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Continuous flow left ventricular assist device

Ju H Kim, Ramesh Singh, Francis D Pagani, Shashank S Desai, Nicholas A Haglund, Shannon M Dunlay, Simon Maltais, Keith D Aaronson, John M Stulak, Mary E Davis, Christopher T Salerno, Jennifer A Cowger, Palak Shah
BACKGROUND: Limited data exist on outcomes in patients greater than 70 years of age supported with continuous flow left ventricular assist devices (LVAD). METHODS: Data on 1,149 continuous-flow LVAD recipients was queried from the Mechanical Circulatory Support Research Network. Groups were assigned based on age: ≥70 years ("older patients") and <70 years. The primary outcome was survival at one-year based on age grouping. RESULTS: Compared with younger patients, (54...
October 17, 2016: Journal of Cardiac Failure
Yoshifumi Itoda, Kan Nawata, Haruo Yamauchi, Osamu Kinoshita, Mitsutoshi Kimura, Minoru Ono
Aortic insufficiency (AI) is a significant complication of long-term support of continuous flow left ventricular assist device (CF-LVAD) for patients with end-stage heart failure. A 26-year-old female with osteogenesis imperfecta (OI) was diagnosed with dilated phase hypertrophic cardiomyopathy (d-HCM)) and was implanted with Jarvik 2000, for bridge to transplantation. AI gradually developed and surgical intervention was indicated. We performed central aortic valve closure (CAVC) instead of valve replacement 20 months after CF-LVAD implantation...
October 15, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Snehal R Patel, Shivank Madan, Omar Saeed, Mohammed Algodi, Anne Luke, Marc Gibber, Daniel J Goldstein, Ulrich P Jorde
OBJECTIVES: This study sought to determine whether the nasal mucosa can serve as a surrogate for evaluating arteriovenous malformations (AVMs) related gastrointestinal (GI) bleeding in patients supported by continuous flow left ventricular assist devices (CF LVADs). BACKGROUND: Bleeding from the mucosal surfaces of GI tract, particularly AVMs, is the most common complication of CF LVAD support. The pathophysiology of AVM formation during CF LVAD support is of critical interest yet poorly understood; in large part because of the length and accessibility of the GI tract...
September 29, 2016: JACC. Heart Failure
James Wever-Pinzon, Craig H Selzman, Greg Stoddard, Omar Wever-Pinzon, Anna Catino, Abdallah G Kfoury, Nikolaos A Diakos, Bruce B Reid, Stephen McKellar, Michael Bonios, Antigone Koliopoulou, Deborah Budge, Aaron Kelkhoff, Josef Stehlik, James C Fang, Stavros G Drakos
BACKGROUND: Small-scale studies focused mainly on nonischemic cardiomyopathy (NICM) have shown that a subset of left ventricular assist device (LVAD) patients can achieve significant improvement of their native heart function, but the impact of ischemic cardiomyopathy (ICM) has not been specifically investigated. Many patients with acute myocardial infarction are discharged from their index hospitalization without heart failure (HF), only to return much later with overt HF syndrome, mainly caused by chronic remodeling of the noninfarcted region of the myocardium...
October 18, 2016: Journal of the American College of Cardiology
Dipanjan Banerjee, Chun Choi, Richard Ha
No abstract text is available yet for this article.
September 17, 2016: Journal of Thoracic and Cardiovascular Surgery
Carlo R Bartoli, Jooeun Kang, David Zhang, Jessica Howard, Michael Acker, Pavan Atluri, Tadashi Motomura
BACKGROUND: Supraphysiologic shear stress from continuous-flow left ventricular assist devices (LVADs) accelerates von Willebrand factor (vWF) degradation and predisposes patients to nonsurgical bleeding. It is unknown whether unique design characteristics of LVADs differentially affect vWF degradation. We tested the hypothesis that the centrifugal-flow EVAHEART (Evaheart, Houston, TX) left ventricular assist system (LVAS), which was designed to minimize shear stress (low operational revolutions per minute [rpm], larger flow gaps, low shear stress, flat H-Q curve), reduced vWF degradation versus the axial-flow HeartMate II (Thoratec, Pleasanton, CA) LVAD...
October 4, 2016: Annals of Thoracic Surgery
Francisco González-Vílchez, Javier Segovia Cubero, Luis Almenar, María G Crespo-Leiro, José M Arizón, Iago Sousa, Juan Delgado, Eulalia Roig, José Manuel Sobrino, José González-Costello
INTRODUCTION AND OBJECTIVES: The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984. METHODS: We describe the main features of recipients, donors, surgical procedures, and results of all heart transplants performed in Spain until December 31, 2015. RESULTS: A total of 299 cardiac transplants were performed in 2015, with the whole series comprising 7588 procedures...
October 1, 2016: Revista Española de Cardiología
Andrew I Chin, Kathleen Tong, John P McVicar
Heart failure necessitating left ventricular assist device (LVAD) support can lead to kidney failure requiring dialysis. Some of these patients may require long-term hemodialysis (HD). Optimal vascular access for a patient on long-term HD therapy with an LVAD remains a complex issue. The majority of LVADs are of the continuous-flow type, and it has been theorized that native arteriovenous fistula maturation may be impaired in a setting of decreased pulsatile arterial flow. We describe a case of successful creation and use of an arteriovenous fistula in an HD-dependent patient with a continuous-flow LVAD...
September 27, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Laila Hubbert, Jacek Baranowski, Baz Delshad, Henrik Ahn
Following implantation of a continuous-flow left ventricular assist device (LVAD), left atrial pressure (LAP) monitoring allows for precise management of intravascular volume, inotropic therapy and pump speed. In this case series of 4 LVAD recipients we report the first clinical use of this wireless pressure sensor for long-term monitoring of LAP during LVAD support. A wireless microelectromechanical system (MEMS) pressure sensor, (Titan™, ISS Inc., Ypsilanti, MI, USA) was placed in the left atrium in four patients at the time of LVAD implantation...
September 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Kevin Phan, Joshua M Haswell, Joshua Xu, Yusuf Assem, Stephanie L Mick, Samir R Kapadia, Anson Cheung, Frederick S Ling, Tristan D Yan, Vakhtang Tchantchaleishvili
De novo progressive aortic insufficiency (AI) is a side effect frequently related to prolonged support with continuous-flow left ventricular assist devices (CF-LVAD). Its progression can result in recurrent clinical heart failure symptoms and significantly increased mortality. Recently, percutaneous intervention methods such as transcatheter aortic valve replacement (TAVR) and percutaneous occluder devices have emerged, However, given the very scarce global experience with these approaches, evidence in the literature is lacking...
September 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Joseph A R Englert, Jennifer A Davis, Selim R Krim
BACKGROUND: Heart transplantation remains the definitive therapy for patients with advanced heart failure; however, owing to limited donor organ availability and long wait times, continuous-flow left ventricular assist devices (LVADs) have become standard therapy. METHODS: This review summarizes the history, progression, function, and basic management of LVADs. Additionally, we provide some clinical pearls and important caveats for managing this unique patient population...
2016: Ochsner Journal
Amanda R Vest, Peter J Kennel, Dawn Maldonado, James B Young, Maria M Mountis, Yoshifumi Naka, Paolo C Colombo, Donna M Mancini, Randall C Starling, P Christian Schulze
BACKGROUND: Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure. METHODS AND RESULTS: A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available...
September 2016: Circulation. Heart Failure
Christopher T Holley, Megan Fitzpatrick, Samit S Roy, M Chadi Alraies, Rebecca Cogswell, Laura Souslian, Peter Eckman, Ranjit John
BACKGROUND: Aortic insufficiency (AI) is a significant long-term complication of continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate its impact on clinical outcomes and mortality in CF-LVAD recipients. METHODS: We retrospectively analyzed 237 patients implanted with HeartMate II CF-LVADs at our institution from June 2005 through June 2013. We evaluated recipients' baseline characteristics and annual echocardiograms, grading AI severity as either none, trace, mild, moderate or severe...
July 28, 2016: Journal of Heart and Lung Transplantation
Kevin J Clerkin, Yoshifumi Naka, Donna M Mancini, Paolo C Colombo, Veli K Topkara
OBJECTIVES: This study sought to determine if obese patients had worse post-left ventricular assist device (LVAD) implantation outcomes and if the implantation of an LVAD allowed for weight loss. BACKGROUND: Obesity is a risk factor for cardiovascular disease including heart failure. Obese heart failure patients have better outcomes than those with normal weight; however, obese patients have worse outcomes after heart transplantation. METHODS: Patients were identified in the United Network for Organ Sharing (UNOS) database that underwent LVAD implantation as bridge to transplantation from May 2004 and April 2014, with follow-up through June 2014...
October 2016: JACC. Heart Failure
Daniel Rüschen, Miriam Rimke, Jonas Gesenhues, Steffen Leonhardt, Marian Walter
BACKGROUND AND OBJECTIVES: Sufficient cardiac output is one of the main goals of ventricular assist device therapy. To date, there is no adequate method to estimate the combined amount of blood the native heart and a continuous-flow assist device pump through the circulatory system. This paper presents an approach to estimate total cardiac output based on the signals provided by optical pressure sensors mounted on the inlet and outlet of an Abiomed Impella CP pump. METHODS: Two Kalman filters were used in parallel for joint estimation of the aortic flow rate and the hydraulic resistance of the aortic valve...
August 30, 2016: Computer Methods and Programs in Biomedicine
Daniel Zimpfer, Martin Strueber, Philipp Aigner, Jan D Schmitto, Arnt E Fiane, Robert Larbalestier, Steven Tsui, Paul Jansz, Andre Simon, Stephan Schueler, Francesco Moscato, Heinrich Schima
OBJECTIVES: Ventricular blood stasis is a concern for continuous flow mechanical support devices and might contribute to the formation of thromboembolic events. The HeartWare® Ventricular Assist System (HVAD®) is equipped with the Lavare™ cycle that is a periodic speed modulation feature designed to alter flow patterns within the left ventricle and reduce areas of potential blood stasis. Here, we report in vitro and clinical findings on the effects of the Lavare cycle. METHODS: The effect of pump speed changes on the intraventricular flow field was examined with an in vitro particle image velocimetry model...
September 7, 2016: European Journal of Cardio-thoracic Surgery
Shinichi Fukuhara, Koji Takeda, Alexander Blair, Paul A Kurlansky, Hiroo Takayama, Yoshifumi Naka
BACKGROUND: A bridge to transplant strategy with a continuous-flow left ventricular assist device is increasingly being offered to older patients. However, the upper patient age limit has not been defined. METHODS: The United Network of Organ Sharing (UNOS) database was used to identify 21,258 heart transplant recipients from 2004 to 2014. Of these, 4,850 (22.8%) were bridged with a continuous-flow left ventricular assist device. Recipients were stratified by age: group 1, aged 70 years or more (n = 115, 2...
August 28, 2016: Annals of Thoracic Surgery
Allen Cheng, Jaimin R Trivedi, Victor H Van Berkel, H Todd Massey, Mark S Slaughter
BACKGROUND: The use of left ventricular assist devices (LVAD) has increased significantly in the last decade. However, right heart dysfunction remains a problem despite the improved outcomes with continuous-flow LVADs. Surgical options for bridge to transplantation (BTT) in patients with biventricular failure are total artificial heart (TAH) or biventricular support (BiVAD). This study examines the differences in pre- and post-transplantation outcomes and survival in patients with TAH or BiVAD support as BTT...
October 2016: Journal of Cardiac Surgery
U Köksel, O Erbasan, Ö Bayezid, C Kemaloğlu, S Özçobanoğlu, I Gölbaşı, C Türkay
BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVADs) such as the HeartMate II and HeartWare left ventricular assist device are important alternatives to heart transplantation. Thrombosis is a serious complication in both devices and we present our approach to treating thrombosis and analysis of predisposition factors. METHODS: Our center's CF-LVADs database was retrospectively reviewed for pump thrombosis between January 2011 and January 2015. The patients were grouped for pump thrombosis (n = 13) and nonpump thrombosis (n = 85)...
July 2016: Transplantation Proceedings
O N Tuncer, C Kemaloğlu, O Erbasan, I Gölbaşı, C Türkay, Ö Bayezid
INTRODUCTION: Donor organ shortage is still a problem for heart transplantation. Only 10% of patients in waiting list undergo heart transplantation. Over the last 5 years, 2 different continuous flow pumps, the HeartMate II and the HeartWare, have been successful clinically in the alternative treatment of patients with end-stage heart disease. METHODS: Fifty-five patients underwent left ventricular assist device implantation between 2011 and 2014. Patients were followed on pump support for complications and intraoperative outcomes...
July 2016: Transplantation Proceedings
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