1
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Jeyakumar S, Nguyen H, Robson D, Olsen N, Schnegg B, Macdonald P, Fraser CL, Liew G, Jiang J, Hayward C, Muthiah K. Retinal microvascular remodeling associates with adverse events in continuous-flow left ventricular assist device supported patients. J Heart Lung Transplant 2024:S1053-2498(24)01750-9. [PMID: 39089605 DOI: 10.1016/j.healun.2024.07.017] [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: 12/14/2023] [Revised: 06/13/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Continuous-flow left ventricular assist device (cfLVAD) use is effective in supporting patients with end-stage heart failure (ESHF). Reduced flow pulsatility within the systemic circulation in cfLVAD-supported patients may lead to alterations within the microcirculation. Temporal changes in microvasculature in relation to adverse events in cfLVAD supported patients has not been studied. We aimed to profile changes within retinal microvasculature and its association with adverse events. METHODS Retinal photography was performed using Topcon TRC-NW8 non-mydriatic fundus camera in cfLVAD supported patients and ESHF control patients. Retinal measurements including arteriolar and venular caliber, fractal dimension, branching angle, and vessel tortuosity were evaluated using a validated semi-automated program. Demographic and adverse event data were documented. RESULTS 172 images were recorded from 48 patients (n=29 cfLVAD, n=19 ESHF, mean age 54.2 ± 11.9 years). There were significant trends in retinal arteriolar caliber (B = -0.53 µm, 95% CI: -0.96 - -0.10, p = 0.016) and retinal fractal dimension parameters (B = 0.014, 95% CI: 0.001 - 0.002, p = 0.016) in linear mixed model regressions. Amongst cfLVAD patients, there was a significant association between the incidence of gastrointestinal bleeding and stepwise increases in retinal arteriolar-venular caliber ratio (HR: 3.03, 95% CI: 2.06 - 4.45, p = 0.005), a measure of arteriolar narrowing. CONCLUSIONS We have observed for the first time that alterations in retinal microvasculature in cfLVAD-supported patients may be associated with gastrointestinal bleeding. While understanding these temporal changes may predict future adverse events in cfLVAD-supported patients, further multi-center studies are required to confirm the associations observed.
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Affiliation(s)
| | - Helen Nguyen
- Westmead Institute for Medical Research, The University of Sydney
| | | | | | | | - Peter Macdonald
- University of New South Wales Sydney; St. Vincent's Hospital Sydney; Victor Chang Cardiac Research Institute
| | | | - Gerald Liew
- University of New South Wales Sydney; Westmead Institute for Medical Research, The University of Sydney
| | | | - Christopher Hayward
- University of New South Wales Sydney; St. Vincent's Hospital Sydney; Victor Chang Cardiac Research Institute
| | - Kavitha Muthiah
- University of New South Wales Sydney; St. Vincent's Hospital Sydney; Victor Chang Cardiac Research Institute.
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2
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Hough R, Dunn JL, Hepburn LA. Re-imagining the future state of the ventricular assist device controller interface through human-centered design. Artif Organs 2024. [PMID: 39016684 DOI: 10.1111/aor.14817] [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: 02/03/2024] [Revised: 06/01/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Ventricular assist devices (VADs) are effective therapy for patients with end-stage heart failure. Current VAD controllers offer improved interactivity, yet limitations of the visual, tactile, and auditory interface persist that impact patient experience and quality of life (QoL). This study explores how VAD controllers can be redesigned using a human-centered design approach to enhance the emotional and functional experience of the device for patients. METHODS VAD patients (n = 21), caregivers (n = 4) and healthcare practitioners (n = 24) were interviewed to uncover design opportunities. From this, a series of realistic scenarios to design for emerged. A "design by analogy" method took inspiration from existing consumer products to ideate new functionality for the VAD wearable system, creating concepts for a controller interface and paired wearable device. An additional 15 patients and 2 caregivers were engaged to explore current VAD controller experiences and evaluate the future-state concepts. RESULTS This research validated the need for increased automation and emergency functionality in VAD controllers, including remote monitoring of data, accurate communication of battery status, and automated medical alerts for critical device alarms. "Manage my health," "Feeling normal," "Social belonging," "Feeling safe," and "Sense of control" emerged as key patient concerns to be met by future VAD controller designs. CONCLUSIONS The study demonstrated an innovative and relevant approach to improve usability of future VAD peripherals. By considering both emotional and functional perspectives in the design of lifesaving medical devices such as VADs, device manufacturers can uncover new opportunities to improve patient QoL through improved user experiences.
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Affiliation(s)
- Rosie Hough
- School of Architecture, Design and Planning, University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Lea Dunn
- School of Architecture, Design and Planning, University of Sydney, Sydney, New South Wales, Australia
| | - Leigh-Anne Hepburn
- School of Architecture, Design and Planning, University of Sydney, Sydney, New South Wales, Australia
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3
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Kummerow M, von Dossow V, Pasero D, Martinez Lopez de Arroyabe B, Abrams B, Kowalsky M, Wilkey BJ, Subramanian K, Martin AK, Marczin N, de Waal EEC. PERSUADE Survey-PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States. J Cardiothorac Vasc Anesth 2024; 38:197-206. [PMID: 37980193 DOI: 10.1053/j.jvca.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To comprehensively assess relevant institutional variations in anesthesia and intensive care management during left ventricular assist device (LVAD) implantation. DESIGN The authors used a prospective data analysis. SETTING This was an online survey. PARTICIPANTS Participants were from LVAD centers in Europe and the US. INTERVENTIONS After investigating initial interest, 91 of 202 European and 93 of 195 US centers received a link to the survey targeting institutional organization and experience, perioperative hemodynamic monitoring, medical management, and postoperative intensive care aspects. MEASUREMENTS AND MAIN RESULTS The survey was completed by 73 (36.1%) European and 60 (30.8%) US centers. Although most LVAD implantations were performed in university hospitals (>5 years of experience), significant differences were observed in the composition of the preoperative multidisciplinary team and provision of intraoperative care. No significant differences in monitoring or induction agents were observed. Propofol was used more often for maintenance in Europe (p < 0.001). The choice for inotropes changed significantly from preoperatively (more levosimendan in Europe) to intraoperatively (more use of epinephrine in both Europe and the US). The use of quantitative methods for defining right ventricular (RV) function was reported more often from European centers than from US centers (p < 0.05). Temporary mechanical circulatory support for the treatment of RV failure was more often used in Europe. Nitric oxide appeared to play a major role only intraoperatively. There were no significant differences in early postoperative complications reported from European versus US centers. CONCLUSIONS Although the perioperative practice of care for patients undergoing LVAD implantation differs in several aspects between Europe and the US, there were no perceived differences in early postoperative complications.
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Affiliation(s)
- Maren Kummerow
- Department of Anesthesiology and Intensive Care Medicine, Mathias-Spital Rheine, Rheine, Germany
| | - Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center North Rhine-Westphalia, University Clinic of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Daniela Pasero
- Department of Anesthesiology and Intensive Care, University Hospital, Sassari, Italy
| | | | - Benjamin Abrams
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Markus Kowalsky
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Barbara J Wilkey
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathirvel Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, Pittsburgh, PA
| | - Archer K Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - Nandor Marczin
- Division of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, Royal Brompton & Harefield Hospitals, Guy's & St. Thomas' NHS, London, United Kingdom; Department of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
| | - Eric E C de Waal
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
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4
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Sweeney J, Pahwa S, Trivedi J, Slaughter MS. Durable left ventricular assist device implant-how I teach it. Indian J Thorac Cardiovasc Surg 2023; 39:114-122. [PMID: 37525699 PMCID: PMC10387025 DOI: 10.1007/s12055-023-01533-4] [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: 02/21/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 08/02/2023] Open
Abstract
Left ventricular assist devices (LVADs) have become a mainstay of advanced heart failure therapy. The technical aspects of performing a device implant are nuanced and attention to these details allows for successful therapy with good outcomes. As more patient with heart failure are expected to benefit from mechanical circulatory support, the need for a concise and consistent technique for LVAD implantation is needed. Teaching this procedure is most comprehensible when broken down into separate steps, as with many other procedures. Here, we describe our standard protocol for LVAD implantation, as well as rudimentary outcomes of 6-year experience in our center. We hope this will provide some insight and guidance to centers who are expanding into the field of mechanical circulatory support and can help them form a foundation with which to build their own experience and success.
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Affiliation(s)
- Joseph Sweeney
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA
| | - Siddharth Pahwa
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA
| | - Jaimin Trivedi
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA
| | - Mark Sullivan Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA
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Gambato M, Scotti N, Borsari G, Zambon Bertoja J, Gabrieli JD, De Cassai A, Cester G, Navalesi P, Quaia E, Causin F. Chest X-ray Interpretation: Detecting Devices and Device-Related Complications. Diagnostics (Basel) 2023; 13:599. [PMID: 36832087 PMCID: PMC9954842 DOI: 10.3390/diagnostics13040599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
This short review has the aim of helping the radiologist to identify medical devices when interpreting a chest X-ray, as well as looking for their most commonly detectable complications. Nowadays, many different medical devices are used, often together, especially in critical patients. It is important for the radiologist to know what to look for and to remember the technical factors that need to be considered when checking each device's positioning.
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Affiliation(s)
- Marco Gambato
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Nicola Scotti
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Giacomo Borsari
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Jacopo Zambon Bertoja
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | | | - Alessandro De Cassai
- Anesthesia and Intensive Care Unit, University Hospital of Padova, 35121 Padua, Italy
| | - Giacomo Cester
- Department of Neuroradiology, University Hospital of Padova, 35121 Padua, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
- Institute of Radiology, University Hospital of Padova, 35121 Padua, Italy
| | - Francesco Causin
- Department of Neuroradiology, University Hospital of Padova, 35121 Padua, Italy
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6
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Read JM, Azih NI, Peters CJ, Gurtu V, Vishram-Nielsen JK, Wright SP, Alba AC, Gregoski MJ, Pilch NA, Hsu S, Genuardi MV, Inampudi C, Jackson GR, Pope N, Witer LP, Kilic A, Houston BA, Mak S, Birati EY, Tedford RJ. Hemodynamic reserve predicts early right heart failure after LVAD implantation. J Heart Lung Transplant 2022; 41:1716-1726. [PMID: 35934606 PMCID: PMC10729844 DOI: 10.1016/j.healun.2022.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/09/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early right heart failure (RHF) remains a major source of morbidity and mortality after left ventricular assist device (LVAD) implantation, yet efforts to predict early RHF have proven only modestly successful. Pharmacologic unloading of the left ventricle may be a risk stratification approach allowing for assessment of right ventricular and hemodynamic reserve. METHODS We performed a multicenter, retrospective analysis of patients who had undergone continuous-flow LVAD implantation from October 2011 to April 2020. Only those who underwent vasodilator testing with nitroprusside during their preimplant right heart catheterization were included (n = 70). Multivariable logistic regression was used to determine independent predictors of early RHF as defined by Mechanical Circulatory Support-Academic Research Consortium. RESULTS Twenty-seven patients experienced post-LVAD early RHF (39%). Baseline clinical characteristics were similar between patients with and without RHF. Patients without RHF, however, achieved higher peak stroke volume index (SVI) (30.1 ± 8.8 vs 21.7 ± 7.4 mL/m2; p < 0.001; AUC: 0.78; optimal cut-point: 22.1 mL/m2) during nitroprusside administration. Multivariable analysis revealed that peak SVI was significantly associated with early RHF, demonstrating a 16% increase in risk of early RHF per 1 ml/m2 decrease in SVI. A follow up cohort of 10 consecutive patients from July 2020 to October 2021 resulted in all patients being categorized appropriately in regards to early RHF versus no RHF according to peak SVI. CONCLUSION Peak SVI with nitroprusside administration was independently associated with post-LVAD early RHF while resting hemodynamics were not. Vasodilator testing may prove to be a strong risk stratification tool when assessing LVAD candidacy though additional prospective validation is needed.
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Affiliation(s)
| | | | - Carli J Peters
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Vikram Gurtu
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Julie K Vishram-Nielsen
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Stephen P Wright
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ana Carolina Alba
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Mathew J Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Nicole A Pilch
- Deparment of Pharmacy, Medical University of South Carolina, Charleston, SC
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, John Hopkins School of Medicine, Baltimore, MD
| | - Michael V Genuardi
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Gregory R Jackson
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Nicholas Pope
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Lucas P Witer
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Arman Kilic
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Brian A Houston
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Susanna Mak
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Edo Y Birati
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Cardiovascular Division, Poriya Medical Center, Bar Ilan University, Isreal
| | - Ryan J Tedford
- Division of Cardiology, Medical University of South Carolina, Charleston, SC.
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7
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Hernandez NS, Kanter M, Sharma V, Wang A, Kiernan M, Kryzanski D, Heller R, Nail T, Riesenburger RI, Kryzanski JT. Radiographic risk factors for intracranial hemorrhage in patients with left ventricular assist devices. J Stroke Cerebrovasc Dis 2022; 31:106869. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
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8
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Erdoğan SB, Barutça H, Bastopcu M, Sargın M, Albeyoğlu Ş. Is pectoralis muscle index a risk factor for mortality in left ventricular assist device patients? Rev Assoc Med Bras (1992) 2022; 68:1692-1697. [PMID: 36449796 PMCID: PMC9779975 DOI: 10.1590/1806-9282.20220744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/17/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We aimed to investigate whether sarcopenia measured from pectoralis muscles is a risk factor for long-term mortality in left ventricular assist device patients. METHODS Patients aged >18 years implanted with a left ventricular assist device in a single center between 2013 and 2019 were retrospectively included. Patients without a thoracic computed tomography scan performed within 3 months of left ventricular assist device implantation and without computed tomography scans appropriate for pectoralis muscle measurement were excluded. Pectoralis muscle measurements were made on thoracic computed tomography slices, and pectoralis muscle indices were calculated for each patient. Sarcopenia was defined as being in the gender-specific lowest tertile of pectoralis muscle index. Survival was compared between patients with and without sarcopenia. RESULTS The study was conducted on 64 left ventricular assist device patients who met the inclusion criteria. Notably, 21 (32.8%) of the study patients were sarcopenic. Diabetes mellitus and sarcopenia were more common in patients with 2-year mortality in our cohort. Patients with sarcopenia had a worse 2-year survival (p<0.001). Sarcopenia had an adjusted hazard ratio of 4.04 (95% confidence interval (CI) 1.36-12.02, p=0.012), while diabetes mellitus was associated with an adjusted hazard ratio of 3.14 (95%CI 1.17-8.39, p=0.023). CONCLUSION Sarcopenia defined by low pectoralis muscle index increases the risk for 2-year mortality in left ventricular assist device patients.
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Affiliation(s)
- Sevinç Bayer Erdoğan
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery – Istanbul, Turkey.,Corresponding author:
| | - Hakan Barutça
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Radiology – Istanbul, Turkey
| | - Murat Bastopcu
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery – Istanbul, Turkey
| | - Murat Sargın
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery – Istanbul, Turkey
| | - Şebnem Albeyoğlu
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery – Istanbul, Turkey
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9
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Jedrzejewska A, Braczko A, Kawecka A, Hellmann M, Siondalski P, Slominska E, Kutryb-Zajac B, Yacoub MH, Smolenski RT. Novel Targets for a Combination of Mechanical Unloading with Pharmacotherapy in Advanced Heart Failure. Int J Mol Sci 2022; 23:9886. [PMID: 36077285 PMCID: PMC9456495 DOI: 10.3390/ijms23179886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 12/19/2022] Open
Abstract
LVAD therapy is an effective rescue in acute and especially chronic cardiac failure. In several scenarios, it provides a platform for regeneration and sustained myocardial recovery. While unloading seems to be a key element, pharmacotherapy may provide powerful tools to enhance effective cardiac regeneration. The synergy between LVAD support and medical agents may ensure satisfying outcomes on cardiomyocyte recovery followed by improved quality and quantity of patient life. This review summarizes the previous and contemporary strategies for combining LVAD with pharmacotherapy and proposes new therapeutic targets. Regulation of metabolic pathways, enhancing mitochondrial biogenesis and function, immunomodulating treatment, and stem-cell therapies represent therapeutic areas that require further experimental and clinical studies on their effectiveness in combination with mechanical unloading.
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Affiliation(s)
- Agata Jedrzejewska
- Department of Biochemistry, Medical University of Gdansk, Debinki 1 Street, 80-211 Gdansk, Poland
| | - Alicja Braczko
- Department of Biochemistry, Medical University of Gdansk, Debinki 1 Street, 80-211 Gdansk, Poland
| | - Ada Kawecka
- Department of Biochemistry, Medical University of Gdansk, Debinki 1 Street, 80-211 Gdansk, Poland
| | - Marcin Hellmann
- Department of Cardiac Diagnostics, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Piotr Siondalski
- Department of Cardiac Surgery, Medical University of Gdansk, Debinki 7 Street, 80-211 Gdansk, Poland
| | - Ewa Slominska
- Department of Biochemistry, Medical University of Gdansk, Debinki 1 Street, 80-211 Gdansk, Poland
| | - Barbara Kutryb-Zajac
- Department of Biochemistry, Medical University of Gdansk, Debinki 1 Street, 80-211 Gdansk, Poland
| | - Magdi H. Yacoub
- Heart Science Centre, Imperial College of London at Harefield Hospital, Harefield UB9 6JH, UK
| | - Ryszard T. Smolenski
- Department of Biochemistry, Medical University of Gdansk, Debinki 1 Street, 80-211 Gdansk, Poland
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10
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Zhao X, Zhao L, Xu J, Li D, Li H, Li Y, Chen H, Zhang Y. Aortic valve opening in mock-loop with continuous-flow left ventricular assist device. Int J Artif Organs 2022; 45:809-816. [PMID: 35818176 DOI: 10.1177/03913988221111811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The appropriate opening of aortic valves is crucial for heart failure (HF) patients with left ventricular assist devices (LVADs). Nevertheless, up to the present time, aortic valve monitoring has not been performed in discharged patients. In this study, a mock-loop platform was developed to investigate the aortic valve performance in LVAD patients. An additional sluice valve was placed next to the aortic valve that when the sluice valve is manually closed, the aortic valve will remain closed; when the sluice valve is open, the aortic valve is opened or closed upon the pressures. The results showed that when the LVAD speed was below 2600 rpm, the aortic valve can be intermittently opened, while when the LVAD speed was over 2600 rpm, the aortic valve was persistently closed. The left ventricular end-systolic pressure (LVESP) was found to be an indicator of aortic valve closure that, upon the aortic valve closure LVESP suddenly decreased. The LVESP is suggested for future monitoring the status of the aortic valve for patients with implanted LVADs. The effects of heart failure (HF) degrees, circulation resistance, and aortic compliance on aortic valve closure were further studied. The results revealed that LVAD implantation in patients with early HF degrees will help to avoid persistent aortic valve closure.
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Affiliation(s)
- Xiang Zhao
- School of Medicine, Tsinghua University (School of Medicine) - RocketHeart Co. Ltd Joint Research Center for Artificial Heart, Tsinghua University, Beijing, China.,School of Mechanical Engineering, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
| | - Luxiang Zhao
- School of Medicine, Tsinghua University (School of Medicine) - RocketHeart Co. Ltd Joint Research Center for Artificial Heart, Tsinghua University, Beijing, China.,School of Mechanical Engineering, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
| | - Jian Xu
- School of Medicine, Tsinghua University (School of Medicine) - RocketHeart Co. Ltd Joint Research Center for Artificial Heart, Tsinghua University, Beijing, China
| | - Donghai Li
- Advanced Medical Research Institute, Shandong University, Shandong, China
| | - Heping Li
- Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Yongjian Li
- School of Mechanical Engineering, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
| | - Haosheng Chen
- School of Mechanical Engineering, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
| | - Yu Zhang
- School of Medicine, Tsinghua University (School of Medicine) - RocketHeart Co. Ltd Joint Research Center for Artificial Heart, Tsinghua University, Beijing, China
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11
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Zhalbinova MR, Rakhimova SE, Kozhamkulov UA, Akilzhanova GA, Kaussova GK, Akilzhanov KR, Pya YV, Lee JH, Bekbossynova MS, Akilzhanova AR. Association of Genetic Polymorphisms with Complications of Implanted LVAD Devices in Patients with Congestive Heart Failure: A Kazakhstani Study. J Pers Med 2022; 12:jpm12050744. [PMID: 35629166 PMCID: PMC9143784 DOI: 10.3390/jpm12050744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
The left ventricular assist device (LVAD) is one of the alternative treatments for heart failure (HF) patients. However, LVAD support is followed by thrombosis, and bleeding complications which are caused by high non-physiologic shear stress and antithrombotic/anticoagulant therapy. A high risk of complications occurs in the presence of the genotype polymorphisms which are involved in the coagulation system, hemostasis function and in the metabolism of the therapy. The aim of the study was to investigate the influence of single-nucleotide polymorphisms (SNP) in HF patients with LVAD complications. We analyzed 21 SNPs in HF patients (n = 98) with/without complications, and healthy controls (n = 95). SNPs rs9934438; rs9923231 in VKORC1, rs5918 in ITGB3 and rs2070959 in UGT1A6 demonstrated significant association with HF patients’ complications (OR (95% CI): 3.96 (1.42–11.02), p = 0.0057), (OR (95% CI): 3.55 (1.28–9.86), p = 0.011), (OR (95% CI): 5.37 (1.79–16.16), p = 0.0056) and OR (95% CI): 4.40 (1.06–18.20), p = 0.044]. Genotype polymorphisms could help to predict complications at pre- and post-LVAD implantation period, which will reduce mortality rate. Our research showed that patients can receive treatment with warfarin and aspirin with a personalized dosage and LVAD complications can be predicted by reference to their genotype polymorphisms in VKORC1, ITGB3 and UGT1A6 genes.
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Affiliation(s)
- Madina R. Zhalbinova
- National Laboratory Astana, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.R.Z.); (S.E.R.); (U.A.K.)
- Department of General Biology and Genomics, L. N. Gumilyov Eurasian National University, Nur-Sultan 010000, Kazakhstan
| | - Saule E. Rakhimova
- National Laboratory Astana, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.R.Z.); (S.E.R.); (U.A.K.)
| | - Ulan A. Kozhamkulov
- National Laboratory Astana, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.R.Z.); (S.E.R.); (U.A.K.)
| | - Gulbanu A. Akilzhanova
- Semey Medical University, Pavlodar Branch, Pavlodar 140000, Kazakhstan; (G.A.A.); (K.R.A.)
| | | | - Kenes R. Akilzhanov
- Semey Medical University, Pavlodar Branch, Pavlodar 140000, Kazakhstan; (G.A.A.); (K.R.A.)
| | - Yuriy V. Pya
- National Research Cardiac Surgery Center, Nur-Sultan 010000, Kazakhstan; (Y.V.P.); (M.S.B.)
| | - Joseph H. Lee
- Sergievsky Center, Taub Institute, Columbia University Irving Medical Centerx, 630 W, New York, NY 10032, USA;
| | | | - Ainur R. Akilzhanova
- National Laboratory Astana, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.R.Z.); (S.E.R.); (U.A.K.)
- Department of General Biology and Genomics, L. N. Gumilyov Eurasian National University, Nur-Sultan 010000, Kazakhstan
- Correspondence: ; Tel.: +7-7172-706501
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12
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Martinolli M, Cornat F, Vergara C. Computational Fluid-Structure Interaction Study of a New Wave Membrane Blood Pump. Cardiovasc Eng Technol 2021; 13:373-392. [PMID: 34773241 DOI: 10.1007/s13239-021-00584-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/13/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Wave membrane blood pumps (WMBP) are novel pump designs in which blood is propelled by means of wave propagation by an undulating membrane. In this paper, we computationally studied the performance of a new WMBP design (J-shaped) for different working conditions, in view of potential applications in human patients. METHODS Fluid-structure interaction (FSI) simulations were conducted in 3D pump geometries and numerically discretized by means of the extended finite element method (XFEM). A contact model was introduced to capture membrane-wall collisions in the pump head. Mean flow rate and membrane envelope were determined to evaluate hydraulic performance. A preliminary hemocompatibility analysis was performed via calculation of fluid shear stress. RESULTS Numerical results, validated against in vitro experimental data, showed that the hydraulic output increases when either the frequency or the amplitude of membrane oscillations were higher, with limited increase in the fluid stresses, suggesting good hemocompatibility properties. Also, we showed better performance in terms of hydraulic power with respect to a previous design of the pump. We finally studied an operating point which achieves physiologic flow rate target at diastolic head pressure of 80 mmHg. CONCLUSION A new design of WMBP was computationally studied. The proposed FSI model with contact was employed to predict the new pump hydraulic performance and it could help to properly select an operating point for the upcoming first-in-human trials.
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Affiliation(s)
- Marco Martinolli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | | | - Christian Vergara
- LaBS, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milan, Italy.
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13
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Rossi Ferrario S, Panzeri A, Pistono M. Psychological difficulties of LVAD patients and caregivers: A follow up over 1 year from discharge. Artif Organs 2021; 46:479-490. [PMID: 34519060 PMCID: PMC9292387 DOI: 10.1111/aor.14071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022]
Abstract
Background After the rehabilitation program, patients with left ventricular assist device (LVAD) are discharged home, but the adaption to the daily life with the implant is challenging, both with practical and psychological consequences. Literature is lacking detailed information about the quality of life of LVAD patients and caregivers after discharge to home. Objective This study aimed at evaluating the post‐discharge outcomes of both LVAD patients and their caregivers in terms of quality of life, affectivity, and psychological health. Methods In this observational follow‐up study, LVAD dyads discharged home from 1 year to 6 years were re‐contacted by phone and received by mail an envelope with self‐report questionnaires. Responses of 39 complete dyads of patients (mean age 68.59 ± 4.31; males: 92.31%) and their caregivers (mean age 61.59 ± 11.64; males: 17.95%) were analyzed. Results Patients and caregivers reported the moderate levels of anxiety, depression, and caregiver strain, and Illness denial and conscious avoidance were associated between them. The couples often reported that the LVAD has impairments for their sleep and for their affective–sexual relationship. Caregivers often reported impairment in social life and self‐care. Discussions Despite the satisfaction for the medical and territorial assistance, patients showed psychological difficulties such as anxious and depressive symptoms and caregivers tend to neglect themselves. Even after a long time from discharge to home, the psychological distress of LVAD patients and caregivers is still considerable. Structured and continuous psychological interventions are required to support their psychological health overtime after the discharge to home.
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Affiliation(s)
- Silvia Rossi Ferrario
- Unit of Psychology-Neuropsychology, IRCCS ICS Maugeri, Institute of Veruno, Veruno, Italy
| | - Anna Panzeri
- Department of General Psychology, University of Padua, Padova, Italy
| | - Massimo Pistono
- Unit of Cardiology, IRCCS ICS Maugeri, Institute of Veruno, Veruno, Italy
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14
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Hilse MS, Kretzschmar T, Pistulli R, Franz M, Bekfani T, Haase D, Neugebauer S, Kiehntopf M, Gummert JF, Milting H, Schulze PC. Analysis of Metabolic Markers in Patients with Chronic Heart Failure before and after LVAD Implantation. Metabolites 2021; 11:metabo11090615. [PMID: 34564430 PMCID: PMC8465815 DOI: 10.3390/metabo11090615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022] Open
Abstract
Chronic heart failure (HF) is a clinical syndrome characterized by functional impairments of the myocardium. Metabolic and clinical changes develop with disease progression. In an advanced state, left ventricular assist devices (LVADs) are implanted for mechanical unloading. Our study aimed to assess the effects of LVAD implantation on the metabolic phenotypes and their potential to reverse the latter in patients with advanced HF. Plasma metabolites were analyzed by LC–MS/MS in 20 patients with ischemic cardiomyopathy (ICM), 20 patients with dilative cardiomyopathy (DCM), and 20 healthy controls. Samples were collected in HF patients before, 30 days after, and >100 days after LVAD implantation. Out of 188 measured metabolites, 63 were altered in HF. Only three metabolites returned to pre-LVAD concentrations 100 days after LVAD implantation. Pre-LVAD differences between DCM and ICM were mainly observed for amino acids and biogenic amines. This study shows a reversal of metabolite abnormalities in HF as a result of LVAD implantation. The etiology of the underlying disease plays an essential role in defining which specific metabolic parameter is altered in HF and reversed by LVAD implantation. Our findings provide a detailed insight into the disease pattern of ICM and DCM and the potential for reversibility of metabolic abnormalities in HF.
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Affiliation(s)
- Marion S. Hilse
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
| | - Tom Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
| | - Rudin Pistulli
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, Münster University Hospital, 48149 Münster, Germany;
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Daniela Haase
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
| | - Sophie Neugebauer
- Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, 07747 Jena, Germany; (S.N.); (M.K.)
| | - Michael Kiehntopf
- Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, 07747 Jena, Germany; (S.N.); (M.K.)
| | - Jan F. Gummert
- Heart and Diabetes Center NRW, 32545 Bad Oeynhausen, Germany; (J.F.G.); (H.M.)
| | - Hendrik Milting
- Heart and Diabetes Center NRW, 32545 Bad Oeynhausen, Germany; (J.F.G.); (H.M.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
- Correspondence: ; Tel.: +49-3641-9-32-41-00
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15
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How Are We Monitoring Brain Injuries in Patients With Left Ventricular Assist Device? A Systematic Review of Literature. ASAIO J 2021; 67:149-156. [PMID: 33512913 DOI: 10.1097/mat.0000000000001204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Despite the common occurrence of brain injury in patients with left ventricular assist device (LVAD), optimal neuromonitoring methods are unknown. A systematic review of PubMed and six electronic databases from inception was conducted until June 5, 2019. Studies reporting methods of neuromonitoring while on LVAD were extracted. Of 5,190 records screened, 37 studies met the inclusion criteria. The neuromonitoring methods include Transcranial Doppler ultrasound for emboli monitoring (TCD-e) (n = 13) and cerebral autoregulation (n = 3), computed tomography and magnetic resonance imaging (n = 9), serum biomarkers (n = 7), carotid ultrasound (n = 3), and near-infrared spectroscopy (n = 2). Of 421 patients with TCD-e, thromboembolic events (TEs) were reported in 79 patients (20%) and microembolic signals (MES) were detected in 105 patients (27%). Ischemic stroke was more prevalent in patients with MES compared to patients without MES (43% vs.13%, p < 0.001). Carotid ultrasound for assessing carotid stenosis was unreliable after LVAD implantation. Elevated lactate dehydrogenase (LDH) levels were associated with TEs. Significant heterogeneity exists in timing, frequency, and types of neuromonitoring tools. TCD-e and serial LDH levels appeared to have potential for assessing the risk of ischemic stroke. Future prospective research incorporating protocolized TCD-e and LDH may assist in monitoring adverse events in patients with LVAD.
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16
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Au SL, Ho CS. Cardiac implantable therapeutic medical devices: A narrative review. JOURNAL OF ACUTE DISEASE 2021. [DOI: 10.4103/2221-6189.316672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Emmanuel S, Engelman J, Hayward CS. Reviewing the clinical utility of ventricular assist device log files. Indian J Thorac Cardiovasc Surg 2020; 36:247-255. [PMID: 33061209 DOI: 10.1007/s12055-019-00891-2] [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: 08/07/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 10/24/2022] Open
Abstract
Background Ventricular assist devices (VADs) have provided a temporising solution to many individuals with refractory heart failure (HF) while awaiting a suitable donor for heart transplantation which remains the gold standard in treatment. Many of the discussions around VADs involve ongoing morbidity; however, one aspect of VADs that is often overlooked is the utility of their log files. We decided to review the literature for mentions of the clinical utility of VAD log files. Methods A keyword search was utilised on PUBMED using the terms 'Ventricular Assist Device' and 'Log files'. Perhaps unsurprisingly, this search only yielded 4 results with further articles being discovered through the bibliography of these publications. Results The 4 identified articles provided basic information on log files, particularly with reference to the HVAD. Logs can be categorised into three types-data (pump parameters), events (changes in parameters) and alarms (abnormal function). Using a combination of these logs, we can readily identify abnormal pump operation such as the development and progression of pump thrombosis, suction events and gastrointestinal bleeding. However, the research potential of log files was not discussed in these publications, particularly as it pertains to areas such as studying speed modulation and pulsatility in VADs. Conclusions VADs are an important staple in the treatment of patients with refractory HF. Log files provide a treasure-trove of information and knowledge that can be utilised for clinical benefit. Furthermore, log files provide an excellent tool for conducting research into device functionality. Current literature on the clinical utility of log files is sparse with much untapped potential.
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Affiliation(s)
- Sam Emmanuel
- Cardiology Department, St Vincent's Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia
| | - Jared Engelman
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Christopher Simon Hayward
- Cardiology Department, St Vincent's Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
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18
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Kong E. F-18 fluorodeoxyglucose positron emission tomography/computed tomography in the infection of heart. Yeungnam Univ J Med 2020; 38:95-106. [PMID: 33053614 PMCID: PMC8016625 DOI: 10.12701/yujm.2020.00479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023] Open
Abstract
Infections involving the heart are becoming increasingly common, and a timely diagnosis of utmost importance, despite its challenges. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently introduced diagnostic tool in cardiology. This review focuses on the current evidence for the use of FDG PET/CT in the diagnosis of infective endocarditis, cardiac implantable device infection, left ventricular assist device infection, and secondary complications. The author discusses considerations when using FDG PET/CT in routine clinical practice, patient preparation for reducing physiologic myocardial uptake, acquisition of images, and interpretation of PET/CT findings. This review also functions to highlight the need for a standardized acquisition protocol.
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Affiliation(s)
- Eunjung Kong
- Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu, Korea
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19
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Welches ventrikuläre Assistenzsystem für welchen Patienten? ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00375-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Aimo A, Bianchi G, Vergaro G. Integrated Imaging to Investigate Low-Flow Alarms of Left Ventricular Assist Devices. JACC Case Rep 2020; 2:1457-1460. [PMID: 34316996 PMCID: PMC8302162 DOI: 10.1016/j.jaccas.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Giacomo Bianchi
- Division of Adult Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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21
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Gumus F, Sarıcaoglu C, Inan MB, Akar AR. Right Ventricular Strain to Assess Early Right Heart Failure in the Left Ventricular Assist Device Candidate. Curr Heart Fail Rep 2020; 16:212-219. [PMID: 31741233 DOI: 10.1007/s11897-019-00445-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Right heart failure (RHF) following left ventricular assist device implantation (LVAD) remains the primary cause of postoperative mortality and morbidity, and prediction of RHF is the main interest of the transplantation community. In this review, we outline the role and impact of right ventricular strain in the evaluation of the right ventricle function before LVAD implantation. RECENT FINDINGS Accumulating data suggest that measurement of right ventricular longitudinal strain (RVLS) has a critical role in predicting RHF preoperatively and may improve morbidity and mortality following LVAD implantation. However, the significant intraobserver, interobserver variability, the lack of multicenter, prospective studies, and the need for a learning curve remain the most critical limitations in the clinical practice at present. This review highlighted the importance of right ventricular strain in the diagnosis of RHF preoperatively and revealed that RVLS might have a crucial clinical measurement for the selection and management of LVAD patients in the future with the more extensive multicenter studies.
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Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Cahit Sarıcaoglu
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Mustafa Bahadir Inan
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Ahmet Ruchan Akar
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey.
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22
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Chang MG, Miller M, Dalia AA. Intraoperative Management of Left Ventricular Assist Device Explantation: Complications and Lessons Learned. J Cardiothorac Vasc Anesth 2019; 34:1002-1004. [PMID: 31787431 DOI: 10.1053/j.jvca.2019.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/04/2019] [Accepted: 10/11/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Marvin G Chang
- Department of Anesthesiology, Pain Medicine, and Critical Care, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Monica Miller
- Department of Anesthesiology, Pain Medicine, and Critical Care, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Adam A Dalia
- Department of Anesthesiology, Pain Medicine, and Critical Care, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
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23
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Burnside L, Whyte S, Cooper SG. Advanced Heart Failure Treatment Modalities and Hospice Care: The Need for High Level Care Coordination. Am J Hosp Palliat Care 2019; 36:812-814. [DOI: 10.1177/1049909119838250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Advanced heart failure therapies such as ventricular assist devices and home inotrope use are becoming more common. Technology advances as well as increased indications for use of such therapies is leading to a higher percentage of patients with end-stage heart failure receiving these therapies at end of life. We present a case of a young man with dilated cardiomyopathy who undergoes advanced cardiac care in the setting of progressively declining cardiac function. Our case outlines the importance of acute care, palliative care, and hospice services being coordinated prior to and during acute-care services to provide goal-concordant and expeditious care. With advancing medical therapies for heart disease, increased coordination and collaboration of services are needed, particularly between hospice and acute-care services.
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Affiliation(s)
- Lee Burnside
- Division of Gerontology and Geriatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sharon Whyte
- Regional Center for Advanced Heart Failure, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephanie G. Cooper
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
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24
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Kittipibul V, Rattanawong P, Kewcharoen J, Chongsathidkiet P, Vutthikraivit W, Kanjanahattakij N. Atrial Fibrillation Is Not Associated With Thromboembolism in Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis. ASAIO J 2019; 65:456-464. [DOI: 10.1097/mat.0000000000000832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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25
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Abstract
This paper discusses the physiological and technological concepts that might form the future of critical care medicine. Initially, we discuss the need for a personalized approach and introduce the concept of personalized physiological medicine (PPM), including (1) assessment of frailty and physiological reserve, (2) continuous assessment of organ function, (3) assessment of the microcirculation and parenchymal cells, and (4) integration of organ and cell function for continuous therapeutic feedback control. To understand the cellular basis of organ failure, we discuss the processes that lead to cell death, including necrosis, necroptosis, autophagy, mitophagy, and cellular senescence. In vivo technology is used to monitor these processes. To this end, we discuss new materials for developing in vivo biosensors and drug delivery systems. Such in vivo biosensors will define the diagnostic platform of the future ICU in vivo interacting with theragnostic drugs. In addition to pharmacological therapeutic options, placement and control of artificial organs to support or replace failing organs will be central in the ICU in vivo of the future. Remote monitoring and control of these biosensors and artificial organs will be made using adaptive physiological mathematical modeling of the critically ill patient. The current state of these developments is discussed.
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Affiliation(s)
- Can Ince
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands.
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26
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Ophthalmic Surgery in Patients with Left Ventricular Assist Devices. Case Rep Ophthalmol Med 2019; 2019:5097597. [PMID: 31016058 PMCID: PMC6446112 DOI: 10.1155/2019/5097597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/22/2019] [Accepted: 03/04/2019] [Indexed: 11/17/2022] Open
Abstract
The newer generation of left ventricular assist devices (LVADs) are commonly used as destination therapy; these devices have demonstrated improved outcomes and increased survival. Given the longer lifespan, it is not surprising that patients with LVADS are increasingly presenting with noncardiac, chronic diseases and interventions for their treatment. This includes ophthalmic procedures in patients with LVAD. There is a paucity of literature about the experiences and outcomes in this cohort of patients presenting for ophthalmologic surgery. Here we present a case series consisting of 7 patients with LVAD that underwent 10 ophthalmic surgeries. No adverse events including intraoperative hemodynamic instability or respiratory compromise occurred. All patients had an on-time discharge with no 30-day recidivism. Most patients underwent a phacoemulsification with intraocular lens implantation and received a topical with intracameral anesthetic. We attribute these successful outcomes to a standardized clinical workflow consisting of careful preoperative screening, communication and presence of VAD coordinator, continuation of antithrombotics, monitoring based on presence of pulsatile flow, and a plan for rapid transfer if needed.
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27
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Millar BC, de Camargo RA, Alavi A, Moore JE. PET/Computed Tomography Evaluation of Infection of the Heart. PET Clin 2019; 14:251-269. [PMID: 30826023 DOI: 10.1016/j.cpet.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The 2015 European Society of Cardiology guidelines for the management of infective endocarditis included 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the diagnostic work-up of prosthetic valve endocarditis. This article examines the literature from the last 3 years to highlight the additional role 18F-FDG-PET/CT can contribute to an accurate diagnosis of cardiac infections and associated infectious complications. The challenges and pitfalls associated with 18F-FDG-PET/CT in such clinical settings must be recognized and these are discussed along with the suggested protocols that may be incorporated in an attempt to address these issues.
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Affiliation(s)
- Beverley Cherie Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Corry Building, Belfast City Hospital, Lisburn Road, Belfast, Co. Antrim BT9 7AD, Northern Ireland, UK.
| | - Raphael Abegão de Camargo
- Nuclear Medicine and Infectious Diseases, University of Sao Paulo Medical School (FMUSP), Sao Paulo, Sao Paulo, Brazil; Hospital Aristides Maltez, Avenida Dom João VI, n° 332, Serviço de Medicina Nuclear, 2° subssolo, Brotas, CEP: 40285-001, Salvador-BA, Brazil
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - John Edmund Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Corry Building, Belfast City Hospital, Lisburn Road, Belfast, Co. Antrim BT9 7AD, Northern Ireland, UK
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28
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Gumus F, Durdu MS, Cakici M, Kurklu TST, Inan MB, Dincer I, Sirlak M, Akar AR. Right ventricular free wall longitudinal strain and stroke work index for predicting right heart failure after left ventricular assist device therapy. Interact Cardiovasc Thorac Surg 2018; 28:674-682. [DOI: 10.1093/icvts/ivy328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Serkan Durdu
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Cakici
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Turkan Seda Tan Kurklu
- Department of Cardiology, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Bahadir Inan
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Irem Dincer
- Department of Cardiology, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Sirlak
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Ahmet Ruchan Akar
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
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Abstract
It is currently estimated that 5.7 million Americans live with heart failure. Of these, less than 3000 will receive a heart transplant this year, according to the US Department of Health and Human Services Organ Procurement and Transplantation Network. With successful transplantation can come significant emotional and physical symptoms that are not always addressed. Although palliative care is an interdisciplinary subspecialty designed to alleviate multiple domains of suffering in serious illness, many mistakenly associate it solely with the end of life. Traditionally associated with cancer, research into the role of palliative care in other chronic illnesses and complex life-changing therapies such as solid organ transplantation remains scarce but is nonetheless developing. Here, we try to investigate a potential role for palliative care for heart transplant recipients. Early research thus far has demonstrated importance of early involvement of palliative care teams and the significant improvement of physical and emotional symptoms in the pre- and post-transplant period. Nevertheless, more research is warranted to determine the ideal timing of palliative care integration, the effects on health care resource utilization, and whether improving quality of life can affect morbidity and mortality. By understanding these critical elements and others we may be able to develop a model for the role of palliative care for heart transplant patients.
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Does cognition improve following LVAD implantation? Gen Thorac Cardiovasc Surg 2018; 66:456-463. [PMID: 29796750 DOI: 10.1007/s11748-018-0947-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Studies of cognition after LVAD surgery have produced mixed results. To explore whether cognition would improve, decline, or remain stable after LVAD surgery, we examined cognition before and 1- and 3-months after LVAD surgery. Patients with post-surgical stroke were excluded. METHODS 28 subjects (mean age = 54.31 ± 12 years) comprised an observational case series from the DuraHeart LVAS device® trial. Cognitive testing was performed at baseline, 1-month, and 3-month post-surgery, and included tests of attention, memory, language, visualmotor speed (TMT) and visualconstruction. RESULTS No difference in cognition was found between baseline and 1-month exams (means z score improvement = 0.06, p = 0.43) but cognition improved significantly between baseline and 3-month exams (mean z score improvement = 0.34, p < 0.00001). Examination of individual test scores found, after correction for multiple comparisons, only the TMT variable was significantly different at the 3-month exam. CONCLUSIONS We found significantly improved cognition 3 months after LVAD surgery in a subset of patients without post-surgical stroke. The reasons for the lack of cognitive improvement at the 1-month post-surgical assessment may include ongoing medical and physiological disruptions in the immediate post-operative period. Further research into the sources of delayed improvement is warranted. Cognitive assessments performed immediately after surgery should be interpreted with caution because the results may not reflect longer term cognitive outcomes. LVAD patients may require additional support to successfully manage their health in the weeks immediately following surgery but assistance needs may decrease over time.
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Poptsov VN, Zakharevich VM, Spirina EA, Uhrenkov SG, Dogonasheva AA, Aliev EZ. Outcomes and risk factors of mechanical circulatory support by peripheral venoarterial extracorporeal membrane oxygenation in heart transplant candidates needing urgent heart transplantation. ACTA ACUST UNITED AC 2018. [DOI: 10.15825/1995-1191-2017-4-54-60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction Peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) is one of the most frequently used methods of temporary mechanical circulatory support (MCS) at patients with life-threatening circulatory derangement.Aim: to evaluate the effectiveness and risk factors of peripheral VA ECMO in patients waiting of urgent heart transplantation (HT). Materials and methods. The study included 149 (129 (86.6%) men and 20 (13.4%) women, age 12 to 72 (43.0 ± 1.2) years) heart transplant candidates who in the period 01.01.2011–31.12.2016 were supported by peripheral VA ECMO. These patients were 21.1% of the total waiting list (n = 706) of our institute at the same period. Indication for MCS by VA ECMO was advanced heart failure corresponding to I or II level of INTERMACS classifi cation.Results. 135 (90.6%) from 149 patients were successfully supported to HT. 14 (9.4%) deed following MCS. Before of VA ECMO these patients (n = 14) had more severe (p < 0.05) hemodynamic disorders, organ dysfunction, electrolyte and metabolic disorders compared to patients TC successfully supported to HT. Left atrium (n = 24)/left ventricle drainage (n = 8) was performed for volume decompression of left heart (n = 32 (21.5%)). In a single-factor analysis, statistically signifi cant pre VA ECMO risk factors for the lethal outcome were: creatinine ≥ 140 mmol/l, urea ≥ 15 mmol/l, total bilirubin ≥ 80 μmol/l, ALT ≥ 300 U/l, AST ≥ 300 U/l, INR ≥ 3.0, procalcitonin ≥ 3.0 ng/ml, preexisting left ventricular thrombosis complicated thromboembolic stroke with brain death following VA ECMO (n = 3). Statistically signifi cant factors for the lethal outcome following MCS were: transthoracic left ventricle drainage (n = 8) compared to transcutaneous transfemoral transseptal left atrium drainage (n = 24) for volume decompression of left heart; hemolysis ≥ 300 mg%. Conclusion. VA ECMO is high effi ciency method of temporary MCS in 90.6% heart transplant candidates needed at urgent HT. VA ECMO must be begin before development of potential lethal multiorgan and septic complications. Preexisting left ventricular thrombosis increase risk of lethal thromboembolic brain injury following VA ECMO. Patients with transcutaneous transfemoral transseptal left atrium drainage for left heart volume decompression had better outcome following MCS by VA ECMO.
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Affiliation(s)
- V. N. Poptsov
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation; I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation
| | - V. M. Zakharevich
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation; I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation
| | - E. A. Spirina
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
| | - S. G. Uhrenkov
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
| | - A. A. Dogonasheva
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
| | - E. Z. Aliev
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
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Arai K, Murata D, Verissimo AR, Mukae Y, Itoh M, Nakamura A, Morita S, Nakayama K. Fabrication of scaffold-free tubular cardiac constructs using a Bio-3D printer. PLoS One 2018; 13:e0209162. [PMID: 30557409 PMCID: PMC6296519 DOI: 10.1371/journal.pone.0209162] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 12/02/2018] [Indexed: 12/18/2022] Open
Abstract
A major challenge in cardiac tissue engineering is the host's immune response to artificial materials. To overcome this problem, we established a scaffold-free system for assembling cell constructs using an automated Bio-3D printer. This printer has previously been used to fabricate other three-dimensional (3D) constructs, including liver, blood vessels, and cartilage. In the present study, we tested the function in vivo of scaffold-free cardiac tubular construct fabricated using this system. Cardiomyocytes derived from induced pluripotent stem cells (iCells), endothelial cells, and fibroblasts were combined to make the spheroids. Subsequently, tubular cardiac constructs were fabricated by Bio-3D printer placing the spheroids on a needle array. Notably, the spheroid fusion and beat rate in the constructs were observed while still on the needle array. After removal from the needle array, electrical stimulation was used to test responsiveness of the constructs. An increased beat rate was observed during stimulation. Importantly, the constructs returned to their initial beat rate after stimulation was stopped. In addition, histological analysis shows cellular reorganization occurring in the cardiac constructs, which may mimic that observed during organ transplantation. Taken together, our results indicate that these engineered cardiac tubular constructs, which address both the limited supply of donor tissues as well as the immune-induced transplant rejection, has potential to be used for both clinical and drug testing applications. To our knowledge, this is the first time that cardiac tubular constructs have been produced using optimized Bio-3D printing technique and subsequently tested for their use as cardiac pumps.
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Affiliation(s)
- Kenichi Arai
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
| | - Daiki Murata
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
| | - Ana Raquel Verissimo
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
| | - Yosuke Mukae
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Manabu Itoh
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Anna Nakamura
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
| | - Shigeki Morita
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
- * E-mail:
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Yoshioka D, Toda K, Ono M, Nakatani T, Shiose A, Matsui Y, Yamazaki K, Saiki Y, Usui A, Niinami H, Matsumiya G, Arai H, Sawa Y. Clinical Results, Adverse Events, and Change in End-Organ Function in Elderly Patients With HeartMateII Left Ventricular Assist Device ― Japanese Multicenter Study ―. Circ J 2018; 82:409-418. [DOI: 10.1253/circj.cj-17-0881] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital
| | | | - Takeshi Nakatani
- Department of Transplantation, National Cardiovascular Research Center
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University
| | - Yoshiro Matsui
- Department of Cardiovascular Surgery, Hokkaido University
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | | | - Akihiko Usui
- Department of Cardiovascular Surgery, Nagoya University Hospital
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Saitama Kokusai Medical Center
| | | | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Hospital
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Outcomes of Abdominal Surgery in Patients With Mechanical Ventricular Assist Devices: A Multi-institutional Study. Ann Surg 2017; 269:774-777. [PMID: 28885501 DOI: 10.1097/sla.0000000000002513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the outcomes of elective and emergent abdominal operations performed in end-stage heart failure patients supported with ventricular assist devices (VADs). SUMMARY OF BACKGROUND DATA With the growing volume of end-stage heart failure patients receiving VADs, an increasing number of these patients require surgery for noncardiac pathology. There is a paucity of studies on the safety of abdominal operations in this population. METHODS We performed a retrospective chart review across 3 hospitals of patients with VADs who underwent abdominal surgeries between 2003 and 2015. We used Chi-square, Fisher exact, and Mann-Whitney U tests for comparison of elective and emergent cases. RESULTS Fifty-seven patients underwent 63 operations, of which 23 operations were elective, 24 were emergent, and 16 were emergently performed in the same admission as VAD placement and analyzed separately. Patients undergoing elective versus emergent procedures had similar comorbidities (Charlson score 2.9 vs 3.0). 43% versus 32% of patients had VADs as a destination therapy. Although perioperative anticoagulation approach was variable, holding warfarin and starting heparin/enoxaparin/bivalirudin bridge was most common (65% vs 54%). Although 2-fold higher in the emergent group (50 vs 100 mL, P = 0.06), median estimated blood loss was low. Postoperative bleeding requiring transfusion was not very common (13% vs 8%), whereas rate of ischemic cerebrovascular accident (4% each) and venous thromboembolism was low (0% vs 13%, P = 0.23). Thirty-day mortality rate was 4% versus 17%, P = 0.19. CONCLUSION VAD patients have an acceptable risk profile for abdominal surgery.
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