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Michael Dandel, Roland Hetzer
Severe right ventricular (RV) failure is more likely reversible than similar magnitudes of left ventricular (LV) failure and, because reversal of both adaptive remodeling and impaired contractility require most often only short periods of support, the use of temporary RV assist devices (t-RVADs) can be a life-saving therapy option for many patients. Although increased experience with t-RVADs and progresses made in the development of safer devices with lower risk for complications has improved both recovery rate of RV function and patient survival, the mortality of t-RVAD recipients can still be high but it depends mainly on the primary cause of RV failure (RVF), the severity of end-organ dysfunction, and the timing of RVAD implantation, and much less on adverse events and complications related to RVAD implantation, support, or removal...
February 17, 2018: Heart Failure Reviews
Antonio Salsano, Elena Sportelli, Guido Maria Olivieri, Nicola Di Lorenzo, Silvia Borile, Francesco Santini
Patients with submassive pulmonary embolism (PE), although normotensive, are characterized by right ventricular (RV) dysfunction and elevated levels of biomarkers of cardiac damage. The best treatment option in these cases is still a subject of debate and the use of thrombolysis in submassive PE remains controversial. A 57-year-old Caucasian male with unprovoked PE, normal blood pressure, and elevated troponin I values was referred to the cardiovascular department. In view of the presence of a right atrium thrombus, the patient underwent surgical embolectomy under extracorporeal circulation, with the extraction of a huge thrombus together with fragmented thrombi from both pulmonary arteries...
December 2017: Journal of Extra-corporeal Technology
Amit Pawale, Yosef Schwartz, Shinobu Itagaki, Sean Pinney, David H Adams, Anelechi C Anyanwu
OBJECTIVE: Surgical therapy for refractory primary cardiogenic shock is largely based on emergent placement of extracorporeal membrane oxygenation or short-term ventricular assist devices. We have adopted a strategy of routine implantation of durable left ventricular assist devices (LVAD) as initial therapy for refractory cardiogenic shock, in patients who are potential candidates for heart transplantation, and report our experience. METHODS: Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n = 21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution...
March 2018: Journal of Thoracic and Cardiovascular Surgery
Javier J Lasa, Daniel A Castellanos, Susan W Denfield, William J Dreyer, Sebastian C Tume, Henri Justino, Athar M Qureshi
There is a growing interest in the use of percutaneously delivered ventricular assist devices (PVAD) in the pediatric patient population. A 16 year old female and 18 year old male both status post heart transplantation presented with evidence of graft rejection and acute severe global systolic and diastolic heart failure necessitating hemodynamic catheterization and inotropic support. Both underwent percutaneous Impella CP LVAD (Abiomed, Danvers, MA) placement with close monitoring of right ventricular function...
December 11, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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
Ashwin K Ravichandran, David A Baran, Kelly Stelling, Jennifer A Cowger, Christopher T Salerno
Recently, a percutaneous right ventricular assist device (RVAD) called the TandemLife Protek Duo (TPD; TandemLife, Pittsburgh, PA) has been introduced. The Protek Duo (TPD) is a temporary RVAD placed via the right internal jugular vein, capable of providing up to 4.5 L of flow. We report a two-center experience using the TPD in 17 patients with right ventricular (RV) failure, 12 of whom were post-left ventricular assist device (LVAD) implantation.
October 31, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Vanessa Blumer, Rodrigo Mendirichaga, Gabriel A Hernandez, Gerardo Zablah, Sandra V Chaparro
Continuous-flow left ventricular assist devices (CF-LVADs) decrease mortality and improve quality of life in patients with advanced heart failure (HF). Their widespread utilization has led to concerns regarding increased adverse effects, especially in women. Nevertheless, sex-specific data remain limited. We searched Medline, Embase, Scopus, and the Cochrane Library for publications reporting sex-specific outcomes after CF-LVADs from January 2008 through January 2017. Outcomes were compared under the random-effects model and heterogeneity examined via χ test and I statistics...
October 26, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Erik J S Packer, Grete Slettom, Atle Solholm, Arve Mongstad, Rune Haaverstad, Vegard Tuseth, Ketil Grong, Jan Erik Nordrehaug
Maintaining adequate organ perfusion during cardiac arrest remains a challenge, and various assist techniques have been evaluated. We assessed whether a right ventricular impeller assist device (RVAD) in adjunct to a left ventricular impeller assist device (LVAD) is beneficial. Twenty anesthetized pigs were randomized to maximized circulatory support by percutaneously implanted left- or biventricular assist device(s) during 30 minutes of electrically induced ventricular fibrillation followed by three attempts of cardioversion...
October 20, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Michael S Kiernan, E Wilson Grandin, Marshall Brinkley, Navin K Kapur, Duc Thinh Pham, Robin Ruthazer, J Eduardo Rame, Pavan Atluri, Edo Y Birati, Guilherme H Oliveira, Francis D Pagani, James K Kirklin, David Naftel, Robert L Kormos, Jeffrey J Teuteberg, David DeNofrio
BACKGROUND: To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery. METHODS AND RESULTS: Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression...
October 2017: Circulation. Heart Failure
Snehal R Patel, Omar Saeed, David Naftel, Susan Myers, James Kirklin, Ulrich P Jorde, Daniel J Goldstein
BACKGROUND: Patients with restrictive (RCM) and hypertrophic (HCM) cardiomyopathies are felt to be a difficult population to treat with left ventricular assist device (LVAD) therapy. Scarce data exist on outcomes of continuous-flow (CF) LVAD support in these challenging patient cohorts. METHODS: The Interagency Registry for Mechanically Assisted Circulatory Support Registry was queried for all patients with RCM (n = 94) and HCM (n = 104) who underwent CF LVAD implantation between March 2008 and March 2014...
December 2017: Journal of Cardiac Failure
Yu Wang, Steven C Koenig, Zhongjun Wu, Mark S Slaughter, Guruprasad A Giridharan
Rotary biventricular assist devices (BiVAD) are becoming a clinically accepted treatment option for end-stage biventricular failure. To improve BiVAD efficacy and safety, we propose a control algorithm to achieve the clinical objectives of maintaining left-right-sided balance, restoring physiologic flows, and preventing ventricular suction. The control algorithm consists of two proportional-integral (PI) controllers for left and right ventricular assist devices (LVAD and RVAD) to maintain differential pump pressure across LVAD (ΔPL) and RVAD (ΔPR) to provide left-right balance and physiologic flow...
September 21, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Motohiko Goda, Naoto Yabu, Norihisa Tominaga, Daisuke Machida, Yukihisa Isomatsu, Shinichi Suzuki, Manabu Nitta, Naohiro Komura, Naoki Nakayama, Masayoshi Kiyokuni, Teruyasu Sugano, Munetaka Masuda
The AB5000 Circulatory Support System is paracorporeal pulsatile ventricular assist device. The AB Portable Driver is a portable console for this system. We experienced two cases with accelerated hemolysis while receiving support by the AB Portable Driver. The purpose of this study was to clarify the mechanical differences associated with the hemolysis between the AB5000 console and the AB Portable Driver. The mock circulatory system modeled by an AB5000 ventricle and a blood sampling bag of vinyl chloride was run with an AB5000 console or AB Portable Driver...
August 29, 2017: Artificial Organs
Eric L Wu, Frank Nestler, Matthias Kleinheyer, Michael C Stevens, Jo P Pauls, John F Fraser, Shaun D Gregory
Right ventricular failure is a common complication associated with rotary left ventricular assist device (LVAD) support. Currently, there is no clinically approved long-term rotary right ventricular assist device (RVAD). Instead, clinicians have implanted a second rotary LVAD as RVAD in biventricular support. To prevent pulmonary hypertension, the RVAD must be operated by either reducing pump speed or banding the outflow graft. These modes differ in hydraulic performance, which may affect the pulmonary valve opening (PVO) and subsequently cause fusion, valvular insufficiency, and thrombus formation...
July 25, 2017: Artificial Organs
Anna K Schmidt, Diyar Saeed, Arash Mehdiani, Bozena Sowinski, Ralf Westenfeld, Payam Akhyari, Artur Lichtenberg, Udo Boeken
INTRODUCTION: In times of organ shortage, death while on the heart waiting-list still represents a major problem. As a consequence, bridging to transplant as well as the decision when to escalate therapy play a very important role. METHODS AND RESULTS: We report on two young patients with dilated cardiomyopathy and acute decompensation who were successfully bridged to heart transplantation with both left and temporary right ventricular assist devices in just 2 months...
October 27, 2017: International Journal of Artificial Organs
Carly L Lodewyks, Joseph M Bednarczyk, Owen T Mooney, Rakesh C Arora, Rohit K Singal
Consensus regarding the management of massive pulmonary embolism (PE) and persistent shock after thrombolysis is lacking. A 30-year-old man collapsed with massive PE 3 days after an exploratory laparotomy for penetrating trauma, and he remained hypoxic and hypotensive despite thrombolytic therapy. Extracorporeal membrane oxygenation (ECMO) was instituted as a bridge to surgical embolectomy, and placement of a right ventricular assist device (RVAD) was used to facilitate separation from cardiopulmonary bypass...
July 2017: Canadian Journal of Cardiology
Edris Wedi, Mohamed Bounnah, Riccardo Memeo, Carlo Jung
Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot...
November 2017: Clinical Endoscopy
Teresa A Mulaikal, Laura H Bell, Boyangzi Li, Gebhard Wagener, Hiroo Takayama
Right ventricular (RV) failure that necessitates isolated mechanical support is extremely rare. Outcomes have not been described and are limited to case reports. We sought to evaluate this select group of patients and determine their 30 day and 1 year survival. We retrospectively reviewed the Mechanical Assist Device Database at Columbia University from 2007 to 2015. Inclusion criteria consisted of patients who received isolated RV assist devices (RVADs) without mechanical support of the left ventricle. We evaluated survival, duration of support, intensive care unit (ICU) length of stay, and adverse events...
May 12, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Rob C Brink, Tom P C Schlösser, Marijn van Stralen, Koen L Vincken, Moyo C Kruyt, Winnie C W Chu, Jack C Y Cheng, René M Castelein
STUDY DESIGN: Cross-sectional study. OBJECTIVE: To establish the relevance of the conventional two-dimensional (2D) RVAD and the relationship with the complex three-dimensional (3D) apical morphology in scoliosis. SUMMARY OF BACKGROUND DATA: The rib vertebra angle difference (RVAD, also known as Mehta's angle) describes apical rib asymmetry on conventional radiographs and was introduced as a prognostic factor for curve severity in early onset scoliosis, and later applied to other types of scoliosis as well...
May 11, 2017: Spine
Takamichi Inoue, Tadashi Kitamura, Shinzo Torii, Mitsuhiro Hirata, Toshiaki Mishima, Koichi Sughimoto, Hirotoki Ohkubo, Kensuke Kobayashi, Mamika Motokawa, Miyuki Shibata, Takuya Matsushiro, Yuta Tsuchida, Yurie Miyata, Minoru Ono, Kagami Miyaji
Patients with mechanical aortic valves are generally contraindicated for left ventricular assist device (LVAD) insertion because the prosthetic valve often becomes fixed in closed position. A 41-year-old woman with mechanical aortic valve prosthesis experienced sudden chest pain and developed cardiogenic shock. A paracorporeal pulsatile LVAD and a monopivot centrifugal pump as a right VAD (RVAD) were implanted. The mechanical aortic valve was intentionally left in place. Soon after the operation, LVAD support was discontinued daily for few seconds to allow the mechanical aortic valve to open and to avoid thrombus formation...
September 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Daisuke Yoshioka, Hiroo Takayama, Reshad A Garan, Veli K Topkara, Jiho Han, Paul Kurlansky, Melana Yuzefpolskaya, Paolo C Colombo, Yoshifumi Naka, Koji Takeda
OBJECTIVES: The timely use of a right ventricular assist device (RVAD) becomes necessary for severe right heart failure (RHF) after left ventricular assist device (LVAD) insertion. This study evaluates outcomes in patients who required unplanned RVAD support early after continuous-flow (CF) LVAD insertion. METHODS: We retrospectively reviewed 305 patients who underwent HeartMate II/HeartWare CF-LVAD insertion between 2009 and 2014. Twenty-seven (9%) patients required unplanned RVAD for severe RHF early after LVAD insertion...
June 1, 2017: Interactive Cardiovascular and Thoracic Surgery
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