, Farhan Zafar, Chesney Castleberry, John L Jefferies, Angela Lorts, Clifford Chin, David L S Morales
The Berlin Heart EXCOR pediatric ventricular assist device is approved by the FDA for bridge to cardiac transplantation (BTT) in children. As the clinical outcomes of the EXCOR continue to be evaluated in the U.S., data on post transplant survival are needed. The UNOS database was used to identify patients < 18 years old undergoing orthotopic heart transplantation (OHT) from 6/2004 to 6/2014. Patients undergoing BTT with the EXCOR were identified. A matched cohort of (358) patients undergoing OHT without pre-transplant mechanical circulatory support (no-MCS) was also identified as controls...
September 20, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Joseph A R Englert, Jennifer A Davis, Selim R Krim
BACKGROUND: Heart transplantation remains the definitive therapy for patients with advanced heart failure; however, owing to limited donor organ availability and long wait times, continuous-flow left ventricular assist devices (LVADs) have become standard therapy. METHODS: This review summarizes the history, progression, function, and basic management of LVADs. Additionally, we provide some clinical pearls and important caveats for managing this unique patient population...
2016: Ochsner Journal
Kevin Ergle, Parham Parto, Selim R Krim
BACKGROUND: Despite recent advances in the management of heart failure, cardiogenic shock remains a challenging and devastating condition with significant morbidity and mortality. METHODS: We review currently available percutaneous mechanical circulatory support (MCS) devices and address each device's characteristics, mechanism of action, specific clinical indications, and contraindications. RESULTS: Four types of percutaneous MCS devices are currently available: the intraaortic balloon pump (IABP), Impella devices, the TandemHeart, and extracorporal membrane oxygenation (ECMO)...
2016: Ochsner Journal
Richard Cheng, Danny Ramzy, Babak Azarbal, Francisco A Arabia, Fardad Esmailian, Lawrence S Czer, Jon A Kobashigawa, Jaime D Moriguchi
For Interagency Registry for Mechanically Assisted Circulatory Support profiles 1 and 2 cardiogenic shock patients initially placed on extracorporeal membrane oxygenation (ECMO), whether crossover to more durable devices is associated with increased survival, and its optimal timing, are not established. Profiles 1 and 2 patients placed on mechanical support were prospectively registered. Survival and successful hospital discharge were compared between patients placed on ECMO only, ECMO with early crossover, and ECMO with delayed crossover...
September 23, 2016: Artificial Organs
Xin Li, Iago Sousa-Casasnovas, Carolina Devesa, Miriam Juárez, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND: Cardiogenic shock (CS) has a poor prognosis. The heterogeneity in the mortality through different subgroups suggests that some factors can be useful to perform risk stratification and guide management. We aimed to find predictors of in-hospital mortality in these patients. METHODS: We analyzed all cases of cardiogenic shock due to medical conditions admitted in our intensive acute cardiovascular care unity from November 2010 till November 2015. Clinical, biochemical and hemodynamic variables were registered, as was the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile at 24h of CS diagnosis...
September 12, 2016: International Journal of Cardiology
David Schibilsky, Tobias Kruger, Henning F Lausberg, Christoph Eisenlohr, Christoph Haller, Attila Nemeth, Barbara Schibilsky, Helene Haeberle, Peter Rosenberger, Tobias Walker, Christian Schlensak
The catheter-based Impella 5.0 left ventricular assist device is a powerful and less invasive alternative for patients in cardiogenic shock. The use as second-line therapy in patients with precedent extracorporeal life support (ECLS) has not been described before now. We analyzed our experience of consecutive patients treated with this alternative strategy. From April 2014 to December 2014, eight patients had been implanted as a second-line option after ECLS support. The reason for the change from ECLS to Impella 5...
September 2016: Artificial Organs
Walter P Jeske, Jeanine M Walenga, Bryan Menapace, Jeffrey Schwartz, Mamdouh Bakhos
For heart failure patients unable to undergo cardiac transplantation, mechanical circulatory support with left ventricular assist devices can be utilized. These devices improve quality of life and prolong life expectancy, but they are associated with bleeding and thrombotic complications impacting patient survival. Little is known of the relevant mechanisms of these hemostatic issues, hindering identification of a clinically useful biomarker. However, there is suggestive evidence that blood cell-derived microparticles may fulfill this unmet clinical need...
October 2016: Biomarkers in Medicine
Garry R Thomas, Michael A McDonald, Jennifer Day, Heather J Ross, Diego H Delgado, Filio Billia, Jagdish W Butany, Vivek Rao, Eitan Amir, Philippe L Bedard, Paaladinesh Thavendiranathan
Anthracycline-induced cardiomyopathy (AIC) may progress to end-stage heart failure requiring mechanical circulatory support or orthotopic heart transplantation (OHT). Previous studies have described important clinical differences between AIC and nonischemic cardiomyopathy (NIC) cohorts requiring these advanced interventions. Therefore, we sought to extend this literature by comparing echocardiographic parameters, treatment strategies, and the prognosis between matched patients from these cohorts. This is a retrospective matched cohort study...
August 23, 2016: American Journal of Cardiology
Anatol Prinzing, Ulf Herold, Anna Berkefeld, Markus Krane, Rüdiger Lange, Bernhard Voss
Mechanical circulatory support devices have become an important treatment tool for severe acute and chronic heart failure, since heart transplantation cannot meet the demands because of a lack of available donor organs. Since implantation of the first ventricular assist device a constant development of the suitability of these devices has been made. This review will introduce different generations of left ventricular assist devices (LVAD) and elaborate on clinical indications, risk stratification and current literature...
August 2016: Journal of Thoracic Disease
Marc K Halushka, Richard N Mitchell, Robert F Padera
Heart failure, whether acute or chronic, remains a major health care crisis affecting almost 6 million Americans and over 23 million people worldwide. Roughly half of those affected will die within 5 years, and the annual cost exceeds $30 billion in the US alone. Although medical therapy has made some modest inroads in partially stemming the heart failure tsunami, there remains a significant population for whom medication is unsuccessful or has ceased being effective; such patients can benefit from heart transplantation or mechanical circulatory support...
August 29, 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
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