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Ventricular assist

Maanasi S Mistry, Sara M Trucco, Timothy Maul, Mahesh S Sharma, Li Wang, Shawn West
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides respiratory and hemodynamic support to pediatric patients in severe cardiac failure. We aim to identify risk factors associated with poorer outcomes in this population. METHODS: A retrospective chart review was conducted of pediatric patients requiring VA-ECMO support for cardiac indications at our institution from 2004 to 2015. Data were collected on demographics, indication, markers of cardiac output, ventricular assist device (VAD) insertion, heart transplantation, or left atrial (LA) decompression...
January 1, 2018: World Journal for Pediatric & Congenital Heart Surgery
Nathan McClane, Walter Jeske, Jeanine M Walenga, Vicki Escalante, Debra Hoppensteadt, Jeffrey Schwartz, Mamdouh Bakhos
Heart failure affects over 5 million people in the United States. Its rising prevalence and the limited supply of donor hearts is increasing the use of mechanical cardiac support with the implantation of continuous-flow ventricular assist devices (CF-VAD). Patients with CF-VAD implants are at risk of complications, specifically adverse hemostatic events such as nonsurgical bleeding and thrombosis. Development of a pump thrombus requires clinical intervention and/or surgical replacement significantly increasing the risk of patient morbidity and mortality...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Katharina Huenges, Bernd Panholzer, Jochen Cremer, Assad Haneya
Left ventricular assist device (LVAD) is nowadays a routine therapy for patients with advanced heart failure. We present the case of a 74-year-old male patient who was admitted to our center with terminal heart failure in dilated cardiomyopathy and ascending aortic aneurysm with aortic valve regurgitation. The LVAD implantation with simultaneous aortic valve and supracoronary ascending aortic replacement was successfully performed.
2018: Case Reports in Medicine
Simone Frea, Paolo Centofanti, Stefano Pidello, Francesca Giordana, Virginia Bovolo, Andrea Baronetto, Beatrice Franco, Marco Matteo Cingolani, Matteo Attisani, Mara Morello, Serena Bergerone, Mauro Rinaldi, Fiorenzo Gaita
OBJECTIVES: The aim of this prospective study was to validate an echocardiographic protocol derived from 5 HeartWare left ventricular assist device (HVAD) patients for the noninvasive evaluation of right atrial pressure (RAP) and left atrial pressure (LAP) in HVAD patients. BACKGROUND: Echocardiography is an invaluable tool to optimize medical treatment and pump settings and also for troubleshooting residual heart failure. Little is known about the echocardiographic evaluation of hemodynamic status in HVAD patients...
March 9, 2018: JACC. Cardiovascular Imaging
Jongho Kim, Erika D Feller, Wengen Chen, Yuanyuan Liang, Vasken Dilsizian
OBJECTIVES: The feasibility of18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis of left ventricular assist device (LVAD) infection has been demonstrated. Beyond the diagnoses of LVAD infection, the authors hypothesized that the pattern and site of the infection along its various components may significantly impact clinical management and patient outcome. BACKGROUND: In patients with end-stage heart failure, the clinical use of LVAD for destination therapy is on the rise, accompanied by a higher prevalence of infections and serious complications...
March 9, 2018: JACC. Cardiovascular Imaging
Muhammad Naveed, Lei Han, Ghulam Jilany Khan, Sufia Yasmeen, Reyaj Mikrani, Muhammad Abbas, Li Cunyu, Zhou Xiaohui
Congestive heart failure (CHF) is a complicated pathophysiological syndrome, leading cause of hospitalization as well as mortalities in developed countries wherein an irregular function of the heart leads to the insufficient blood supply to the body organs. It is an accumulative slackening of various complications including myocardial infarction (MI), coronary heart disease (CAD), hypertension, valvular heart disease (VHD) and cardiomyopathy; its hallmarks include hypertrophy, increased interstitial fibrosis and loss of myocytes...
March 14, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Taichi Sakaguchi, Toshinori Totsugawa, Kentaro Tamura, Arudo Hiraoka, Genta Chikazawa, Hidenori Yoshitaka
OBJECTIVE: Despite excellent long-term results reported for a trans-aortic septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM), surgery for patients with diffuse hypertrophy is very challenging. In addition, a left ventricular outflow obstruction is often aggravated by an abnormal mitral valve and subvalvular apparatus. METHODS: We performed video-assisted minimally invasive trans-mitral septal myectomy procedures in 3 patients with diffuse-type HOCM, who were highly symptomatic despite maximal medical therapy...
March 16, 2018: General Thoracic and Cardiovascular Surgery
Alina Yang, Ji Liu
The population of patients on left ventricular assist devices (LVADs) has increased significantly since the 1990s, and with it, need for non-cardiac elective surgeries. Presence of an LVAD or heart failure, however, can cause physicians to perceive these patients to be at prohibitively high risk for elective surgery. Nevertheless, as one of the most common causes of poor vision in the elderly, cataracts can significantly limit improvements in quality of life that a patient may have otherwise gained from LVAD support...
March 16, 2018: BMJ Case Reports
P Alex Smith, Yaxin Wang, Ralph W Metcalfe, Luiz C Sampaio, Daniel L Timms, William E Cohn, O H Frazier
PURPOSE: A minimally invasive, partial-assist, intra-atrial blood pump has been proposed, which would unload the left ventricle with a flow path from the left atrium to the arterial system. Flow modulation is a common strategy for ensuring washout in the pump, but it can increase power consumption because it is typically achieved through motor-speed variation. However, if a pump's performance curve had the proper gradient, flow modulation could be realized passively. To achieve this goal, we propose a pump performance operating curve as an alternative to the more standard operating point...
March 2018: International Journal of Artificial Organs
Eloisa Basile, Giulio Russo, Antonio M Leone
It is essential to understand the pathophysiology of cardiogenic shock and the possible deterioration of contractile function during high-risk PCI in order to select those patients who could benefit from mechanical support thus choosing the most suitable device in every situation. Percutaneous Ventricular Assist Devices (pVAD) provide hemodynamic support by improving cardiac output and mean arterial pressure, but their specific features result in different hemodynamic effects and degrees of myocardial ischemic protection and LV unloading...
March 15, 2018: Minerva Cardioangiologica
Napatt Kanjanahattakij, Benjamin Horn, Basma Abdulhadi, Nicha Wongjarupong, Kenechukwu Mezue, Pattara Rattanawong
Cerebrovascular accident (CVA) is one of the major complications and a leading cause of death in patients with a left ventricular assist device (LVAD). Multiple studies of have shown that patients with blood stream infection (BSI) are more likely to develop CVA compared to patients without BSI. However, there is no meta-analysis to confirm this association. Studies were systematically acquired from MEDLINE and EMBASE electronic databases. Included studies assessed patients with heart failure requiring LVAD and reported the number of patients who had BSI post LVAD, incidence of ischemic CVA, hemorrhagic CVA, or any CVA...
March 16, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Sven Persoon, Michael Paulus, Stephan Hirt, Carsten Jungbauer, Alexander Dietl, Andreas Luchner, Christof Schmid, Lars S Maier, Christoph Birner
Implantation of left ventricular assist devices (LVADs) as bridge to transplant in end-stage heart failure allows for analyzing reverse remodeling processes of the supported heart. Whether this therapy influences the cGMP-PKG signaling pathway, which is currently under thorough investigation for developing new heart failure therapeutics, is unknown. In fourteen end-stage heart failure patients (8 with dilated cardiomyopathy, DCM; 6 with ischemic cardiomyopathy, ICM) tissue specimens of left ventricles were collected at LVAD implantation and afterwards at receiver heart explantation, respectively...
March 15, 2018: Heart and Vessels
D Marshall Brinkley, David DeNofrio, Robin Ruthazer, Amanda R Vest, Navin K Kapur, Gregory S Couper, Michael S Kiernan
BACKGROUND: Since Food and Drug Administration's approval of the HeartMate II left ventricular assist device (LVAD) as destination therapy, the number of hospitals offering LVAD therapy has grown rapidly. A rising number are performed at centers without internal transplant programs. We sought to determine whether outcomes after destination therapy LVAD implantation are similar at transplant and nontransplant centers. METHODS AND RESULTS: Adult recipients of a primary, continuous-flow LVAD as destination therapy between January 2012 and March 2014 from the Interagency Registry for Mechanically Assisted Circulatory Support were included...
March 2018: Circulation. Heart Failure
Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence...
March 14, 2018: Endoscopy
Heidi J Reich, Lawrence S C Czer, Danny Ramzy, Francisco Arabia, Jaime Moriguchi, Deborah D Ascheim, Timothy D Henry
The use of stem cell therapy in combination with a left ventricular assist device (LVAD) for patients with advanced heart failure (HF) is an attractive concept with the potential to alter the natural history of HF. Cell therapy trials for HF have demonstrated excellent safety and encouraging results, but current rates of myocardial recovery after LVAD implantation are limited. Early trials combining these 2 therapies to increase the likelihood of recovery and to potentially obviate the need for subsequent transplantation appear promising...
March 13, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Pavol Sajgalik, Vaclav Kremen, Vratislav Fabian, Simon Maltais, John M Stulak, Sudhir S Kushwaha, Lyle D Joyce, John A Schirger, Bruce D Johnson
The gold standard for noninvasive blood pressure (BP) measurement, the Doppler technique, does not provide systolic blood pressure (SBP) and diastolic blood pressure (DBP) and may limit therapy outcomes. To improve patient care, we tested specifically designed experimental BP (ExpBP) monitor and the Doppler technique by comparing noninvasive measures to the intraarterial (I-A) BP in 31 patients with end-stage heart failure (4 females) 2.6 ± 3.4 days post-LVAD implantation (20 HeartMate II and 11 HeartWare)...
March 13, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
David M Tehrani, Daniel Rodgers, Sirtaz Adatya, Nitasha Sarswat, Jayant Raikhelkar, Gene H Kim, Gabriel Sayer, Nir Uriel
We aim to evaluate the echocardiographic/hemodynamic effects of left ventricular assist devices in African American (AA) versus non-AA patients undergoing ramp speed optimization and its subsequent effect on readmissions. In 65 patients (26 AA), no differences in baseline echocardiographic/hemodynamic parameters were noted. During ramp testing, there was a significantly greater increase in cardiac output (slope: 0.29 ± 0.24 vs. 0.15 ± 0.12, p < 0.01) with more rapid decrease in left ventricular end-diastolic diameter (slope: -0...
March 13, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
David J Horvath, Jamshid H Karimov, Nicole A Byram, Barry D Kuban, Gengo Sunagawa, Nader Moazami, Kiyotaka Fukamachi
Control of mechanical circulatory support pump output typically requires that pressure-regulating functions be accomplished by active control of the speed or geometry of the device, with feedback from pressure or flow sensors. This article presents a different design approach, with a pressure-regulating device as the core design feature, allowing the essential control function of regulating pressure to be directly programmed into the hydromechanical design. We show the step-by-step transformation of a pressure-regulating device into a continuous-flow total artificial heart that passively balances left and right circulations without the need for pressure and flow sensors...
March 7, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Jessica Schultz, Ranjit John, Cindy Martin, Forum Kamdar, Thenappan Thenappan, Rebecca Cogswell
Myocardial fibrosis identified by apical core pathology at the time of left ventricular assist device (LVAD) implantation may add information regarding myocardial recovery potential. In this analysis, we report the prevalence of myocardial fibrosis by cardiomyopathy type and its association with other known markers of left ventricular recovery. Left ventricular assist device core pathology was reviewed on 332 patients who underwent LVAD implantation at a single institution between 2005 and 2016. Baseline clinical and echocardiographic characteristics were compared among patients with and without myocardial fibrosis by cardiomyopathy type...
March 10, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Mohsen Bakouri
In this study, the physiological control algorithm using sliding mode control method is implemented to track the reference input signal. The controller is developed using feed-forward part, reference model, and steady-state flow estimator. The proposed control method is evaluated using a dynamic heart-pump interaction model incorporating descriptions of the cardiovascular system - rotary blood pump. The immediate response of the controller to preload as well as afterload was studied. Stability and feasibility of the control system were demonstrated through the tests...
April 2018: IET Systems Biology
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