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Francesca Condemi, Dongfang Wang, Gionata Fragomeni, Fuqian Yang, Guangfeng Zhao, Cameron Jones, Cherry Ballard-Croft, Joseph B Zwischenberger
OBJECTIVES: Our goal is to develop a double lumen cannula (DLC) for a percutaneous right ventricular assist device (pRVAD) in order to eliminate two open chest surgeries for RVAD installation and removal. The objective of this study was to evaluate the performance, flow pattern, blood hemolysis, and thrombosis potential of the pRVAD DLC. METHODS: Computational fluid dynamics (CFD), using the finite volume method, was performed on the pRVAD DLC. For Reynolds numbers <4000, the laminar model was used to describe the blood flow behavior, while shear-stress transport k-ω model was used for Reynolds numbers >4000...
2016: Biocybernetics and Biomedical Engineering
E Wilson Grandin, Payman Zamani, Jeremy A Mazurek, Gregory S Troutman, Edo Y Birati, Esther Vorovich, Julio A Chirinos, Ryan J Tedford, Kenneth B Margulies, Pavan Atluri, J Eduardo Rame
BACKGROUND: Right ventricular (RV) adaptation to afterload is crucial for patients undergoing continuous-flow left ventricular assist device (cf-LVAD) implantation. We hypothesized that stratifying patients by RV pulsatile load, using pulmonary arterial compliance (PAC), and RV response to load, using the ratio of central venous to pulmonary capillary wedge pressure (CVP:PCWP), would identify patients at high risk for early right heart failure (RHF) and 6-month mortality after cf-LVAD...
June 24, 2016: Journal of Heart and Lung Transplantation
Heinz Deschka, Alexander J Holthaus, Jürgen R Sindermann, Henryk Welp, Dominik Schlarb, Nadejda Monsefi, Sven Martens, Mirela Scherer
OBJECTIVES: Depending on the pre-existing condition of the right ventricle (RV), left ventricular assist device (LVAD) implantation may have a detrimental effect on RV function, subsequently leading to right heart failure. This study details the authors' experience with perioperative mechanical RV support in patients with biventricular impairment but primarily scheduled for isolated LVAD implantation. DESIGN: Retrospective study. SETTING: Two center study, university hospital...
June 2016: Journal of Cardiothoracic and Vascular Anesthesia
Mohamed Zeriouh, Prashant Mohite, Binu Rai, Anton Sabashnikov, Javid Fatullayev, Diana Garcia Saez, Bartrlomiej Zych, Ali Ghodsizad, Parwis Rahmanian, Yeong-Hoon Choi, Thorsten Wahlers, Andre R Simon, Aron F Popov, Achim Koch
PURPOSE: Low cardiac output syndrome is associated with significant mortality. In patients with refractory low cardiac output left ventricular assist devices (VAD) are used to re-establish cardiac output and to prevent death. However, long-term LVAD implantation in these is complicated by a high rate of right heart failure and mortality. Therefore, our strategy is to implant a short-term VAD (left or biventricular) as a bridge to decission. METHODS: We retrospectively analysed data from 66 patients who received a short-term LVAD support prior to implantation of a long-term LVAD or HTx between 2003 and 2014...
May 16, 2016: International Journal of Artificial Organs
Marlene Speth, Frank Münch, Ariawan Purbojo, Martin Glöckler, Okan Toka, Robert A Cesnjevar, André Rüffer
This study reports a single-centre experience of the Medos Deltastream diagonal-pump (DP3) for extracorporeal cardiac, pulmonary, or combined support in a single-center pediatric cohort. Twenty-seven consecutive patients with 28 runs of the DP3 between January 2013 and June 2014 were included for analysis. Median patient age, weight, and duration of support were 278 days (range: 0 days-14.2 years), 7.2 kg (range: 2.5-39 kg), and 8 days (range: 2-69 days). Midline sternotomy (n = 20, 71.4%) or cervical approaches (n = 8, 28...
July 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Mohammed Quader, Damien J LaPar, Luke Wolfe, Gorav Ailawadi, Jeffrey Rich, Alan Speir, Clifford Fonner, Vigneshwar Kasirajan
Patient and institutional factors predictive of delayed sternal closure (DSC) practice and its impact on clinical and cost outcomes when compared with primary sternal closure (PSC) following continuous-flow left ventricular assist device (CF-LVAD) implantation were examined. Statewide Society of Thoracic Surgeons and hospital cost data on CF-LVADs implanted were analyzed. Between January 2007 and December 2013, 558 CF-LVADs were implanted (PSC = 464, 83.2%; DSC = 94, 16.8%). Among the six institutions implanting CF-LVADs, DSC practice ranged from 3...
July 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Bastian Schmack, Alexander Weymann, Aron-Frederik Popov, Nikhil Prakash Patil, Anton Sabashnikov, Jamila Kremer, Mina Farag, Andreas Brcic, Christoph Lichtenstern, Matthias Karck, Arjang Ruhparwar
Right ventricular failure (RVF) is an unfortunate complication that continues to limit outcomes following durable left ventricular assist device (LVAD) implantation. Despite several 'RVF risk scores' having been proposed, preoperative prediction of post-LVAD RVF remains a guesstimate at best. Current strategies for institution of temporary RVAD support are invasive, necessitate additional re-thoracotomy, restrict postoperative mobilization, and/or entail prolonged retention of prosthetic material in-situ. The authors propose a novel surgical strategy comprising simultaneous implantation of a permanent LVAD and percutaneous TandemHeart® plus ProtekDuo® to provide temporary RVAD support and preempt RVF in patients with impaired RV function...
2016: Medical Science Monitor Basic Research
Bibek S Pannu, Devang K Sanghavi, Pramod K Guru, Dereddi Raja Reddy, Vivek N Iyer
Protamine sulfate is the only Food and Drug administration approved medication for reversal of intraoperative heparin-induced anticoagulation during cardiac and vascular surgeries. One of the rare side effects of protamine sulfate is an idiosyncratic reaction resulting in acute pulmonary hypertension (APH) and right ventricular (RV) failure occurring after protamine administration. These reactions are rare but catastrophic with high mortality. A 36-year-old female with severe congestive heart failure was undergoing cardiac transplant surgery...
March 2016: Indian Journal of Critical Care Medicine
Seiko Nakajima, Osamu Seguchi, Tomoyuki Fujita, Hiroki Hata, Kizuku Yamashita, Takuma Sato, Haruki Sunami, Masanobu Yanase, Norihide Fukushima, Junjiro Kobayashi, Takeshi Nakatani
Fulminant myocarditis is a rare but fatal serious disease that may cause prolonged native cardiac dysfunction with multiorgan failure despite temporary mechanical circulatory support with percutaneous venoatrial extracorporeal membrane oxygenation (VA-ECMO) or intraaortic balloon pumping (IABP). A 26-year-old man with fulminant myocarditis developed life-threatening multiorgan failure after 8 days support by VA-ECMO and IABP. He was transferred to our institution with prolonged cardiac dysfunction on hospital day 8; massive pulmonary edema developed into severe pulmonary dysfunction...
September 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Javier Pizones, Lorenzo Zúñiga, Felisa Sánchez-Mariscal, Enrique Izquierdo
INTRODUCTION: Torsion has recently become essential in curve evaluation, not only to assess the degree of clinical deformity that can influence decision making, but also to predict curve progression. Since torsion cannot be currently measured using plain X-rays, our aim was to study the relationships between the different torsion-related parameters measured on 2D radiographs that can indirectly guide the clinician about the torsion of a given curve. METHODS: This is a cross-sectional study analyzing prospectively registered data of a consecutive cohort of 113 AIS patients with progressive main thoracic deformity...
October 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Martin Schweiger, Barnard Krüger, Anna Cavigelli-Brunner, Hitendu Dave, Martin Schmiady, Michael Hübler
PURPOSE: The pediatric population has benefited greatly by the evolution of ventricular assist devices (VADs) leading to miniaturization. Device design like the HeartWare® VAD allows for implantation in smaller patients or even as an implantable biventricular assist device. CASE REPORT: A ten-year-old female patient (body surface area: 1.02 m2, 27 kg) waiting for 7 months for heart transplantation was admitted to the intensive care unit due to terminal heart failure...
January 2016: International Journal of Artificial Organs
Sajad Shehab, Peter S Macdonald, Anne M Keogh, Eugene Kotlyar, Andrew Jabbour, Desiree Robson, Phillip J Newton, Sriram Rao, Louis Wang, Sabine Allida, Mark Connellan, Emily Granger, Kumud Dhital, Phillip Spratt, Paul C Jansz, Christopher S Hayward
BACKGROUND: There is limited information on outcomes using the HeartWare ventricular assist device (HVAD; HeartWare, Framington, MA) as a biventricular assist device, especially with respect to site of right ventricular assist device (RVAD) implantation. METHODS: Outcomes in 13 patients with dilated cardiomyopathy and severe biventricular failure who underwent dual HVAD implantation as bridge to transplantation between August 2011 and October 2014 were reviewed...
April 2016: Journal of Heart and Lung Transplantation
Arianna Di Molfetta, Gianfranco Ferrari, Roberta Iacobelli, Sergio Filippelli, Libera Fresiello, Maria G Gagliardi, Alessandro Toscano, Maria G Trivella, Antonio Amodeo
BACKGROUND: Right ventricular failure (RVF) is one of the major complications during LVAD. Apart from drug therapy, the most reliable option is the implantation of RVAD. However, BIVAD have a poor prognosis and increased complications. Experiments have been conducted on alternative approaches, such as the creation of an atrial septal defect (ASD), a cavo-aortic shunt (CAS) including the LVAD and a cavo-pulmonary connection (CPC). This work aims at realizing a lumped parameter model (LPM) to compare the acute hemodynamic effects of ASD, CPC, CAS, RVAD in LVAD pediatric patients with RVF...
December 2015: International Journal of Artificial Organs
Xu Sun, Qi Ding, Shifu Sha, Saihu Mao, Feng Zhu, Zezhang Zhu, Bangping Qian, Bin Wang, Jack C Y Cheng, Yong Qiu
PURPOSE: To investigate the predictive role of rib-vertebral angle (RVA) measurements in early adolescent idiopathic scoliosis (AIS) girls with right thoracic curve during brace treatment. METHODS: Early AIS (premenarchal and Risser 0) girls who had undergone brace treatment and had been followed regularly were recruited to this study. According to the bracing outcome, they were divided into Group A (non-progressed) and Group B (curve worsened over six degrees or indicated for surgery)...
January 23, 2016: European Spine Journal
Jeffrey A Morgan, William W O'Neill
Right ventricular failure requiring short-term mechanical support is a relatively common complication after left ventricular assist device (LVAD) implantation. Removal of the temporary right ventricular assist device (RVAD) generally requires a reoperative sternotomy. In this report, we describe an innovative percutaneous approach for placing an RVAD at the time of LVAD implantation using the Impella RP (Abiomed Inc.) that does not require reoperation for removal, as the Impella RP can be removed at the patient's bedside...
July 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Sharven Taghavi, Senthil N Jayarajan, Eugene Komaroff, Abeel A Mangi
BACKGROUND: To our knowledge, how the need for a right ventricular assist device (RVAD) with a left ventricular assist device (LVAD) affects outcomes after orthotopic heart transplantation has not been studied in a multi-institutional database. METHODS: The United Network for Organ Sharing (UNOS) database was queried for all adult orthotopic heart transplantations from the period 2005-2012. Patients requiring a RVAD + LVAD as a bridge to transplant were compared with patients requiring a LVAD only and patients requiring no ventricular assist device (VAD)...
February 2016: Journal of Heart and Lung Transplantation
Po-Lin Hsu, Madeleine McIntyre, Fiete Boehning, Weiguo Dang, Jack Parker, Rüdiger Autschbach, Thomas Schmitz-Rode, Ulrich Steinseifer
Right heart failure (RHF) is a serious health issue with increasing incidence and high mortality. Right ventricular assist devices (RVADs) have been used to support the end-stage failing right ventricle (RV). Current RVADs operate in parallel with native RV, which alter blood flow pattern and increase RV afterload, associated with high tension in cardiac muscles and long-term valve complications. We are developing an in-series RVAD for better RV unloading. This article presents a mathematical model to compare the effects of RV unloading and hemodynamic restoration on an overloaded or failing RV...
June 2016: Artificial Organs
Arianna Di Molfetta, Gianfranco Ferrari, Sergio Filippelli, Libera Fresiello, Roberta Iacobelli, Maria G Gagliardi, Antonio Amodeo
Failing single-ventricle (SV) patients might benefit from ventricular assist devices (VADs) as a bridge to heart transplantation. Considering the complex physiopathology of SV patients and the lack of established experience, the aim of this work was to realize and test a lumped parameter model of the cardiovascular system, able to simulate SV hemodynamics and VAD implantation effects. Data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline...
May 2016: Artificial Organs
Henryk Welp, Jürgen R Sindermann, Heinz Deschka, Sven Martens, Mirela Scherer
OBJECTIVES: Right heart failure still occurs in up to 20% of patients after implantation of a left ventricular assist device (LVAD). One treatment option for these patients is the implantation of a temporary right ventricular assist device (RVAD). Experimental data suggest that non-pulsatile perfusion of the lungs is associated with an increased rate of pulmonary hemorrhage. The aim of this study was to determine the incidence of pulmonary bleeding complications in these patients. DESIGN: Observational study...
June 2016: Journal of Cardiothoracic and Vascular Anesthesia
David P Cork, Hao A Tran, Jorge Silva, Denise Barnard, Barry Greenberg, Eric D Adler, Victor Pretorius
Increased use of continuous-flow left ventricular assist devices (LVADs) to treat advanced heart failure has heightened concern for right ventricular failure after LVAD implantation, which is associated with increased morbidity and mortality. Biventricular support is required in up to 30% of LVAD recipients. Currently, no durable long-term right ventricular assist device (RVAD) has been approved other than the Syncardia (Tucson, AZ) total artificial heart. A recent publication reported the placement of continuous flow LVAD in the heavily trabeculated right ventricle; however, this orientation may jeopardize both assist device and right ventricle function...
October 2015: Annals of Thoracic Surgery
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