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heart failure device therapy

Riccardo Toninato, Silvia Scuri, Vincenzo Tarzia, Gino Gerosa, Francesca M Susin
PURPOSE: The gold standard therapy for patients with advanced heart failure is heart transplant. The gap between donors and patients in waiting lists promoted the development of circulatory support devices, such as the total artificial heart (TAH). Focusing on in vitro tests performed with CardioWest™ TAH (CW) driven by the SynCardia Freedom® portable driver (FD) the present study goals are: i) prove the reliability of a hydraulic circuit used as patient simulator to replicate a quasi-physiological scenario for various hydrodynamic conditions, ii) investigate the hydrodynamic performance of the CW FD, iii) help clinicians in possible interpretation of clinical cases outcomes...
October 15, 2016: International Journal of Artificial Organs
David Snipelisky, Yogesh N V Reddy, Kevin Manocha, Aalok Patel, Shannon M Dunlay, Paul A Friedman, Thomas M Munger, Samuel J Asirvatham, Douglas L Packer, Yong-Mei Cha, Suraj Kapa, Peter A Brady, Peter A Noseworthy, Joseph J Maleszewski, Siva K Mulpuru
BACKGROUND: Patients with advanced heart failure (HF) are predisposed to ventricular arrhythmias (VA), particularly following implantation of an LVAD. There is minimal evidence for appropriate management strategies. OBJECTIVES: This study aimed to compare the burden of VA and response to ablation performed either before or following left ventricular assist device (LVAD) implantation. METHODS: We created a retrospective cohort of patients who underwent both VA ablation and HeartMate II (Thoratec, CA) LVAD implantation at Mayo Clinic (Rochester, MN)...
October 21, 2016: Journal of Cardiovascular Electrophysiology
Jessica Rimsans, Katelyn W Sylvester, Jean M Connors
Available options for the treatment of advanced heart failure have expanded to include the use of mechanical circulatory assist devices to improve quality of life in those both eligible and ineligible for heart transplant. Although there have been significant advancements in device technologies, anticoagulation protocols, and multidisciplinary team management, bleeding and thrombosis are the most common adverse effects. Management strategies for pump thrombosis and their outcomes vary considerably among mechanical circulatory support centers and include intensification of antithrombotic therapy (medical) and device exchange (surgical)...
October 7, 2016: Clinical and Applied Thrombosis/hemostasis
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
Daniel J Friedman, Haikun Bao, Erica S Spatz, Jeptha P Curtis, James P Daubert, Sana M Al-Khatib
BACKGROUND: -A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and data are conflicting. METHODS: -We conducted inverse probability weighted (IPW) analyses of 26,451 CRT eligible (EF≤35, QRS≥120ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes...
October 19, 2016: Circulation
Shannon M Dunlay, Jacob J Strand, Sara E Wordingham, John M Stulak, Angela J Luckhardt, Keith M Swetz
BACKGROUND: Despite the ability of left ventricular assist device as destination therapy (DT-LVAD) to prolong survival for many patients with advanced heart failure, little is known about the eventual end-of-life care that patients with DT-LVAD receive. METHODS AND RESULTS: All patients undergoing DT-LVAD at the Mayo Clinic in Rochester, Minnesota, from January 1, 2007, to September 30, 2014, who subsequently died before July 1, 2015, were included. Information about end-of-life care was obtained from documentation in the electronic medical record...
October 2016: Circulation. Heart Failure
Ali Vasheghani-Farahani, Masih Tajdini, Seyed Abolfazl Mohsenizadeh, Seyed Mohammad Reza Hosseini
BACKGROUND: Cardiac resynchronization therapy (CRT) is a medical device to help cardiac synchronized contractility by electrical impulses. Improvement of symptoms and left ventricular systolic function, reducing hospital admissions and mortality in patients with moderate to severe heart failure are the main benefits of administration of cardiac resynchronization therapy. CASE REPORT: In this article, we describe a case of heart failure and left bundle branch block (LBBB) who was candidate for cardiac resynchronization therapy; but after managing hyperkalemia, left bundle branch block resolved, ejection fraction increased and cardiac resynchronization therapy implantation was canceled...
May 2016: ARYA Atherosclerosis
Ranjit Kumar Nath, Ajay Raj, C Parvatagouda, Neeraj Pandit
Left ventricular lead placement in the appropriate branch of coronary sinus is the key to successful cardiac resynchronization therapy (CRT) and this step is technically challenging. We describe a case of non-ischemic cardiomyopathy with heart failure, taken up for cardiac resynchronization therapy with defibrillator (CRT-D) implantation. The quadripolar left ventricular lead was impossible to advance into the target lateral branch of the coronary sinus. We made a veno-venous loop, advancing the coronary guidewire through the middle cardiac vein to coronary sinus and then to superior vena cava...
September 2016: Indian Heart Journal
Marie Christine Iliou, Jean Christophe Blanchard, Aurélia Lamar-Tanguy, Pascal Cristofini, François Ledru
Large subsets of patients admitted in cardiac rehabilitation centers are having a pacemaker, cardiac resynchronization (CRT) or implantable cardiac defibrillator (ICD). Cardiac rehabilitation for patients, mostly with heart failure, with implanted electronic devices as pacemakers or ICD is a unique opportunity not only to optimize the medical treatment, to increase their exercise capacity and improves their clinical condition but also to supervise the correct functioning of the device. CRT reduces clinical symptoms and increases slightly the exercise capacity...
October 14, 2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Jonathan D Rich, Igor Gosev, Chetan B Patel, Susan Joseph, Jason N Katz, Peter M Eckman, Sangjin Lee, Kartik Sundareswaran, Ahmet Kilic, Brian Bethea, Behzad Soleimani, Brian Lima, Nir Uriel, Michael Kiernan
BACKGROUND: Early right-sided heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with increased mortality, but little is known about patients who develop late RHF (LRHF). We evaluated the incidence, risk factors, and clinical impact of LRHF in patients supported by axial-flow LVADs. METHODS: Data were analyzed from 537 patients enrolled in the HeartMate II (HM II; Thoratec/St. Jude) destination therapy clinical trial. LRHF was defined as the development of clinical RHF accompanied by the need for inotropic support occurring more than 30 days after discharge from the index LVAD implant hospitalization...
August 20, 2016: Journal of Heart and Lung Transplantation
Tatsuya Nishikawa, Masashi Fujino, Ikutaro Nakajima, Yasuhide Asaumi, Yu Kataoka, Toshihisa Anzai, Kengo Kusano, Teruo Noguchi, Yoichi Goto, Kunihiro Nishimura, Yoshihiro Miyamoto, Keisuke Kiso, Satoshi Yasuda
AIMS: The prognostic impact of chronic total coronary occlusion (CTO) on implantable cardioverter-defibrillator (ICD) recipients remains unclear. METHODS AND RESULTS: Eighty-four consecutive patients with ischaemic heart disease who received ICD therapy for primary or secondary prevention were analysed. We investigated all-cause mortality and major adverse cardiac events (MACEs) including cardiac death, appropriate device therapy, hospitalization for heart failure, and ventricular assist device implantation...
October 13, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Shweta R Motiwala, Hanna K Gaggin
Left ventricular remodeling appears to be a critical link between cardiac injury and the development and progression of heart failure with reduced ejection fraction (HFrEF). Several drug and device therapies that modify and reverse the remodeling process in patients with HFrEF are closely associated with improvement in clinical outcomes. Reverse remodeling, including partial or complete recovery of systolic function and structure, is possible but its determinants are incompletely understood. Methods to predict reverse remodeling in response to therapy are not well defined...
October 10, 2016: Current Heart Failure Reports
Barış Akdemir, David G Benditt
The vagus nerve is a major component of the autonomic nervous system and plays a critical role in many body functions including for example, speech, swallowing, heart rate and respiratory control, gastric secretion, and intestinal motility. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, with electrical stimulation being the most important. Implantable devices for VNS are approved therapy for refractory epilepsy and for treatment-resistant depression. In the case of heart disease applications, implantable VNS has been shown to be beneficial for treating heart failure in both preclinical and clinical studies...
October 2016: Anatolian Journal of Cardiology
Denise C Joffe, Thomas K Jones, Mark Reisman, Elizabeth Perpetua, Yuk Law, Andreas Schuler, G Burkhard Mackensen
We present the primary report of a paediatric patient who had placement of the MitraClip device for severe functional mitral regurgitation. The patient was a 14-year-old boy with symptomatic end-stage non-compaction type cardiomyopathy secondary to a mitochondrial cytopathy. He had severe mitral regurgitation, tricuspid valve regurgitation, a severely dilated LV with apical non-compaction, severe LV dysfunction and severe pulmonary hypertension. Despite optimal medical therapy he developed progressive symptoms of congestive heart failure and he was not a candidate for an assist device or cardiac transplantation...
October 10, 2016: EuroIntervention
W Amara, S Naccache, C Akret, S Cheggour, S M'Zoughi, G Galuscan, A Dompnier
INTRODUCTION: Management of antiplatelet therapy at the time of device implantation remains controversial. This study aimed to assess the risk of bleeding complications in patients receiving ticagrelor at the time of cardiac device surgery. METHODS: We performed a multicentre (n=4), retrospective study from January 2015 to January 2016. The survey included all patients (pts) treated with ticagrelor before undergoing pacemaker, implantable cardioverter-defibrillator (ICD) implantation or generator replacement...
September 29, 2016: Annales de Cardiologie et D'angéiologie
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
Van-Khue Ton, Gordana Vunjak-Novakovic, Veli K Topkara
Left ventricular assist device (LVAD) therapy has revolutionized the treatment of patients with advanced heart failure. Although originally intended for bridge-to-transplantation and destination therapy indications, a small subset of patients supported with LVADs exhibit complete myocardial recovery leading to device explanation. However, genetic and molecular determinants of partial and/or complete myocardial recovery remain largely unknown. Areas covered: We summarize current knowledge on alterations in heart failure transcriptome in response to LVAD support, as well as discuss common gene signatures potentially responsible for the reverse remodeling phenotype in the failing human heart...
October 14, 2016: Expert Review of Medical Devices
D Vinayagam, S Bampoe, B Thilaganathan, A Khalil
BACKGROUND: Intraoperative haemodynamic monitoring is carried out in high-risk surgical patients, often using invasive methods, including pulmonary artery catheterisation. Early goal-directed therapy in high-risk surgical patients reduces tissue hypoxia, organ failure and improves outcomes. Significant maternal morbidity arises as a result of perioperative haemorrhage. At present, heart rate and brachial blood pressure are used as proxy markers to aid in fluid resuscitation, however, we know that these exhibit minimal change during early stages of shock, and are poor indicators of the adequacy of therapeutic intervention...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
D O Verschure, B L F van Eck-Smit, G A Somsen, R J J Knol, H J Verberne
Heart failure is a life-threatening disease with a growing incidence in the Netherlands. This growing incidence is related to increased life expectancy, improvement of survival after myocardial infarction and better treatment options for heart failure. As a consequence, the costs related to heart failure care will increase. Despite huge improvements in treatment, the prognosis remains unfavourable with high one-year mortality rates. The introduction of implantable devices such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) has improved the overall survival of patients with chronic heart failure...
September 27, 2016: Netherlands Heart Journal
Braghadheeswar Thyagarajan, Monisha Priyadarshini Kumar, Rutuja R Sikachi, Abhinav Agrawal
Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality...
August 2016: Intractable & Rare Diseases Research
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