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Rashad Zayat, Ajay Moza, Oliver Grottke, Tim Grzanna, Tamara Fechter, Tadashi Motomura, Christian Schmidt-Mewes, Thomas Breuer, Rüdiger Autschbach, Rolf Rossaint, Andreas Goetzenich, Christian Bleilevens
OBJECTIVES: Shear stress from left ventricular assist devices induces von Willebrand factor degradation and platelet dysfunction, leading to nonsurgical bleeding. We characterized the hemostatic changes induced by 2 centrifugal left ventricular assist devices, the HeartMate 3 (Abbott Inc, Chicago, Ill) and the EVAHEART (Evaheart Inc, Houston, Tex), for comparison. METHODS: Whole blood from 8 healthy volunteers was used ex vivo. Blood from the same donor was used for 6 hours of circulation in a miniature mock-loop system consisting of 2 identical extracorporeal circuits to compare the following experimental settings: (1) optimal revolutions per minute (rpm) for the HeartMate 3 (n = 4; 5000 rpm) and the EVAHEART (n = 4; 2500 rpm) and (2) equal rpm (3000 rpm for the HeartMate 3 and EVAHEART, n = 4 vs n = 4)...
August 6, 2018: Journal of Thoracic and Cardiovascular Surgery
Amrish Deshmukh, Ankit Bhatia, Gabriel T Sayer, Gene Kim, Jayant Raikhelkar, Teruhiko Imamura, Cevher Ozcan, Takeyoshi Ota, Valluvan Jeevanandam, Nir Uriel
BACKGROUND: Thromboembolic events (TEs) are common adverse events with continuous flow left ventricular assist devices (LVADs). Left atrial appendage occlusion (LAAO) is commonly performed at time of cardiac surgery. The effect of LAAO on TEs in LVAD patients remains unknown. METHODS: All patients receiving first LVAD implantation between 1/2013-1/2014 were reviewed. TEs included device thrombosis (DT) and ischemic cerebrovascular accidents (CVA). The incidence of TEs with respect to LAAO was evaluated using Kaplan Meier and Cox proportional hazards analyses...
October 23, 2018: Annals of Thoracic Surgery
Yu Xia, Stephen Forest, Patricia Friedmann, Lin-Chiang Chou, Snehal Patel, Ulrich Jorde, Daniel Goldstein
BACKGROUND: Limited data exists on factors predicting prolonged survival in left ventricular assist device (LVAD) recipients. We sought to identify patient characteristics and complications associated with prolonged survival. METHODS: We conducted retrospective review of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), including primary continuous flow LVAD recipients between May 2012 and March 2013. Patients were identified as having survived with a device in place after three years or not conditional on having initially survived six months...
October 11, 2018: Annals of Thoracic Surgery
Jens Garbade, Finn Gustafsson, Steven Shaw, Jacob Lavee, Diyar Saeed, Yuriy Pya, Thomas Krabatsch, Jan D Schmitto, Michiel Morshuis, Joyce Chuang, Daniel Zimpfer
BACKGROUND: The HeartMate 3TM left ventricular assist device is designed to provide circulatory support with enhanced hemocompatibility for patients with advanced heart failure. The purpose of this study was to compare the surgical outcomes between patients treated during the CE Mark (CEM) clinical trial and those treated in the post-market era. METHODS: The prospective, observational, multinational ELEVATETM registry includes patients receiving HeartMate 3 following CEM approval...
October 3, 2018: Annals of Thoracic Surgery
Ibrahim Sultan, Arman Kilic, Ahmet Kilic
Severe right ventricular (RV) failure is a significant cause of morbidity and mortality, with an in-hospital mortality rate up to 70% to 75%. Medical management is employed and is successful for most of these patients. However, a small percentage of patients will continue to have persistent RV failure, for which mechanical support is used for management.
October 2018: Heart Failure Clinics
Mandeep R Mehra, Christopher Salerno, Yoshifumi Naka, Nir Uriel, Joseph C Cleveland, Douglas Horstmanshof, Daniel J Goldstein
No abstract text is available yet for this article.
November 2018: Journal of Heart and Lung Transplantation
Lauren K Truby, Koji Takeda, Veli K Topkara, Hiroo Takayama, A Reshad Garan, Melana Yuzefpolskaya, Paolo Colombo, Yoshifumi Naka, Maryjane Farr
BACKGROUND: Primary graft dysfunction (PGD) remains a significant cause of post-transplant morbidity and mortality. The exact mechanism and risk factors for this phenomenon remain unknown in the contemporary era. METHODS: In this study we reviewed adult patients undergoing heart transplantation (HT) at our institution between 2009 and 2017. Severe PGD was defined as the need for mechanical circulatory support (MCS) within the first 24 hours after HT. Multivariate logistic regression analysis was used to identify risk factors for severe PGD, focusing on those bridged to transplant (BTT) with a continuous-flow left ventricular assist device (CF-LVAD)...
July 26, 2018: Journal of Heart and Lung Transplantation
Nadia Bouabdallaoui, Ismail El-Hamamsy, Magali Pham, Genevieve Giraldeau, Marie-Claude Parent, Michel Carrier, Jean L Rouleau, Anique Ducharme
Aortic regurgitation (AR) developing while using a continuous-flow left ventricular assist device (CF-LVAD) affects 25% to 30% of patients within the first year of implantation and is increasingly being recognized as a cause of recurrence of symptomatic heart failure (HF). The underlying mechanisms are likely multifactorial, including changes in the leaflets of the aortic valve (AV), altered root biomechanics, and excessive left ventricular (LV) unloading, together promoting cusp remodeling and commissural fusion...
November 2018: Journal of Heart and Lung Transplantation
Akiko Tanaka, Hiroto Kitahara, David Onsager, Tae Song, Jayant Raikhelkar, Gene Kim, Nitasha Sarswat, Gabriel Sayer, Nir Uriel, Valluvan Jeevanandam, Takeyoshi Ota
BACKGROUND: This is a retrospective single-institutional study to investigate the impact of significant valvular regurgitation after left ventricular assist device (LVAD) implantation and the role of concomitant valve surgery during LVAD surgery. METHODS: All patients receiving LVAD (HeartMateII) during 2008 and 2015 were enrolled. The cohort was divided into two groups based on the valve-status at the end of surgery; patients without significant valvular regurgitation, no valvular regurgitation (no-VR); with significant valvular regurgitation, residual valvular regurgitation (residual-VR)...
August 24, 2018: Annals of Thoracic Surgery
Takaaki Samura, Daisuke Yoshioka, Koichi Toda, Ryoto Sakaniwa, Mikito Shimizu, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Shunsuke Saito, Yasushi Sakata, Yoshiki Sawa
OBJECTIVE: Stroke is one of the major adverse events after left ventricular assist device implantation. Risk of stroke is the highest immediately after left ventricular assist device implantation and then increases again in chronic periods. There is no study that has analyzed risk factors for stroke in acute phase. We investigated the risk factors for stroke in the acute phase after left ventricular assist device implantation in the present study. METHODS: Between October 2005 and December 2016, 158 consecutive patients (mean age, 43 ± 14 years; 34% were women) underwent continuous-flow left ventricular assist device (50 HeartMate II [Abbott Medical, Abbott Park, Ill], 38 DuraHeart [Terumo Heart, Ann Arbor, Mich], 33 Jarvik2000 [Jarvik Heart, New York, NY], 23 EVAHEART [Sun Medical, Moriyama City, Japan], 14 HeartWare [Framingham, Mass]) implantation in our institution...
July 3, 2018: Journal of Thoracic and Cardiovascular Surgery
Yubing Shi, Theodosios Korakianitis
Previous numerical models of impeller pumps for ventricular assist devices utilize curve-fitted polynomials to simulate experimentally-obtained pressure difference versus flow rate characteristics of the pumps, with pump rotational speed as a parameter. In this paper the numerical model for the pump pressure difference versus flow rate characteristics is obtained by analytic derivation. The mass, energy and angular momentum conservation laws are applied to the working fluid passing through the impeller geometry and coupled with the turbomachine's velocity diagram...
February 1, 2018: Computers in Biology and Medicine
Saima Aslam, Rongbing Xie, Jennifer Cowger, James K Kirklin, Vivian H Chu, Stephan Schueler, Theo de By, Kate Gould, Orla Morrissey, Lars H Lund, Stanley Martin, Daniel Goldstein, Margaret Hannan
BACKGROUND: We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. METHODS: Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non-MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality...
August 2018: Journal of Heart and Lung Transplantation
Roxana Moayedifar, Andreas Zuckermann, Arezu Aliabadi-Zuckermann, Julia Riebandt, Philipp Angleitner, Kamen Dimitrov, Thomas Schloeglhofer, Angela Rajek, Guenther Laufer, Daniel Zimpfer
OBJECTIVES: Fixed pulmonary hypertension (fPH) is a contraindication for heart transplantation (HTX). Left ventricular assist device (LVAD) implantation as a bridge to candidacy can reverse fPH in patients with terminal heart failure by chronic left ventricular unloading. We report our institutional experience with terminal heart failure patients and fPH that were successfully bridged to candidacy and underwent subsequent HTX. METHODS: We retrospectively reviewed the data of 79 patients with terminal heart failure and fPH who were successfully bridged to candidacy for HTX with 6 different LVAD devices at our centre from October 1998 to September 2016 (Novacor n = 4, MicroMed DeBakey n = 29, DuraHeart n = 2, HeartMate II n = 14, HVAD n = 29 and MVAD n = 1)...
June 13, 2018: European Journal of Cardio-thoracic Surgery
Yan K Gernhofer, Michael Ross, Swapnil Khoche, Victor Pretorius
BACKGROUND: Optimal anticoagulation strategy for cardiopulmonary bypass (CPB) in end-stage heart failure patients with heparin-induced thrombocytopenia (HIT) requiring left ventricular assist device (LVAD) implantation remains uncertain. Presently, there are no large-scale randomized studies comparing outcomes of alternative anticoagulation strategies for CPB in this patient population. A novel antiplatelet agent - cangrelor, which is a potent P2Y12 inhibitor with robust antiplatelet efficacy, rapid reversibility, and measurable drug effect, has become available since 2015...
April 17, 2018: Journal of Cardiothoracic Surgery
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
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
Julia Riebandt, Dominik Wiedemann, Paul Simon, Kamen Dimitrov, Guenther Laufer, Daniel Zimpfer
This report presents an initial experience with the novel Abbott surgical enhancement tools for less invasive HeartMate 3 (Abbott, Chicago, IL) left ventricular assist system implantation. Three new devices are introduced: (1) a mini-apical cuff with (2) a cuff holder and (3) a newly designed coring knife, facilitating access through a left sided minithoracotomy.
October 2018: Annals of Thoracic Surgery
Rajkumar Doshi, Krunalkumar Patel, Dean Decter, Rajeev Gupta, Perwaiz Meraj
Heart failure with reduced ejection fraction (HFrEF) is a systolic dysfunction with an ejection fraction below 40% and the prevalence of it is substantially increasing in the United States. Mechanical circulatory support (MCS) devices have increasingly been used for the management of HFrEF and are associated with improved outcomes. The National Inpatient Sample database was used to identify hospitalisations with mechanical circulatory support for HFrEF from 2005 to 2014. This study observed a reduction in the utilisation of intra-aortic balloon pump (IABP), which is partially replaced by percutaneous left ventricular assist device (pLVAD) and extracorporeal membrane oxygenation (ECMO) for the management of HFrEF...
April 4, 2018: Heart, Lung & Circulation
Justin A Fried, Abhinav Nair, Koji Takeda, Kevin Clerkin, Veli K Topkara, Amirali Masoumi, Melana Yuzefpolskaya, Hiroo Takayama, Yoshifumi Naka, Daniel Burkhoff, Ajay Kirtane, Dimitrios Karmpaliotis, Jeffrey Moses, Paolo C Colombo, A Reshad Garan
BACKGROUND: The role of the intra-aortic balloon pump (IABP) in acute decompensated heart failure (HF) with cardiogenic shock (CS) is largely undefined. In this study we sought to assess the hemodynamic and clinical response to IABP in chronic HF patients with CS and identify predictors of response to this device. METHODS: We retrospectively reviewed all patients undergoing IABP implantation from 2011 to 2016 at our institution to identify chronic HF patients with acute decompensation and CS (cardiac index <2...
November 2018: Journal of Heart and Lung Transplantation
Ivan Netuka, Peter Ivák, Zuzana Tučanová, Stanislav Gregor, Ondrej Szárszoi, Poornima Sood, Daniel Crandall, Jessica Rimsans, Jean Marie Connors, Mandeep R Mehra
BACKGROUND: The HeartMate 3 left ventricular assist system is engineered to avoid pump thrombosis, yet bleeding complications persist. We investigated the safety of low-intensity anti-coagulation in patients with the HeartMate 3. METHODS: The Minimal AnticoaGulation EvaluatioNTo aUgment heMocompatibility (MAGENTUM 1) pilot study is a prospective, single-arm study of low-intensity warfarin anti-coagulation in patients implanted with the HeartMate 3 pump. After standard warfarin anti-coagulation (international normalized ratio [INR] 2...
May 2018: Journal of Heart and Lung Transplantation
2018-04-18 18:19:59
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