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Ensminger SM, Gerosa G, Gummert JF, Falk V. Mechanical Circulatory Support: Heart Failure Therapy “in Motion”. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephan M. Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetescenter NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Gino Gerosa
- Department of Cardiac Surgery, Padova University Hospital, Padova, Italy
| | - Jan F. Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetescenter NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
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Mechanical Circulatory Support: Heart Failure Therapy “in Motion”. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:305-314. [DOI: 10.1097/imi.0000000000000305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Because the first generation of pulsatile-flow devices was primarily used to bridge the sickest patients to transplantation (bridge-to-transplant therapy), the current generation of continuous-flow ventricular assist devices qualifies for destination therapy for patients with advanced heart failure who are ineligible for transplantation. The first-generation devices were associated with frequent adverse events, limited mechanical durability, and patient discomfort due device size. In contrast, second-generation continuous-flow devices are smaller, more quiet, and durable, thus resulting in less complications and significantly improved survival rates. Heart transplantation remains an option for a limited number of patients only, and this fact has also triggered the discussion about the optimal timing for device implantation. The increasing use of continuous-flow devices has resulted in new challenges, such as adverse events during long-term support, and high hospital readmission rates. In addition, there are a number of device-related complications including mechanical problems such as device thrombosis, percutaneous driveline damage, as well as conditions such as hemolysis, infection, and cerebrovascular accidents. This review provides an overview of the evolution of mechanical circulatory support systems from bridge to transplantation to destination therapy including technological advances and clinical improvements in long-term patient survival and quality of life. In addition, recent changes in device implant strategies and current trials are reviewed and discussed. A brief glimpse into the future of mechanical circulatory support therapy will summarize the innovations that may soon enter clinical practice.
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Willey JZ, Boehme AK, Castagna F, Yuzefpolskaya M, Garan AR, Topkara V, Colombo PC. Hypertension and Stroke in Patients with Left Ventricular Assist Devices (LVADs). Curr Hypertens Rep 2016; 18:12. [PMID: 26781252 DOI: 10.1007/s11906-015-0618-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Stroke is one of the most dreaded complications of left ventricular assist device therapy in patients with end-stage congestive heart failure. There is strong evidence linking anticoagulation and infection with ischemic and hemorrhagic strokes, though recent data has emerged regarding the importance of elevated blood pressure. In the recently completed Heartware Ventricular Assist Device studies, a mean arterial pressure greater than 90 mmHg was associated with greater stroke risk, particularly the hemorrhagic subtype. In this review, we discuss recent evidence regarding deleterious effects of uncontrolled hypertension in patients with left ventricular devices, and propose measurement and management strategies.
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Affiliation(s)
- Joshua Z Willey
- Department of Neurology, Division of Stroke and Cerebrovascular Diseases, Columbia University, New York, NY, USA.
| | - Amelia K Boehme
- Department of Neurology, Division of Neurology Clinical Outcomes Research and Population Science, Columbia University, New York, NY, USA
| | - Francesco Castagna
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA
| | - A Reshad Garan
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA
| | - Veli Topkara
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA
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Abstract
Ventricular assist device patients (VAD) are at increased risk for thromboembolism. Biomarkers of hemolysis, such as lactate dehydrogenase (LDH) and poorly controlled international normalized ratio (INR) has been identified as predictors of thromboembolism. Patients aged 19 years and older who had a continuous flow VAD placed from 2006 to 2012 were included in this study (N = 115). We assessed the relationship of LDH elevation (≥600 IU/L) at different time points and thromboembolism. Over the 51.3 person-years of follow-up, a total of 23 first thromboembolic events occurred. Patients with elevated LDH on the day of VAD implantation had an increased risk for thromboembolism (hazard ratio [HR]: 4.72, 95% confidence interval [CI]: 1.44-15.4; p = 0.01). There was an increased risk of thromboembolism with early LDH elevation within the first month post-VAD (HR: 4.95, 95% CI: 1.69-14.4; p = 0.003) and estimated glomerular filtration rate <30 before VAD implantation (HR: 4.74, 95% CI: 1.12-20.1; p = 0.0346), whereas there was a decreased risk with good anticoagulation control (HR: 0.30, 95% CI: 0.10-0.86; p = 0.0247). Our study is the first to highlight the association between LDH elevation on the day of implantation and post-VAD thromboembolism. This study details the increased risk of thromboembolism with early LDH elevation and the importance of maintaining time in therapeutic INR range.
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Preoperative atrial fibrillation may not increase thromboembolic events in left ventricular assist device recipients on midterm follow-up. J Heart Lung Transplant 2016; 35:906-12. [DOI: 10.1016/j.healun.2016.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/13/2016] [Accepted: 03/11/2016] [Indexed: 11/23/2022] Open
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Nassif ME, LaRue SJ, Raymer DS, Novak E, Vader JM, Ewald GA, Gage BF. Relationship Between Anticoagulation Intensity and Thrombotic or Bleeding Outcomes Among Outpatients With Continuous-Flow Left Ventricular Assist Devices. Circ Heart Fail 2016; 9:e002680. [PMID: 27154497 PMCID: PMC4860612 DOI: 10.1161/circheartfailure.115.002680 10.1161/circheartfailure.115.002680.relationship] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND We evaluated thrombotic and bleeding outcomes in patients with continuous-flow left ventricular assist devices (CF-LVADs), stratified by anticoagulation intensity. Previous studies of outpatients with CF-LVADs have suggested that target international normalized ratio (INR) values <2.5 (range, 2-3) may be used. However, recent studies reported an increase in pump thrombosis among CF-LVADs, especially within the first 6 months of implant. METHODS AND RESULTS We retrospectively reviewed 249 outpatients at our center who received a CF-LVAD between January 2005 and August 2013. Using Poisson models, we analyzed their 10 927 INRs to determine INR-specific rates of thrombotic (ischemic stroke and suspected pump thrombosis) and hemorrhagic (gastrointestinal bleeding and hemorrhagic stroke) events occurring outside of the hospital. In multivariate analyses, we adjusted for age, sex, atrial fibrillation, coronary disease, and LVAD type as time-dependent Cox proportional hazard models. During a mean follow-up of 17.6±13.6 months, thrombotic events occurred in 46 outpatients. The highest event rate (0.40 thrombotic events per patient-year) was in the INR range of <1.5, but INR values of 1.5 to 1.99 also had high rates (0.16 thrombotic events per patient-year). INR was inversely associated with thrombotic events (hazard ratio, 0.40; 95% confidence interval, 0.22-0.72; P=0.002). The optimal INR based on weighted mortality of thrombotic and bleeding events was 2.6. CONCLUSIONS INR is inversely related to thrombotic events occurring outside of the hospital among patients supported with CF-LVADs. INR values <2.0 increase the rate of thrombotic events occurring outside of the hospital among patients supported with CF-LVADs.
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Affiliation(s)
- Michael E Nassif
- From the Division of Cardiology, Department of Medicine (M.E.N., S.J.L., E.N., J.M.V., G.A.E.) and Department of Medicine (D.S.R., B.F.G.), Washington University School of Medicine, St. Louis, MO
| | - Shane J LaRue
- From the Division of Cardiology, Department of Medicine (M.E.N., S.J.L., E.N., J.M.V., G.A.E.) and Department of Medicine (D.S.R., B.F.G.), Washington University School of Medicine, St. Louis, MO.
| | - David S Raymer
- From the Division of Cardiology, Department of Medicine (M.E.N., S.J.L., E.N., J.M.V., G.A.E.) and Department of Medicine (D.S.R., B.F.G.), Washington University School of Medicine, St. Louis, MO
| | - Eric Novak
- From the Division of Cardiology, Department of Medicine (M.E.N., S.J.L., E.N., J.M.V., G.A.E.) and Department of Medicine (D.S.R., B.F.G.), Washington University School of Medicine, St. Louis, MO
| | - Justin M Vader
- From the Division of Cardiology, Department of Medicine (M.E.N., S.J.L., E.N., J.M.V., G.A.E.) and Department of Medicine (D.S.R., B.F.G.), Washington University School of Medicine, St. Louis, MO
| | - Gregory A Ewald
- From the Division of Cardiology, Department of Medicine (M.E.N., S.J.L., E.N., J.M.V., G.A.E.) and Department of Medicine (D.S.R., B.F.G.), Washington University School of Medicine, St. Louis, MO
| | - Brian F Gage
- From the Division of Cardiology, Department of Medicine (M.E.N., S.J.L., E.N., J.M.V., G.A.E.) and Department of Medicine (D.S.R., B.F.G.), Washington University School of Medicine, St. Louis, MO
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Stulak JM, Davis ME, Haglund N, Dunlay S, Cowger J, Shah P, Pagani FD, Aaronson KD, Maltais S. Adverse events in contemporary continuous-flow left ventricular assist devices: A multi-institutional comparison shows significant differences. J Thorac Cardiovasc Surg 2016; 151:177-89. [DOI: 10.1016/j.jtcvs.2015.09.100] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 08/27/2015] [Accepted: 09/06/2015] [Indexed: 10/23/2022]
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58
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Al-Mufti F, Bauerschmidt A, Claassen J, Meyers PM, Colombo PC, Willey JZ. Neuroendovascular Interventions for Acute Ischemic Strokes in Patients Supported with Left Ventricular Assist Devices: A Single-Center Case Series and Review of the Literature. World Neurosurg 2015; 88:199-204. [PMID: 26739903 DOI: 10.1016/j.wneu.2015.12.061] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND With the shortage of donor hearts, increasingly more patients with end-stage heart failure are implanted with left ventricular assist devices (LVADs). LVADs are associated with a significant risk of developing acute ischemic strokes (AISs). Very little is known on about the management of AIS in patients with LVAD, especially with regard to the safety and efficacy of neuroendovascular techniques. METHODS We identified 5 patients with heart failure and LVAD implants who developed AIS and underwent neuroendovascular interventions at Columbia University Medical Center. Their cases were reviewed for the safety, efficacy of the interventions, and potential complications. RESULTS There were no significant complications from the interventions. In all 5 cases, there was at least a 4-point improvement in the National Institutes of Health Stroke scale and none of the cases developed symptomatic hemorrhage. Two patients had substantial improvement and received cardiac transplantations. CONCLUSIONS Neuroendovascular intervention is safe and feasible in patients with LVAD and may potentially contribute to improving the outcome of a disease that has a poor natural history. Further study is recommended.
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Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurology, Columbia University Medical Center, New York, New York, USA.
| | - Andrew Bauerschmidt
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Medical Center, New York, New York, USA; Department of Neurosurgery, Columbia University Medical Center, New York, New York, USA
| | - Philip M Meyers
- Department of Neurosurgery, Columbia University Medical Center, New York, New York, USA; Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Paolo C Colombo
- Department of Internal Medicine-Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Joshua Z Willey
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
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59
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Coffin ST, Haglund NA, Davis ME, Xu M, Dunlay SM, Cowger JA, Shah P, Aaronson KD, Pagani FD, Stulak JM, Maltais S. Adverse neurologic events in patients bridged with long-term mechanical circulatory support: A device-specific comparative analysis. J Heart Lung Transplant 2015; 34:1578-85. [DOI: 10.1016/j.healun.2015.08.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/23/2015] [Accepted: 08/31/2015] [Indexed: 11/26/2022] Open
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60
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Left ventricular dimension decrement index early after axial flow assist device implantation: A novel risk marker for late pump thrombosis. J Heart Lung Transplant 2015; 34:1561-9. [DOI: 10.1016/j.healun.2015.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/29/2015] [Accepted: 08/31/2015] [Indexed: 01/14/2023] Open
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61
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Susen S, Rauch A, Van Belle E, Vincentelli A, Lenting PJ. Circulatory support devices: fundamental aspects and clinical management of bleeding and thrombosis. J Thromb Haemost 2015; 13:1757-67. [PMID: 26302994 DOI: 10.1111/jth.13120] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/02/2015] [Indexed: 12/01/2022]
Abstract
Circulatory support devices are increasingly being used to overcome cardiac or respiratory failure. Long-term devices are used either as a 'bridge to transplant' to support patients who are unable to wait any longer for a heart transplant, or, more recently, as 'destination therapy' for older patients suffering from end-stage heart failure and who have contraindications to heart transplantation. Short-term support devices for high-risk percutaneous coronary intervention, or as a 'bridge for decision' for patients suffering from refractory cardiogenic shock, have also been developed. The clinical benefit of such assist devices has been demonstrated in several important studies, but, unfortunately, thrombotic and bleeding complications are two major clinical issues in patients requiring these devices. Overcoming these issues is of major importance to allow the safe and broad use of these devices, and to consider them as true alternatives to heart transplantation. The present review focuses on thrombotic and bleeding complications, and describes how the risk of thrombosis and bleeding may vary according to the clinical indication, but also according to the type of device. We describe the current knowledge of the mechanisms underlying the occurrence of these complications, provide some guidance for choosing the most appropriate anticoagulation regimen to prevent their occurrence for each type of device and indication, and provide some recommendations for the management of patients when the complication occurs.
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Affiliation(s)
- S Susen
- Department of Hematology and Transfusion, Lille University Hospital, Lille, France
- Institut Pasteur de Lille, EGID, INSERM UMR 1011, University of Lille 2, Lille, France
| | - A Rauch
- Department of Hematology and Transfusion, Lille University Hospital, Lille, France
- Institut Pasteur de Lille, EGID, INSERM UMR 1011, University of Lille 2, Lille, France
| | - E Van Belle
- Institut Pasteur de Lille, EGID, INSERM UMR 1011, University of Lille 2, Lille, France
- Department of Cardiology, Lille University Hospital, Lille, France
| | - A Vincentelli
- Institut Pasteur de Lille, EGID, INSERM UMR 1011, University of Lille 2, Lille, France
- Department of Cardiology, Lille University Hospital, Lille, France
- Department of Cardiac Surgery, Lille University Hospital, Lille, France
| | - P J Lenting
- Inserm U1176 & UMR_S 1176, University Paris-Sud, Le Kremlin Bicêtre, France
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Compostella L, Russo N, Setzu T, Bottio T, Compostella C, Tarzia V, Livi U, Gerosa G, Iliceto S, Bellotto F. A Practical Review for Cardiac Rehabilitation Professionals of Continuous-Flow Left Ventricular Assist Devices. J Cardiopulm Rehabil Prev 2015; 35:301-11. [DOI: 10.1097/hcr.0000000000000113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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63
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Grimm JC, Magruder JT, Kemp CD, Shah AS. Late Complications Following Continuous-Flow Left Ventricular Assist Device Implantation. Front Surg 2015; 2:42. [PMID: 26347873 PMCID: PMC4541033 DOI: 10.3389/fsurg.2015.00042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/03/2015] [Indexed: 12/20/2022] Open
Abstract
Left ventricular assist devices have become standard therapy for patients with end-stage heart failure. They represent potential long-term solutions for a growing public health problem. However, initial enthusiasm for this technology has been tempered by challenges posed by long-term support. This review examines these challenges and out current understanding of their etiologies.
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Affiliation(s)
- Joshua C Grimm
- Division of Cardiac Surgery, The Johns Hopkins Hospital , Baltimore, MD , USA
| | - J Trent Magruder
- Division of Cardiac Surgery, The Johns Hopkins Hospital , Baltimore, MD , USA
| | - Clinton D Kemp
- Division of Cardiac Surgery, The Johns Hopkins Hospital , Baltimore, MD , USA
| | - Ashish S Shah
- Division of Cardiac Surgery, The Johns Hopkins Hospital , Baltimore, MD , USA
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64
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Blitz A. Pump thrombosis-A riddle wrapped in a mystery inside an enigma. Ann Cardiothorac Surg 2014; 3:450-71. [PMID: 25452905 DOI: 10.3978/j.issn.2225-319x.2014.09.10] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/12/2014] [Indexed: 11/14/2022]
Abstract
This manuscript reviews the state of the art regarding the subject of pump thrombosis (PT). The historical context of PT and the clinical data are described, the etiologic factors are elucidated, preventive strategies are explored, diagnostic modalities are reviewed, and management principles are defined. There clearly remains much work to be done towards solving this riddle wrapped in a mystery inside an enigma, but promising foundations are being established.
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Affiliation(s)
- Arie Blitz
- Division of Cardiac Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
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65
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Puehler T, Ensminger S, Schoenbrodt M, Börgermann J, Rehn E, Hakim-Meibodi K, Morshuis M, Gummert J. Mechanical circulatory support devices as destination therapy-current evidence. Ann Cardiothorac Surg 2014; 3:513-24. [PMID: 25452913 DOI: 10.3978/j.issn.2225-319x.2014.08.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/23/2014] [Indexed: 01/23/2023]
Abstract
Advanced heart failure is an increasing problem worldwide. Nowadays, mechanical circulatory support devices (MSCD) are an established therapeutic option for terminal heart failure after exhaustion of medical and conventional surgical treatment, and are becoming a realistic alternative to heart transplantation (HTX). There are a number of different treatment options for these patients, such as bridge to transplantation (BTT), bridge to candidacy (BTC), bridge to recovery (BTR) and the destination therapy (DT) option. The latter option has become more frequent throughout the last years, due to a donor organ shortage and an increasing number of older patients with terminal heart failure who are not eligible for HTX. These factors have led to a rapidly increasing number of LVAD implantations as well as centers which perform these procedures. This has also been due to improved LVAD survival rates and quality of life following the introduction of smaller, intrapericardial and more durable continuous flow left ventricular devices. The most common complications for these patients are device-related problems, such as coagulation disorders, gastrointestinal bleeding, device related infection, pump thrombosis or cerebrovascular accidents. However, some questions still remain unanswered or under debate, such as the exact time-point for LVAD implantation. In addition, aspects such as better biocompatibility for LVADs remain a major challenge. This review will concentrate on DT for terminal heart failure and provide an overview of the current evidence for LVAD implantation in this patient group, with particular emphasis on indication and time-point of implantation, choice of LVADs, and long term outcomes and quality of life.
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Affiliation(s)
- Thomas Puehler
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Michael Schoenbrodt
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Erik Rehn
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
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66
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Eckman PM. Maybe atrial fibrillation does matter in ventricular assist device patients? J Am Coll Cardiol 2014; 64:1891-3. [PMID: 25444142 DOI: 10.1016/j.jacc.2014.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Peter M Eckman
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota.
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67
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Enriquez AD, Calenda B, Gandhi PU, Nair AP, Anyanwu AC, Pinney SP. Clinical Impact of Atrial Fibrillation in Patients With the HeartMate II Left Ventricular Assist Device. J Am Coll Cardiol 2014; 64:1883-90. [DOI: 10.1016/j.jacc.2014.07.989] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/26/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022]
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68
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Cerebrovascular disease in the era of left ventricular assist devices with continuous flow: Risk factors, diagnosis, and treatment. J Heart Lung Transplant 2014; 33:878-87. [DOI: 10.1016/j.healun.2014.05.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/16/2014] [Accepted: 05/28/2014] [Indexed: 01/14/2023] Open
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