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LVAD thrombus

Gianluigi Perri, Sergio Filippelli, Rachele Adorisio, Roberta Iacobelli, Francesca Iodice, Giuseppina Testa, Maria Giovanna Paglietti, Domenico D'Amario, Massimo Massetti, Antonio Amodeo
OBJECTIVE: We report our experience with the use of a left ventricular assist device (LVAD) as destination therapy (DT) for the management of patients with cardiac end-stage dystrophinopathies. METHODS: From February 2011 to February 2016, 7 patients with dystrophinopathies and dilated cardiomyopathy (DCM) were treated with LVADs at our institution. Median age at surgery was 16.5 years (range, 14.2-23.4 years). All patients were preoperatively evaluated by a multidisciplinary team approach...
August 28, 2016: Journal of Thoracic and Cardiovascular Surgery
Gardner Yost, Christine Rachel Joseph, Thomas Royston, Antone Tatooles, Geetha Bhat
Despite increasing use of left ventricular assist devices (LVADs) as a surgical treatment for advanced heart failure in an era of improved outcomes with LVAD support, the mechanical interactions between these pumps and the cardiovascular system are not completely understood. We utilized an in vitro mock circulatory loop to analyze the heat production incurred by operation of an axial flow and centrifugal flow LVAD.A HeartMate II and a HeartWare HVAD were connected to an abbreviated flow loop and were implanted in a viscoelastic gel...
September 20, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Mitsugu Ogawa, Keki R Balsara, Muhammad Faraz Masood, Akinobu Itoh
We present the case of a 57-year-old woman who developed pan-left ventricular thrombus while being supported with central extracorporeal membrane oxygenation support for cardiogenic shock. The left heart thrombus was evacuated emergently through the aortic valve, left atriotomy and left ventriculotomy. The cannulation was then revised with the addition of a 36-French angled cannula in the apex of the left ventricle to decompress the ventricle, minimize stasis and allow for any residual micro thrombus to be trapped in the oxygenator membrane, not causing embolization...
August 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Anna Mara Scandroglio, Friedrich Kaufmann, Marina Pieri, Alexandra Kretzschmar, Marcus Müller, Panagiotis Pergantis, Stephan Dreysse, Volkmar Falk, Thomas Krabatsch, Evgenij V Potapov
BACKGROUND: Thrombosis is an uncommon, but severe complication of left ventricular assist devices (LVADs). OBJECTIVES: This study analyzed experience with obstruction of blood flow through the LVAD with the purpose of developing optimal diagnosis and treatment of LVAD-related thrombosis. METHODS: Between October 2009 and July 2015, a total of 652 LVAD were implanted in 557 patients. Blood flow abnormalities in patients with LVAD (n = 524) were identified and classified as "high-power" and "low-flow" events...
June 14, 2016: Journal of the American College of Cardiology
Mohammed G Al-Azawy, A Turan, A Revell
A detailed Computational Fluid Dynamics (CFD) study of transient, turbulent blood flow through a positive displacement left ventricular assist device (LVAD) is performed. Two common models for Non-Newtonian blood flow are compared to the Newtonian model to investigate their impact on predicted levels of shear rate and wall shear stress. Given that both parameters are directly relevant to the evaluation of risk from thrombus and haemolysis, there is a need to assess the sensitivity to modelling non-Newtonian flow effects within a pulsatile turbulent flow, in order to identify levels of uncertainly in CFD...
February 26, 2016: International Journal for Numerical Methods in Biomedical Engineering
James Fitzgibbon, Nicholas E Kman, Diane Gorgas
BACKGROUND: Left ventricular assist devices (LVADs) are a viable treatment option for patients with end-stage heart failure. LVADs can improve survival, quality of life, and functional status. The indications for LVAD placement to support left ventricular function are temporary support, a bridge to transplantation, or destination therapy. CASE REPORT: A 61-year-old man with past medical history significant for advanced congestive heart failure from ischemic cardiomyopathy, status post LVAD (HeartMate II; Thoratec Corporation, Pleasanton, CA) placement 2009 as destination therapy, presented to the Emergency Department (ED) with implantable cardiac defibrillators firing four times that morning...
March 2016: Journal of Emergency Medicine
John M Stulak, Shannon M Dunlay, Shashank Sharma, Nicholas A Haglund, Mary Beth Davis, Jennifer Cowger, Palak Shah, Faraz Masood, Keith D Aaronson, Francis D Pagani, Simon Maltais
BACKGROUND: Pump thrombosis is a major adverse event in patients supported with a left ventricular assist device (LVAD). Treatment approaches include device exchange, lytic therapy, or augmentation of anticoagulation or antiplatelet therapy. The optimal strategy in the HeartWare HVAD Ventricular Assist System (HeartWare, Framingham, MA) is uncertain, and because few large studies have examined differing treatment outcomes, we have reviewed findings from the Mechanical Circulatory Support Research Network registry...
December 2015: Journal of Heart and Lung Transplantation
John M Stulak, Mary E Davis, Nicholas Haglund, Shannon Dunlay, Jennifer Cowger, Palak Shah, Francis D Pagani, Keith D Aaronson, Simon Maltais
OBJECTIVES: We review differences in the incidence and timing of adverse events in patients implanted with continuous-flow left ventricular assist devices (LVADs), using the Mechanical Circulatory Support Research Network registry. METHODS: From May 2004 to September 2014, a total of 734 patients (591 men; median age: 59 years) underwent primary continuous-flow LVAD implantation at our institutions. Patients implanted with the HeartMate II (HMII) (560 [76%] patients), compared with the HeartWare ventricular assist device (HVAD; 174 [24%]) were more often receiving destination therapy (47% vs 20%; P < ...
January 2016: Journal of Thoracic and Cardiovascular Surgery
Guanghui Wu, Changyan Lin, Haiyang Li, Xiaotong Hou, Chen Chen, Xiujian Liu, Chuangye Xu, Jing Wang, Peng Yang, Wenbo Qu
The aim of the study was to use the ovine model to evaluate the hemocompatibility and end-organ effects of a newly developed magnetic suspension centrifugal left ventricular assist device (LVAD) by CH Biomedical Inc., Jiangsu, China. The LVADs were implanted in 6 healthy sheep, where inflow was inserted into the left ventricular apex and outflow was anastomosed to the descending aorta. All sheep received anticoagulation and antiaggregation therapy during the study. Hematologic and biochemical tests were performed to evaluate anemia, hepatorenal function, and the extent of hemolysis...
2015: BioMed Research International
Gardner Yost, Geetha Bhat, Sejal Modi, Pat Pappas, Antone Tatooles
Despite advancements in left ventricular assist device (LVAD) design and clinical management, device thrombosis remains a pertinent complication. Limited imaging makes precise visualization of clot location and shape very challenging. We report the usage of videobronchoscopic exploration of explanted LVADs for direct visualization of clot in two patients. This technique is a rapid and inexpensive means of improving our understanding of LVAD clot formation and may be useful in surgical exploration of inflow and outflow tracts during LVAD exchange...
July 2016: Perfusion
Jonida Bejko, Giacomo Bortolussi, Vincenzo Tarzia, Gino Gerosa, Tomaso Bottio
A 41-year-old-male with diagnosis of dilated cardiomyopathy was referred to our hospital for heart failure, despite standard medical therapy, to evaluate indications for heart transplantation or mechanical cardiac support. Preoperative contrast computer tomography (CT) scan diagnosed pulmonary thrombosis of the left branch of the pulmonary artery. Treatment with low molecular weight heparin was established and the next day a thrombus-arteriectomy and Heartware (Heartware, Framingham, MA, USA) left ventricular assist device (LVAD) implantation were performed simultaneously...
August 2015: International Journal of Artificial Organs
Charles T Klodell, H Todd Massey, Robert M Adamson, David A Dean, Douglas A Horstmanshof, John M Ransom, Christopher T Salerno, Jennifer A Cowger, Juan M Aranda, Leway Chen, James W Long, Walter Dembitsky
BACKGROUND: Recent reports suggested that HeartMate II (HMII) thrombosis rates may be higher in implants after 2011. We characterize events at HMII centers (>100 HMII implants) whose device thrombosis rates are equivalent or lower than reported by INTERMACS. METHODS: Seven centers pooled implants from 2011 through June 2013 to examine pump thrombus and identify characteristics and clinical strategies that potentially mitigate the risk. A total of 666 patients (age 59 ± 13 years; 81% male) were studied (support duration: 13...
October 2015: Journal of Cardiac Surgery
Takuma Miyamoto, Tomohiro Nishinaka, Toshihide Mizuno, Eisuke Tatsumi, Kenji Yamazaki
BACKGROUND: Thrombus formation at the interfaces of inflow cannulas and left ventricular apexes is considered to be one of the predominant sources of thromboembolic complication. Use of a fine titanium mesh-covered inflow cannula is expected to prevent such thrombus formation by inducing neointimal tissue around the cannula. METHODS: Titanium pins (20 mm long, 3 mm diameter) covered with a fine titanium mesh (wire dia. 85 μm; volumetric porosity 40-70%) were developed to mimic the inflow cannulas of left ventricular assist devices (LVADs)...
June 2015: International Journal of Artificial Organs
Seana G Hall, Kayla Gardner, Douglas F Larson, Richard Smith
INTRODUCTION: The Thoratec Corporation has over 10,000 patients registered as recipients of the HeartMate II left ventricular assist device (LVAD) worldwide. Although it has undoubtedly prolonged the lifespan of heart failure patients, the most recognized risk associated with these devices is the development of thrombus. In the presence of a small or developing clot, the HeartMate II display module and system monitor indicate that there is a decrease in pump flow, adjusts its pump power and is accompanied by audible and visual alarms when flow rates drop below a fixed threshold established by Thoratec...
March 2016: Perfusion
Ilana M Ruff, Jenelle A Jindal
Heparin has long been a contested therapy in acute ischemic stroke (AIS). In current practice, heparin is considered on a case-by-case basis, but there is no consensus as to the appropriate timing of anticoagulation or for which ischemic stroke subtypes heparin may be beneficial. To provide better clarity on this issue, we review current research focusing on the use of heparin in AIS in each stroke subtype and subsequently make recommendations to provide readers with a systematic approach to managing complex stroke patients for which acute anticoagulation may be valuable...
September 2015: Current Atherosclerosis Reports
Brian P Barrick, Alan Smeltz, Arun Ganesh, Harendra Arora, Priya A Kumar
No abstract text is available yet for this article.
January 2016: Journal of Cardiothoracic and Vascular Anesthesia
Julia Hillebrand, Juergen Sindermann, Christoph Schmidt, Rolf Mesters, Sven Martens, Mirela Scherer
Heparin-induced thrombocytopenia (HIT) is a rare but life-threatening side effect of heparin therapy. It is a demanding therapeutic challenge in patients undergoing left ventricular assist device (LVAD) implantation. We present our experience with LVAD implantation under extracorporeal life support (ECLS) in patients suffering from HIT. Seven patients (mean age 54.0 ± 16.7 years, 1 female, 6 male patients) suffering from acute heart failure were stabilized with ECLS. Under heparin therapy, they all showed a sudden decrease of mean platelet count (maximum 212...
December 2015: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Matthaeus Zerdzitzki, Christof Schmid, Stephan Hirt, Christina Wendl, Felix Schlachetzki, Daniele Camboni
Cerebral thromboembolism builds the Achilles heel for patients on left ventricular support (LVAD). Thrombolytic therapy is usually contraindicated considering the increased risk of intracranial hemorrhage in patients with LVAD under therapeutic oral anticoagulation with concomitant platelet inhibition. We report on an alternative approach to this dilemma. On day 1,091 of LVAD support (INCOR Berlin Heart), a 69 year-old male patient was admitted to a rural hospital unconscious with a left-sided hemiplegia. Cerebral computed tomography (CT) with CT angiography revealed a thromboembolic distal basilar artery occlusion...
May 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Marijke H van der Meulen, Michiel Dalinghaus, Alexander P W M Maat, Pieter C van de Woestijne, M van Osch, M de Hoog, Ulrike S Kraemer, Ad J J C Bogers
OBJECTIVES: Mechanical circulatory support (MCS) with a ventricular assist device (VAD) as a bridge to heart transplantation (HTx) or recovery may improve outcome in children with terminal heart failure. We report our experience with MCS in children eligible for HTx and its effect on waiting list mortality. METHODS: Retrospective single-centre cohort study, National Paediatric HTx Programme including all children eligible for HTx, since the introduction of MCS-VAD in 2006...
December 2015: European Journal of Cardio-thoracic Surgery
Michael E Nassif, Jayendrakumar S Patel, Jerrica E Shuster, David S Raymer, Ronald Jackups, Eric Novak, Brian F Gage, Sunil Prasad, Scott C Silvestry, Gregory A Ewald, Shane J LaRue
OBJECTIVES: This study evaluated clinical outcomes associated with erythropoiesis stimulating agent (ESA) use in left ventricular assist devices (LVAD)-supported patients. BACKGROUND: Use of ESAs in patients with LVADs may minimize blood transfusions and decrease allosensitization. ESAs increase thrombotic events, which is concerning because LVADs are sensitive to pump thrombosis (PT). METHODS: We retrospectively reviewed 221 patients at our center who received a HeartMate II (Thoratec Corp...
February 2015: JACC. Heart Failure
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