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Garbade J, Zimpfer D, Lim S, Beyersdorf F, Diegeler A, Gustafsson F, Shaw S, Saeed D, Morshuis M, Schmitto J. International Experience with Left Ventricular Assist Device Exchange to a Fully Magnetically Levitated Centrifugal Pump: Data from the ELEVATE Registry. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1679024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schramm R, Zittermann A, Morshuis M, Schoenbrodt M, Freifrau E, Hakim-Meibodi K, Gummert J. Short-Term Outcome after Centrifugal Continuous Flow Left Ventricular Assist Device Implantation Comparing the HeartWare, HVAD, and Abbot Heartmate III. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Morshuis M, Bruenger F, Becker T, Kempa-Haupt A, Kizner L, Al-Khalil R, Gummert JF, Schramm R. Inter-hospital transfer of extracorporeal membrane oxygenation-assisted patients: the hub and spoke network. Ann Cardiothorac Surg 2019; 8:62-65. [PMID: 30854313 DOI: 10.21037/acs.2018.12.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background The treatment of cardiogenic shock (CS) in peripheral hospitals may be challenging when acute mechanical circulatory support (MCS) is not available. Tertiary care centers may provide mobile extracorporeal membrane oxygenation (ECMO) teams to support the treatment of CS-patients externally. Methods We retrospectively analyzed our single-center experience with a mobile ECMO team focussing on decision-making and survival data of CS-patients retrieved by ECMO support from peripheral hospitals to our tertiary care center between January 2012 and October 2018. Results A total number of 134 CS-patients have been retrieved by ECMO support to our center within the observation period. Forty-three (32%) died on the acute MCS device, while 59 (44%) patients could be weaned from the acute MCS. Twenty-nine (22%) were bridged to implantation of a durable MCS system and 6 were finally transplanted. The overall 1-year survival was 33%. Interestingly, advanced patient age did not significantly affect survival. Conclusions Acute MCS for CS may be provided by experienced mobile teams allowing for retrieval of patients from peripheral hospitals to tertiary care centers. Relatively low survival rates oppose intensive material and human resources. It is therefore mandatory to constantly refine logistics and selection criteria.
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Saeed D, Potapov E, Loforte A, Morshuis M, Schibilsky D, Zimpfer D, Riebandt J, Pappalardo F, Attisani M, Haneya A, Ramjankhan F, Donker D, Tsyganenko D, Jorde U, Wieloch R, Cremer J, Beyersdorf F, Lichtenberg A, Gummert J. Transition from Short Term to Durable Mechanical Circulatory Support Systems. Outcome and Patient Selection. On Behalf of ECMO-VAD Study Group. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sunavsky J, Fujita B, Ensminger S, Börgermann J, Morshuis M, Fuchs U, Oldenburg O, Gummert JF, Schulz U. Predictors of failure after high urgent listing for a heart transplant. Interact Cardiovasc Thorac Surg 2018; 27:950-957. [PMID: 30085128 DOI: 10.1093/icvts/ivy140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES As waiting times for a heart transplant (HTx) increase, the decision of whether a patient should have a high urgent (HU) listing or mechanical circulatory support becomes crucial for further prognosis. The aim of this study was to determine the characteristics that predict failure of an HU listing (death/delisting due to urgent mechanical circulatory support implant or poor clinical condition), the 5-year survival rate, the 1-year post-transplant survival rate and the prognostic accuracy of the cardiac allocation score of patients on the HU list. METHODS A total of 447 patients who were on the HU list at our institution between 2005 and 2016 were analysed and stratified according to occurrence of therapy failure or reception of an HTx. RESULTS A total of 114 patients suffered from HU listing failure after a median HU time of 31.5 (15-69) days; 320 patients had a primary HTx after a median time of 51.5 (26-90) days on the HU list; 13 patients were excluded from data analysis because of an ongoing HU listing or delisting due to improvement in their haemodynamic condition. In multivariable logistic regression analysis, blood group 0 [odds ratio (OR) 2.48, 95% confidence interval (CI) 1.43-4.3; P = 0.001], INTERMACS Class 1 or 2 (OR 5.1, 95% CI 2.7-9.4; P < 0.001), vasoactive inotropic score (OR 1.18, 95% CI 1.09-1.27; P < 0.001) and brain natriuretic peptide levels (OR 1.00, 95% CI 1.00-1.00; P = 0.001) were identified as independent predictors of HU listing failure. Cardiac allocation score was not independently associated with listing failure. Estimated 5-year and 1-year post-HTx survival rates were similar in the primary HTx group and in patients receiving an HTx after HU therapy failure (P = 0.48 and P = 0.7, respectively). CONCLUSIONS INTERMACS levels 1 and 2 and vasoactive inotropic score were the strongest predictors of HU listing failure.
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Loforte A, Morshuis M, Zimpfer D, Pappalardo F, Attisani M, Riebandt J, Ramjankhan F, Donker D, Jorde U, Albert A, Lichtenberg A, Rinaldi M, Saeed D. OC31 HOW TO IDENTIFY THE APPROPRIATE LEFT VENTRICULAR ASSIST DEVICE CANDIDATE AMONG PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549875.87567.cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ljajikj E, Zittermann A, Koster A, Börgermann J, Schönbrodt M, Hakim-Meibodi K, Gummert J, Morshuis M. Corrigendum to ‘Extracorporeal resuscitation as a further modifier of clinical outcome in patients with left ventricular assist device implantation and Interagency Registry for Mechanically Assisted Circulatory Support 1 level’ [Interact CardioVasc Thorac Surg 2018;27:139–41]†. Interact Cardiovasc Thorac Surg 2018; 27:794. [DOI: 10.1093/icvts/ivy308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gustafsson F, Shaw S, Lavee J, Saeed D, Pya Y, Krabatsch T, Schmitto J, Morshuis M, Chuang J, Damme L, Zimpfer D, Garbade J. Six-month outcomes after treatment of advanced heart failure with a full magnetically levitated continuous flow left ventricular assist device: report from the ELEVATE registry. Eur Heart J 2018; 39:3454-3460. [DOI: 10.1093/eurheartj/ehy513] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/05/2018] [Indexed: 12/20/2022] Open
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Schmitto JD, Pya Y, Zimpfer D, Krabatsch T, Garbade J, Rao V, Morshuis M, Beyersdorf F, Marasco S, Sood P, Damme L, Netuka I. Long-term evaluation of a fully magnetically levitated circulatory support device for advanced heart failure-two-year results from the HeartMate 3 CE Mark Study. Eur J Heart Fail 2018; 21:90-97. [PMID: 30052304 DOI: 10.1002/ejhf.1284] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/11/2018] [Accepted: 06/26/2018] [Indexed: 01/25/2023] Open
Abstract
AIM This study aimed to assess safety and outcomes of patients, 2 years after implantation with the HeartMate 3 Left Ventricular Assist System. METHODS AND RESULTS This study included 50 adults with New York Heart Association (NYHA) class IIIB or IV symptoms or American College of Cardiology/American Heart Association stage D heart failure with an ejection fraction ≤25% and a cardiac index ≤2.2 L/min/m2 without inotropes, or inotrope-dependent with optimal medical management, or listed for heart transplant. The median duration of left ventricular assist device support was 694 days (range: 19-833 days). At baseline, cardiac index was 1.8 ±0.5 L/min/m2 , 58% of patients were receiving inotropes, and 92% were INTERMACS profiles 2-4. At 2 years, Kaplan-Meier survival was 74 ±6%, 5 (10%) patients were transplanted, and 32 patients (64%) remain with support. Adverse event rates include bleeding requiring surgery (16%), gastrointestinal bleeding (20%), driveline infection (24%), ischaemic stroke (16%), haemorrhagic stroke (8%), right heart failure (14%), and outflow graft thrombosis (2%). Notably, no haemolysis, pump thrombosis, or pump malfunction events occurred. At 2 years, 47% of patients remained in NYHA class I and 41% in NYHA class II (P <0.0001). From baseline to 2 years, the mean six-minute walk distance increased from 239 m to 347 m (P <0.0001), and the mean EQ-5D quality of life score improved from 48.2 to 70.6 (P < 0.0001). CONCLUSIONS Two years post-HeartMate 3 implantation, results show expected and acceptable survival, enhanced haemocompatibility, improved patient functional status and quality of life. This corroborates the success of HeartMate 3 since its first-in-man implantation case in Germany. ClinicalTrials.gov: NCT02170363.
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Aissaoui N, Jouan J, Gourjault M, Diebold B, Ortuno S, Hamdan A, Latremouille C, Pirracchio R, Morshuis M. Understanding Left Ventricular Assist Devices. Blood Purif 2018; 46:292-300. [PMID: 30048974 DOI: 10.1159/000491872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Long-term mechanical assist devices are now commonly used in the treatment of severe heart failure to unload the failing ventricle, maintain sufficient end-organ perfusion and improve functional capacity. Depending on the assisted ventricles, 3 categories of long-term assist devices are available: left ventricular assist device (LVAD), biventricular assist device and total artificial heart. Improvements in technology, especially the advent of smaller, durable continuous flow pumps, have led to the use of LVADs in a much broader population of patients in the last 10 years. Both the number of patients living with LVADs and the life expectancy of these patients are increasing. Regarding this growing number of patients with LVAD, intensivists need to understand the physiology of the devices, their functioning, potential complications and their management. METHODS We performed a narrative review of relevant medical literature regarding the physiology of patients with LVAD and management of common complications relevant to the critical care physicians. RESULTS The most frequent complications occurring in the LVAD patients after the post-operative period are bleeding, driveline infections, thrombosis, device malfunction, right ventricular failure and arrhythmias. Bleeding is the most frequent adverse event in LVAD due to a combination of anticoagulation and acquired von Willebrand disease secondary to shear stress produced within the pump. Their management includes antiplatelet therapy arrest, reduction of the anticoagulation regimen and specific therapy if feasible. Infection is the second most common cause of death after cardiac failure in LVAD patients. All infections must be aggressively treated to avoid seeding the device. Device thrombosis can develop even when patients are adequately anticoagulated and taking antiplatelet therapy because the LVAD is responsible for a chronic hypercoagulable state. CONCLUSION Management of these unique patients in the ICU is best accomplished with a multidisciplinary team that includes specialists in advanced heart failure, LVAD nurse coordinators and intensivists.
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Saeed D, Loforte A, Pappalardo F, Attisani M, Morshuis M, Zimpfer D, Ramjankhan F, Jorde U, Wieloch R, Albert A, Lichtenberg A. Identifying Appropriate Durable VAD Candidates in Patients with Veno-Arterial Extracorporeal Membrane Oxygenation: Can We Identify the “Point of No Return”? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Tenderich G, Arusoglu L, El-Banayosy A, Morshuis M, Mirow N, Hornik L, Wlost S, Koerfer R, Koerner MM. Influence of Different Assist Devices on Survival after Orthotopic Heart Transplantation. Int J Artif Organs 2018. [DOI: 10.1177/039139889902201110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Reiß N, Morshuis M, Landich R, Frerichs I, Frerichs A, Hellige G, Illian M, Dramburg W, Scheid P, Minami K, KöRfer R. Development and Initial in Vivo Testing of a New Hydraulic Drive System (Paedipump) for Circulatory Support in Infants. Int J Artif Organs 2018. [DOI: 10.1177/039139889802100709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main limitation in the use of circulatory support in children is the lack of an adequate system with regard to size and pumping capacity Recently, two pneumatically driven ventricular support systems with low volume chambers for use in a pediatric population became available. We have developed a hydraulic drive system with an advantageous exact control of the stroke volume. The system enables two different modes of operation: the full-empty and the filled-empty modes. In both cases the ventricle is empty at the end of systole. This new system was tested in experimental animals (6 pigs, body weight 9.5–14.0 kg) with normal and reduced left ventricular function (MAP<45 mmHg). A 25 ml ventricle (HIA-Medos) was implanted. The full-empty and the filled-empty mode used led to a significant load reduction, both in animals with normal and impaired cardiac function. Plasma lactate levels, pH-values and total body 0 2 consumption were in the normal range during circulatory support indicating adequate organ perfusion. Results showed that sufficient ventricular support was achieved during all pumping modes due to the possibility of controlling and modifying the stroke volume of the hydraulically driven support system employed according to necessity. This is a promising feature for its future application in infants with congenital or acquired heart diseases.
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Gazzoli F, Viganò M, Pagani F, Alloni A, Silvaggio G, Panzavolta M, Banayosy AE, Koerfer R, Morshuis M, Pavie A, Leprince P, Glauber M, Del Sarto P, Haxhiademi D, Vitali E, Russo CF, Scuri S. Initial Results of Clinical Trial with a New Left Ventricular Assist Device (LVAD) Providing Synchronous Pulsatile Flow. Int J Artif Organs 2018; 32:344-53. [DOI: 10.1177/039139880903200605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives A multicentric European Clinical Study is ongoing to evaluate safety and efficacy of a new pulsatile implantable LVAD (BestBeat), smaller and lighter than similar devices, capable of providing synchronous and counterpulsating flow with respect to the LV of end-stage heart failure patients. Preliminary clinical results are reported. Methods The new BestBeat LVAD was used, consisting of an implantable pulsatile blood pump, electromechanically driven by a ball screw mechanism, and a wearable electronic controller and power sources. The clinical trial was conducted at 5 European centers. Adult patients affected by CHF in NYHA Class IV despite optimized medical treatment were enrolled. The primary study endpoint was survival at 90 days. Further study endpoints were maintenance of adequate LVAD pump flow and a minimum rate of adverse events during support. Results As of June 2008, 6 patients received the implant. Cumulative support time was 3.7 years, median support time 176 days. All patients who completed the study survived except for one, who died after 48 days, due to combined infection and cerebrovascular accident. Another two patients died: one from intracranial bleeding 113 days after implant, and one from septic shock after 123 days. Hemodynamic improvement with Cl>2.0 l/min/m2 and recovery of end-organ function expressed by consistent improvement of BUN, creatinine and bilirubin were reached in all patients. No device failure was observed. There was no bleeding requiring re-exploration, no hemolysis and only two device-related infections (both in one patient). Neurologic events were reported, the most serious ones occurring in patients with pre-implant respiratory and kidney failure. Three patients were discharged home. Two patients were successfully transplanted, one after 6 months and one after 13 months on device. Conclusions Good performance and efficacy of the device were observed; the endpoints of the study were achieved, and its safety was consistent with expectations. The ongoing study will allow further conclusions to be drawn.
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Kwant PB, Finocchiaro T, Förster F, Reul H, Rau G, Morshuis M, El Banayosi A, Körfer R, Schmitz-Rode T, Steinseifer U. The MiniACcor: Constructive Redesign of an Implantable Total Artificial Heart, Initial Laboratory Testing and Further Steps. Int J Artif Organs 2018; 30:345-51. [PMID: 17520573 DOI: 10.1177/039139880703000411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Aachen Total Artificial Heart (ACcor) has been under development at the Helmholtz Institute in Aachen over the last decade. It may serve as a bridge to transplant or as a long-term replacement of the natural heart. Based upon previous in vivo experiments with the ACcor total artificial heart, it was decided to optimize and redesign the pump unit. Smaller dimensions, passive filling and separability into three components were the three main design goals. The new design is called the MiniACcor, which is about 20% smaller than its predecessor, and weighs only 470 grams. Also its external driver/control unit was miniaturized and a new microcontroller was selected. To validate the design, it was extensively tested in laboratory mock loops. The MiniACcor was able to pump between 4.5 and 7 l/min at different pump rates against normal physiological pressures. Several requirements for the future compliance chamber and transcutaneous energy transmission (TET) system were also measured in the same mock loop. Further optimization and validation are being performed in cooperation with the Heart and Diabetes Centre North Rhine-Westphalia.
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Koster A, Morshuis M, Birschmann I. Abciximab/Heparin During Acute Heparin-Induced Thrombocytopenia: A Word of Caution. Ann Thorac Surg 2018; 106:309. [PMID: 29305853 DOI: 10.1016/j.athoracsur.2017.11.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 11/19/2022]
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Burkhard-Meier C, Morshuis M. [Left Ventricular Assist Device Therapy - Ways to Improve the Ambulatory Care]. Dtsch Med Wochenschr 2017; 143:349-353. [PMID: 29232736 DOI: 10.1055/s-0043-119105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The use of left-ventricular assist device therapy (LVAD) in terminal heart failure patients is increasing. Many patients are receiving LVAD-therapy as final solution (destination therapy). After discharge from the implanting heart center patient-centered care has to be implemented on an outpatient basis. A responsible ambulatory treatment of this severe heart failure population requires knowledge about LVAD specific problems (general medical care, long term complications, device management). The referring cardiologist as well as the private practitioner should be more involved in the care of patients with LVAD. By this means patients safety would increase and the overall costs decline not at least due to fewer hospital readmissions.
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Ljajikj E, Zittermann A, Morshuis M, Börgermann J, Ruiz-Cano M, Schoenbrodt M, Gummert J, Koster A. Erratum to: "Bivalirudin anticoagulation for left ventricular assist device implantation on an extracorporeal life support system in patients with heparin-induced thrombocytopenia antibodies" [Interact CardioVasc Thorac Surg 2017:1-7; doi:10.1093/icvts/ivx251]. Interact Cardiovasc Thorac Surg 2017; 25:675. [PMID: 28962517 DOI: 10.1093/icvts/ivx300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ljajikj E, Zittermann A, Morshuis M, Börgermann J, Ruiz-Cano M, Schoenbrodt M, Gummert J, Koster A. Bivalirudin anticoagulation for left ventricular assist device implantation on an extracorporeal life support system in patients with heparin-induced thrombocytopenia antibodies. Interact Cardiovasc Thorac Surg 2017; 25:898-904. [DOI: 10.1093/icvts/ivx251] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/04/2017] [Indexed: 11/12/2022] Open
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Aissaoui N, Morshuis M, Maoulida H, Salem JE, Lebreton G, Brunn M, Chatellier G, Hagège A, Schoenbrodt M, Puymirat E, Latremouille C, Varnous S, Ouldamar S, Guillemain R, Diebold B, Guedeney P, Barreira M, Mutuon P, Guerot E, Paluszkiewicz L, Hakim-Meibodi K, Schulz U, Danchin N, Gummert J, Durand-Zaleski I, Leprince P, Fagon JY. Management of end-stage heart failure patients with or without ventricular assist device: an observational comparison of clinical and economic outcomes†. Eur J Cardiothorac Surg 2017; 53:170-177. [DOI: 10.1093/ejcts/ezx258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 06/17/2017] [Indexed: 12/19/2022] Open
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Krabatsch T, Netuka I, Schmitto JD, Zimpfer D, Garbade J, Rao V, Morshuis M, Beyersdorf F, Marasco S, Damme L, Pya Y. Heartmate 3 fully magnetically levitated left ventricular assist device for the treatment of advanced heart failure -1 year results from the Ce mark trial. J Cardiothorac Surg 2017; 12:23. [PMID: 28376837 PMCID: PMC5379553 DOI: 10.1186/s13019-017-0587-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/24/2017] [Indexed: 12/22/2022] Open
Abstract
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. Methods A prospective, non-randomized study included adults with advanced heart failure and ejection fraction (EF) ≤ 25%, cardiac index (CI) ≤ 2.2 L/min/m2 while not on inotropes, or inotrope dependent, or on optimal medical management for 45/60 days. Results Fifty patients—54% bridge to transplant (BTT) and 46% destination therapy (DT)—were enrolled and implanted with the HeartMate 3. At baseline, 92% of the patients were INTERMACS profiles 2–4, with cardiac index 1.8 + 0.5 L/min/m2 and 58% were supported with inotropes. At 1 year, 74% of the patients remain on support, 18% expired, 6% transplanted, and 2% explanted. The adverse events include 12% gastrointestinal bleeding, 16% driveline infections, 18% strokes, and 2% outflow graft thrombosis. There was no hemolysis, pump thrombosis or pump malfunction through 1 year. The six-minute walk test distance increased from a mean of 273 m to 371 m (P <0.0001). EQ-5D quality-of-life score increased from a mean of 52.7 to 70.8 (P = 0.0006). Conclusions The 1-year HeartMate 3 LVAS results show survival and adverse-event profile are similar to other approved devices, with no pump thrombosis or pump failure. Patient’s functional status and quality of life significantly improved over time. Trial registration Clinicaltrials.gov registration number: NCT02170363. Registered June 19, 2014.
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Sandica E, Blanz U, Ben L, Schultz-Kaizler U, Kececioglu D, Laser K, Kirchner G, zu E, Morshuis M. Bad Oeynhausen Experience with Berlin Heart EXCOR in Children with Single- and Two-Ventricle Physiology. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zittermann A, Ernst JB, Pilz S, Dreier J, Kuhn J, Knabbe C, Gummert JF, Morshuis M, Milting H. Calciotropic and Phosphaturic Hormones in End-Stage Heart Failure Patients Supported by a Left-Ventricular Assist Device. PLoS One 2016; 11:e0164459. [PMID: 27788150 PMCID: PMC5082971 DOI: 10.1371/journal.pone.0164459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background Calcium and phosphate are central for myocardial contractility and energy metabolism, and low levels of the calciotropic hormone 1,25-dihydroxyvitamin D (1,25(OH)2D), as well as high levels of the phosphaturic hormone fibroblast growth factor (FGF)-23, are independently associated with poor clinical outcome in heart failure (HF) patients. We therefore aimed to investigate the postoperative time course of the aforementioned hormones in HF patients supported with a left-ventricular assist device (LVAD) implant. Methods For the present study, stored biobank plasma samples of 69 patients, collected before LVAD implantation (t0) and 12 days (t1), 30 days (t2), 83 days (t3), and 300 days (t4) post-intervention, were used to measure circulating FGF-23, parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), 1,25(OH)2D, and kidney function. Results Most patients were male and had baseline INTERMACS levels and cardiac index values ≤ 3 and ≤ 2.7 L/min/m2, respectively. There were significant time effects on estimated glomerular filtration rate (eGFR), FGF-23 and 1,25(OH)2D, but not on PTH or 25OHD. Notably, eGFR values increased and FGF-23 levels decreased only transiently, whereas 1,25(OH)2D increased continuously until t4. The rise in 1,25(OH)2D was largely influenced by those patients who survived the first post-implant year, and was not seen in non-survivors. Variations in 1,25(OH)2D levels could only partly be explained by eGFR values or FGF-23, 25OHD, and PTH levels (multiple R2 = 0.305;P<0.001). Conclusions The present study indicates that LVAD implantation has only transient effects on circulating FGF-23 levels, but is associated with a continuous increase in circulating 1,25(OH)2D levels, especially in survivors.
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Pühler T, Fujita B, Renner A, Hakim-Meibodi K, Bögermann J, Morshuis M, Gummert J, Ensminger S. Operative Myokardrevaskularisation bei schlechter linksventrikulärer Funktion – STICH forever? AKTUELLE KARDIOLOGIE 2016. [DOI: 10.1055/s-0042-114219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zimpfer D, Netuka I, Schmitto JD, Pya Y, Garbade J, Morshuis M, Beyersdorf F, Marasco S, Rao V, Damme L, Sood P, Krabatsch T. Multicentre clinical trial experience with the HeartMate 3 left ventricular assist device: 30-day outcomes. Eur J Cardiothorac Surg 2016; 50:548-54. [PMID: 27436871 DOI: 10.1093/ejcts/ezw169] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/11/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe the operative experience and 30-day outcomes of patients implanted with the HeartMate 3 Left Ventricular Assist System (LVAS) during the Conformité Européenne (CE) Mark clinical trial. METHODS Adult patients met inclusion and exclusion criteria defining advanced-stage heart failure and included the indications of bridge to transplant and destination therapy. Operative parameters, outcomes, adverse events, physical status and quality-of-life parameters were assessed in the first 30 days after LVAS implant. RESULTS Fifty patients were implanted with the HeartMate 3 at 10 centres in 6 countries. The 30-day survival rate was 98%. The median operative and cardiopulmonary bypass times were 200 (range: 95-585) min and 84 (range: 47-250) min, respectively. Patients required transfusion with packed red blood cells (3.6 ± 2.3 units), fresh frozen plasma (6.5 ± 5 units) and platelets (2 ± 1 units). Six patients (12%) required reoperation for postoperative bleeding and 10 patients (20%) did not require blood transfusion. The median intensive care time was 6 days (range: 1-112 days) and the total hospital stay was 28 days (range: 14-116 days). The most common adverse events were bleeding (15, 30%), arrhythmia (14, 28%) and infection (10, 20%). There were 2 (4%) strokes. CONCLUSIONS The 30-day outcomes following implantation of the HeartMate 3 demonstrates excellent survival with low adverse event rates. The LVAD performed as intended with no haemolysis or device failure. CLINICALTRIALSGOV IDENTIFIER NCT02170363. HeartMate 3™ CE Mark Clinical Investigation Plan (HM3 CE Mark).
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