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Continuous flow left ventricular assist device

Rakesh Gopinathannair, Henri Roukoz, Adarsh Bhan, Ashwin Ravichandran, Mustafa M Ahmed, Dmitry Familtsev, Geetha Bhat, Jennifer Cowger, Munazzah Abdullah, Chirag Sandesara, Rahul Dhawan, Emma J Birks, Jaimin R Trivedi, Mark S Slaughter
BACKGROUND: Many patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF-LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF-LVAD patients. METHODS AND RESULTS: Analysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT-D (n=265) who underwent CF-LVAD implantation at 5 centers from 2007 to 2015...
June 15, 2018: Journal of the American Heart Association
Inna Tchoukina, Melissa C Smallfield, Keyur B Shah
The authors discuss principles of continuous flow left ventricular assist device (LVAD) operation, basic differences between the axial and centrifugal flow designs and hemodynamic performance, normal LVAD physiology, and device interaction with the heart. Systematic interpretation of LVAD parameters and recognition of abnormal patterns of flow and pulsatility on the device interrogation are necessary for clinical assessment of the patient. Optimization of pump flow using LVAD parameters and echocardiographic and hemodynamics guidance are reviewed...
July 2018: Critical Care Clinics
Amresh Raina, Maria Patarroyo-Aponte
Left ventricular assist devices (LVAD) are increasingly used for the treatment of end-stage heart failure. Right ventricular (RV) failure after LVAD implantation is an increasingly common clinical problem, occurring in patients early after continuous flow LVAD implant. RV failure is associated with a substantial increase in post-LVAD morbidity and mortality. RV failure can be predicted using preoperative hemodynamic, clinical, and echocardiographic variables and a variety of risk prediction algorithms. However, RV failure may also develop due to unanticipated intraoperative or perioperative factors...
July 2018: Critical Care Clinics
James H Tabibian, Daniel P Rhoades, Kimberly A Forde, Rhondalyn C McLean, Vinay Chandrasekhara
BACKGROUND & AIMS: Continuous-flow left ventricular assist devices (LVADs) for advanced heart failure have been associated with gastrointestinal bleeding (GIB). We examined the association between time of GIB after LVAD implantation and bleeding location (determined by endoscopy), etiology, and patient outcomes. METHODS: We performed a retrospective study of consecutive patients who underwent implantation of continuous-flow LVADs from 2008 through 2015. We analyzed data on anatomic location of GIB, etiology, length of hospital stay, transfusion requirement, time to endoscopy, and rate of readmission within 30 days...
June 12, 2018: Clinical Gastroenterology and Hepatology
Suneet N Purohit, William K Cornwell, Jay D Pal, JoAnn Lindenfeld, Amrut V Ambardekar
Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure compared with lower ordered animals. Yet despite years of such natural selection, the modern generation of continuous-flow left ventricular assist devices (CF-LVADs) that have been increasingly used for the last decade have created a unique physiology characterized by a nonpulsatile, nonlaminar blood flow profile with the absence of the usual large elastic artery Windkessel effect during diastole...
June 2018: Circulation. Heart Failure
Harry Magunia, Clemens Dietrich, Harald F Langer, David Schibilsky, Christian Schlensak, Peter Rosenberger, Martina Nowak-Machen
BACKGROUND: Right heart failure remains a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Multiple 2D echocardiography derived parameters are associated with right ventricular failure (RV failure), but none of them has been proven to be a reliable predictor to date. We hypothesized that novel 3D-echocardiography (3DE) based parameters are associated with RV failure and predict long term outcome in patients undergoing LVAD implantation. METHODS: This single-center study retrospectively enrolled 26 patients undergoing continuous-flow LVAD implantation...
June 8, 2018: International Journal of Cardiology
Liza Grosman-Rimon, Michael A McDonald, Danit Freedman, Paul Yip, David Z Cherney, Vivek Rao
INTRODUCTION: The levels of neurohormones were assessed in continuous-flow left ventricular assist device (CF-LVAD) recipients and compared to patients with heart failure (HF) and to healthy controls (HCs), and CF-LVAD recipients with closed or open aortic valves (AVs). METHODS: Aldosterone, norepinephrine, and renin levels were assessed in a total of 46 participants, including CF-LVAD recipients (n = 18), HF patients (n = 14), and HC individuals (n = 14)...
June 14, 2018: Journal of Cardiac Surgery
Rabea Asleh, Tal Hasin, Alexandros Briasoulis, Sarah D Schettle, Barry A Borlaug, Atta Behfar, Naveen L Pereira, Brooks S Edwards, Alfredo L Clavell, Lyle D Joyce, Simon Maltais, John M Stulak, Sudhir S Kushwaha
OBJECTIVE: To investigate differences in invasive hemodynamic parameters and outcomes in patients with and without heart failure (HF) symptoms after left ventricular assist device (LVAD) implantation. PATIENTS AND METHODS: We performed a single-center retrospective analysis of 51 symptomatic patients and 50 patients with resolved HF symptoms who underwent right-sided heart catheterization (RHC) after LVAD implantation from March 1, 2007, through June 30, 2016. Patient characteristics and outcomes including all-cause mortality and right ventricular (RV) failure were compared between groups...
June 8, 2018: Mayo Clinic Proceedings
Dominik Wiedemann, Thomas Haberl, Philipp Angleitner, Kamen Dimitrov, Günther Laufer, Daniel Zimpfer
The era of intracorporal continuous flow pumps has initiated significant success of left ventricular assist device (LVAD) surgery. However, median sternotomy has been the only surgical approach for implantation over many years. During the last decade, less-invasive access ways gained popularity. Within this review, we describe our own clinical experience in minimally invasive ventricular assist device (VAD) surgery and summarize the current scientific literature on this topic.
2018: Indian Journal of Thoracic and Cardiovascular Surgery
Meghana Halkar, Amy S Nowacki, Kay Kendall, Nephertiti Efeovbokhan, Eiran Z Gorodeski, Nader Moazami, Randall C Starling, James B Young, Sangjin Lee, W H Wilson Tang
PURPOSE: Psychosocial assessment of patients comprises an important element in the selection process of appropriate candidates for left ventricular assist device (LVAD) implantation. We sought to determine the association of the well-validated psychosocial assessment of candidates for transplantation (PACT) scale to clinical outcomes post-LVAD implantation. MATERIALS AND METHODS: The PACT scale was used retrospectively to reconstruct psychosocial profiles of all patients who underwent a continuous-flow LVAD implantation for all indications at our institution between March 2008 and August 2012 (N = 230)...
January 1, 2018: Progress in Transplantation
Veraprapas Kittipibul, Pattara Rattanawong, Jakrin Kewcharoen, Pakawat Chongsathidkiet, Wasawat Vutthikraivit, Napatt Kanjanahattakij
Atrial fibrillation (AF) is a well-established risk factor of thromboembolism (TE). Thromboembolism is one of the most common complications in patients supported by continuous-flow left ventricular assisted devices (CF-LVADs). However, the association between AF and TE complications in this population is controversial. We conducted a systematic review and meta-analysis to assess the association between AF and overall TE, stroke, and device thrombosis events in CF-LVAD patients. We performed a comprehensive literature search through September 2017 in the databases of MEDLINE and EMBASE...
June 5, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
J Christopher Bouwmeester, Jiheum Park, John Valdovinos, Pramod Bonde
Changing the speed of left ventricular assist devices (LVADs) cyclically may be useful to restore aortic pulsatility; however, the effects of this pulsation on right ventricular (RV) function are unknown. This study investigates the effects of direct ventricular interaction by quantifying the amount of wave energy created by RV contraction when axial and centrifugal LVADs are used to assist the left ventricle. In 4 anesthetized pigs, pressure and flow were measured in the main pulmonary artery and wave intensity analysis was used to identify and quantify the energy of waves created by the RV...
May 29, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
J Christopher Bouwmeester, Jiheum Park, Arnar Geirsson, John Valdovinos, Pramod Bonde
The current generation of left ventricular assist devices (LVADs) provides continuous flow and has the capacity to reduce aortic pulsatility, which may be related to a range of complications associated with these devices. Pulsed LVAD operation using speed modulation presents a mechanism to restore aortic pulsatility and potentially mitigate complications. We sought to investigate the interaction of axial and centrifugal LVADs with the LV and quantify the effects of continuous and pulsed LVAD operations on LV generated wave patterns under different physiologic conditions using wave intensity analysis (WIA) method...
May 23, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Jessica G Y Luc, Vakhtang Tchantchaleishvili, Kevin Phan, Shannon M Dunlay, Simon Maltais, John M Stulak
Pump thrombosis is a major adverse event in patients supported on left ventricular assist devices (LVAD). The aim of this systematic review and meta-analysis was to determine the outcomes of various treatment approaches for pump thrombosis, including surgical or medical therapy. Electronic search was performed to identify all studies in the English literature addressing surgical and medical management of pump thrombosis in the modern LVAD era. All identified articles were systematically assessed for inclusion and exclusion criteria...
May 23, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Omar Saeed, Sabarivinoth Rangasamy, Morayma Reyes Gil, Daniel J Goldstein, Henny H Billett, Ulrich P Jorde, Snehal R Patel
Acquired von Willebrand Syndrome (AVWS) in patients undergoing continuous-flow left ventricular assist device support is due to the loss of von Willebrand factor (vWF) high molecular weight multimers (HMWMs) by shear-mediated mechanisms. We investigated whether reducing speed in vivo would mitigate the shear effect. In outpatients (n = 6) with a HeartMate II, pump speed was decreased to 8,000 rpm for 6 hours. At baseline (9,140 ± 189 rpm), patients had an AVWS as evidenced by low vWF activity:antigen ratios (0...
May 23, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Mandeep R Mehra, Christopher Salerno, Joseph C Cleveland, Sean Pinney, Melana Yuzefpolskaya, Carmelo A Milano, Akinobu Itoh, Daniel J Goldstein, Nir Uriel, Sanjeev Gulati, Francis D Pagani, Ranjit John, Robert M Adamson, Roberta C Bogaev, Vinay Thohan, Joyce Chuang, Poornima Sood, Scott Goates, Scott C Silvestry
Background : MOMENTUM 3 compares the centrifugal HeartMate 3 (HM3) to the axial HeartMate II (HMII) continuous-flow Left Ventricular Assist System (LVAS) in patients with advanced heart failure, irrespective of the intended goal of therapy. The trial's 2-year clinical outcome (n=366), demonstrated superiority of the HM3 for the primary endpoint (survival free of a disabling stroke or reoperation to replace or remove a malfunctioning pump). This analysis evaluates health resource use and cost implications of the observed differences between the two devices while patients were enrolled in the trial...
May 27, 2018: Circulation
Rebecca Cogswell, Sue Duval, Ranjit John
BACKGROUND: Left ventricular assist device (LVAD) related complications have the potential to disqualify patients for heart transplantation. We sought to determine whether LVAD support was associated with increased rates of delisting due to medical unsuitability or clinical deterioration. METHODS: The analysis included adult candidates listed for first-time heart transplantation in the UNOS registry in the contemporary, continuous flow (CF)- LVAD era (2010-2016)...
May 9, 2018: International Journal of Cardiology
Robert B Hawkins, J Hunter Mehaffey, Abra Guo, Eric J Charles, Alan M Speir, Jeffrey B Rich, Mohammed A Quader, Gorav Ailawadi, Leora T Yarboro
BACKGROUND: Postoperative atrial fibrillation (POAF) is a known risk factor for morbidity and mortality after cardiac surgery but has not been investigated in the left ventricular assist device (LVAD) population. We hypothesize that POAF will increase morbidity and resource utilization after LVAD placement. METHODS: Records were extracted for all patients in a regional database who underwent continuous-flow LVAD placement (n = 1064, 2009-2017). Patients without a history of atrial fibrillation (n = 689) were stratified by POAF for univariate analysis...
April 18, 2018: Journal of Thoracic and Cardiovascular Surgery
Jessica Rimsans, Amy Levesque, Erin Lyons, Katelyn Sylvester, Michael M Givertz, Mandeep R Mehra, Garrick C Stewart, Jean M Connors
Continuous flow left ventricular assist devices (CF-LVAD) require therapeutic anticoagulation which is often interrupted for procedures or bleeding. Prior to the availability of four factor prothrombin complex concentrate (4F-PCC) in the United States, warfarin was held and its effects reversed by vitamin K or fresh frozen plasma. We evaluated the use of 4F-PCC for temporary warfarin reversal in patients with CF-LVADs and assessed outcomes. This analysis is a retrospective study of CF-LVAD patients who received 4F-PCC for warfarin reversal in the setting of bleeding or need for urgent or elective procedures...
May 21, 2018: Journal of Thrombosis and Thrombolysis
Jun I K Park, Aulia Khamas Heikhmakhtiar, Chang Hyun Kim, Yoo Seok Kim, Seong Wook Choi, Kwang Soup Song, Ki Moo Lim
BACKGROUND AND AIMS: Although it is important to analyze the hemodynamic factors related to the right ventricle (RV) after left ventricular assist device (LVAD) implantation, previous studies have focused only on the alteration of the ventricular shape and lack quantitative analysis of the various hemodynamic parameters. Therefore, we quantitatively analyzed various hemodynamic parameters related to the RV under normal, heart failure (HF), and HF incorporated with continuous flow LVAD therapy by using a computational model...
May 22, 2018: Biomedical Engineering Online
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