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Cai AW, Islam S, Hankins SR, Fischer W, Eisen HJ. Mechanical Circulatory Support in the Treatment of Advanced Heart Failure. Am J Transplant 2017; 17:3020-3032. [PMID: 28643428 DOI: 10.1111/ajt.14403] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 01/25/2023]
Abstract
According to the Centers for Disease Control, heart failure (HF) remains a pervasive condition with high morbidity and mortality, affecting 5.8 million people in the United States and 23 million worldwide. For patients with refractory end-stage HF, heart transplantation is the "gold standard" for definitive treatment. However, the demand for heart transplantation has consistently exceeded the availability of donor hearts, with approximately 2331 orthotopic heart transplantations performed in the United States in 2015 despite an estimated 100 000 to 250 000 patients with New York Heart Association class IIIB or IV symptoms that are refractory to medical treatment, making such patients potential transplant candidates. As such, the need for mechanical circulatory support (MCS) to treat patients with end-stage HF has become paramount. In this review, we focus on the history, advancements, and current use of durable MCS device therapy in the treatment of advanced heart failure.
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Affiliation(s)
- A W Cai
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - S Islam
- Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA
| | - S R Hankins
- Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA
| | - W Fischer
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - H J Eisen
- Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA
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102
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Crespo-Leiro MG, Barge-Caballero E. Heart transplantation and left ventricular assist systems. Not too early, not too late. Eur J Heart Fail 2017; 20:161-163. [PMID: 29148255 DOI: 10.1002/ejhf.1070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV. INIBIC, La Coruña, Spain
| | - Eduardo Barge-Caballero
- Advanced Heart Failure and Heart Transplant Unit, Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV. INIBIC, La Coruña, Spain
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103
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Holmberg E, Ahn H, Peterzén B. More than 20 years' experience of left ventricular assist device implantation at a non-transplant Centre. SCAND CARDIOVASC J 2017; 51:293-298. [PMID: 29029567 DOI: 10.1080/14017431.2017.1388536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Over recent decades implantable left ventricular assist devices (LVAD) have increased the possibility of improved survival in patients with advanced heart failure who also benefit from a better quality of life. The aim of this retrospective survey was to review the clinical results of LVAD implantation at a low-volume non-transplant centre (Linköping, Sweden) between 1993 and 2016. Our aim was also to assess the mortality and morbidity rates associated with implantation of three LVAD versions at our centre, and to compare our results with those from transplant centres. DESIGN A retrospective cohort study was performed examining the medical records of patients who had a HeartMate® (HMI, HMII, HMIII) LVAD implanted as a bridge to heart transplantation (BTT) or as destination therapy (DT) at the University Hospital, Linköping. RESULTS Our main finding was a survival to heart transplantation rate of 82% among our BTT LVAD patients. The most common adverse event among our patients was infection. A higher frequency of temporary dialysis was seen in the HMII group compared to the HMI group, and the frequency of right ventricular failure was higher in our HMII material. CONCLUSIONS Our data suggests that patients requiring long-term LVAD support can safely have their device implanted and cared for at a non-transplant centre.
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Affiliation(s)
- Erica Holmberg
- a Department of Cardiothoracic and Vascular Surgery , University Hospital and Department of Medical and Health Sciences, Linköping University , Linköping , Sweden
| | - Henrik Ahn
- a Department of Cardiothoracic and Vascular Surgery , University Hospital and Department of Medical and Health Sciences, Linköping University , Linköping , Sweden
| | - Bengt Peterzén
- a Department of Cardiothoracic and Vascular Surgery , University Hospital and Department of Medical and Health Sciences, Linköping University , Linköping , Sweden
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104
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Kenyhercz WE, Pérez JL, Wolfe AN, Starkey MR, Bagnoli Iii DJ, Ozgur AF, Ciullo A, Ahmed R. Trauma Resuscitation in a Left Ventricular Assist Device Patient: An Emergency Medicine Simulation Scenario. Cureus 2017; 9:e1773. [PMID: 29250473 PMCID: PMC5729031 DOI: 10.7759/cureus.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/13/2017] [Indexed: 11/06/2022] Open
Abstract
Heart failure is a leading cause of death worldwide. While heart transplantation is the most successful treatment for end-stage heart failure, the scarcity in donor hearts has ushered in the use of alternative therapies, such as the left ventricular assist device (LVAD). This patient population may present with low frequency, but they require disease-specific management. Learners may fine-tune these principles in a safe learning environment, such as a medical simulation lab. Here, we present a case in which a patient with a LVAD sustained serious traumatic injuries.
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Affiliation(s)
| | - Jorge L Pérez
- Área De Ciencias De La Salud, Instituto Tecnológico De Santo Domingo
| | | | | | | | | | - Anna Ciullo
- Department of Anesthesia Critical Care, University of Cincinnati
| | - Rami Ahmed
- Emergency Medicine, Summa Akron City Hospital, Summa Health System
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105
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Potential palliative care quality indicators in heart disease patients: A review of the literature. J Cardiol 2017; 70:335-341. [DOI: 10.1016/j.jjcc.2017.02.010] [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: 01/20/2017] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 11/17/2022]
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106
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Lund LH, Trochu JN, Meyns B, Caliskan K, Shaw S, Schmitto JD, Schibilsky D, Damme L, Heatley J, Gustafsson F. Screening for heart transplantation and left ventricular assist system: results from the ScrEEning for advanced Heart Failure treatment (SEE-HF) study. Eur J Heart Fail 2017; 20:152-160. [PMID: 28960673 DOI: 10.1002/ejhf.975] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart transplantation (HTx) and implantable left ventricular assist systems (LVAS) improve outcomes in advanced heart failure but may be underutilized. We hypothesized that screening can identify appropriate candidates. METHODS AND RESULTS The ScrEEning for advanced Heart Failure treatment (SEE-HF) study was a multicentre prospective study screening patients with existing cardiac resynchronization therapy (CRT) and/or implantable cardioverter-defibrillator (ICD) for ejection fraction ≤40% and New York Heart Association (NYHA) class III-IV, and subsequently for guideline-based HTx and LVAS indication. Of 1722 (mean age 64 ± 14 years, 26% women) patients screened at eight centres in seven European countries, 121 (7.0%) were eligible and 99 (5.7%; mean age 61 ± 10 years, 19% women) patients were enrolled for detailed assessment. Twenty-six of the 99 enrolled patients (26%) were eligible for either HTx or LVAD (18 eligible for HTx; 7 eligible for LVAD; and 1 eligible for both). Eleven patients were listed for HTx and three received an LVAS. Eligible patients were 61 ± 8 years and 19% women, whereas those actually receiving intervention were 56 ± 8 years and 8% women. CONCLUSIONS Among patients with CRT and/or ICD, a minority have NYHA class III-IV heart failure and ejection fraction ≤40%. Among these, however, more than one-quarter have an unrecognized need for HTx or LVAS. When patients are offered intervention based on screening, many decline. Discrepancies exist between clinical and patient equipoise. Clinical Trial Registration ClinicalTrials.gov Unique Identifier: NCT00894387.
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Affiliation(s)
- Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-Noel Trochu
- Institut du Thorax, Inserm UMR 1087-CIC1413, Centre Hospitalier Universaire de Nantes, Nantes, France
| | | | - Kadir Caliskan
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Steven Shaw
- University Hospital of S. Manchester NHS Trust, Manchester, UK
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - David Schibilsky
- German Heart Competance Center, University Clinical Center Tuebingen, Tuebingen, Germany
| | | | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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107
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van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 933] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
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108
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Nour S, Carbognani D, Chachques JC. Circulatory Flow Restoration Versus Cardiopulmonary Resuscitation: New Therapeutic Approach in Sudden Cardiac Arrest. Artif Organs 2017; 41:E356-E366. [PMID: 28884833 DOI: 10.1111/aor.12984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
Sudden cardiac arrest (SCA) remains a major problem for health authorities worldwide. Insufficiencies of current cardiopulmonary resuscitation (CPR) are most probably related to an inappropriate concept and applied methods that still concentrate on heartbeat as priority, instead of blood circulation to maintain organs' perfusions. The aim of this works is to propose a new therapeutic approach for SCA in a more effective and secure manner compared with current CPR methods. It correlates to a non-invasive circulatory flow restoration (CFR) device composed of a multilayered thoracic and infradiaphragmatic compartments that will be pulsated alternatively and in fixed frequencies using a low-pressure pneumatic generator. Proof-of-concept studies with different prototypes and methods of SCA, showed restoration of hemodynamics (BP ≥ 100 mm Hg) and increased urine output after 20 min of cardiac arrest in pediatric dogs and piglets. In summary, a CFR device can induce shear stress-mediated endothelial function to restore microcirculation and cellular metabolism. This represents a cost-effective method, predisposes to return of spontaneous circulation in case of SCA, adaptable for all age groups, in public and hospital environments.
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Affiliation(s)
- Sayed Nour
- Biosurgical Research Laboratory, Alain Carpentier Foundation, Pompidou Hospital, University of Paris Descartes, Paris, France
| | - Daniel Carbognani
- Biosurgical Research Laboratory, Alain Carpentier Foundation, Pompidou Hospital, University of Paris Descartes, Paris, France
| | - Juan Carlos Chachques
- Biosurgical Research Laboratory, Alain Carpentier Foundation, Pompidou Hospital, University of Paris Descartes, Paris, France
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109
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Bidwell JT, Lyons KS, Mudd JO, Gelow JM, Chien CV, Hiatt SO, Grady KL, Lee CS. Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy: Longitudinal Outcomes for Patients and Family Caregivers. J Cardiovasc Nurs 2017; 32:455-463. [PMID: 27811585 PMCID: PMC5413439 DOI: 10.1097/jcn.0000000000000378] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device. OBJECTIVE The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation. METHODS This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes. RESULTS Patients' QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers. CONCLUSIONS This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.
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Affiliation(s)
- Julie T Bidwell
- Julie T. Bidwell, PhD, RN Predoctoral Fellow, Oregon Health & Science University School of Nursing, Portland. Karen S. Lyons, PhD, FGSA Associate Professor, Oregon Health & Science University School of Nursing, Portland. James O. Mudd, MD Associate Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Jill M. Gelow, MD, MPH Assistant Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Christopher V. Chien, MD Assistant Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Shirin O. Hiatt, MPH, MS, RN Research Associate, Oregon Health & Science University School of Nursing, Portland. Kathleen L. Grady, PhD, MS, RN, FAHA, FHSA, FAAN Professor, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Christopher S. Lee, PhD, RN, FAHA, FHFSA, FAAN Associate Professor, Oregon Health & Science University School of Nursing and Knight Cardiovascular Institute, Portland
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110
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Blum EC, Martz CR, Selektor Y, Nemeh H, Smith ZR, To L. Anticoagulation of Percutaneous Ventricular Assist Device Using Argatroban-Based Purge Solution: A Case Series. J Pharm Pract 2017; 31:514-518. [PMID: 28830286 DOI: 10.1177/0897190017727191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Impella devices are percutaneously inserted ventricular assist devices which require a continuous purge solution that contains heparin to prevent pump thrombosis and device failure. We describe 2 patients with heparin-induced thrombocytopenia (HIT) supported with an Impella device utilizing an argatroban-based purge solution. Case 1 involved an 83-year-old female with biventricular failure which resulted in right ventricle Impella support. The purge solution was changed to include argatroban due to concern of device clotting in the setting of HIT. Case 2 involved a 55-year-old male with worsening cardiogenic shock which resulted in left ventricle Impella support. Due to decreased purge flow rates and concerns for clotting, argatroban was added to the purge solution. Both patients' total argatroban regimens were monitored and adjusted by pharmacy, resulting in therapeutic anticoagulation without any major bleeding or thrombotic events. Subsequently, a protocol was designed and implemented. These case reports appear to demonstrate the safe and effective use of argatroban purge solutions for the necessary anticoagulation with an Impella device. Further studies are needed to confirm these results and determine the optimal dosing regimen.
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Affiliation(s)
- Emily C Blum
- 1 Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - Carolyn R Martz
- 1 Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - Yelena Selektor
- 2 Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Hassan Nemeh
- 3 Division of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Zachary R Smith
- 1 Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - Long To
- 1 Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
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111
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Sumida H, Morihisa K, Katahira K, Sugiyama S, Kishi T, Oshima S. Isolated Right Ventricular Stress (Takotsubo) Cardiomyopathy. Intern Med 2017; 56:2159-2164. [PMID: 28781307 PMCID: PMC5596277 DOI: 10.2169/internalmedicine.8323-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/11/2017] [Indexed: 01/11/2023] Open
Abstract
A 79-year-old woman was admitted with a left femoral neck fracture and she immediately developed circulatory shock. Echocardiography showed a markedly enlarged right ventricle (RV) with systolic ballooning of the mid-ventricular wall and preserved contractility of the apex. The left ventricular (LV) motion was normal. Multi-detector-row computed tomography showed severe congestion of the contrast media in the right atrium with no forward flow to RV, but no pulmonary embolism. She was successfully treated with percutaneous veno-arterial extracorporeal membrane oxygenation. This case presented with acute, profound, but reversible RV dysfunction triggered by acute stress in a manner similar to that seen in LV stress cardiomyopathy.
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Affiliation(s)
- Hitoshi Sumida
- Division of Intensive Care Unit, Kumamoto Central Hospital, Japan
| | - Kenji Morihisa
- Division of Cardiovascular Medicine, Kumamoto Central Hospital, Japan
| | | | - Seigo Sugiyama
- Division of Cardiovascular Medicine, Jinnouchi Hospital, Japan
| | - Takuya Kishi
- Collaborative Research Institute of Innovation for Cardiovascular Diseases, Kyushu University Center for Disruptive Cardiovascular Medicine, Japan
| | - Shuichi Oshima
- Division of Cardiovascular Medicine, Kumamoto Central Hospital, Japan
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112
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113
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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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114
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Hernandez GA, Breton JDN, Chaparro SV. Driveline Infection in Ventricular Assist Devices and Its Implication in the Present Era of Destination Therapy. Open J Cardiovasc Surg 2017; 9:1179065217714216. [PMID: 28680268 PMCID: PMC5489074 DOI: 10.1177/1179065217714216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 05/16/2017] [Indexed: 12/28/2022] Open
Abstract
Advances in mechanical circulatory support devices provided the technology to develop long-term, implantable left ventricular assist devices as bridge to transplant, destination therapy, and in a lesser group of patients, as bridge to recovery. Despite the benefits from this innovative therapy, with their increased use, many complications have been encountered, one of the most common being infections. With the driveline acting as a portal to the exterior environment, an infection involving this structure is the most frequent one. Because patients with destination therapy are expected to receive circulatory support for a longer period of time, we will focus this review on the risk factors, prevention, and treatment options for driveline infections.
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Affiliation(s)
- Gabriel A Hernandez
- Cardiovascular Division, University of Miami Hospital and Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jonatan D Nunez Breton
- Department of Internal Medicine, University of Miami Hospital and Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Sandra V Chaparro
- Cardiovascular Division, University of Miami Hospital and Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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115
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2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant). J Am Coll Cardiol 2017; 69:2977-3001. [DOI: 10.1016/j.jacc.2017.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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116
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Jessup M, Drazner MH, Book W, Cleveland JC, Dauber I, Farkas S, Ginwalla M, Katz JN, Kirkwood P, Kittleson MM, Marine JE, Mather P, Morris AA, Polk DM, Sakr A, Schlendorf KH, Vorovich EE. 2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant): A Report of the ACC Competency Management Committee. Circ Heart Fail 2017; 10:HHF.0000000000000021. [DOI: 10.1161/hhf.0000000000000021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | | | - Joseph C. Cleveland
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | - Ira Dauber
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | | | - Mahazarin Ginwalla
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | - Jason N. Katz
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | | | | | | | - Paul Mather
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | - Alanna A. Morris
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | | | | | - Kelly H. Schlendorf
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
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Botta L, De Chiara B, Macera F, Cannata A, Costetti A, Voltolini A, Moreo A, Cipriani M, Frigerio M, Russo CF. HeartWare-HVAD for end-stage heart failure: a review of clinical experiences with ≥50 patients. Expert Rev Med Devices 2017; 14:423-437. [DOI: 10.1080/17434440.2017.1325318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Luca Botta
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Benedetta De Chiara
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Francesca Macera
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Aldo Cannata
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Alessandro Costetti
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Alessandra Voltolini
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Antonella Moreo
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Manlio Cipriani
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Maria Frigerio
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
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Jessup M, Drazner MH, Book W, Cleveland JC, Dauber I, Farkas S, Ginwalla M, Katz JN, Kirkwood P, Kittleson MM, Marine JE, Mather P, Morris AA, Polk DM, Sakr A, Schlendorf KH, Vorovich EE. 2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant): A Report of the ACC Competency Management Committee. J Card Fail 2017; 23:492-511. [PMID: 28454730 DOI: 10.1016/j.cardfail.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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119
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Price S, Platz E, Cullen L, Tavazzi G, Christ M, Cowie MR, Maisel AS, Masip J, Miro O, McMurray JJ, Peacock WF, Martin-Sanchez FJ, Di Somma S, Bueno H, Zeymer U, Mueller C. Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol 2017; 14:427-440. [PMID: 28447662 PMCID: PMC5767080 DOI: 10.1038/nrcardio.2017.56] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Echocardiography is increasingly recommended for the diagnosis and assessment of patients with severe cardiac disease, including acute heart failure. Although previously considered to be within the realm of cardiologists, the development of ultrasonography technology has led to the adoption of echocardiography by acute care clinicians across a range of specialties. Data from echocardiography and lung ultrasonography can be used to improve diagnostic accuracy, guide and monitor the response to interventions, and communicate important prognostic information in patients with acute heart failure. However, without the appropriate skills and a good understanding of ultrasonography, its wider application to the most acutely unwell patients can have substantial pitfalls. This Consensus Statement, prepared by the Acute Heart Failure Study Group of the ESC Acute Cardiovascular Care Association, reviews the existing and potential roles of echocardiography and lung ultrasonography in the assessment and management of patients with acute heart failure, highlighting the differences from established practice where relevant.
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Affiliation(s)
- Susanna Price
- Royal Brompton &Harefield NHS Foundation Trust, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115, USA
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Butterfield St &Bowen Bridge Road, Herston, Queensland 4029, Australia
| | - Guido Tavazzi
- University of Pavia Intensive Care Unit 1st Department, Fondazione Policlinico IRCCS San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Michael Christ
- Department of Emergency and Critical Care Medicine, Klinikum Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419 Nürnberg, Germany
| | - Martin R Cowie
- Department of Cardiology, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, California 92161, USA
| | - Josep Masip
- Critical Care Department, Consorci Sanitari Integral, Hospital Sant Joan Despí Moisès Broggi and Hospital General de l'Hospitalet, University of Barcelona, Grand Via de las Corts Catalanes 585, 08007 Barcelona, Spain
| | - Oscar Miro
- Emergency Department, Hospital Clínic de Barcelona, Carrer de Villarroel 170, 08036 Barcelona, Spain
| | - John J McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - W Frank Peacock
- Emergency Medicine, Baylor College of Medicine, Scurlock Tower, 1 Baylor Plaza, Houston, Texas 77030, USA
| | - F Javier Martin-Sanchez
- Emergency Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, Calle del Prof Martín Lagos, 28040 Madrid, Spain
| | - Salvatore Di Somma
- Emergency Department, Sant'Andrea Hospital, Faculty of Medicine and Psychology, LaSapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares and Department of Cardiology, Hospital 12 de Octubre, Avenida de Córdoba, 28041 Madrid, Spain
| | - Uwe Zeymer
- Klinikum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen, Bremserstraße 79, 67063 Ludwigshafen am Rhein, Germany
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Renal dysfunction and chronic mechanical circulatory support: from patient selection to long-term management and prognosis. Curr Opin Cardiol 2017; 31:277-86. [PMID: 27022890 DOI: 10.1097/hco.0000000000000278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the effects of mechanical circulatory support (MCS) on changes in kidney function and their relationship with mortality, with an additional focus on the evaluation and management of both preimplant and post-MCS renal dysfunction. RECENT FINDINGS Renal dysfunction is highly prevalent in patients referred for MCS and is associated with significantly increased mortality and postoperative acute kidney injury. Most patients, including those with renal dysfunction, experience marked early improvement in renal function with MCS, likely secondary to correction of the cardiogenic shock, volume overload, and neurohormonal activation characteristic of advanced heart failure. Currently, there are no diagnostic tests to definitively distinguish reversible forms of renal dysfunction likely to improve with MCS from irreversible renal dysfunction. Furthermore, the characteristic improvements in renal function observed in the early months of MCS are often transient, with subsequent recurrence of renal dysfunction with longer durations of support. Venous congestion, right ventricular dysfunction, and reduced pulsatility are potential mechanisms involved in resurgence of renal dysfunction following MCS. SUMMARY With the exponential growth of MCS, research endeavors to both improve understanding of the mechanisms behind observed changes in renal function and elucidate the device-related effects on the kidney are imperative.
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Kim JH, Singh R, Pagani FD, Desai SS, Haglund NA, Dunlay SM, Maltais S, Aaronson KD, Stulak JM, Davis ME, Salerno CT, Cowger JA, Shah P. Ventricular Assist Device Therapy in Older Patients With Heart Failure: Characteristics and Outcomes. J Card Fail 2016; 22:981-987. [DOI: 10.1016/j.cardfail.2016.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/06/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
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Jain A, Rohrer B, Gebhardt B, Breeze JL, Quick JD, Couper G, Kiernan MS, Lawrence M, Cobey FC. Left Ventricular Assist Device Thrombosis Is Associated With an Increase in the Systolic-to-Diastolic Velocity Ratio Measured at the Inflow and Outflow Cannulae. J Cardiothorac Vasc Anesth 2016; 31:497-504. [PMID: 28216204 DOI: 10.1053/j.jvca.2016.11.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether the ratio of peak systolic-to-nadir diastolic velocity (S/D ratio) measured using Doppler at the left ventricular assist device (LVAD) inflow and outflow cannulae is associated with pump thrombosis and to determine whether there is an absolute decrease in the diastolic cannula velocities in LVAD thrombosis. DESIGN Retrospective chart review. SETTING University hospital. PARTICIPANTS Patients who underwent LVAD exchange. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Transesophageal echocardiograms were reviewed from all patients with the HeartMate II device (Thoratec Corporation, Pleasanton, CA) over a 6-year period and who underwent LVAD exchange for pump thrombosis. The following 3 time points were evaluated: (1) initial LVAD placement (prethrombosis), (2) thrombosis, and (3) exchanged LVAD placement (postthrombosis). Systolic and diastolic flow velocities were examined using pulse-wave spectral Doppler at the inflow and outflow cannulae, and the S/D ratio for each was determined. Statistical analysis was performed with SAS, version 9.4 (SAS Institute, Cary, NC), using 2-tailed tests and alpha = 0.05. Thirteen patients were included in the study. Significant differences were observed in S/D ratios among the 3 phases at both the inflow (p = 0.0234) and outflow (p = 0.0047) cannulae. Pairwise tests of the inflow cannulae showed that the mean S/D ratio at the time of thrombosis (mean ± standard deviation [SD], 4.29 ± 1.74) was significantly greater than the prethrombosis ratio (2.49 ± 0.65; p = 0.0069). Among outflow measurements, the mean S/D ratio at thrombosis (3.94 ± 1.34) was significantly higher than both the prethrombosis (2.63 ± 0.56; p = 0.0025) and postthrombosis (2.74 ± 0.83) (p = 0.0093) ratios. Decreases in diastolic velocities were not statistically significant at the inflow cannula. At the outflow cannula, there was a significant difference in diastolic velocity among the phases (p = 0.0233). Specifically, the postthrombosis diastolic measurements (41.50 ± 9.94) were significantly higher than both the prethrombosis (26.85 ± 10.13; p = 0.0140) and thrombosis (26.7 ± 15.35; p = 0.0151) values. CONCLUSIONS An increased S/D ratio measured with Doppler at the LVAD inflow and outflow cannulas may be associated with pump thrombosis. Decreased diastolic cannula velocities were not observed in LVAD thrombosis.
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Affiliation(s)
- Ankit Jain
- Department of Anesthesia, Tufts Medical Center, Boston, MA
| | - Ben Rohrer
- Department of Anesthesia, Tufts Medical Center, Boston, MA
| | - Brian Gebhardt
- Department of Anesthesia, Tufts Medical Center, Boston, MA
| | - Janis L Breeze
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Joshua D Quick
- Department of Anesthesia, Yale University School of Medicine, New Haven, CT
| | - Gregory Couper
- Department of Cardiothoracic Surgery, Tufts Medical Center, Boston, MA
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Khorsandi M, Dougherty S, Sinclair A, Buchan K, MacLennan F, Bouamra O, Curry P, Zamvar V, Berg G, Al-Attar N. A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery. J Cardiothorac Surg 2016; 11:151. [PMID: 27821152 PMCID: PMC5100311 DOI: 10.1186/s13019-016-0545-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refractory post-cardiotomy cardiogenic shock (PCCS) is a relatively rare phenomenon that can lead to rapid multi-organ dysfunction syndrome and is almost invariably fatal without advanced mechanical circulatory support (AMCS), namely extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). In this multicentre observational study we retrospectively analyzed the outcomes of salvage venoarterial ECMO (VA ECMO) and VAD for refractory PCCS in the 3 adult cardiothoracic surgery centres in Scotland over a 20-year period. METHODS The data was obtained through the Edinburgh, Glasgow and Aberdeen cardiac surgery databases. Our inclusion criteria included any adult patient from April 1995 to April 2015 who had received salvage VA ECMO or VAD for PCCS refractory to intra-aortic balloon pump (IABP) and maximal inotropic support following adult cardiac surgery. RESULTS A total of 27 patients met the inclusion criteria. Age range was 34-83 years (median 51 years). There was a large male predominance (n = 23, 85 %). Overall 23 patients (85 %) received VA ECMO of which 14 (61 %) had central ECMO and 9 (39 %) had peripheral ECMO. Four patients (15 %) were treated with short-term VAD (BiVAD = 1, RVAD = 1 and LVAD = 2). The most common procedure-related complication was major haemorrhage (n = 10). Renal failure requiring renal replacement therapy (n = 7), fatal stroke (n = 5), septic shock (n = 2), and a pseudo-aneurysm at the femoral artery cannulation site (n = 1) were also observed. Overall survival to hospital discharge was 40.7 %. All survivors were NYHA class I-II at 12 months' follow-up. CONCLUSION AMCS for refractory PCCS carries a survival benefit and achieves acceptable functional recovery despite a significant complication rate.
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Affiliation(s)
- Maziar Khorsandi
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, old Dalkeith road, Edinburgh, EH16 4SA, UK.
| | - Scott Dougherty
- Department of Cardiology, Ninewells University Hospital, Dundee, DD2 1UB, UK
| | - Andrew Sinclair
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon street, Clydebank, Glasgow, G81 4DY, UK
| | - Keith Buchan
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Burnside house, Cornhill road, Aberdeen, AB25 2ZR, UK
| | - Fiona MacLennan
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon street, Clydebank, Glasgow, G81 4DY, UK
| | - Omar Bouamra
- Medical Statistics, Trauma Audit & Research Network, Salford Royal NHS foundation trust and the University of Manchester, Manchester, M6 8HD, UK
| | - Philip Curry
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon street, Clydebank, Glasgow, G81 4DY, UK
| | - Vipin Zamvar
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, old Dalkeith road, Edinburgh, EH16 4SA, UK
| | - Geoffrey Berg
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon street, Clydebank, Glasgow, G81 4DY, UK
| | - Nawwar Al-Attar
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon street, Clydebank, Glasgow, G81 4DY, UK
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Reporte del primer caso de implante exitoso de asistencia ventricular izquierda HeartMate II como terapia de destino en Suramérica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Puymirat E, Fagon JY, Aegerter P, Diehl JL, Monnier A, Hauw‐Berlemont C, Boissier F, Chatellier G, Guidet B, Danchin N, Aissaoui N. Cardiogenic shock in intensive care units: evolution of prevalence, patient profile, management and outcomes, 1997–2012. Eur J Heart Fail 2016; 19:192-200. [DOI: 10.1002/ejhf.646] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/16/2016] [Accepted: 07/19/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Etienne Puymirat
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpital Européen Georges Pompidou Cardiologie, and Université Paris 5 Paris France
| | - Jean Yves Fagon
- AP‐HP, Hôpital Européen Georges Pompidou Intensive Care Unit and Université Paris 5 Paris France
| | - Philippe Aegerter
- AP‐HP, Hôpital Ambroise ParéUnité de Recherche Clinique et Département de Santé Publique Boulogne Billancourt France
- UVSQ, UMR‐S 1168 Université Versailles St‐Quentin‐en‐Yvelines France
- INSERM, U1168 VIMA Villejuif France
| | - Jean Luc Diehl
- AP‐HP, Hôpital Européen Georges Pompidou Intensive Care Unit and Université Paris 5 Paris France
| | - Alexandra Monnier
- AP‐HP, Hôpital Européen Georges Pompidou Intensive Care Unit and Université Paris 5 Paris France
| | - Caroline Hauw‐Berlemont
- AP‐HP, Hôpital Européen Georges Pompidou Intensive Care Unit and Université Paris 5 Paris France
| | - Florence Boissier
- AP‐HP, Hôpital Européen Georges Pompidou Intensive Care Unit and Université Paris 5 Paris France
| | - Gilles Chatellier
- AP‐HP, Hôpital Européen Georges Pompidou Unité de Recherche Clinique and Centre d'Investigation Epidémiologique 4 Paris France
| | - Bertrand Guidet
- AP‐HP, Hôpital Saint Antoine Intensive Care Unit and INSERM U444 Paris France
| | - Nicolas Danchin
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpital Européen Georges Pompidou Cardiologie, and Université Paris 5 Paris France
| | - Nadia Aissaoui
- AP‐HP, Hôpital Européen Georges Pompidou Intensive Care Unit and Université Paris 5 Paris France
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Matsuura H, Ichida F, Saji T, Ogawa S, Waki K, Kaneko M, Tahara M, Soga T, Ono Y, Yasukochi S. Clinical Features of Acute and Fulminant Myocarditis in Children - 2nd Nationwide Survey by Japanese Society of Pediatric Cardiology and Cardiac Surgery. Circ J 2016; 80:2362-2368. [PMID: 27725476 DOI: 10.1253/circj.cj-16-0234] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The 1st nationwide survey by the Japanese Society of Pediatric Cardiology and Cardiac Surgery of acute or fulminant myocarditis (AMC/FMC) in children revealed that the survival rate of FMC was only 51.6%. The 2nd nationwide survey was performed to evaluate the recent outcomes of pediatric myocarditis.Methods and Results:Questionnaires regarding patients aged ≤18 years with AMC/FMC during the period from January 2006 to December 2011 were mailed. A total of 221 cases (age 6.5±5.3 years, 116 boys and 105 girls) were reported. There were 145 (65.6%) and 74 cases (33.5%) of AMC/FMC, respectively; the type of myocarditis was not reported in the remaining 2 cases (0.9%). Viruses were identified in 56 cases (25.3%), including coxsackie B in 9 and influenza A in 8. Histopathology by either endomyocardial biopsy or autopsy was obtained in 38 cases (19.2%). Intravenous immunoglobulin was effective in 49 (34.3%) of 143 cases. Steroid therapy was effective in 20 (32.8%) of 61 cases. Mechanical circulatory support was given in 54 cases (24.4%) and 94.2% of them were patients with FMC. The survival rates for the whole study population, acute myocarditis, and FMC were 75.6%, 91.0%, and 48.6%, respectively. CONCLUSIONS The survival rate of children with myocarditis was almost identical to that of 10 years ago. (Circ J 2016; 80: 2362-2368).
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Affiliation(s)
- Hiroyuki Matsuura
- The First Department of Pediatrics, Toho University School of Medicine
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Doñate Bertolín L, Torregrosa Puerta S, Montero Argudo JA. Asistencia mecánica circulatoria de corta duración. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rich MW, Chyun DA, Skolnick AH, Alexander KP, Forman DE, Kitzman DW, Maurer MS, McClurken JB, Resnick BM, Shen WK, Tirschwell DL. Knowledge Gaps in Cardiovascular Care of Older Adults: A Scientific Statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society: Executive Summary. J Am Geriatr Soc 2016; 64:2185-2192. [PMID: 27673575 DOI: 10.1111/jgs.14576] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older. Despite the effect of CVD on quality of life, morbidity, and mortality in older adults, individuals aged 75 and older have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older adults with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in nursing homes and assisted living facilities. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older adults typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision-making, and recommend future research to close existing knowledge gaps. To achieve these objectives, a detailed review was conducted of current American College of Cardiology/American Heart Association (ACC/AHA) and American Stroke Association (ASA) guidelines to identify content and recommendations that explicitly targeted older adults. A pervasive lack of evidence to guide clinical decision-making in older adults with CVD was found, as well as a paucity of data on the effect of diagnostic and therapeutic interventions on outcomes that are particularly important to older adults, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older adults representative of those seen in clinical practice and that incorporate relevant outcomes important to older adults in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older adults and enhance person-centered care of older individuals with CVD in the United States and around the world.
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Affiliation(s)
- Michael W Rich
- School of Medicine, Washington University, St. Louis, Missouri
| | | | - Adam H Skolnick
- Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, New York
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Daniel E Forman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Veterans Affairs, Geriatric, Research, Education, and Clinical Center, Pittsburgh, Pennsylvania
| | - Dalane W Kitzman
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | | | - James B McClurken
- RA Reif Heart Institute, Doylestown Hospital, Doylestown, Pennsylvania.,Temple University, Philadelphia, Pennsylvania
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Hammond DA, Smith MN, Lee KC, Honein D, Quidley AM. Acute Decompensated Heart Failure. J Intensive Care Med 2016; 33:456-466. [PMID: 27638544 DOI: 10.1177/0885066616669494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Heart failure (HF) is a societal burden due to its high prevalence, frequent admissions for acute decompensated heart failure (ADHF), and the economic impact of direct and indirect costs associated with HF and ADHF. Common etiologies of ADHF include medication and diet noncompliance, arrhythmias, deterioration in renal function, poorly controlled hypertension, myocardial infarction, and infections. Appropriate medical management of ADHF in patients is guided by the identification of signs and symptoms of fluid overload or low cardiac output and utilization of evidence-based practices. In patients with fluid overload, various strategies for diuresis or ultrafiltration may be considered. Depending on hemodynamics and patient characteristics, vasodilator, inotropic, or vasopressor therapies may be of benefit. Upon ADHF resolution, patients should be medically optimized, have lifestyle modifications discussed and implemented, and medication concierge service considered. After discharge, a multidisciplinary HF team should follow up with the patient to ensure a safe transition of care. This review article evaluates the management options and considerations when treating a patient with ADHF.
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Affiliation(s)
- Drayton A Hammond
- 1 Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA
| | - Melanie N Smith
- 2 Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Kristen C Lee
- 3 Department of Pharmacy, Orlando Regional Medical Center, Orlando, FL, USA
| | - Danielle Honein
- 4 Department of Pharmacy, Sarasota Memorial Hospital, Sarasota, FL, USA
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Van Mieghem NM, Daemen J, Lenzen MJ, Zandstra R, Malkin O, van Geuns RJM. The PulseCath iVAC 2L left ventricular assist device: conversion to a percutaneous transfemoral approach. EUROINTERVENTION 2016; 11:835-9. [PMID: 26603991 DOI: 10.4244/eijv11i7a168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This technical report describes the essentials and practical implantation technique of the completely percutaneous PulseCath iVAC 2L left ventricular assist device. METHODS AND RESULTS Percutaneously inserted mechanical left ventricular assist devices are used for circulatory support during cardiogenic shock or high-risk percutaneous coronary interventions. The PulseCath concept is a novel pulsatile design that consists of an extracorporeal membrane pump connected to a large-bore catheter which is inserted across the aortic valve retrogradely into the left ventricle. A genuine intra-aortic balloon pump (IABP) console drives the pulsatile pump. CONCLUSIONS The percutaneous PulseCath iVAC 2L is driven by a genuine IABP console and provides more left ventricular support.
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Affiliation(s)
- Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Aissaoui N, Puymirat E, Juilliere Y, Jourdain P, Blanchard D, Schiele F, Guéret P, Popovic B, Ferrieres J, Simon T, Danchin N. Fifteen-year trends in the management of cardiogenic shock and associated 1-year mortality in elderly patients with acute myocardial infarction: the FAST-MI programme. Eur J Heart Fail 2016; 18:1144-52. [DOI: 10.1002/ejhf.585] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 01/14/2023] Open
Affiliation(s)
- Nadia Aissaoui
- AP-HP, Hôpital Européen Georges Pompidou, Paris, France, and Université Paris-Descartes; Paris France
| | - Etienne Puymirat
- AP-HP, Hôpital Européen Georges Pompidou, Paris, France, and Université Paris-Descartes; Paris France
| | | | | | | | | | | | | | | | | | - Nicolas Danchin
- AP-HP, Hôpital Européen Georges Pompidou, Paris, France, and Université Paris-Descartes; Paris France
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Impact of Heart Transplantation on Survival in Patients on Venoarterial Extracorporeal Membrane Oxygenation at Listing in France. Transplantation 2016; 100:1979-87. [DOI: 10.1097/tp.0000000000001265] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Black MC, Schumer EM, Rogers M, Trivedi J, Slaughter MS. Sunshine Heart C-Pulse: device for NYHA Class III and ambulatory Class IV heart failure. Future Cardiol 2016; 12:521-31. [PMID: 27580008 DOI: 10.2217/fca-2016-0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
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. Advantages include shorter operative times without cardiopulmonary bypass, no reported strokes or thrombosis and no need for anticoagulation. Driveline exit site infections, inability to provide full circulatory support and poor function with intractable arrhythmias remain concerns. Current randomized controlled studies will evaluate long-term efficacy and safety compared with medical and resynchronization therapy.
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Affiliation(s)
- Matthew C Black
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Erin M Schumer
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Michael Rogers
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Jaimin Trivedi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
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Schmitto JD, Zimpfer D, Fiane AE, Larbalestier R, Tsui S, Jansz P, Simon A, Schueler S, Strueber M. Long-term support of patients receiving a left ventricular assist device for advanced heart failure: a follow-up analysis of the Registry to Evaluate the HeartWare Left Ventricular Assist System. Eur J Cardiothorac Surg 2016; 50:834-838. [DOI: 10.1093/ejcts/ezw224] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/09/2016] [Indexed: 11/13/2022] Open
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Alvarez P, Cordero-Reyes AM, Uribe C, De Hoyos P, Martinez D, Bhimaraj A, Trachtenberg BH, Ashrith G, Torre-Amione G, Loebe M, Amione-Guerra J, Rice L, Estep JD. Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices: Prevalence and Thrombotic Complications. J Card Fail 2016; 22:501-11. [DOI: 10.1016/j.cardfail.2015.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 12/12/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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Sajgalik P, Grupper A, Edwards BS, Kushwaha SS, Stulak JM, Joyce DL, Joyce LD, Daly RC, Kara T, Schirger JA. Current Status of Left Ventricular Assist Device Therapy. Mayo Clin Proc 2016; 91:927-40. [PMID: 27378038 DOI: 10.1016/j.mayocp.2016.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/22/2016] [Accepted: 05/03/2016] [Indexed: 02/05/2023]
Abstract
Congestive heart failure (HF) remains a serious burden in the Western World. Despite advances in pharmacotherapy and resynchronization, many patients have progression to end-stage HF. These patients may be candidates for heart transplant or left ventricular assist device (LVAD) therapy. Heart transplants are limited by organ shortages and in some cases by patient comorbidities; therefore, LVAD therapy is emerging as a strategy of bridge to transplant or as a destination therapy in patients ineligible for transplant. Patients initially ineligible for a transplant may, in certain cases, become eligible for transplant after physiologic improvement with LVAD therapy, and a small number of patients with an LVAD may have sufficient recovery of myocardial function to allow device explantation. This clinically oriented review will describe (1) the most frequently used pump types and aspects of the continuous-flow physiology and (2) the clinical indications for and the shift toward the use of LVADs in less sick patients with HF. Additionally, we review complications of LVAD therapy and project future directions in this field. We referred to the Interagency Registry for Mechanically Assisted Circulatory Support, landmark trials, and results from recently published studies as major sources in obtaining recent outcomes, and we searched for related published literature via PubMed. This review focuses primarily on clinical practice for primary care physicians and non-HF cardiologists in the United States.
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Affiliation(s)
- Pavol Sajgalik
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Cardioangiology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Avishay Grupper
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Brook S Edwards
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David L Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Lyle D Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Tomas Kara
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Cardioangiology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - John A Schirger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Yamamoto S, Hotta K, Ota E, Matsunaga A, Mori R. Exercise-based cardiac rehabilitation for people with ventricular assist devices. Hippokratia 2016. [DOI: 10.1002/14651858.cd012222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Shuhei Yamamoto
- Shinshu University Hospital; Department of Rehabilitation; 3-1-1 Asahi Matsumoto Nagano Japan
| | - Kazuki Hotta
- Florida State University College of Medicine; Department of Biomedical Sciences; 1115 West Call Street Tallahassee Florida USA 32306
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing Sciences; Global Health Nursing; 10-1 Akashi-cho Chuo-Ku Tokyo Japan 104-0044
| | - Atsuhiko Matsunaga
- Graduate School of Medical Sciences, Kitasato University; Department of Rehabilitation Sciences; 1-15-1 Kitasato Minami-ku, Sagamihara Kanagawa Japan
| | - Rintaro Mori
- National Center for Child Health and Development; Department of Health Policy; 2-10-1 Okura Setagaya-ku Tokyo Tokyo Japan 157-0074
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Ammirati E, Cipriani MG, Varrenti M, Colombo T, Garascia A, Cannata A, Pedrazzini G, Benazzi E, Milazzo F, Oliva F, Gagliardone MP, Russo CF, Frigerio M. A prospective comparison of mid-term outcomes in patients treated with heart transplantation with advanced age donors versus left ventricular assist device implantation. Interact Cardiovasc Thorac Surg 2016; 23:584-92. [DOI: 10.1093/icvts/ivw164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/26/2016] [Indexed: 11/13/2022] Open
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141
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In Vitro Thrombogenesis Resulting from Decreased Shear Rate and Blood Coagulability. Int J Artif Organs 2016; 39:194-9. [DOI: 10.5301/ijao.5000496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/20/2022]
Abstract
In vitro antithrombogenic testing with mock circulation is a useful type of pre-evaluation in ex vivo testing of mechanical assist devices. For effective in vitro testing, we have been developing a clear quantitative thrombogenesis model based on shear stress and blood coagulability. Bovine blood was used as the test medium. The activating clotting time (ACT) was adjusted with trisodium citrate and calcium chloride from 200 to 1,000 seconds. The blood was then applied to a rheometer and subjected to shear at 50 to 2,880 s-1. Blood coagulation time and degree of thrombogenesis were measured by the torque sensor of the rheometer. Prothrombin time (PT) and activated partial thromboplastin time (APTT) of the test blood were also measured after the application of shear. Blood coagulation time increased, and the degree of thrombogenesis decreased, with increases in shear rate to between 50 and 2,880 s-1. for test bloods with ACTs of 200 to 250 seconds. An ACT of 200 to 250 seconds is thus appropriate for in vitro antithrombogenic testing under a shear rate of 2,880 s-1. APTT was prolonged, whereas PT did not change, with increasing shear rate: that is, increasing the shear rate reduced thrombogenesis related to the intrinsic clotting pathway. An ACT of 200 to 250 seconds was suitable for in vitro antithrombogenic testing, and increasing the shear stress generated in the mechanical assist device reduced thrombogenesis via the intrinsic clotting pathway.
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Amornsawadwattana S, Nassif M, Raymer D, LaRue S, Chen CH. Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding. World J Gastroenterol 2016; 22:4559-4566. [PMID: 27182165 PMCID: PMC4858637 DOI: 10.3748/wjg.v22.i18.4559] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/17/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess whether video capsule endoscopy (VCE) affects the outcomes of left ventricular assist devices (LVADs) recipients with gastrointestinal bleeding.
METHODS: This is a retrospective study of LVAD recipients with obscure gastrointestinal bleeding (OGIB) who underwent VCE at a tertiary medical center between 2005 and 2013. All patients were admitted and monitored with telemetry and all VCE and subsequent endoscopic procedures were performed as inpatients. A VCE study was considered positive only when P2 lesions were found and was regarded as negative if P1 or P0 were identified. All patients were followed until heart transplant, death, or the end of the study.
RESULTS: Between 2005 and 2013, 30 patients with LVAD underwent VCE. Completion rate of VCE was 93.3% and there was no capsule retention. No interference of VCE recording or the function of LVAD was found. VCE was positive in 40% of patients (n = 12). The most common finding was active small intestinal bleeding (50%) and small intestinal angiodysplasia (33.3%). There was no difference in the rate of recurrent bleeding between patients with positive and negative VCE study (50.0% vs 55.6%, P = 1.00) during an average of 11.6 ± 9.6 mo follow up. Among patients with positive VCE, the recurrent bleeding rate did not differ whether subsequent endoscopy was performed (50% vs 50%, P = 1.00).
CONCLUSION: VCE can be safely performed in LVAD recipients with a diagnostic yield of 40%. VCE does not affect recurrent bleeding in LVAD patients regardless of findings.
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143
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Rich MW, Chyun DA, Skolnick AH, Alexander KP, Forman DE, Kitzman DW, Maurer MS, McClurken JB, Resnick BM, Shen WK, Tirschwell DL. Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society. J Am Coll Cardiol 2016; 67:2419-2440. [PMID: 27079335 DOI: 10.1016/j.jacc.2016.03.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world.
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Rich MW, Chyun DA, Skolnick AH, Alexander KP, Forman DE, Kitzman DW, Maurer MS, McClurken JB, Resnick BM, Shen WK, Tirschwell DL. Knowledge Gaps in Cardiovascular Care of the Older Adult Population. Circulation 2016; 133:2103-22. [DOI: 10.1161/cir.0000000000000380] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Toyama H, Takei Y, Saito K, Ota T, Kurotaki K, Ejima Y, Matsuura T, Akiyama M, Saiki Y, Yamauchi M. Management of three cardiogenic pulmonary edemas occurring in a patient scheduled for left ventricular assist device implantation: indicators for determining left ventricular assist device pump speed. J Anesth 2016; 30:711-5. [PMID: 27001080 DOI: 10.1007/s00540-016-2163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
A male patient with Marfan syndrome underwent aortic root replacement and developed left ventricular (LV) failure. Four years later, he underwent aortic arch and aortic valve replacement. Thereafter, his LV failure progressed, and cardiogenic pulmonary edema (CPE) appeared, which we treated with extracorporeal LV assist device (LVAD) placement. Three months later, the patient developed aspiration pneumonia, which caused hyperdynamic right ventricle (RV) and CPE. We treated by changing his pneumatic LVAD to a high-flow centrifugal pump. A month later, he underwent thoracoabdominal aortic replacement. After four weeks, he developed septic thrombosis and LVAD failure, which caused CPE. We treated with LVAD circuit replacement and an additional membrane oxygenator. Four months later, he underwent DuraHeart(®) implantation. During this course, pulmonary artery wedge pressure (PAWP) varied markedly. Additionally, systolic pulmonary artery pressure (sPAP), left atrial diameter (LAD), RV end-diastolic diameter (RVEDD) and estimated RV systolic pressure (esRVP) changed with PAWP changes. In this patient, LV failure and hyperdynamic RV caused the CPEs, which we treated by adjusting the LVAD output to the RV output. Determining LVAD output, RV function and LV end-diastolic diameter are typically referred, and PAWP, LAD, RVEDD, and sPAP could be also referred.
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Affiliation(s)
- Hiroaki Toyama
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Yusuke Takei
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazutomo Saito
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takahisa Ota
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kenji Kurotaki
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yutaka Ejima
- Division of Surgical Center and Supply, Sterilization, Tohoku University Hospital, Sendai, Japan
| | - Takeshi Matsuura
- Division of Clinical Engineering, Tohoku University Hospital, Sendai, Japan
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masanori Yamauchi
- Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Capítulo 12. Dispositivos de asistencia ventricular: una realidad en Colombia. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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147
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Colvin M, Miranda-Herrera D, Gustafson SK, Heubner B, Skeans M, Wang X, Snyder JJ, Kasiske BL, Israni AK. Impact of increased time at the highest urgency category on heart transplant outcomes for candidates with ventricular assist devices. J Heart Lung Transplant 2016; 35:326-334. [DOI: 10.1016/j.healun.2015.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/22/2015] [Accepted: 10/03/2015] [Indexed: 11/17/2022] Open
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148
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Khorsandi M, Shaikhrezai K, Prasad S, Pessotto R, Walker W, Berg G, Zamvar V. Advanced mechanical circulatory support for post-cardiotomy cardiogenic shock: a 20-year outcome analysis in a non-transplant unit. J Cardiothorac Surg 2016; 11:29. [PMID: 26892226 PMCID: PMC4758144 DOI: 10.1186/s13019-016-0430-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Post-cardiotomy cardiogenic shock (PCCS) has an incidence of 2–6 % after routine adult cardiac surgery. 0.5–1.5 % are refractory to inotropic and intra-aortic balloon pump (IABP) support. Advanced mechanical circulatory support (AMCS) can be used to salvage carefully selected number of such patients. High costs and major complication rates have lead to centralization and limited funding for such devices in the UK. We have looked the outcomes of such devices in a non-transplant, intermediate-size adult cardiothoracic surgery unit. Methods Inclusion criteria included any adult patient who had received salvage veno-arterial extra-corporeal membrane oxygenation (V-A ECMO) or a ventricular assist device (VAD) for PCCS refractory to IABP and inotropic support following cardiac surgery from April 1995-April 2015. Results Sixteen patients met the inclusion criteria. Age range was 34–83 years (median 71). There was a male predominance of 12 (75 %). Overall, 15 (94 %) had received ECMO of which, 10 (67 %) had received central ECMO and 5 (33 %) had received peripheral ECMO. One patient (6 %) had a VAD. The most common complication was haemorrhage. Stroke, femoral artery pseudo-aneurysm, sepsis and renal failure also occurred. Thirty-day survival was 37.5 %. Survival rate to hospital discharge was 31.2 %. All survivors had NYHA class I-II at 24 months follow-up. Conclusions Our survival rate is similar to that reported in several previous studies. However, the use of AMCS for refractory PCCS is associated with serious complications. The survivors in our cohort appear to maintain an acceptable quality of life.
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Affiliation(s)
- Maziar Khorsandi
- Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Kasra Shaikhrezai
- Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Sai Prasad
- Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Renzo Pessotto
- Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William Walker
- Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Geoffrey Berg
- Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Vipin Zamvar
- Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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149
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Fukuhara S, Takeda K, Garan AR, Kurlansky P, Hastie J, Naka Y, Takayama H. Contemporary mechanical circulatory support therapy for postcardiotomy shock. Gen Thorac Cardiovasc Surg 2016; 64:183-91. [DOI: 10.1007/s11748-016-0625-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Indexed: 10/22/2022]
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150
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Valerio L, Tran PL, Sheriff J, Brengle W, Ghosh R, Chiu WC, Redaelli A, Fiore GB, Pappalardo F, Bluestein D, Slepian MJ. Aspirin has limited ability to modulate shear-mediated platelet activation associated with elevated shear stress of ventricular assist devices. Thromb Res 2016; 140:110-117. [PMID: 26938158 DOI: 10.1016/j.thromres.2016.01.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 01/25/2016] [Accepted: 01/31/2016] [Indexed: 10/22/2022]
Abstract
Continuous flow ventricular assist devices (cfVADs) while effective in advanced heart failure, remain plagued by thrombosis related to abnormal flows and elevated shear stress. To limit cfVAD thrombosis, patients utilize complex anti-thrombotic regimens built upon a foundation of aspirin (ASA). While much data exists on ASA as a modulator of biochemically-mediated platelet activation, limited data exists as to the efficacy of ASA as a means of limiting shear-mediated platelet activation, particularly under elevated shear stress common within cfVADs. We investigated the ability of ASA (20, 25 and 125 μM) to limit shear-mediated platelet activation under conditions of: 1) constant shear stress (30 dynes/cm(2) and 70 dynes/cm(2)); 2) dynamic shear stress, and 3) initial high shear exposure (70 dynes/cm(2)) followed by low shear exposure - i.e. a platelet sensitization protocol, utilizing a hemodynamic shearing device providing uniform shear stress in vitro. The efficacy of ASA to limit platelet activation mediated via passage through a clinical cfVAD system (DeBakey Micromed) in vitro was also studied. ASA reduced platelet activation only under conditions of low shear stress (38% reduction compared to control, n=10, p<0.004), with minimal protection at higher shear stress and under dynamic conditions (n=10, p>0.5) with no limitation of platelet sensitization. ASA had limited ability (25.6% reduction in platelet activation rate) to modulate shear-mediated platelet activation induced via cfVAD passage. These findings, while performed under "deconstructed" non-clinical conditions by utilizing purified platelets alone in vitro, provide a potential contributory mechanistic explanation for the persistent thrombosis rates experienced clinically in cfVAD patients despite ASA therapy. An opportunity exists to develop enhanced pharmacologic strategies to limit shear-mediated platelet activation at elevated shear levels associated with mechanical circulatory support devices.
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Affiliation(s)
- Lorenzo Valerio
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy; Department of Cardiothoracic Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Milan, Italy.
| | - Phat L Tran
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Jawaad Sheriff
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - William Brengle
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Ram Ghosh
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Wei-Che Chiu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Alberto Redaelli
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Gianfranco B Fiore
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Federico Pappalardo
- Department of Cardiothoracic Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Milan, Italy
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Marvin J Slepian
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA; Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ, USA; Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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