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https://www.readbyqxmd.com/read/28631345/advantages-and-disadvantages-of-using-intravenous-tissue-plasminogen-activator-as-salvage-therapy-for-inoperable-heartware-thrombosis
#1
Robyn Basken, Charles M Bazzell, Richard Smith, Rajesh Janardhanan, Zain Khalpey
Device thrombosis is a devastating complication of left ventricular assist devices. The definitive treatment has been device exchange or explant. Evidence of increasing morbidity and mortality with device exchange has shifted strategies toward conservative management. In this report, we detail the use of thrombolytics as salvage therapy in a patient with an occlusive HeartWare ventricular assist device (HeartWare Inc., Framingham, MA) thrombus, resulting in long-term survival without further intervention.
June 19, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28621461/the-use-of-eptifibatide-alone-or-in-combination-with-heparin-or-argatroban-for-suspected-thrombosis-in-patients-with-left-ventricular-assist-devices
#2
Abbas Bitar, Rajakrishnan Vijayakrishnan, Andrew Lenneman, Emma Birks, Todd Massey, Mark Slaughter, Dmitry Abramov
Pump thrombosis and hemolysis in patients with left ventricular assist devices (LVADs) are associated with significant morbidity and mortality. Intensification of anticoagulation has been suggested as potential therapy, with mixed results. The aim of this study is to assess the safety and efficacy of adding eptifibatide with or without an anticoagulation agent in managing patients with LVAD presenting with hemolysis and suspected pump thrombosis. This retrospective single center study included all patients who presented with their first episode of suspected pump thrombosis and were treated with eptifibatide with or without an anticoagulant between March 1, 2011 and July 30, 2015...
June 16, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28606584/impact-of-a-modified-anti-thrombotic-guideline-on-stroke-in-children-supported-with-a-pediatric-ventricular-assist-device
#3
David N Rosenthal, Chacy A Lancaster, Doff B McElhinney, Sharon Chen, MaryLyn Stein, Aileen Lin, Lan Doan, Jenna M Murray, Mary Alice Gowan, Katsuhide Maeda, Olaf Reinhartz, Christopher S Almond
BACKGROUND: Stroke is the most feared complication associated with the Berlin Heart EXCOR pediatric ventricular assist device (VAD), the most commonly used VAD in children, and affects 1 in 3 children. We sought to determine whether a modified anti-thrombotic guideline, involving more intense platelet inhibition and less reliance on platelet function testing, is associated with a lower incidence of stroke. METHODS: All children supported with the EXCOR at Stanford from 2009 to 2014 were divided into 2 cohorts based on the primary anti-thrombotic guideline used to prevent pump thrombosis: (1) the Edmonton Anti-thrombotic Guideline (EG) cohort, which included children implanted before September 2012 when dual anti-platelet therapy was used with doses titrated to Thromboelastrography/PlateletMapping (TEG/PM); and (2) the Stanford Modified Anti-thrombotic Guideline (SG) cohort, which included children implanted on or after September 2012 when triple anti-platelet therapy was used routinely and where doses were uptitrated to high, weight-based dosing targets, with low-dose steroids administered as needed for inflammation...
May 20, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28604570/successful-treatment-of-pediatric-ventricular-assist-device-thrombosis
#4
Devin Chetan, Holger Buchholz, Mary Bauman, Vijay Anand, Paula Holinski, Jennifer Conway
Pump thrombosis represents a significant cause of morbidity and mortality in patients on continuous flow ventricular assist devices (CF-VAD). Pump thrombosis in the pediatric CF-VAD population has been reported between 11% and 44%, with the largest reported series from the PediMACS registry reporting a rate of approximately 15%. We report our early experience with four pediatric patients who developed pump thrombosis on a CF-VAD. Our limited experience suggests that the treatment of pediatric VAD thrombosis can be approached with similar principles to the adult population...
June 7, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28602376/left-ventricular-assist-device-in-older-adults
#5
REVIEW
Chris Caraang, Gregg M Lanier, Alan Gass, Wilbert S Aronow, Chhaya Aggarwal Gupta
Left ventricular assist devices (LVADs) are an effective therapy for a growing and aging population in the background of limited donor supply. Selecting the proper patient involves assessment of indications, risk factors, scores for overall outcomes, assessment for right ventricular failure, and optimal timing of implantation. LVAD complications have a 5% to 10% perioperative mortality and complications of bleeding, thrombosis, stroke, infection, right ventricular failure, and device failure. As LVAD engineering technology evolves, so will the risk-prediction scores...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28595702/left-ventricular-assist-devices-for-lifelong%C3%A2-support
#6
REVIEW
Sean P Pinney, Anelechi C Anyanwu, Anuradha Lala, Jeffrey J Teuteberg, Nir Uriel, Mandeep R Mehra
Continuous-flow left ventricular assist devices (LVADs) have revolutionized advanced heart failure care. These compact, fully implantable heart pumps are capable of providing meaningful increases in survival, functional capacity, and quality of life. Implantation volumes continue to grow, but several challenges remain to be overcome before LVADs will be considered as the therapy of choice for all patients with advanced heart failure. They must be able to consistently extend survival for the long term (7 to 10 years), rather than the midterm (3 to 5 years) more typical of contemporary devices; they must incorporate design elements that reduce shear stress and avoid stasis to reduce the frequent adverse events of bleeding, stroke, and pump thrombosis; and they must become more cost-effective...
June 13, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28579115/bleeding-and-thrombosis-associated-with-ventricular-assist-device-therapy
#7
Palak Shah, Udaya S Tantry, Kevin P Bliden, Paul A Gurbel
Over the past decade, continuous-flow rotary pumps have dramatically improved survival for patients with advanced systolic heart failure. Bleeding and thrombosis, however, continue to be the Achilles heel of left ventricular assist device (LVAD) therapy. There is a dynamic and complex interaction between the patient and pump. The net effect of a variety of hematologic derangements, such as hemolysis, high-molecular-weight von Willebrand degradation, platelet activation and diminished pulsatility, is poorly understood...
May 11, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28562236/left-ventricular-assist-device-exchange-the-toronto-general-hospital-experience
#8
Hideki Tsubota, Roberto V P Ribeiro, Filio Billia, Robert J Cusimano, Terrence M Yau, Mitesh V Badiwala, William E Stansfield, Vivek Rao
BACKGROUND: As support times for left ventricular assist devices (LVADs) become longer, several complications requiring device exchange may occur. To our knowledge, this is the first Canadian report regarding implantable LVAD exchange. METHODS: We retrospectively reviewed the cases of consecutive, unique patients implanted with an LVAD between June 2006 and October 2015 at Toronto General Hospital. RESULTS: In total, 122 patients were impanted with an LVAD during the study period...
June 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28532240/ventricular-assist-devices-for-the-failing-univentricular-circulation
#9
Edward Buratto, William Y Shi, Xin Tao Ye, Igor E Konstantinov
Improved survival following single ventricle palliation has led to a large population of patients with a univentricular circulation, many of whom develop heart failure. Increasing experience with ventricular assist devices (VAD) in children has paved the way for VAD support in those with failing univentricular circulation. Areas covered: The use of VADs to support the failing univentricular circulation is a relatively new concept. Most studies have focused on supporting patients with the failing systemic ventricle...
June 2017: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/28515757/emergency-heartware-ventricular-assist-device-hvad-exchange-due-to-pump-thrombosis-using-minimally-invasive-technique
#10
Remigiusz Antończyk, Ewa Trejnowska, Jerzy Pacholewicz, Tomasz Wolny, Paweł Nadziakiewicz, Karolina Antończyk, Izabela Copik, Magdalena Piontek, Małgorzata Jasińska, Krzysztof Filipiak, Maciej Głowacki, Maciej Gawlikowski, Marcin Borowicz, Roman Kustosz, Jacek Waszak, Piotr Przybyłowski, Marian Zembala, Michał Zakliczyński, Michał Oskar Zembala
Left ventricular assist device (LVAD) thrombosis remains a dreadful complication of mechanical circulatory support, with an incidence of 8-12% depending on the pump type and patient's comorbidities. Fibrinolysis may be considered early in pump thrombosis, but when contraindicated a pump exchange remains the only alternative. This short report documents an emergency LVAD exchange in a 55-year-old man who underwent LVAD (HeartWare Inc) implantation in 2013 as a bridge to transplantation. Four months after the initial surgery, he suffered from a hemorrhagic stroke despite properly managed anticoagulation...
March 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28508806/telemonitoring-and-medical-care-of-heart-failure-patients-supported-by-left-ventricular-assist-devices-the-medolution-project
#11
Nils Reiss, Thomas Schmidt, Frerk Müller-von Aschwege, Wolfgang Thronicke, Jan-Dirk Hoffmann, Jenny Inge Röbesaat, Ezin Deniz, Andreas Hein, Heiko Krumm, Franz-Josef Stewing, Detlev Willemsen, Jan Dieter Schmitto, Christina Feldmann
Long-term survival after left ventricular assist device (LVAD) implantation in heart failure patients is mainly determined by a sophisticated after-care. Ambulatory visits only take place every 12 weeks. In case of life-threatening complications (pump thrombosis, driveline infection) this might lead to delayed diagnosis and delayed intervention. It is the intention of the international project Medolution (Medical care evolution) to develop new approaches in order to create best structures for telemonitoring of LVAD patients...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28430913/prediction-of-adverse-events-after-catheter-based-procedures-in-adolescents-and-adults-with-congenital-heart-disease-in-the-impact-registry
#12
Ada C Stefanescu Schmidt, Aimee Armstrong, Kevin F Kennedy, David Nykanen, Jamil Aboulhosn, Ami B Bhatt
Aims: We sought to identify factors associated with major adverse events (MAE) after cardiac catheterization in adolescents and adults with congenital heart disease (CHD), and create the first model to individualize risk discussions in this growing population. Methods and results: Improving Pediatric and Adult Congenital Treatment (IMPACT), a National Cardiovascular Data Registry, contains congenital catheterization data from over 87 hospitals in the United States...
April 18, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28396088/erythrocyte-aging-as-a-mechanism-of-anemia-and-a-biomarker-of-device-thrombosis-in-continuous-flow-left-ventricular-assist-devices
#13
Ziad Taimeh, Ryan J Koene, Julie Furne, Ashish Singal, Peter M Eckman, Michael D Levitt, Marc R Pritzker
BACKGROUND: Blood trauma caused by continuous-flow left ventricular assist devices (CF-LVADs) has been associated with device thrombosis and anemia. Accurate in vivo quantification of erythrocyte turnover and its contribution to CF-LVAD complications have yet to be elucidated. METHODS: We investigated the age (lifespan) of circulating erythrocytes in subjects with CF-LVAD. Erythrocyte lifespan is a quantitative indicator of in vivo erythrocyte turnover that can be accurately derived from measurement of the exhaled carbon monoxide (CO) level...
February 9, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28376837/heartmate-3-fully-magnetically-levitated-left-ventricular-assist-device-for-the-treatment-of-advanced-heart-failure-1%C3%A2-year-results-from-the-ce-mark-trial
#14
Thomas Krabatsch, Ivan Netuka, Jan D Schmitto, Daniel Zimpfer, Jens Garbade, Vivek Rao, Michiel Morshuis, Friedhelm Beyersdorf, Silvana Marasco, Laura Damme, Yuriy Pya
BACKGROUND: The HeartMate 3 Left Ventricular Assist System (LVAS) (St. Jude Medical Inc., St Paul, MN) with full magnetic levitation allows for wide and consistent blood flow paths and an artificial pulse designed for enhanced hemocompatibility. The HeartMate 3 received market approval in the European Union in 2015 following completion of a multicenter study. After reaching the 6-month study endpoint, patients continue to be followed for 2 years with the 1-year results presented herein...
April 4, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28357450/an-alternative-strategy-for-bridge-to-transplant-recovery-in-small-children-with-dilated-cardiomyopathy
#15
REVIEW
Gilles Mets, Joseph Panzer, Daniël De Wolf, Thierry Bové
Dilated cardiomyopathy in children still has a poor prognosis with high rates of mortality and cardiac transplantation (resp. around 20 and 25%). Awaiting transplantation or possible recovery, these pediatric patients are mechanically supported with extracorporeal membrane oxygenation or a paracorporeal ventricular assist device, both resulting in higher survival rates but also entailing considerable risks of infection, thrombosis, or bleeding. A new indication for an old technique, i.e., pulmonary artery banding, presents itself as an interesting alternative to mechanical circulatory support in selected infants and small children with dilated LV cardiomyopathy and preserved RV function...
March 29, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28329060/first-series-of-left-ventricular-assist-device-exchanges-to-heartmate-3
#16
Jasmin S Hanke, Sebastian V Rojas, Günes Dogan, Christina Feldmann, Erik Beckmann, Ezin Deniz, Bettina Wiegmann, Jana-Elena Michaelis, L Christian Napp, Dominik Berliner, Malakh Shrestha, Johann Bauersachs, Axel Haverich, Jan D Schmitto
OBJECTIVES: Left ventricular assist device (LVAD) exchange is becoming a standard surgical procedure. The exchange procedure is an opportunity to upgrade patients to a new generation pump that offers advanced reduction of adverse events or longer battery hours. METHODS: We performed an analysis of 6 consecutive patients who underwent LVAD exchange to HeartMate 3 either from a HeartWare or HeartMate (HM) II device. Minimally invasive operations were performed through a lateral thoracotomy...
May 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28268010/first-experiences-with-heartmate-3-follow-up-and-adverse-events
#17
Jasmin S Hanke, Günes Dogan, Sebastian V Rojas, Amelie Zoch, Christina Feldmann, Ezin Deniz, Murat Avsar, Gregor Warnecke, Axel Haverich, Jan D Schmitto
BACKGROUND: The novel HeartMate 3 (HM3) left ventricular assist device (LVAD) received its CE mark in October 2015. It is a new compact LVAD featuring fully magnetically levitated pump, artificial pulse, large pump gaps, and a modular driveline. Here, we present outcomes and adverse events of a single-center cohort 6 months after HM3 implantation. METHODS: We retrospectively studied a patient cohort of 27 patients who were supported with the HM3 at a single institution...
February 9, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28266662/clinical-correlates-of-b-type-natriuretic-peptide-monitoring-in-outpatients-with-left-ventricular-assist-device
#18
Marketa Hegarova, Milos Kubanek, Ivan Netuka, Jiri Maly, Zora Dorazilova, Tomas Gazdic, Janka Franekova, Vera Lanska, Vojtech Melenovsky, Josef Kautzner, Ivan Malek
BACKGROUND: B-type natriuretic peptide (BNP) is a strong predictor of prognosis in chronic heart failure. We aimed to evaluate the clinical correlates and interpretation of BNP monitoring in LVAD out-patient recipients. METHODS: We performed a prospective study in 136 individuals after HeartMate II LVAD implantation. During follow-up they were divided into group A (severe adverse events requiring hospitalisation), group B (mild to moderate adverse events) and group C (an uneventful course)...
February 27, 2017: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
https://www.readbyqxmd.com/read/28265218/minimally-invasive-lvad-deactivation-in-a-65-year-old-man-with-recurrent-pump-thrombosis-and-left-ventricular-recovery
#19
Akshay Pendyal, Christopher V Chien, James O Mudd, Jill M Gelow
Pump thrombosis is a dire sequela after left ventricular assist device (LVAD) implantation. Treatment comprises antiplatelet agents, anticoagulants, thrombolytic agents, and pump exchange. Although pump exchange is the definitive therapy, it is also the most invasive, often exposing patients to the risks of repeat sternotomy and cardiopulmonary bypass. In some cases, patients experience left ventricular recovery after LVAD implantation. The optimal strategy surrounding the management of LVADs in patients who have experienced ventricular recovery is unknown; techniques range from total system explantation to partial pump resection...
February 2017: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/28216204/left-ventricular-assist-device-thrombosis-is-associated-with-an-increase-in-the-systolic-to-diastolic-velocity-ratio-measured-at-the-inflow-and-outflow-cannulae
#20
Ankit Jain, Ben Rohrer, Brian Gebhardt, Janis L Breeze, Joshua D Quick, Gregory Couper, Michael S Kiernan, Matthew Lawrence, Frederick C Cobey
OBJECTIVE: To determine whether the ratio of peak systolic-to-nadir diastolic velocity (S/D ratio) measured using Doppler at the left ventricular assist device (LVAD) inflow and outflow cannulae is associated with pump thrombosis and to determine whether there is an absolute decrease in the diastolic cannula velocities in LVAD thrombosis. DESIGN: Retrospective chart review. SETTING: University hospital. PARTICIPANTS: Patients who underwent LVAD exchange...
April 2017: Journal of Cardiothoracic and Vascular Anesthesia
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