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ventricular assist device thrombosis

Vikram Sood, Osman Alam, Vakhtang Tchantchaleishvili, Francis D Pagani, Keith D Aaronson, Jonathan Haft, David L Joyce, Lyle D Joyce, Richard C Daly, Simon Maltais, John M Stulak
BACKGROUND: Analyses of the HeartMate II left ventricular assist device are routinely performed after explant if returned to the manufacturer. Findings from manufacturer-reported pump analyses have not been correlated with pre-explant serum lactate dehydrogenase (LDH) values. METHODS: Between May 2004 and December 2014, 502 patients underwent primary HeartMate II implantation. Seventy pumps were explanted in 58 patients and returned to the manufacturer for pump analysis: 51 (73%) for suspected pump thrombosis, 12 (17%) for device-related infection, and 7 (13%) for percutaneous lead fracture...
October 12, 2016: Annals of Thoracic Surgery
Walter P Jeske, Jeanine M Walenga, Bryan Menapace, Jeffrey Schwartz, Mamdouh Bakhos
For heart failure patients unable to undergo cardiac transplantation, mechanical circulatory support with left ventricular assist devices can be utilized. These devices improve quality of life and prolong life expectancy, but they are associated with bleeding and thrombotic complications impacting patient survival. Little is known of the relevant mechanisms of these hemostatic issues, hindering identification of a clinically useful biomarker. However, there is suggestive evidence that blood cell-derived microparticles may fulfill this unmet clinical need...
October 2016: Biomarkers in Medicine
Matthew C Black, Erin M Schumer, Michael Rogers, Jaimin Trivedi, Mark S Slaughter
Advanced heart failure (HF) patients not meeting criteria for ventricular assist device or heart transplant with life-limiting symptoms are limited to medical and resynchronization therapy. The Sunshine Heart C-Pulse, based on intra-aortic balloon pump physiology, provides implantable, on-demand, extra-aortic counterpulsation, which reduces afterload and improves cardiac perfusion in New York Heart Association Class III and ambulatory Class IV HF. The C-Pulse reduces New York Heart Association Class, improves 6-min walk distances, inotrope requirements and HF symptom questionnaires...
September 2016: Future Cardiology
Francesca Condemi, Dongfang Wang, Gionata Fragomeni, Fuqian Yang, Guangfeng Zhao, Cameron Jones, Cherry Ballard-Croft, Joseph B Zwischenberger
OBJECTIVES: Our goal is to develop a double lumen cannula (DLC) for a percutaneous right ventricular assist device (pRVAD) in order to eliminate two open chest surgeries for RVAD installation and removal. The objective of this study was to evaluate the performance, flow pattern, blood hemolysis, and thrombosis potential of the pRVAD DLC. METHODS: Computational fluid dynamics (CFD), using the finite volume method, was performed on the pRVAD DLC. For Reynolds numbers <4000, the laminar model was used to describe the blood flow behavior, while shear-stress transport k-ω model was used for Reynolds numbers >4000...
2016: Biocybernetics and Biomedical Engineering
U Köksel, O Erbasan, Ö Bayezid, C Kemaloğlu, S Özçobanoğlu, I Gölbaşı, C Türkay
BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVADs) such as the HeartMate II and HeartWare left ventricular assist device are important alternatives to heart transplantation. Thrombosis is a serious complication in both devices and we present our approach to treating thrombosis and analysis of predisposition factors. METHODS: Our center's CF-LVADs database was retrospectively reviewed for pump thrombosis between January 2011 and January 2015. The patients were grouped for pump thrombosis (n = 13) and nonpump thrombosis (n = 85)...
July 2016: Transplantation Proceedings
O N Tuncer, C Kemaloğlu, O Erbasan, I Gölbaşı, C Türkay, Ö Bayezid
INTRODUCTION: Donor organ shortage is still a problem for heart transplantation. Only 10% of patients in waiting list undergo heart transplantation. Over the last 5 years, 2 different continuous flow pumps, the HeartMate II and the HeartWare, have been successful clinically in the alternative treatment of patients with end-stage heart disease. METHODS: Fifty-five patients underwent left ventricular assist device implantation between 2011 and 2014. Patients were followed on pump support for complications and intraoperative outcomes...
July 2016: Transplantation Proceedings
Roland Hetzer, Friedrich Kaufmann MEng, Evgenij Potapov, Thomas Krabatsch, Eva Maria Delmo Walter
This article reports our 15-year single-center experience with rotary blood pumps (RBPs) as long-term mechanical circulatory support (MCS) with emphasis on outcomes. For more than 15-year period, we have used various RBPs as bridge to transplantation or to myocardial recovery. Our group performed the first human implantation worldwide of RBCs, the MicroMed DeBakey ventricular assist device in November 1998 in a patient with end-stage heart failure who was supported for 47 days until his death. Based on this initial experience, we recognized the feasibility of providing long-term support and since then it has been our primary armamentarium in treating patients with heart failure...
2016: Seminars in Thoracic and Cardiovascular Surgery
P Elliott Miller, Brian A Houston, Andrea L C Schneider, Aaron Bush, Glenn J Whitman, Gerin Stevens, Ryan J Tedford, Stuart D Russell
Left ventricular assist devices (LVADs) are increasingly used for end-stage heart failure. However, post-LVAD complications are potentially devastating and remain unpredictable. The red blood cell distribution width (RDW) is a predictor of adverse events in patients with heart failure, but has not been studied in the LVAD population. We reviewed laboratory results and clinical outcomes for all continuous flow LVADs implanted from 2004 to June 2014 (N=188). Cox proportional hazards models adjusted for demographic, cardiovascular, and laboratory variables were used to assess association of pre-implant RDW tertiles with mortality, GI bleed, infection, pump thrombosis, and stroke over 1-year of follow-up...
August 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ian B Hollis, Sheh-Li Chen, Patricia P Chang, Jason N Katz
Patients with a durable, continuous-flow left ventricular assist device (LVAD) are commonly prescribed the combination of an oral anticoagulant and an oral antiplatelet agent as prophylaxis against device thrombosis and systemic embolic events. Current guidelines recommend warfarin with an INR goal of 2-3 and concomitant aspirin 81-325mg daily for patients with a HeartMate II ® LVAD (HM II). Unfortunately, gastrointestinal bleeding (GIB) is very common in these patients due to multiple factors including the development of arteriovenous malformations (AVMs) and acquired von Willebrand syndrome (AvWS)...
August 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Linnea Xuereb, Pauline H Go, Babbaljeet Kaur, Silvy Akrawe, Hassan W Nemeh, Jamil Borgi, Celeste T Williams, Gaetano Paone, Jeffrey A Morgan
BACKGROUND: The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist device (LVAD) implantation is high. However, the impact of AF on clinical outcomes has not been clarified. We reviewed our 9-year experience of continuous flow (CF) LVADs to determine the impact of preoperative AF on stroke, device thrombosis, and survival. METHODS: Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs, 127 (52...
July 25, 2016: Annals of Thoracic Surgery
Mahwash Kassi, Jerry D Estep
PURPOSE OF REVIEW: The article provides an overview of recent advances in imaging patients with a left ventricular assist device (LVAD). RECENT FINDINGS: There is a growing population of patients with LVADs. LVADs improve survival in patients with end-stage heart failure, but are also associated with significant adverse outcomes. Imaging, particularly echocardiography, plays a critical role in patient selection and in predicting and detecting complications. SUMMARY: Recent studies have illustrated links between imaging parameters with adverse outcomes, such as pump thrombosis, right ventricular failure, and continuous aortic regurgitation...
September 2016: Current Opinion in Cardiology
P Ivak, J Pitha, I Netuka
Microparticles are small circulating vesicles originating from circulatory system and vascular wall cells released during their activation or damage. They possess different roles in regulation of endothelial function, inflammation, thrombosis, angiogenesis, and in general, cellular stress. Microparticles are the subject of intensive research in pulmonary hypertension, atherosclerotic disease, and heart failure. Another recently emerging role is the evaluation of the status of vasculature in end-stage heart failure patients treated with implantable ventricular assist devices...
July 15, 2016: Physiological Research
Nuccia Morici, Enrico Perna, Manlio Cipriani, Eti Alessandra Femia, Fabrizio Oliva, Maria Frigerio, Marco Cattaneo
No abstract text is available yet for this article.
October 15, 2016: International Journal of Cardiology
Alvin H Schmaier
PURPOSE OF REVIEW: This report examines the mechanism(s) by which each protein of the contact activation system - factor XII (FXII), high-molecular-weight kininogen, and prekallikrein - influences thrombosis risk. RECENT FINDINGS: FXII generates thrombin through contact activation via interaction with artificial surfaces as on medical instruments such as indwelling catheters, mechanical valves, stents, and ventricular assist devices. Inhibition of FXIIa-mediated contact activation prevents thrombosis under contact activation circumstances without affecting hemostasis...
September 2016: Current Opinion in Hematology
Jaimin R Trivedi, Keshava Rajagopal, Erin M Schumer, Emma J Birks, Andrew Lenneman, Allen Cheng, Mark S Slaughter
BACKGROUND: Heart transplantation remains the gold standard therapy for end-stage heart failure patients; however, volumes are limited because of donor organ shortage. With the increasing availability of more durable continuous flow left ventricular assist devices (CFLVADs), the matrix of the heart transplantation waiting list and that of donor allocation have seen substantial changes. We aimed to evaluate the impact of the stated reasons for status 1A at time of transplantation on post-transplantation survival in CFVAD patients...
June 18, 2016: Annals of Thoracic Surgery
Adam C Adler, Ramesh Kodavatiganti
Kawasaki disease, although common in children, may rarely affect the coronary arteries, leading to aneurysm formation and potential for coronary thrombus formation. Extremely rarely, coronary aneurysms from Kawasaki disease can thrombose, resulting in ischemic myocardium. We present a case of a 31-month-old patient requiring a left ventricular assist device after thrombosis of giant coronary aneurysms led to ischemic cardiomyopathy. At the termination of the surgical procedure, we encountered 2 periods of ventricular assist device dropout requiring intervention...
August 15, 2016: A & A Case Reports
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
Serkan Ertugay, Cagatay Engin, Ahmet Daylan, Erman Pektok, Pelin Ozturk, Sanem Nalbantgil, Mehdi Zoghi, Tahir Yagdi, Mustafa Ozbaran
Pump thrombosis is associated with high morbidity and mortality in patients with a continuous-flow left ventricular assist device. Although it has been defined clearly, the diagnosis and treatment of this complication still remain controversial. Between 2010 and 2014, 163 consecutive patients (mean age: 50.7 ± 13 years, 84% males, median duration of support: 277 (2-1077) days) were implanted a continuous-flow left ventricular assist device. Prospectively collected data of all patients who had at least one pump thrombosis event have been analyzed, retrospectively...
September 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
David Faraoni, Katherine M Gardella, Kirsten C Odegard, Sitaram M Emani, James A DiNardo
BACKGROUND: Children with congenital heart disease are at increased risk of thrombotic complications (thrombosis and thromboembolism). This study sought to assess the incidence and predictors of thrombotic complications in children with surgical and nonsurgical heart diseases. METHODS: We performed a retrospective analysis of the Health Care Cost and Use Project Kid's Inpatient Database. Children with surgical and nonsurgical heart diseases were categorized into the following four subgroups: (1) septal defects, (2) single ventricle physiology, (3) right ventricle outflow tract obstruction, and (4) left ventricle outflow tract obstruction...
October 2016: Annals of Thoracic Surgery
Kevin Bourque, Christopher Cotter, Charles Dague, Daniel Harjes, Onur Dur, Julien Duhamel, Kaitlyn Spink, Kelly Walsh, Edward Burke
The HeartMate 3 (HM3) left ventricular assist device (LVAD) is designed to support advanced heart failure patients. This centrifugal flow pump has a magnetically levitated rotor, artificial pulse, textured blood-contacting surfaces, optimized fluid dynamics, large blood-flow gaps, and low shear stress. Preclinical tests were conducted to assess hemocompatibility. A computational fluid dynamics (CFD) model guided design for low shear stress and sufficient washing. Hemolysis testing was conducted on six pumps...
July 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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