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https://www.readbyqxmd.com/read/29336405/looking-inside-the-third-generation-left-ventricular-assist-device-using-color-doppler-transesophageal-echocardiography
#1
Ankit Jain, Frederick C Cobey
HeartWare is a third-generation continuous flow left ventricular assist device (LVAD) and generates centrifugal pattern of blood flow. In the perioperative setting, interrogating the HeartWare devices is very difficult due to the interference of the Doppler by the impeller frequency and generation of the waterfall artifact. We present a case where using color Doppler a view "inside" the impeller can be seen which corresponds to the centrifugal flow of blood. With time, these images can be looked into in pathological states such as pump thrombosis, to come to a more meaningful conclusion regarding the flow of blood within the centrifugal chamber...
January 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29305851/quantitative-assessment-of-inflow-malposition-in-two-continuous-flow-left-ventricular-assist-devices
#2
Erik N Sorensen, Zachary N Kon, Erika D Feller, Si M Pham, Bartley P Griffith
BACKGROUND: We previously investigated preoperative variables associated with qualitative inflow cannula (IFC) malposition in the Heartmate II continuous-flow left ventricular assist device. In this report, we assess IFC malposition quantitatively in recipients of both the Heartmate II and the Heartware and examine its association with device thrombosis. METHODS: Malposition was quantified based on angular deviation from a hypothetical ideal IFC position in two orthogonal computed tomography (CT) imaging planes...
January 3, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29300199/recent-advances-in-heart-failure
#3
Mahwash Kassi, Bashar Hannawi, Barry Trachtenberg
PURPOSE OF REVIEW: Acute heart failure continues to be a challenge as there is limited benefit of numerous agents that have been tested. Cardiac resynchronization therapy remains standard of care, yet timing and need for implantable cardiac defibrillator has been brought into question with the recent randomized trials. Several recent advances have been made towards management of heart failure both in drug and device therapy. The purpose of this review is to provide an update on the most important recent studies on heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF)...
January 2, 2018: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29287808/clinical-implications-of-hemodynamic-assessment-during-left-ventricular-assist-device-therapy
#4
REVIEW
Teruhiko Imamura, Ben Chung, Ann Nguyen, Gabriel Sayer, Nir Uriel
Left ventricular assist devices (LVADs) significantly improve outcomes of advanced heart failure patients. However, patients continue to have high readmission rates due to complications ranging from bleeding, thrombosis, heart failure, and infection. Considering that the hallmark benefit of LVAD therapy is improvement in hemodynamics (cardiac unloading and increased cardiac output), hemodynamic assessment on LVAD support is key to better understand these difficult complications and may serve as a tool to resolving them...
December 26, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/29282819/platelet-activation-is-a-preoperative-risk-factor-for-the-development-of-thromboembolic-complications-in-patients-with-continuous-flow-left-ventricular-assist-device
#5
Filippo Consolo, Giulia Sferrazza, Giulia Motolone, Rachele Contri, Lorenzo Valerio, Rosalba Lembo, Loris Pozzi, Patrizia Della Valle, Michele De Bonis, Alberto Zangrillo, Gianfranco B Fiore, Alberto Redaelli, Marvin J Slepian, Federico Pappalardo
AIMS: To correlate the dynamics of platelet activation with the development of thromboembolic events in patients with continuous-flow left ventricular assist device (cf-LVAD). METHODS AND RESULTS: The platelet activity state (PAS) assay was utilized to evaluate platelet activation in 68 cf-LVAD patients implanted with the HeartMate II (n = 15, 22%), HeartMate 3 (n = 15, 22%), or HeartWare HVAD (n = 38, 56%). PAS was measured preoperatively, early post-implant, and at long-term follow-up (1, 3, 6, 12, 18, and 24 months post-implant)...
December 28, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29279816/when-ablation-is-not-the-answer-acute-left-main-thrombosis-causing-incessant-ventricular-tachycardia-following-left-ventricular-assist-device-implant
#6
Mohammad K Mojadidi, Ahmed N Mahmoud, Akram Y Elgendy, R David Anderson
Ventricular arrhythmia from aortic cusp thrombosis and coronary embolization is a rare complication of left ventricular assist device (LVAD) implantation. In this report, we present a case of acute left main and left anterior descending artery occlusion from embolic aortic cusp thrombi after LVAD implant. The patient presented with chest pain and incessant ventricular tachycardia post-LVAD implant. This was successfully treated by intracoronary thrombolysis, aspiration thrombectomy, and rheolytic thrombectomy...
October 21, 2017: Curēus
https://www.readbyqxmd.com/read/29274191/acquired-coagulopathy-in-patients-with-left-ventricular-assist-devices
#7
REVIEW
R Muslem, K Caliskan, F W G Leebeek
Chronic heart failure (HF) is a major emerging health care problem, associated with a high morbidity and mortality. Left ventricular assist devices (LVADs) have emerged as a successful treatment option for patients with end-stage HF. Despite its great benefit, the use of LVAD is associated with a high risk for complications. Bleeding, pump thrombosis, and thrombo-embolic events are frequently observed complications, with bleeding complications occurring in over a third of the patients. Although the design of the third generation LVAD has improved greatly, these hemostatic complications still occur...
December 23, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29237991/survival-of-heartmate-ii-patients-despite-cessation-of-anticoagulation%C3%A3-outcomes-and-hemostatic-analysis
#8
Rashad Zayat, Mohammad Amen Khattab, Oliver Grottke, Markus Honickel, Andreas Goetzenich, Ajay Moza, Christian Stoppe, Rüdiger Autschbach, Lachmandath Tewarie
BACKGROUND: In long-term left ventricular assist device (LVAD) therapy, recurrent bleeding events may justify cessation of anticoagulation therapy (AT). However, data about THE safety and risks of AT cessation in LVAD patients are scarce.Methods and Results:Between 2010 and 2015, 128 patients received a HeartMate II (HMII). Following recurrent bleeding events, we ceased vitamin K antagonist (VKA) therapy in 13 patients (10%) (no-VKA group). To characterize the hemostatic profile, we performed von Willebrand factor (vWF), platelet function (PF), and other hemostatic tests in all HMII patients...
December 12, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29230110/letter-to-the-editor-management-of-aortic-root-thrombosis-after-implantation-of-a-continuous-flow-left-ventricular-assist-device-a-real-conundrum
#9
John Gulotta, Daniel P Morin, Selim R Krim
No abstract text is available yet for this article.
2017: Ochsner Journal
https://www.readbyqxmd.com/read/29226531/pre-implant-left-ventricular-apex-position-predicts-risk-of-heartmate-ii-pump-thrombosis
#10
Leora T Yarboro, James Hunter Mehaffey, Robert B Hawkins, Irving L Kron, Gorav Ailawadi, John A Kern, Ravi K Ghanta
BACKGROUND: Thrombosis within a left ventricular assist device (LVAD) is a devastating complication that often necessitates device exchange. Few studies have evaluated the relationship between patient anatomy and pump thrombosis. We hypothesize that lateral displacement of the left ventricular (LV) apex increases risk for pump thrombosis. METHODS: All patients who underwent primary implantation of a HeartMate II (HM2) device (Thoratec, Pleasanton, CA) at a single center (2009-2015) were evaluated...
December 10, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29211226/implantation-of-short-term-and-long-term-right-ventricular-assist-devices
#11
Christiano Castello Branco Caldeira, Regimar Carla Machado, Debora Castello Branco Caldeira
The last decade has seen considerable growth in the use of left ventricular assist devices (LVAD), in end-phase heart failure treatment. The indications, contraindications and implantation techniques are well-defined. However, information about mechanical support for right ventricular failure is lacking. The aim of this communication is to present alternative techniques for implantation of short- and longterm right ventricular assist devices. Implanting the device in the right atrium has certain advantages when compared with the right ventricle...
September 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29204246/constricted-microfluidic-devices-to-study-the-effects-of-transient-high-shear-exposure-on-platelets
#12
Nesreen Z Alsmadi, Sarah J Shapiro, Christopher S Lewis, Vinit M Sheth, Trevor A Snyder, David W Schmidtke
Due to the critical roles that platelets play in thrombosis during many biological and pathological events, altered platelet function may be a key contributor to altered hemostasis, leading to both thrombotic and hemorrhagic complications. Platelet adhesion at arterial shear rates occurs through binding to von Willebrand Factor via the glycoprotein (GP) GPIb receptor. GPIb binding can induce platelet activation distinguishable by P-selectin (CD62P) surface expression and αIIbβ3 activation, resulting in platelet aggregation and formation of the primary hemostatic plug to stop bleeding...
November 2017: Biomicrofluidics
https://www.readbyqxmd.com/read/29189404/artifactual-appearance-of-thrombosis-on-using-metal-artifact-reduction-software-reconstruction-in-computed-tomographic-angiography
#13
Richard Thomas, Ayaz Aghayev, Michael L Steigner
The authors attempted to use metal artifact reduction software in 2 computed tomographic angiogram studies to decrease beam hardening. Although the beam hardening artifacts were reduced in the postprocessed images, there was an artifactual appearance of thrombosis in the adjacent arteries in the first case and in the inflow cannula of a left ventricular assist device in the second case. Comparison of the reconstructed images with the original images is therefore essential to avoid a misdiagnosis.
November 16, 2017: Journal of Computer Assisted Tomography
https://www.readbyqxmd.com/read/29179901/ct-imaging-of-complications-associated-with-continuous-flow-left-ventricular-assist-devices-lvads
#14
Girish S Shroff, Daniel Ocazionez, Bindu Akkanti, Daniel Vargas, Alheli Garza, Pushpender Gupta, Jayeshkumar A Patel, Manish K Patel, Igor D Gregoric
Heart failure is becoming increasingly prevalent, and more patients are being treated with left ventricular assist devices (LVADs), either as a bridge to transplant or as destination therapy. The use of continuous-flow LVADs is on the rise. LVAD therapy is associated with several classes of complications, including bleeding, thrombosis, and infection. CT imaging can be used effectively to diagnose LVAD complications, including mediastinal hematomas and pericardial, abdominal wall, and retroperitoneal hemorrhage, inflow and outflow graft and aortic thrombi, and driveline and pump pocket infections...
December 2017: Seminars in Ultrasound, CT, and MR
https://www.readbyqxmd.com/read/29165737/management-of-hemostasis-for-pediatric-patients-on-ventricular-assist-devices
#15
Iki Adachi, Vadim Kostousov, Lisa Hensch, Martin A Chacon-Portillo, Jun Teruya
Ventricular-assist devices (VADs) have seen increased utilization in the pediatric population. Formerly, this therapeutic modality was limited to only the pulsatile VAD, EXCOR (Berlin Heart GmbH). However, the continuous flow VAD devices, HeartMate II (Abbott Inc.) and HeartWare (Medtronic Inc.), are now increasingly used in this population. Postoperatively, VAD patients are acutely anticoagulated using unfractionated heparin, often beginning 24 to 48 hours after VAD placement. Once the patient is stabilized and ready to transition to a lower acuity or outpatient setting, low-molecular-weight heparin or warfarin therapy may be instituted...
November 17, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29153812/surgical-management-of-extensive-perinatal-myocardial-infarction
#16
Stephanie Perrier, Alice Parker, Christian P Brizard, Bennett Sheridan, Igor E Konstantinov, Yves d'Udekem, Johann Brink
Extensive perinatal myocardial infarction caused by coronary artery thrombosis is extremely rare and has a dismal prognosis. We report a 3.5-kg neonate who presented at birth with an extensive myocardial infarction caused by aortic root and left main coronary artery thrombus after an emergency cesarean section. We performed emergency surgical thrombectomy and insertion of extracorporeal membrane oxygenation support. After subsequent conversion to long-term left ventricular assist device with an EXCOR device (Berlin Heart, Berlin, Germany), the patient had no ventricular recovery after 163 days of support...
December 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29153809/heartmate-iii-left-ventricular%C3%A2-assist-device-thrombosis-triggered-by-an%C3%A2-automatic-implantable-cardioverter-defibrillator-shock
#17
Stefan Klotz, Antje Karluss, Sina Stock, Alex Frydrychowicz, Hans-Hinrich Sievers
We report the case of an HeartMate III left ventricular assist device (LVAD) thrombosis triggered by a shock from an automatic implantable cardioverter defibrillator, releasing a left ventricular thrombus sucked in the LVAD inflow cannula. With LVAD low flow only the increase in motor temperature gave a hint of the thrombosis and a computer tomography scan confirmed the diagnosis. Pump exchange was performed with an uneventful outcome.
December 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29153636/early-intervention-for-lactate-dehydrogenase-elevation-improves-clinical-outcomes-in-patients-with-the-heartmate-ii-left-ventricular-assist-device-insights-from-the-prevent-study
#18
Thenappan Thenappan, John M Stulak, Richa Agarwal, Simon Maltais, Palak Shah, Peter Eckman, Sitaramesh Emani, Jason N Katz, Igor Gregoric, Mary E Keebler, Nir Uriel, Eric Adler, Joyce Chuang, David J Farrar, Kartik S Sundareswaran, Ranjit John
BACKGROUND: Hemolysis, assessed by elevated serum lactate dehydrogenase (LDH), is strongly associated with HeartMate II pump thrombosis (PT). However, it is unknown whether early intervention for elevated LDH circumvents the risk of serious PT requiring pump exchange. We sought to evaluate the relationship between elevated LDH and clinical outcomes, the effectiveness of early medical intervention, and risk factors for elevated LDH. METHODS: We studied 268 patients in the prospective, multicenter PREVENT study who had 2 or more LDH measurements at ≥30 days post-implant...
October 24, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29141856/impact-of-diabetes-mellitus-on-outcomes-in-patients-supported-with-left-ventricular-assist-devices-a-single-institutional-9-year-experience
#19
Rabea Asleh, Alexandros Briasoulis, Sarah D Schettle, Vakhtang Tchantchaleishvili, Naveen L Pereira, Brooks S Edwards, Alfredo L Clavell, Simon Maltais, David L Joyce, Lyle D Joyce, Richard C Daly, Sudhir S Kushwaha, John M Stulak
BACKGROUND: Diabetes mellitus (DM) is a risk factor for morbidity and mortality in patients with heart failure. The effect of DM on post-left ventricular assist device (LVAD) implantation outcomes is unclear. This study sought to investigate whether patients with DM had worse outcomes than patients without DM after LVAD implantation and whether LVAD support resulted in a better control of DM. METHODS AND RESULTS: We retrospectively reviewed 341 consecutive adults who underwent implantation of LVAD from 2007 to 2016...
November 2017: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29130648/emergent-percutaneous-therapy-for-left-ventricular-assist-device-retrograde-flow
#20
Ryan E Wilson, John C Gurley, Navin Rajagopalan, Thomas A Tribble
With the number of heart transplants being performed each year stagnating due to lack of donors the left ventricular assist device (LVAD) patient population will continue to grow. As more and more patients are living longer with LVADs, either as a bridge to transplant or destination therapy, we will continue to see an increased number of complications related to assist device therapy. One of the common challenges physicians face are patients who suffer from both bleeding and thrombotic complications. When bleeding complications occur anticoagulation is usually reduced or discontinued and then the thrombosis risk increases...
November 11, 2017: Catheterization and Cardiovascular Interventions
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