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ventricular assist device thrombosis

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https://www.readbyqxmd.com/read/29773577/determinants-and-outcomes-of-vasoplegia-following-left-ventricular-assist-device-implantation
#1
Kristen M Tecson, Brian Lima, Andy Y Lee, Fayez S Raza, Grace Ching, Cheng-Han Lee, Joost Felius, Ronald D Baxter, Sasha Still, Justin D G Collier, Shelley A Hall, Susan M Joseph
BACKGROUND: Vasoplegia is associated with adverse outcomes following cardiac surgery; however, its impact following left ventricular assist device implantation is largely unexplored. METHODS AND RESULTS: In 252 consecutive patients receiving a left ventricular assist device, vasoplegia was defined as the occurrence of normal cardiac function and index but with the need for intravenous vasopressors within 48 hours following surgery for >24 hours to maintain a mean arterial pressure >70 mm Hg...
May 17, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29768282/baseline-thromboelastogram-as-a-predictor-of-left-ventricular-assist-device-thrombosis
#2
Shannon L Piche, Scott D Nei, Erin Frazee, Sarah D Schettle, Barry A Boilson, Matthew F Plevak, Ross A Dierkhising, John M Stulak
Left ventricular assist device (LVAD) pump thrombosis occurs in up to 8.4% of patients within 3-months postimplantation. Thromboelastography (TEG) could be used to signal hypercoagulability at LVAD implantation to predict patients at high risk for thrombosis. We sought to evaluate whether TEG maximum amplitude (MA) hypercoagulability (MA ≥69 mm) at the time of LVAD implantation predicts pump thrombosis. A single center, retrospective, nested case-control study was conducted using patients from January 1, 2005, to March 31, 2015...
May 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29759673/characterization-of-ventricular-tachycardia-after-left-ventricular-assist-device-implantation-as-destination-therapy-a-single-center-ablation-experience
#3
Joshua D Moss, Erin E Flatley, Andrew D Beaser, John H Shin, Hemal M Nayak, Gaurav A Upadhyay, Martin C Burke, Valluvan Jeevanandam, Nir Uriel, Roderick Tung
OBJECTIVES: This study sought to report mechanisms of ventricular tachycardia (VT) and outcomes of VT ablation in patients with a left ventricular assist device (LVAD) as destination therapy. BACKGROUND: Continuous flow LVAD implantation plays a growing role in the management of end-stage heart failure, and VT is common. There are limited reports of VT ablation in patients with a destination LVAD. METHODS: Patients with a continuous-flow LVAD referred for VT ablation from 2010 to 2016 were analyzed retrospectively...
December 11, 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29750405/heartmate-3-implantation-via-left-antero-lateral-thoracotomy-to-avoid-resternotomy-in-high-risk-patients
#4
Raymond Pfister, Piergiorgio Tozzi, Roger Hullin, Patrick Yerly, Fritz-Patrick Jahns, René Prêtre, Matthias Kirsch
Left ventricular assist devices (LVADs) are currently the best alternative to cardiac transplantation for patients with end-stage heart failure (HF) as a bridge to transplant or to decision, or as destination therapy. Full median sternotomy or minimally invasive techniques are the more standard approaches used at present.  LVADs are usually implanted between the left ventricle apex and the ascending aorta. An implantation through a left thoracotomy with an outflow graft connected to the descending aorta is much less performed nowadays due to the longer times to extubation, higher incidence of postoperative pain, and poorer hemodynamics in the ascending aorta, which may lead to thrombosis...
April 25, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
https://www.readbyqxmd.com/read/29734260/the-hemopump-the-first-intravascular-ventricular-assist-device
#5
Richard Wampler, O H Frazier
Development of durable left ventricular assist devices (LVADs), based on rotary flow blood pumps, began in earnest after the successful implantation of a catheter-mounted axial flow blood pump via intravascular access in 1988. This device, the Hemopump, successfully supported the circulation of a patient in cardiogenic shock secondary to acute rejection of a transplanted heart. Duration of support was 46 hours, resulting in complete recovery of cardiac function and hospital discharge. In effect, this sentinel event demonstrated that continuous-flow blood pumps could be used to support patients in cardiogenic shock...
April 19, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29710092/evolution-of-left-ventricular-assist-device-therapy-for-advanced-heart-failure-a-review
#6
Leslie W Miller, Joseph G Rogers
Importance: The mortality rate for the most advanced forms of heart failure with medical therapy alone remains unacceptably high at 30% to 80% at 1 year. In the past decade, left ventricular assist devices have assumed an increasingly prominent role in the management of these patients. This review included all English-language articles published over the past 15 years on left ventricular assist devices. Search topics focused on advanced heart failure and ventricular assist devices, including volume of implantations, patient selection, complications, cost, and recovery of function...
April 18, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29677037/small-left-ventricular-size-is-an-independent-risk-factor-for-ventricular-assist-device-thrombosis
#7
Venkat Keshav Chivukula, Jennifer A Beckman, Anthony R Prisco, Shin Lin, Todd F Dardas, Richard K Cheng, Stephen D Farris, Jason W Smith, Nahush A Mokadam, Claudius Mahr, Alberto Aliseda
The prevalence of ventricular assist device (VAD) therapy has continued to increase due to a stagnant donor supply and growing advanced heart failure (HF) population. We hypothesize that left ventricular (LV) size strongly influences biocompatibility and risk of thrombosis. Unsteady computational fluid dynamics (CFD) was used in conjunction with patient-derived computational modeling and virtual surgery with a standard, apically implanted inflow cannula. A dual-focus approach of evaluating thrombogenicity was employed: platelet-based metrics to characterize the platelet environment and flow-based metrics to investigate hemodynamics...
April 18, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29666072/left-ventricular-assist-device-inflow-cannula-angle-and-thrombosis-risk
#8
Venkat Keshav Chivukula, Jennifer A Beckman, Anthony R Prisco, Todd Dardas, Shin Lin, Jason W Smith, Nahush A Mokadam, Alberto Aliseda, Claudius Mahr
BACKGROUND: As heart failure prevalence continues to increase in the setting of a static donor supply, left ventricular assist device (LVAD) therapy for end-stage heart failure continues to grow. Anecdotal evidence suggests that malalignment of the LVAD inflow cannula may increase thrombosis risk, but this effect has not been explored mechanistically or quantified statistically. Our objective is to elucidate the impact of surgical angulation of the inflow cannula on thrombogenicity. METHODS AND RESULTS: Unsteady computational fluid dynamics is used in conjunction with computational modeling and virtual surgery to model flow through the left ventricle for 5 different inflow cannula angulations...
April 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29648627/late-outcomes-of-subcostal-exchange-of-the-heartmate-ii-left-ventricular-assist-device-a-word-of-caution
#9
Sarah N Yu, Hiroo Takayama, Jiho Han, Arthur R Garan, Paul Kurlansky, Melana Yuzefpolskaya, Paolo C Colombo, Yoshifumi Naka, Koji Takeda
OBJECTIVES: Previous studies have shown the usefulness of the subcostal exchange of the HeartMate II left ventricular assist device for device malfunction. However, long-term data are still limited. METHODS: Between March 2004 and July 2017, 41 of 568 (7.2%) patients who had received a HeartMate II implant at our institution had a device exchange via a subcostal incision. We summarized early and late outcomes. RESULTS: Forty-one patients had a total of 48 subcostal pump exchanges...
April 10, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29629921/assessment-of-cardiac-thrombosis-in-patients-with-left-ventricular-assist-device-using-multidetector-cardiac-computed-tomography
#10
Chukwuemeka A Obi, Nicholas Chan, Monica G Rizkalla, John N Makaryus
: A 79-year-old man with nonischemic cardiomyopathy who underwent left ventricular assist device HeartMate II and automated implantable cardioverter defibrillator placement presented with recurrent refractory sustained ventricular tachycardia, elevated lactate dehydrogenase, and low haptoglobin. Echocardiography demonstrated no thrombosis; cardiac computed tomography showed patent inflow and outflow cannulas while detecting an irregularly shaped mass adherent to the left coronary cusp of the aortic valve, suggesting a thrombus...
April 7, 2018: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/29618581/causes-and-predictors-of-30-day-readmission-in-patients-with-acute-myocardial-infarction-and-cardiogenic-shock
#11
Mahek Shah, Shantanu Patil, Brijesh Patel, Manyoo Agarwal, Carlos D Davila, Lohit Garg, Sahil Agrawal, Navin K Kapur, Ulrich P Jorde
BACKGROUND: Acute myocardial infarction (AMI) occurs as a result of irreversible damage to cardiac myocytes secondary to lack of blood supply. Cardiogenic shock complicating AMI has significant associated morbidity and mortality, and data on postdischarge outcomes are limited. METHODS AND RESULTS: We derived the study cohort of patients with AMI and cardiogenic shock from the 2013 to 2014 Healthcare Cost and Utilization Project National Readmission Database. Incidence, predictors, and causes of 30-day readmissions were analyzed...
April 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29613888/the-effect-of-inflow-cannula-angle-on-the-intraventricular-flow-field-of-the-left-ventricular-assist-device-assisted-heart-an-in-vitro-flow-visualization-study
#12
Karen May-Newman, Nikolas Marquez-Maya, Ricardo Montes, Saniya Salim
Previous studies have identified left ventricular assist device (LVAD) inflow cannula (IC) malposition as a significant risk for pump thrombosis. Thrombus development is a consequence of altered flow dynamics, which can produce areas of flow stasis or high shear that promote coagulation. The goal of this study was to measure the effect of IC orientation on the left ventricle (LV) flow field using a mock circulatory loop, and identify flow-based indices that are sensitive measures of cannula malposition. Experimental studies were with a customized silicone model of the dilated LV and the EVAHEART LVAS...
March 30, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29596613/repeat-left-ventricular-assist-device-exchange-with-inflow-or-outflow-correction-for-recurrent-pump-thrombosis-and-cerebral-haemorrhage-through-limited-incisions
#13
Medhat Radwan, Petar Risteski, Richard Hoffmann, Aron-Frederik Popov
Left ventricular assist devices (LVADs) may require subsequent pump exchange due to device thrombosis or thromboembolism. A limited left thoracotomy may offer advantages over standard full sternotomy in redo procedures by preserving pristine median access and decreasing the potential for re-entry injuries, postoperative bleeding and transfusion requirements. We describe repeat LVAD exchange via the left limited thoracotomy with outflow graft anastomosis to the left subclavian artery with the correction of LVAD inflow cannula angulation following recurrent LVAD thromboses...
March 27, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29567308/ventricular-flow-dynamics-with-varying-lvad-inflow-cannula-lengths-in-silico-evaluation-in-a-multiscale-model
#14
Sam Liao, Michael Neidlin, Zhiyong Li, Benjamin Simpson, Shaun D Gregory
Left ventricular assist devices are associated with thromboembolic events, which are potentially caused by altered intraventricular flow. Due to patient variability, differences in apical wall thickness affects cannula insertion lengths, potentially promoting unfavourable intraventricular flow patterns which are thought to be correlated to the risk of thrombosis. This study aimed to present a 3D multiscale computational fluid dynamic model of the left ventricle (LV) developed using a commercial software, Ansys, and evaluate the risk of thrombosis with varying inflow cannula insertion lengths in a severely dilated LV...
March 10, 2018: Journal of Biomechanics
https://www.readbyqxmd.com/read/29562790/role-of-computed-tomography-angiography-for-heartmate-ii-left-ventricular-assist-device-thrombosis
#15
Sarah N Yu, Jiho Han, Koji Takeda, Jonathan N Ginns, Paul A Kurlansky, Arthur R Garan, Melana Yuzefpolskaya, Veli K Topkara, Paolo C Colombo, Yoshifumi Naka, Hiroo Takayama
INTRODUCTION: Device thrombosis is one of the most devastating complications of HeartMate II left ventricular assist devices. The purpose of this study is to assess the anatomical properties that the inflow and outflow computed tomography angiography provides in assessing for left ventricular assist device thrombosis, as well as their impact on clinical management and postoperative outcomes. METHODS: Between April 2010 and December 2016, 22 patients who received a HeartMate II left ventricular assist device implantation were readmitted for suspected device thrombosis and underwent a computed tomography angiography for workup...
March 1, 2018: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/29561270/low-dose-prothrombin-complex-concentrate-in-patients-with-left-ventricular-assist-devices
#16
Caitlin S Brown, Wesley R Zemrak, Kaitlin J Dyer, Stephen Rolfe
Left ventricular assist devices (LVADs) have become an important advancement for patients with end-stage heart failure. Left ventricular assist devices come with the risk of stroke and pump thrombosis, and to mitigate these risks, anticoagulation is given to these patients. With anticoagulation comes increased bleeding risk, and urgent reversal may be necessary. Reports have shown that the risk of thrombosis with prothrombin complex concentrate (PCC) does exist, especially in patients with baseline risk factors for thrombosis...
March 20, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29558840/symptoms-of-massive-cardiac-tamponade-during-support-of-biventricular-assist-device
#17
Mosab Al Shakaki, Angelo M Dell'Aquila, Andreas Rukosujew
Typical symptoms of cardiac tamponade are jugular venous distension, pulsus paradoxus, hypotension, and rest dyspnea. However, these clinical symptoms can be masked in patients with ventricular assist device and even more in patients supported with a biventricular-HeartWare ventricular assist device. Hereby, we report the case of a 30-year-old man supported with a biventricular-HeartWare ventricular assist device, who underwent a computed tomography scan due to suspect of ventricular assist device thrombosis...
March 1, 2018: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/29552914/identification-of-novel-hemostatic-biomarkers-of-adverse-clinical-events-in-patients-implanted-with-a-continuous-flow-left-ventricular-assist-device
#18
Nathan McClane, Walter Jeske, Jeanine M Walenga, Vicki Escalante, Debra Hoppensteadt, Jeffrey Schwartz, Mamdouh Bakhos
Heart failure affects over 5 million people in the United States. Its rising prevalence and the limited supply of donor hearts is increasing the use of mechanical cardiac support with the implantation of continuous-flow ventricular assist devices (CF-VAD). Patients with CF-VAD implants are at risk of complications, specifically adverse hemostatic events such as nonsurgical bleeding and thrombosis. Development of a pump thrombus requires clinical intervention and/or surgical replacement significantly increasing the risk of patient morbidity and mortality...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29528019/treatment-of-left-ventricular-assist-device-thrombosis-single-center-experience
#19
D Sarp Beyazpınar, Özgür Ersoy, Bahadır Gültekin, Anar Aliyev, Mert Avsever, H Tankut Akay, Murat Özkan, Atilla Sezgin, Sait Aşlamacı
Heart failure is the one of the biggest health problem in the world. Because of limited donors for heart transplant procedures, the ventricular assist device has become a solution for heart failure therapy. With the increase in number of ventricular assist devices, the incidence of complications has also increased. One of the most important life-threatening complications is ventricular assist device thrombosis. Medical therapy and changes in the ventricular assist device are the main therapy methods for ventricular assist device thrombosis...
March 2018: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29525258/one-year-outcomes-with-the-heartmate-3-left-ventricular-assist-device
#20
Jasmin S Hanke, Günes Dogan, Amelie Zoch, Marcel Ricklefs, Leonhard Wert, Christina Feldmann, Christoph Bara, Malakh Shrestha, Jochen Tillmanns, Tibor Kempf, Johann Bauersachs, Axel Haverich, Jan D Schmitto
BACKGROUND: The HeartMate 3 (HM3; Abbott Laboratories, Lake Forest, Ill) left ventricular assist device (LVAD) received its Conformité Européenne mark for Europe in October 2015 and is currently under investigation of the Food and Drug Administration to gain approval in the United States. Within this study, we present the first real-world experiences, 1-year outcomes, and adverse events of a single-center cohort treated with the HM3. METHODS: We prospectively studied midterm results of 27 consecutive patients receiving the HM3 at a single institution...
February 13, 2018: Journal of Thoracic and Cardiovascular Surgery
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