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mechanical circulatory assistance

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https://www.readbyqxmd.com/read/29355988/variation-in-practice-patterns-and-outcomes-across-united-network-for-organ-sharing-allocation-regions
#1
Dushyanth Srinivasan, Benjamin Vaccaro, Pooja Rao, Rohit Ghosh, Prashant Warier, Tariq Ahmad, Nihar Desai
BACKGROUND: The number of heart transplants performed is limited by organ availability and is managed by the United Network for Organ Sharing (UNOS). Efforts are underway to make organ disbursement more equitable as demand increases. HYPOTHESIS: Significant variation exists in contemporary patterns of care, wait times, and outcomes among patients undergoing heart transplantation across UNOS regions. METHODS: We identified adult patients undergoing first, single-organ heart transplantation between January 2006 and December 2014 in the UNOS dataset and compared sociodemographic and clinical profiles, wait times, use of mechanical circulatory support (MCS), status at time of transplantation, and 1-year survival across UNOS regions...
January 22, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29350305/percutaneous-mechanical-circulatory-support-devices-for-high-risk-percutaneous-coronary-intervention
#2
REVIEW
Subrata Kar
PURPOSE OF REVIEW: Percutaneous mechanical circulatory support devices (PMCSD) consist of the intra-aortic balloon pump (IABP), Impella (Abiomed Inc., Danvers, Massachusetts), Tandem Heart (Cardiac Assist, Inc., Pittsburgh, Pennsylvania), or extracorporeal membranous oxygenation (ECMO). They augment cardiac output, cardiac index, and cardiac power which allow the operator to mitigate hemodynamic perturbations during high-risk percutaneous coronary intervention (HR-PCI). This review discusses PMCSD and their contemporary literature...
January 19, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29346259/do-patients-supported-with-continuous-flow-left-ventricular-assist-device-cf-lvads-have-a-sufficient-risk-of-death-to-justify-a-priority-allocation-a-propensity-score-matched-analysis-of-patients-listed-in-unos-status-2
#3
Stefano Mastrobuoni, Angelo Maria Dell'Aquila, Olivier Van Caenegem, Alain Poncelet, Luc-Marie Jacquet, Josè Garcia
BACKGROUND: Outcomes of Continuous Flow Left Ventricular Assist Devices (CF-LVADs) as bridge to transplant have significantly improved. The question has arisen whether patients on CF-LVADs have an increased risk of death on the waiting list as to justify a priority allocation (status 1). The aim of this study was to compare the survival following implantation of CF-LVADs to the survival on the waiting list for patients initially listed in United Network for Organ Sharing (UNOS) status 2...
January 18, 2018: Transplantation
https://www.readbyqxmd.com/read/29341860/risk-management-of-free-radicals-involved-in-air-travel-syndromes-by-antioxidants
#4
Jeum-Nam Kim, Byung-Mu Lee
Frequent air travelers and airplane pilots may develop various types of illnesses. The environmental risk factors associated with air travel syndromes (ATS) or air travel-related adverse health outcomes raised concerns and need to be assessed in the context of risk management and public health. Accordingly, the aim of the present review was to determine ATS, risk factors, and mechanisms underlying ATS using scientific data and information obtained from Medline, Toxline, and regulatory agencies. Additional information was also extracted from websites of organizations, such as the International Air Transport Association (IATA), International Association for Medical Assistance to Travelers (IAMAT), and International Civil Aviation Organization (ICAO)...
January 17, 2018: Journal of Toxicology and Environmental Health. Part B, Critical Reviews
https://www.readbyqxmd.com/read/29324511/evolutionary-improvements-in-the-jarvik-2000-left-ventricular-assist-device
#5
Craig H Selzman, Antigone Koliopoulou, Jason P Glotzbach, Stephen H McKellar
Mechanical circulatory support devices experience a wide range of operating conditions during patient use. Since its first implant in June 2000, the Jarvik 2000 left ventricular assist device has witnessed systematic stepwise modifications to reduce the risk of serious adverse events and improve patient outcomes. Over time, clinical experience revealed a number of low-incidence failure modes that presented opportunities for improvement. Design changes have included, but are not limited to, a Y cable to permit battery changes without pump stoppage, increased pull strength of external cables from 35 to 200 lbs, an intermittent low-speed controller to improve aortic root washout, sintered titanium microsphere surface on the pump housing to prevent apical thrombus, and novel cone bearings to reduce thrombus formation...
January 10, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29310555/mechanical-circulatory-support-for-the-failing-fontan-conversion-to-assisted-single-ventricle-circulation-preliminary-observations
#6
Syed M Peer, Kristopher B Deatrick, Thomas J Johnson, Jonathan W Haft, Francis D Pagani, Richard G Ohye, Edward L Bove, Alvaro Rojas-Peña, Ming-Sing Si
BACKGROUND: Mechanical circulatory support (MCS) of a failing Fontan circulation remains challenging. We hypothesized that MCS can be provided by converting the Fontan circulation into a mechanically assisted single ventricle parallel circulation (MASVC). METHODS: A porcine model of functionally univentricular circulation was created under cardiopulmonary bypass (CPB) by performing an atrial septectomy, tricuspid valvectomy, and interrupting antegrade pulmonary blood flow...
January 2018: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29274191/acquired-coagulopathy-in-patients-with-left-ventricular-assist-devices
#7
REVIEW
R Muslem, K Caliskan, F W G Leebeek
Chronic heart failure (HF) is a major emerging health care problem, associated with a high morbidity and mortality. Left ventricular assist devices (LVADs) have emerged as a successful treatment option for patients with end-stage HF. Despite its great benefit, the use of LVAD is associated with a high risk for complications. Bleeding, pump thrombosis, and thrombo-embolic events are frequently observed complications, with bleeding complications occurring in over a third of the patients. Although the design of the third generation LVAD has improved greatly, these hemostatic complications still occur...
December 23, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29273199/linkage-of-medicare-records-to-the-interagency-registry-of-mechanically-assisted-circulatory-support
#8
Qixing Liang, Sarah Ward, Francis D Pagani, Shashank S Sinha, Min Zhang, Robert Kormos, Keith D Aaronson, Andrew D Althouse, James K Kirklin, David Naftel, Donald S Likosky
BACKGROUND: The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) is a U.S. registry for adults receiving durable U.S. Food and Drug Administration approved mechanical circulatory support devices (MCSDs). We merged INTERMACS records with Medicare claims to investigate the uncertainty of penetrance of Medicare beneficiaries within INTERMACS. METHODS: INTERMACS records and Medicare claims (January 1, 2008 through December 31, 2013) from the Centers for Medicare and Medicaid (CMS) were linked using a deterministic matching methodology...
December 19, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29259511/tolerance-of-sustained-ventricular-fibrillation-during-continuous-flow-left-ventricular-assist-device-support
#9
Andrew C W Baldwin, Courtney J Gemmato, Elena Sandoval, William E Cohn, Jeffrey A Morgan, O H Frazier
The widespread use of continuous-flow left ventricular assist devices for mechanical circulatory support has shown that long-term hemodynamic support is possible, even when a clinical "pulse" cannot be detected. We present the incidental discovery of ventricular fibrillation in 6 alert, hemodynamically stable patients supported only by a continuous-flow device (HeartMate II, n=5; Jarvik 2000, n=1). Ventricular fibrillation was found in 3 patients during routine outpatient follow-up visits and in 3 awaiting discharge from the hospital after device placement...
October 2017: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/29246883/causes-and-consequences-of-missing-health-related-quality-of-life-assessments-in-patients-who-undergo-mechanical-circulatory-support-implantation-insights-from-intermacs-interagency-registry-for-mechanically-assisted-circulatory-support
#10
REVIEW
Kathleen L Grady, Philip G Jones, Adin Cristian-Andrei, David C Naftel, Susan Myers, Mary Amanda Dew, Katharine Idrissi, Gerdi Weidner, Sherri A Wissman, James K Kirklin, John A Spertus
BACKGROUND: Missing health-related quality of life (HRQOL) data in longitudinal studies can reduce precision and power and bias results. Using INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support), we sought to identify factors associated with missing HRQOL data, examine the impact of these factors on estimated HRQOL assuming missing at random missingness, and perform sensitivity analyses to examine missing not at random (MNAR) missingness because of illness severity...
December 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/29245181/revealing-a-new-mode-of-sensitization-induced-by-mechanical-circulatory-support-devices-impact-of-anti-at1-r-antibodies
#11
X Zhang, J Mirocha, T Aintablian, S Dimbil, J Moriguchi, F Arabia, J A Kobashigawa, N L Reinsmoen
BACKGROUND: Increased levels of angiotensin II type 1 receptor (AT1 R) antibody have been shown to be associated with allograft rejection. This study aims to determine the rate of development of antibody to AT1 R after Mechanical Circulatory Support Device (MCS) implantation, and if development of strong binding AT1 R antibodies is associated with survival. METHODS: 88 patients who had one MCS implantation were accessed based on serum availability. MCS in this cohort included pneumatic bilateral paracorporeal ventricular assist device, continuous flow left ventricular assist device, and total artificial heart...
December 15, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/29240628/circulatory-support-with-extracorporeal-membrane-oxygenation-and-or-impella-for-cardiogenic-shock-during-myocardial-infarction
#12
Marc Mourad, Philippe Gaudard, Pablo De La Arena, Jacob Eliet, Norddine Zeroual, Philippe Rouvière, François Roubille, Bernard Albat, Pascal H Colson
Temporary mechanical circulatory support (TCS) is recommended for patients with profound cardiogenic shock (CS). Extracorporeal membrane oxygenation (ECMO) and Impella are possible TCS devices, but the device choice and the implantation timing are not definitely established, specifically during acute myocardial infarction. We have analyzed the respective use of ECMO or Impella (2.5, CP, or 5.0) for CS following acute myocardial infarction , from a cohort of patients who underwent TCS within 72 hours after admission for emergency percutaneous coronary intervention (PCI) from January 2009 to April 2015...
December 11, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29236180/diagnosis-medical-treatment-and-stepwise-mechanical-circulatory-support-for-fulminat-myocarditis
#13
Shunsuke Saito, Koichi Toda, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Daisuke Yoshioka, Keitaro Domae, Yasumasa Tsukamoto, Yasushi Sakata, Yoshiki Sawa
Fulminant myocarditis is one of the most challenging diseases. We sought to examine the outcomes of our multidisciplinary treatment strategy for fulminant myocarditis. A retrospective review of consecutive 30 patients with fulminant myocarditis was conducted. Of the 30 patients, 25 required mechanical circulatory support (MCS). Percutaneous extracorporeal membrane oxygenation (ECMO) was the first-line therapy to rescue the patients and inserted in 23 of them. The other 2 were implanted with temporary ventricular assist device (t-VAD) with extracorporeal centrifugal pump(s)...
December 13, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/29232275/complex-decision-making-in-heart-failure-a-systematic-review-and-thematic-analysis
#14
Aimee V Hamel, Joseph E Gaugler, Carolyn M Porta, Niloufar Niakosari Hadidi
BACKGROUND: Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making...
December 11, 2017: Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29222320/anticoagulation-with-vads-and-ecmo-walking-the-tightrope
#15
REVIEW
Leslie Raffini
The evolution of devices for mechanical circulatory support (MCS), including ventricular assist devices (VADs) for patients with heart failure and extracorporeal membrane oxygenation (ECMO) for patients with acute cardiac or respiratory failure, has improved survival for subsets of critically ill children and adults. The devices are intricate and complex, allowing blood to bypass the heart or lungs (or both). As blood flows through these artificial devices, normal hemostasis is disrupted, coagulation is promoted, and in the absence of anticoagulation, a thrombus may form in the device, resulting in device failure or embolic stroke...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29210774/liberal-right-ventricular-assist-device-extracorporeal-membrane-oxygenation-support-for-right-ventricular-failure-after-implantable-left-ventricular-assist-device-placement
#16
Quentin Fischer, Matthias Kirsch
Refractory right ventricular failure (RVF) after implantation of left ventricular assist device (LVAD) is a dramatic complication. The addition of right ventricular assist device (RVAD) may improve RV recovery and lead to improve outcomes. From February 2012 to September 2014, 44 patients received a HeartMate II. These patients were retrospectively compared in two groups according to early liberal implantation of an extracorporeal membrane oxygenation (ECMO) used as a RVAD established between a femoral vein and the pulmonary artery...
November 27, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29198868/an-interagency-registry-for-mechanically-assisted-circulatory-support-intermacs-analysis-of-hospitalization-functional-status-and-mortality-after-mechanical-circulatory-support-in-adults-with-congenital-heart-disease
#17
Ari Cedars, Christina Vanderpluym, Devin Koehl, Ryan Cantor, Shelby Kutty, James K Kirklin
BACKGROUND: Adult congenital heart disease (ACHD) prevalence is increasing worldwide, with advanced heart failure (HF) as a leading cause of death. Limited data are available on durable mechanical circulatory support (MCS) in ACHD patients. METHODS: ACHD patients from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database were identified and propensity matched with non-ACHD patients using risk factors from the INTERMACS Seventh Annual Report...
November 17, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29193160/multicenter-experience-with-mechanical-circulatory-support-using-a-new-diagonal-pump-in-233-children
#18
Brigitte Stiller, Robert Jan Houmes, André Rüffer, Matthias Kumpf, Andreas Müller, Florian Kipfmüller, Harald Köditz, Susanne Herber Jonat, Claudia Schmoor, Christoph Benk, Dick Tibboel, Thilo Fleck
Technological innovations in pediatric extracorporeal life support circuits can reduce system-related complications and may improve patients' outcome. The Deltastream DP3 (Medos Medizintechnik AG, Stolberg, Germany) is a novel rotational pump with a diagonally streamed impeller that can be used over a broad range of flows. We collected patient data from seven pediatric centers to conduct a retrospective cohort study. We examined 233 patients whose median age was 1.9 (0-201) months. The DP3 system was used for cardiopulmonary support as veno-arterial extracorporeal membrane oxygenation (ECMO) in 162 patients...
November 29, 2017: Artificial Organs
https://www.readbyqxmd.com/read/29191299/implantable-cardioverter-defibrillators-in%C3%A2-patients-with-a-continuous-flow-left%C3%A2-ventricular-assist-device-an-analysis-of%C3%A2-the-intermacs-registry
#19
Kevin J Clerkin, Veli K Topkara, Ryan T Demmer, Jose M Dizon, Melana Yuzefpolskaya, Justin A Fried, Xingchen Mai, Donna M Mancini, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, Paolo C Colombo, A Reshad Garan
OBJECTIVES: This study sought to determine if the presence of implantable cardioverter-defibrillators (ICD) provided a mortality benefit during continuous-flow left ventricular assist device (LVAD) support. BACKGROUND: An ICD decreases mortality in selected patients with advanced heart failure and have been associated with reduced mortality in patients with pulsatile LVAD. However, it is unclear whether that benefit extends to patients with a contemporary continuous-flow LVAD...
December 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/29189423/the-boy-in-the-bubble-and-the-baby-with-the-berlin-heart-the-dangers-of-bridge-to-decision-in-pediatric-mechanical-circulatory-support
#20
Seth A Hollander, Ethan J Hollander
On the day of his birth in 1971, David Vetter was "temporarily" placed in a sterile isolator to wait for a bone marrow donor who would cure his Severe Combined Immunodeficiency Syndrome. After enduring 12 years in isolation, David, now known to the world as "The Boy in the Bubble", received a bone marrow transplant from his unmatched sister and died 4 months later. Like Severe Combined Immunodeficiency Syndrome, pediatric heart failure is a rare and life-threatening condition for which organ transplantation is often the only option for survival...
November 14, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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