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Continuous flow left ventricular assist device

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https://www.readbyqxmd.com/read/29666073/ventricular-assist-device-utilization-in-heart-transplant-candidates-nationwide-variability-and-impact-on-waitlist-outcomes
#1
Lauren K Truby, A Reshad Garan, Raymond C Givens, Koji Takeda, Hiroo Takayama, Pauline N Trinh, Melana Yuzefpolskaya, Maryjane A Farr, Yoshifumi Naka, Paolo C Colombo, Veli K Topkara
BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVADs) have become a standard treatment choice in advanced heart failure patients. We hypothesized that practice patterns with regards to CF-LVAD utilization vary significantly among transplant centers and impact waitlist outcomes. METHODS AND RESULTS: The United Network for Organ Sharing registry was queried to identify adult patients who were waitlisted for heart transplantation (HT) between 2008 and 2015...
April 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29666072/left-ventricular-assist-device-inflow-cannula-angle-and-thrombosis-risk
#2
Venkat Keshav Chivukula, Jennifer A Beckman, Anthony R Prisco, Todd Dardas, Shin Lin, Jason W Smith, Nahush A Mokadam, Alberto Aliseda, Claudius Mahr
BACKGROUND: As heart failure prevalence continues to increase in the setting of a static donor supply, left ventricular assist device (LVAD) therapy for end-stage heart failure continues to grow. Anecdotal evidence suggests that malalignment of the LVAD inflow cannula may increase thrombosis risk, but this effect has not been explored mechanistically or quantified statistically. Our objective is to elucidate the impact of surgical angulation of the inflow cannula on thrombogenicity. METHODS AND RESULTS: Unsteady computational fluid dynamics is used in conjunction with computational modeling and virtual surgery to model flow through the left ventricle for 5 different inflow cannula angulations...
April 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29664404/outcomes-in-patients-with-hypertrophic-cardiomyopathy-awaiting-heart-transplantation
#3
Julio Zuñiga Cisneros, Josef Stehlik, Craig H Selzman, Stavros G Drakos, Stephen H McKellar, Omar Wever-Pinzon
BACKGROUND: Current organ allocation policy and the rapid growth of mechanical support favor heart transplant (HT) candidates on left ventricular assist devices. HT candidates with hypertrophic cardiomyopathy (HCM) are usually not left ventricular assist device candidates and may have a disadvantage compared with dilated forms of cardiomyopathy. METHODS AND RESULTS: Adult HT candidates registered in the Scientific Registry of Transplant Recipients database between 1999 and 2016 were included...
March 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29663283/eeg-artifact-versus-subclinical-status-epilepticus-in-a-patient-following-cardiac-arrest
#4
Jean E Cibula, Daniel S Demos, Brenda G Fahy
BACKGROUND: A challenge in ICU EEG interpretation is identifying subclinical status epilepticus versus patterns on the ictal-interictal continuum versus other repetitive patterns. In the electrically noisy intensive care unit, identifying and eliminating interference and artifact allow accurate diagnoses from the EEG, avoiding unnecessary treatment or sedation. METHODS: We present a case during Impella (Abiomed Inc, Danvers, MA) continuous flow left ventricular assist device use where the EEG artifact was initially misinterpreted as seizure by the resident and treated as status epilepticus because of the "focal" sharply contoured repetitive pattern...
April 16, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29626453/meld-xi-scoring-system-to-predict-outcomes-in-patients-who-undergo-lvad-implantation
#5
Andre Critsinelis, Chitaru Kurihara, Nastasya Volkovicher, Masashi Kawabori, Tadahisa Sugiura, Marcos Manon, Suwei Wang, Andrew B Civitello, Jeffrey A Morgan
BACKGROUND: The use of continuous flow left ventricular assist devices (CF-LVAD) to treat advanced heart failure is increasing. While risk score such as MELD and the HeartMate II Risk Score require the use of INR, many patients are on anticoagulation prior to CF-LVAD implantation. The aim of this study was to evaluate the ability of the Model of End-Stage Liver Disease-eXcluding INR (MELD-XI) scoring system to predict clinical outcomes in patients with advanced heart failure who undergo CF-LVAD implantation...
April 4, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29608506/the-physiological-rationale-for-incorporating-pulsatility-in-continuous-flow-left-ventricular-assist-devices
#6
Liza Grosman-Rimon, Filio Billia, Jeremy Kobulnik, Stacey Pollock Bar-Ziv, David Z Cherney, Vivek Rao
Over the past few decades, left ventricular assist device (LVAD) support has extended the lives of many patients with end-stage heart failure. The most common devices are continuous-flow (CF) LVADs. The use of the CF-LVADs has required that clinicians learn the physiological and clinical consequences of long-term continuous blood flow. While this alteration in the normal physiology still offers advantages from mechanical circulatory support, the lack of pulsatility may also increase the likelihood of adverse events...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29577927/influence-of-diabetes-on-outcomes-in-patients-after-left-ventricular-assist-device-implantation
#7
Chinenye O Usoh, Saadia Sherazi, Barbara Szepietowska, Valentina Kutyifa, Scott McNitt, Anna Papernov, Meng Wang, Jeffrey D Alexis
BACKGROUND: Despite previous studies, the mortality risk of diabetic patients post left ventricular assist device (LVAD) implant remains unclear. In addition, the relationship between the degree of glycemic control and long-term mortality risk in LVAD patients with diabetes has not been established. METHODS: Ninety-five non-diabetic and 96 diabetic patients from the University of Rochester Medical Center, who received a HeartMate II continuous-flow LVAD between May 2008 and June 2014 were included in this study...
March 22, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29575048/advancing-the-science-of-self-management-in-adults-with-long-term-left-ventricular-assist-devices
#8
Jesus Casida, James Aikens, Francis Pagani, Gregory Ewald, Heidi Craddock, Marykay Pavol, Sarah Schroeder, James Yang
This study tested the applicability of the individual and family self-management theory (IFSMT) to self-management (SM) in patients with left ventricular assist devices (LVADs). From an existing data set, we extracted the following variables that correspond to IFSMT's conceptual dimensions: anxiety, depression, and cognition (context dimension); self-efficacy (SM process dimension); adherence and quality of life (QOL; outcome dimensions). Descriptive statistics and partial least squares path modeling procedures were used for data analyses...
March 25, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29573567/comparison-of-continuous-flow-ventricular-assist-device-therapy-with-intensive-medical-therapy-in-fixed-pulmonary-hypertension-secondary-to-advanced-left-heart-failure
#9
Gayathri Kumarasinghe, Pankaj Jain, Andrew Jabbour, Jacqueline Lai, Anne M Keogh, Eugene Kotlyar, Paul Jansz, Peter S Macdonald, Christopher S Hayward
AIMS: Both ventricular assist device (VAD) and pulmonary vasodilator therapy have been shown in uncontrolled studies to improve pulmonary hypertension secondary to advanced left heart failure (Group 2 PH). This study aimed to compare haemodynamic benefits and survival in patients with fixed Group 2 PH treated with continuous-flow VAD to intensive medical therapy. METHODS AND RESULTS: Ninety-five patients listed for heart transplantation with sequential right heart catheters were studied, 24 patients having fixed Group 2 PH (as defined by cardiac index < 2...
March 24, 2018: ESC Heart Failure
https://www.readbyqxmd.com/read/29572191/high-right-atrial-pressure-and-low-pulse-pressure-predict-gastrointestinal-bleeding-in-patients-with-left-ventricular-assist-device
#10
Joanna M Joly, Ashraf El-Dabh, James K Kirklin, Ramey Marshell, Michelle G Smith, Deepak Acharya, Indranee N Rajapreyar, José A Tallaj, Margaret Tresler, Salpy V Pamboukian
BACKGROUND: Gastrointestinal bleeding (GIB) remains a major morbid event during continuous flow left ventricular assist device (LVAD) support. This study investigated whether a common hemodynamic profile is associated with GIB in patients with LVADs. METHODS AND RESULTS: A single institution analysis reviewed all patients who underwent right heart catheterization (RHC) following LVAD implant between 1/1/2006 and 12/31/2013 with follow-up through 6/2015. Kaplan-Meier and multi-phase hazard statistical methods were employed...
March 20, 2018: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/29571237/an-approach-to-treating-a-patient-with-a-heartmate-ii%C3%A2-left-ventricularassist-device-in-a-multiplace-hyperbaric-chamber-a-case-report
#11
D Orwig, C Logue, S Hendriksen, B Westgard, J Walter, M Pullis, T Masters
Introduction: Left-ventricular assist devices (LVAD) are becoming a common therapy for end-stage heart failure. These devicesare not tested for pressurization in a hyperbaricchamber by the manufacturer. In this article, we present an approach to modify the power supply in order to safely treat a patient with an LVAD. Materials and Methods: Our patient had a HeartMateII™ LVAD and presented for hyperbaric oxygen treatments for severe radiation cystitis. In order to modify this patient's equipment to be compliant with NFPA6 safety standards we made several modifications...
January 2018: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
https://www.readbyqxmd.com/read/29562808/prospective-analysis-of-bleeding-events-in-left-ventricular-assist-device-patients
#12
Saadia Sherazi, Peter Kouides, Charles Francis, Charles Julian Lowenstein, Majed Refaai, Grace Conley, Brent Alan Johnson, Eugene Muchnik, Susan Lien, Howard Todd Massey, Jeffrey Dean Alexis
BACKGROUND: Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation. METHODS: A prospective study was performed on 30 patients with HeartMate II implantation at the University of Rochester Medical Center, Rochester, New York, United States. Blood was collected within 1 week before implantation, and at 1, 3, and 30 ± 10 days after implantation...
March 1, 2018: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/29552914/identification-of-novel-hemostatic-biomarkers-of-adverse-clinical-events-in-patients-implanted-with-a-continuous-flow-left-ventricular-assist-device
#13
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
https://www.readbyqxmd.com/read/29540471/outcomes-after-continuous-flow-left-ventricular-assist-device-implantation-as-destination-therapy-at-transplant-versus-nontransplant-centers
#14
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
https://www.readbyqxmd.com/read/29538016/noninvasive-blood-pressure-monitor-designed-for-patients-with-heart-failure-supported-with-continuous-flow-left-ventricular-assist-devices
#15
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
https://www.readbyqxmd.com/read/29538013/advantages-of-integrating-pressure-regulating-devices-into-mechanical-circulatory-support-pumps
#16
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
https://www.readbyqxmd.com/read/29525059/trends-in-utilization-mortality-major-complications-and-cost-after-left-ventricular-assist-device-implantation-in-the-united-states-2009-to-2014
#17
Alexandros Briasoulis, Chakradhari Inampudi, Emmanuel Akintoye, Oluwole Adegbala, Paulino Alvarez, Jay Bhama
The utilization of contemporary continuous-flow left ventricular assist device (CF-LVADs) has increased, accounting for >90% of implants from 2009 to 2014. The present study aimed to identify the annual national estimates in utilization, in-hospital mortality, and major complications with CF-LVAD using data from the National Inpatient Sample, the largest all-payer inpatient data set in the United States, and the US Census Bureau, for the years 2009 to 2014. Participants included all adult patients who received CF-LVADs from 2009 to 2014...
February 12, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29514805/predicting-long-term-outcome-in-patients-treated-with-continuous-flow-left-ventricular-assist-device-the-penn-columbia-risk-score
#18
Edo Y Birati, Thomas C Hanff, Dawn Maldonado, E Wilson Grandin, Peter J Kennel, Jeremy A Mazurek, Esther Vorovich, Matthew Seigerman, Jessica L L Howard, Michael A Acker, Yoshifumi Naka, Joyce Wald, Lee R Goldberg, Mariell Jessup, Pavan Atluri, Kenneth B Margulies, P Christian Schulze, J Eduardo Rame
BACKGROUND: Predicting which patients are unlikely to benefit from continuous flow left ventricular assist device (LVAD) treatment is crucial for the identification of appropriate patients. Previously developed scoring systems are limited to past eras of device or restricted to specific devices. Our objective was to create a risk model for patients treated with continuous flow LVAD based on the preimplant variables. METHODS AND RESULTS: We performed a retrospective analysis of all patients implanted with a continuous flow LVAD between 2006 and 2014 at the University of Pennsylvania and included a total of 210 patients (male 78%; mean age, 56±15; mean follow-up, 465±486 days)...
March 7, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29508409/meta-analysis-of-time-in-therapeutic-range-in-continuous-flow-left-ventricular-assist-device-patients-receiving-warfarin
#19
Brandon K Martinez, Brenda Yik, Raymond Tran, Sabrina Ilham, Craig I Coleman, Douglas L Jennings, William L Baker
Continuous-flow left ventricular assist devices (CF-LVADs) prolong survival in advanced heart failure patients. Anticoagulation control is critical in CF-LVAD patients due to increased thromboembolic and bleeding risk. We assessed the quality of INR control in CF-LVAD patients measured by time in therapeutic range (TTR). We performed a systematic literature search of MEDLINE and SCOPUS through July 2017 to identify studies evaluating TTR in anticoagulated adult CF-LVAD patients. Data on key characteristics and the TTR end point were then extracted from each study by two investigators using a standardized tool...
March 6, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29491185/mechanical-circulatory-support-device-heart-hysteretic-interaction-can-predict-left-ventricular-end-diastolic-pressure
#20
Brian Y Chang, Steven P Keller, Sonya S Bhavsar, Noam Josephy, Elazer R Edelman
The full potential of mechanical circulatory systems in the treatment of cardiogenic shock is impeded by the lack of accurate measures of cardiac function to guide clinicians in determining when to initiate and how to optimally titrate support. The left ventricular end diastolic pressure (LVEDP) is an established metric of cardiac function that refers to the pressure in the left ventricle at the end of ventricular filling and immediately before ventricular contraction. In clinical practice, LVEDP is typically only inferred from, and poorly correlates with, the pulmonary capillary wedge pressure (PCWP)...
February 28, 2018: Science Translational Medicine
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