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Kato H, Iwahana T, Ono R, Okada S, Matsumiya G, Kobayashi Y. Hemodynamic parameters at rest predicting exercise capacity in patients supported with left ventricular assist device. J Artif Organs 2024; 27:7-14. [PMID: 36933087 DOI: 10.1007/s10047-023-01388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/26/2023] [Indexed: 03/19/2023]
Abstract
Left ventricular assist devices improve prognosis and quality of life, but exercise capacity remains limited in most patients after device implantation. Left ventricular assist device optimization through right heart catheterization reduces device-related complications. However, hemodynamic parameters associated with exercise capacity under optimized conditions. The aim of this study was to elucidate the predictors of exercise capacity from hemodynamic parameters at rest after left ventricular assist device optimization. We retrospectively reviewed 24 patients who underwent a ramp test with right heart catheterization, echocardiography and cardiopulmonary exercise testing more than 6 months after left ventricular assist device implantation. Pump speed was optimized to a lower setting that achieved right atrial pressure < 12 mmHg, pulmonary capillary wedge pressure < 18 mmHg, and cardiac index > 2.2 L/min/m2, then exercise capacity was assessed by cardiopulmonary exercise testing. After left ventricular assist device optimization, the mean right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and peak oxygen consumption were 7 ± 5 mmHg, 10 ± 7 mmHg, 2.7 ± 0.5 L/min/m2, and 13.2 ± 3.0 mL/min/kg, respectively. Pulse pressure, stroke volume, right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure were significantly associated with peak oxygen consumption. Multivariate linear regression analysis of factors predicting peak oxygen consumption revealed that pulse pressure, right atrial pressure, and aortic insufficiency remained independent predictors (β = 0.401, p = 0.007; β = - 0.558, p < 0.001; β = - 0.369, p = 0.010, respectively). Our findings suggests that cardiac reserve, volume status, right ventricular function, and aortic insufficiency predict exercise capacity in patients with a left ventricular assist device.
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Affiliation(s)
- Hirotoshi Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-8677, Japan.
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-8677, Japan
| | - Ryohei Ono
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-8677, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-8677, Japan
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Goncharov A, Fox H, Bleiziffer S, Rudolph TK. A case report: transfemoral transcatheter aortic valve replacement with a dedicated valve system for severe aortic regurgitation in a patient with a left ventricular assist device. Eur Heart J Case Rep 2023; 7:ytad267. [PMID: 37323530 PMCID: PMC10266159 DOI: 10.1093/ehjcr/ytad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/06/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
Background Up to 30% of patients with the left ventricular assist device (LVAD) develop moderate to severe aortic regurgitation (AR) within the first year. Surgical aortic valve replacement (SAVR) is the treatment of choice in patients with native AR. However, the high perioperative risk in patients with LVAD might prohibit surgery and choice of therapy is challenging. Case summary We report on a 55-year-old female patient with a severe AR 15 months after implantation of LVAD due to advanced heart failure (HF) as a consequence of ischaemic cardiomyopathy. Surgical aortic valve replacement was discarded due to high surgical risk. Thus, the decision was made to evaluate a transcatheter aortic valve replacement (TAVR) with the TrilogyXTä prothesis (JenaValve Technology, Inc., CA, USA). Echocardiographic and fluoroscopic control showed an optimal valve position with no evidence of valvular or paravalvular regurgitation. The patient was discharged 6 days later in a good general condition. At the 3-month follow-up, the patient showed noteworthy symptomatic improvement with no sign of HF. Discussion Aortic regurgitation is a common complication among advanced HF patients treated with LVADSystems and associated with a deterioration in the quality of life and worsen clinical prognosis. The treatment options are limited to percutaneous occluder devices, SAVR, off-label TAVR, and heart transplantation. With the approval of the TrilogyXT JenaValve system, a novel dedicated TF-TAVR option is now available. Our experience demonstrates the technical feasibility and safety of this system in patients with LVAD and AR resulting in effective elimination of AR.
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Affiliation(s)
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, Bad Oeynhausen 32545, Germany
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Vriz O, Mushtaq A, Shaik A, El-Shaer A, Feras K, Eltayeb A, Alsergnai H, Kholaif N, Al Hussein M, Albert-Brotons D, Simon AR, Tsai FW. Reciprocal interferences of the left ventricular assist device and the aortic valve competence. Front Cardiovasc Med 2023; 9:1094796. [PMID: 36698950 PMCID: PMC9870593 DOI: 10.3389/fcvm.2022.1094796] [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: 11/10/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Patients suffering from end-stage heart failure tend to have high mortality rates. With growing numbers of patients progressing into severe heart failure, the shortage of available donors is a growing concern, with less than 10% of patients undergoing cardiac transplantation (CTx). Fortunately, the use of left ventricular assist devices (LVADs), a variant of mechanical circulatory support has been on the rise in recent years. The expansion of LVADs has led them to be incorporated into a variety of clinical settings, based on the goals of therapy for patients ailing from heart failure. However, with an increase in the use of LVADs, there are a host of complications that arise with it. One such complication is the development and progression of aortic regurgitation (AR) which is noted to adversely influence patient outcomes and compromise pump benefits leading to increased morbidity and mortality. The underlying mechanisms are likely multifactorial and involve the aortic root-aortic valve (AV) complex, as well as the LVAD device, patient, and other factors, all of them alter the physiological mechanics of the heart resulting in AV dysfunction. Thus, it is imperative to screen patients before LVAD implantation for AR, as moderate or greater AR requires a concurrent intervention at the time of LVADs implantation. No current strict guidelines were identified in the literature search on how to actively manage and limit the development and/or progression of AR, due to the limited information. However, some recommendations include medical management by targeting fluid overload and arterial blood pressure, along with adjusting the settings of the LVADs device itself. Surgical interventions are to be considered depending on patient factors, goals of care, and the underlying pathology. These interventions include the closure of the AV, replacement of the valve, and percutaneous approach via percutaneous occluding device or transcatheter aortic valve implantation. In the present review, we describe the interaction between AV and LVAD placement, in terms of patient management and prognosis. Also it is provided a comprehensive echocardiographic strategy for the precise assessment of AV regurgitation severity.
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Affiliation(s)
- Olga Vriz
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia,*Correspondence: Olga Vriz,
| | - Ali Mushtaq
- School of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Shaik
- School of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed El-Shaer
- School of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Khalid Feras
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdalla Eltayeb
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hani Alsergnai
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Naji Kholaif
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mosaad Al Hussein
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dimpna Albert-Brotons
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Andre Rudiger Simon
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Felix Wang Tsai
- Heart Centre Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Surgical Interventions for Late Aortic Valve Regurgitation Associated with Continuous Flow-Left Ventricular Assist Device Therapy: Experience Gained and Lessons Learned. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010094. [PMID: 36676043 PMCID: PMC9867390 DOI: 10.3390/life13010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
This study aimed to investigate the outcomes of surgical interventions for symptomatic moderate-to-severe aortic regurgitation (AR), including aortic valve replacement (AVR) and repair (AVP), in 184 patients who underwent continuous flow-left ventricular assist device (Cf-LVAD) implantation as a bridge-to-transplant (BTT) between November 2007 and April 2020. Ten patients (median age, 34 (25-41) years; 60% men) underwent surgical interventions (AVR, n = 6; AVP, n = 4) late after cf-LVAD implantation. The median duration after the device implantation was 34 (24-44) months. Three patients required additional tricuspid valve repair. Aortic valve suturing resulted in severe recurrent AR 6 months postoperatively, due to leaflet cutting in one patient. Seven patients with AVR survived without regurgitation during the study period, except for one non-survivor complicated by liver failure due to postoperative right heart failure. Therefore, six patients after AVP (n = 4) and AVR (n = 2) underwent successful heart transplantation 7 (4-13) months after aortic intervention. Kaplan-Meier analysis showed no significant difference in overall survival through 5 years after cf-LVAD implantation, regardless of the surgical AV intervention chosen (log-rank test, p = 0.86). In conclusion, surgical interventions (AVR or AVP) for patients with an ongoing cf-LVAD are safe, effective, and viable options.
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Calin E, Ducharme A, Carrier M, Lamarche Y, Ben Ali W, Noly PE. Key questions about aortic insufficiency in patients with durable left ventricular assist devices. Front Cardiovasc Med 2022; 9:1068707. [PMID: 36505355 PMCID: PMC9729243 DOI: 10.3389/fcvm.2022.1068707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
The development of the latest generation of durable left ventricular assist devices (LVAD) drastically decreased adverse events such as pump thrombosis or disabling strokes. However, time-related complications such as aortic insufficiency (AI) continue to impair outcomes following durable LVAD implantation, especially in the context of long-term therapy. Up to one-quarter of patients with durable LVAD develop moderate or severe AI at 1 year and its incidence increases with the duration of support. The continuous regurgitant flow within the left ventricle can compromise left ventricular unloading, increase filling pressures, decrease forward flow and can thus lead to organ hypoperfusion and heart failure. This review aims to give an overview of the epidemiology, pathophysiology, and clinical consequences of AI in patients with durable LVAD.
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Affiliation(s)
- Eliza Calin
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Michel Carrier
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Walid Ben Ali
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada
| | - Pierre-Emmanuel Noly
- Department of Surgery, Montreal Heart Institute, Université de Montreal, Montreal, QC, Canada,*Correspondence: Pierre-Emmanuel Noly,
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Grinstein J, Blanco PJ, Bulant CA, Torii R, Bourantas CV, Lemos PA, Garcia-Garcia HM. A computational study of aortic insufficiency in patients supported with continuous flow left ventricular assist devices: Is it time for a paradigm shift in management? Front Cardiovasc Med 2022; 9:933321. [PMID: 36337891 PMCID: PMC9631475 DOI: 10.3389/fcvm.2022.933321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/29/2022] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND De novo aortic insufficiency (AI) following continuous flow left ventricular assist device (CF-LVAD) implantation is a common complication. Traditional early management utilizes speed augmentation to overcome the regurgitant flow in an attempt to augment net forward flow, but this strategy increases the aortic transvalvular gradient which predisposes the patient to progressive aortic valve pathology and may have deleterious effects on aortic shear stress and right ventricular (RV) function. MATERIALS AND METHODS We employed a closed-loop lumped-parameter mathematical model of the cardiovascular system including the four cardiac chambers with corresponding valves, pulmonary and systemic circulations, and the LVAD. The model is used to generate boundary conditions which are prescribed in blood flow simulations performed in a three-dimensional (3D) model of the ascending aorta, aortic arch, and thoracic descending aorta. Using the models, impact of various patient management strategies, including speed augmentation and pharmacological treatment on systemic and pulmonary (PA) vasculature, were investigated for four typical phenotypes of LVAD patients with varying degrees of RV to PA coupling and AI severity. RESULTS The introduction of mild/moderate or severe AI to the coupled RV and pulmonary artery at a speed of 5,500 RPM led to a reduction in net flow from 5.4 L/min (no AI) to 4.5 L/min (mild/moderate) to 2.1 L/min (severe). RV coupling ratio (Ees/Ea) decreased from 1.01 (no AI) to 0.96 (mild/moderate) to 0.76 (severe). Increasing LVAD speed to 6,400 RPM in the severe AI and coupled scenario, led to a 42% increase in net flow and a 16% increase in regurgitant flow (RF) with a nominal decrease of 1.6% in RV myocardial oxygen consumption (MVO2). Blood pressure control with the coupled RV with severe AI at 5,500 RPM led to an 81% increase in net flow with a 15% reduction of RF and an 8% reduction in RV MVO2. With an uncoupled RV, the introduction of mild/moderate or severe AI at a speed of 5,500 RPM led to a reduction in net flow from 5.0 L/min (no AI) to 4.0 L/min (mild/moderate) to 1.8 L/min (severe). Increasing the speed to 6,400 RPM with severe AI and an uncoupled RV increased net flow by 45%, RF by 15% and reduced RV MVO2 by 1.1%. For the uncoupled RV with severe AI, blood pressure control alone led to a 22% increase in net flow, 4.2% reduction in RF, and 3.9% reduction in RV MVO2; pulmonary vasodilation alone led to a 18% increase in net flow, 7% reduction in RF, and 26% reduction in RV MVO2; whereas, combined BP control and pulmonary vasodilation led to a 113% increase in net flow, 20% reduction in RF and 31% reduction in RV MVO2. Compared to speed augmentation, blood pressure control consistently resulted in a reduction in WSS throughout the proximal regions of the arterial system. CONCLUSION Speed augmentation to overcome AI in patients supported by CF-LVAD appears to augment flow but also increases RF and WSS in the aorta, and reduces RV MVO2. Aggressive blood pressure control and pulmonary vasodilation, particularly in those patients with an uncoupled RV can improve net flow with more advantageous effects on the RV and AI RF.
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Affiliation(s)
- Jonathan Grinstein
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Pablo J. Blanco
- National Laboratory for Scientific Computing, Petrópolis, Brazil
| | - Carlos A. Bulant
- National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Ryo Torii
- Department of Mechanical Engineering, University College of London, London, United Kingdom
| | | | - Pedro A. Lemos
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Rali AS, Taduru SS, Tran LE, Ranka S, Schlendorf KH, Barker CM, Shah AS, Lindenfeld J, Zalawadiya SK. Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency. Card Fail Rev 2022; 8:e30. [PMID: 36644645 PMCID: PMC9819997 DOI: 10.15420/cfr.2022.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/15/2022] [Indexed: 01/17/2023] Open
Abstract
Background: Worsening aortic insufficiency (AI) is a known sequela of prolonged continuous-flow left ventricular assist device (LVAD) support with a significant impact on patient outcomes. While medical treatment may relieve symptoms, it is unlikely to halt progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are among non-medical interventions available to address post-LVAD AI. Limited data are available on outcomes with either SAVR or TAVR for the management of post-LVAD AI. Methods: The National Inpatient Sample data collected for hospital admissions between the years 2015 and 2018 for patients with pre-existing continuous-flow LVAD undergoing TAVR or SAVR for AI were queried. The primary outcome of interest was a composite of in-hospital mortality, stroke, transient ischaemic attack, MI, pacemaker implantation, need for open aortic valve surgery, vascular complications and cardiac tamponade. Results: Patients undergoing TAVR were more likely to receive their procedure during an elective admission (57.1 versus 30%, p=0.002), and a significantly higher prevalence of comorbidities, as assessed by the Elixhauser Comorbidity Index, was observed in the SAVR group (29 versus 18; p=0.0001). We observed a significantly higher prevalence of the primary composite outcome in patients undergoing SAVR (30%) compared with TAVR (14.3%; p=0.001). Upon multivariable analysis adjusting for the type of admission and Elixhauser Comorbidity Index, TAVR was associated with significantly lower odds of the composite outcome (odds ratio 0.243; 95% CI [0.06-0.97]; p=0.045). Conclusion: In this nationally representative cohort of LVAD patients with post-implant AI, it was observed that TAVR was associated with a lower risk of adverse short-term outcomes compared with SAVR.
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Affiliation(s)
- Aniket S Rali
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Siva S Taduru
- Department of Cardiovascular Diseases, University of Kansas Medical CenterKansas City, Kansas, US
| | - Lena E Tran
- Department of Internal Medicine, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Sagar Ranka
- Department of Cardiovascular Diseases, University of Kansas Medical CenterKansas City, Kansas, US
| | - Kelly H Schlendorf
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Colin M Barker
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - JoAnn Lindenfeld
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Sandip K Zalawadiya
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
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8
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Physiology and Clinical Utility of HeartMate Pump Parameters. J Card Fail 2021; 28:845-862. [PMID: 34980564 DOI: 10.1016/j.cardfail.2021.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/10/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022]
Abstract
The HeartMate 3 left ventricular assist device (LVAD) is now the only centrifugal pump intended for durable support being actively manufactured and implanted for adults in the United States. The changes in preload and afterload that accompany common clinical scenarios experienced by patients with an LVAD will cause specific changes to the LVAD pump parameters, namely, the pump power, pulsatility index, and flow. Appropriate care of this unique, and growing, population requires a full understanding of these variables as well as the underlying physiologic principles governing their derivation. The aim of this review is to focus on the updated functionality of the HeartMate 3, specifically in comparison to the HeartMate II, as well as the application of pump parameter interpretation to common clinical scenarios.
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9
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Dlouha D, Ivak P, Netuka I, Benesova S, Tucanova Z, Hubacek JA. An Integrative Study of Aortic mRNA/miRNA Longitudinal Changes in Long-Term LVAD Support. Int J Mol Sci 2021; 22:ijms22147414. [PMID: 34299034 PMCID: PMC8303892 DOI: 10.3390/ijms22147414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022] Open
Abstract
Studying the long-term impact of continuous-flow left ventricular assist device (CF-LVAD) offers an opportunity for a complex understanding of the pathophysiology of vascular changes in aortic tissue in response to a nonphysiological blood flow pattern. Our study aimed to analyze aortic mRNA/miRNA expression changes in response to long-term LVAD support. Paired aortic samples obtained at the time of LVAD implantation and at the time of heart transplantation were examined for mRNA/miRNA profiling. The number of differentially expressed genes (Pcorr < 0.05) shared between samples before and after LVAD support was 277. The whole miRNome profile revealed 69 differentially expressed miRNAs (Pcorr < 0.05). Gene ontology (GO) analysis identified that LVAD predominantly influenced genes involved in the extracellular matrix and collagen fibril organization. Integrated mRNA/miRNA analysis revealed that potential targets of miRNAs dysregulated in explanted samples are mainly involved in GO biological process terms related to dendritic spine organization, neuron projection organization, and cell junction assembly and organization. We found differentially expressed genes participating in vascular tissue engineering as a consequence of LVAD duration. Changes in aortic miRNA levels demonstrated an effect on molecular processes involved in angiogenesis.
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Affiliation(s)
- Dana Dlouha
- Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic;
- Correspondence: ; Tel.: +420-261-362-229
| | - Peter Ivak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic; (P.I.); (I.N.); (Z.T.)
- Department of Physiology, 3rd Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
- Second Department of Surgery, Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic; (P.I.); (I.N.); (Z.T.)
- Second Department of Surgery, Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Sarka Benesova
- Laboratory of Informatics and Chemistry, Faculty of Chemical Technology, University of Chemistry and Technology, 166 28 Prague, Czech Republic;
- Laboratory of Gene Expression, Institute of Biotechnology CAS, BIOCEV, 252 50 Vestec, Czech Republic
| | - Zuzana Tucanova
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic; (P.I.); (I.N.); (Z.T.)
| | - Jaroslav A. Hubacek
- Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic;
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
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Misumi Y, Miyagawa S, Yoshioka D, Kainuma S, Kawamura T, Kawamura A, Maruyama Y, Ueno T, Toda K, Asanoi H, Sawa Y. Prediction of aortic valve regurgitation after continuous-flow left ventricular assist device implantation using artificial intelligence trained on acoustic spectra. J Artif Organs 2021; 24:164-172. [PMID: 33537860 PMCID: PMC8154812 DOI: 10.1007/s10047-020-01243-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
Significant aortic regurgitation (AR) is a common complication after continuous-flow left ventricular assist device (LVAD) implantation. Using machine-learning algorithms, this study was designed to examine valuable predictors obtained from LVAD sound and to provide models for identifying AR. During a 2-year follow-up period of 13 patients with Jarvik2000 LVAD, sound signals were serially obtained from the chest wall above the LVAD using an electronic stethoscope for 1 min at 40,000 Hz, and echocardiography was simultaneously performed to confirm the presence of AR. Among the 245 echocardiographic and acoustic data collected, we found 26 episodes of significant AR, which we categorized as “present”; the other 219 episodes were characterized as “none”. Wavelet (time–frequency) analysis was applied to the LVAD sound and 19 feature vectors of instantaneous spectral components were extracted. Important variables for predicting AR were searched using an iterative forward selection method. Seventy-five percent of 245 episodes were randomly assigned as training data and the remaining as test data. Supervised machine learning for predicting concomitant AR involved an ensemble classifier and tenfold stratified cross-validation. Of the 19 features, the most useful variables for predicting concomitant AR were the amplitude of the first harmonic, LVAD rotational speed during intermittent low speed (ILS), and the variation in the amplitude during normal rotation and ILS. The predictive accuracy and area under the curve were 91% and 0.73, respectively. Machine learning, trained on the time–frequency acoustic spectra, provides a novel modality for detecting concomitant AR during follow-up after LVAD.
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Affiliation(s)
- Yusuke Misumi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuichi Maruyama
- Department of Medical Engineering, Osaka University Hospital, Osaka, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hidetsugu Asanoi
- Department of Chronic Heart Failure Management, Osaka University Global Center for Medical Engineering and Informatics, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan.
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11
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Gao B, Kang Y, Zhang Q, Chang Y. Biomechanical effects of the novel series LVAD on the aortic valve. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105763. [PMID: 32998103 DOI: 10.1016/j.cmpb.2020.105763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The series type of LVAD (i.e., BJUT-II VAD) is a novel left ventricular assist device, whose effects on the aortic valve remain unclear. METHODS The biomechanical effects of BJUT-II VAD on the aortic valve were investigated by using a fluid-structure interaction method. The geometric model of BJUT-II VAD was virtually implanted into the ascending aorta to generate the realistic flow pattern for the aortic valve (i.e., support). In addition, the biomechanical states of the aortic valve without BJUT-II VAD support was computed as control (i.e., control case). RESULTS Results demonstrated that the biomechanical effects of BJUT-II VAD were quite different from that resulting from traditional "bypass LVAD." Compared with those in the control case, BJUT-II VAD support could significantly reduce the stress load of the leaflet (maximum stress, 0.5 MPa in the control case vs. 0.12 MPa in the support case). Similarly, the rapid valve opening time (100 ms in the control case vs. 175 ms in the support case) and rapid valve closing time (50 ms in the control case vs. 150 ms in the support case) in the support case were obviously longer than those in the control case. Moreover, BJUT-II VAD support reduced retrograde blood flow during the diastolic phase and significantly changed the distribution of WSS of the leaflets. CONCLUSIONS In summary, while unloading the left ventricle, BJUT-II VAD could provide beneficial biomechanical states for the aortic leaflets, thereby reducing the risk of aortic valve disease.
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Affiliation(s)
- Bin Gao
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, PR China.
| | - Yizhou Kang
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, PR China
| | - Qi Zhang
- National Energy Conservation Center, Beijing, PR China
| | - Yu Chang
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, PR China
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12
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Sun P, Bozkurt S, Sorguven E. Computational analyses of aortic blood flow under varying speed CF-LVAD support. Comput Biol Med 2020; 127:104058. [PMID: 33091606 DOI: 10.1016/j.compbiomed.2020.104058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/21/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
Continuous Flow Left Ventricular Assist Devices (CF-LVADs) generally operate at a constant speed whilst supporting a failing heart. However, constant speed CF-LVAD support may cause complications and increase the morbidity rates in the patients. Therefore, different varying speed operating modes for CF-LVADs have been proposed to generate more physiological blood flow, which may reduce complication rates under constant speed CF-LVAD support. The proposed varying speed CF-LVAD algorithms simulate time-dependant dynamics and three dimensional blood flow patterns in aorta under varying speed CF-LVAD support remain unclear. The aim of this study is to evaluate three dimensional blood flow patterns in a patient-specific aorta model under co-pulsating and counter-pulsating CF-LVAD support modes driven by speed and flow rate control algorithms using numerical simulations. Aortic blood flow was evaluated for 10,000 rpm constant speed CF-LVAD support generating 4.71 L/min mean flow rate over a cardiac cycle. Co-pulsating and counter-pulsating CF-LVAD speed control operated the pump at the same average speed over a cardiac cycle and co-pulsating and counter-pulsating CF-LVAD flow rate control generated the same average flow rate over cardiac cycle as in the constant speed pump support. Simulation results show that the utilised counter-pulsating pump flow rate control may decrease the haemolysis to a third compared to the most commonly employed constant speed pump operating mode. Moreover, CF-LVAD support utilising counter-pulsating pump flow rate control generated the most favourable hemodynamic characteristics, i.e. low Dean number, least wall shear stress and least haemolysis values among the investigated cases.
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Affiliation(s)
- Peiying Sun
- Thermo Fluid Mechanics Research Centre (TFMRC), University of Sussex, Falmer, BN1 9RS, UK
| | - Selim Bozkurt
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
| | - Esra Sorguven
- Thermo Fluid Mechanics Research Centre (TFMRC), University of Sussex, Falmer, BN1 9RS, UK.
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13
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Ogawa D, Kobayashi S, Yamazaki K, Motomura T, Nishimura T, Shimamura J, Tsukiya T, Mizuno T, Takewa Y, Tatsumi E, Nishinaka T. Evaluation of cardiac beat synchronization control for a rotary blood pump on valvular regurgitation with a mathematical model. Artif Organs 2020; 45:124-134. [PMID: 32813920 DOI: 10.1111/aor.13795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/10/2020] [Accepted: 08/05/2020] [Indexed: 01/17/2023]
Abstract
We have studied the cardiac beat synchronization (CBS) control for a rotary blood pump (RBP) and revealed that it can promote pulsatility and reduce cardiac load. Besides, patients with LVAD support sometimes suffer from aortic and mitral regurgitation (AR and MR). A control method for the RBP should be validated in wider range of conditions to clarify its benefits and pitfalls prior to clinical application. In this study, we evaluated pulsatility and cardiac load reduction obtained with the CBS control on valvular failure conditions with a mathematical model. Diastolic assist could reduce cardiac load on the left ventricle by decreasing external work of the ventricle even in MR cases while it was not so effective in AR cases. Systolic assist can still promote pulsatility in AR and MR cases; however, aortic valve function should be carefully confirmed since pulse pressure can be wider not due to systolic assist but to AR.
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Affiliation(s)
- Daisuke Ogawa
- Sun Medical Technology Research Corp., Nagano, Japan
| | | | | | | | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Graduate school of Medicine, Ehime University, Ehime, Japan
| | - Junichi Shimamura
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshiaki Takewa
- Advanced Medical Engineering Research Center, Asahikawa Medical University, Hokkaido, Japan
| | - Eisuke Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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14
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Oishi H, Kondo T, Fujimoto K, Mutsuga M, Morimoto R, Hirano KI, Sawamura A, Kazama S, Kimura Y, Shibata N, Kato H, Arao Y, Kuwayama T, Yamaguchi S, Hiraiwa H, Okumura T, Usui A, Murohara T. Aortic insufficiency associated with Impella that required surgical intervention upon implantation of the durable left ventricular assist device. J Artif Organs 2020; 23:378-382. [PMID: 32562105 DOI: 10.1007/s10047-020-01184-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/10/2020] [Indexed: 01/02/2023]
Abstract
The Impella is an axial-flow percutaneous ventricular assist device for cardiogenic shock. In this report, we describe two patients who developed aortic insufficiency (AI) associated with Impella and required surgical intervention upon implantation of the durable left ventricular assist device (LVAD). Both patients presented with cardiogenic shock and underwent insertion of Impella 5.0 as a bridge to decision. The cardiac function in these patients did not improve and obtaining approval for heart transplantation required time. They were managed with Impella for 91 and 98 days, respectively. In both cases, moderate AI that was not present before Impella insertion was observed when the Impella was removed. Therefore, we performed aortic valve closure to control the AI during durable LVAD implantation. In patients with durable LVAD implantation, AI may occur and progress after the operation in several cases. Aortic valve surgery is often performed to prevent deterioration of AI, especially in patients with AI before the surgery. Hence, AI is an important complication following Impella device implantation as a bridge to decision. Careful observation of AI is essential when the Impella is removed as the evaluation of AI by echocardiogram during Impella management is cumbersome because of device-generated artifacts.
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Affiliation(s)
- Hideo Oishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Kazuro Fujimoto
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ken-Ichi Hirano
- Laboratory of Cardiovascular Disease, Novel, Non-Invasive, and Nutritional Therapeutics (CNT) and Triglyceride Research Center, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akinori Sawamura
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Shingo Kazama
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuki Kimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshihito Arao
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tasuku Kuwayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shogo Yamaguchi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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15
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Goodwin ML, Bobba CM, Mokadam NA, Whitson BA, Essandoh M, Hasan A, Ganapathi AM. Continuous-Flow Left Ventricular Assist Devices and the Aortic Valve: Interactions, Issues, and Surgical Therapy. Curr Heart Fail Rep 2020; 17:97-105. [DOI: 10.1007/s11897-020-00464-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Kasinpila P, Kong S, Fong R, Shad R, Kaiser AD, Marsden AL, Woo YJ, Hiesinger W. Use of patient-specific computational models for optimization of aortic insufficiency after implantation of left ventricular assist device. J Thorac Cardiovasc Surg 2020; 162:1556-1563. [PMID: 32653292 DOI: 10.1016/j.jtcvs.2020.04.164] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Aortic incompetence (AI) is observed to be accelerated in the continuous-flow left ventricular assist device (LVAD) population and is related to increased mortality. Using computational fluid dynamics (CFD), we investigated the hemodynamic conditions related to the orientation of the LVAD outflow in these patients. METHOD We identified 10 patients with new aortic regurgitation, and 20 who did not, after LVAD implantation between 2009 and 2018. Three-dimensional models of patients' aortas were created from their computed tomography scans. The geometry of the LVAD outflow graft in relation to the aorta was quantified using azimuth angles (AA), polar angles (PAs), and distance from aortic root. The models were used to run CFD simulations, which calculated the pressures and wall shear stress (rWSS) exerted on the aortic root. RESULTS The AA and PA were found to be similar. However, for combinations of high values of AA and low values of PA, there were no patients with AI. The distance from aortic root to the outflow graft was also smaller in patients who developed AI (3.39 ± 0.7 vs 4.07 ± 0.77 cm, P = .04). There was no significant difference in aortic root pressures in the 2 groups. The rWSS was greater in AI patients (4.60 ± 5.70 vs 2.37 ± 1.20 dyne/cm2, P < .001). Qualitatively, we observed a trend of greater perturbations, regions of high rWSS, and flow eddies in the AI group. CONCLUSIONS Using CFD simulations, we demonstrated that patients who developed de novo AI have greater rWSS at the aortic root, and their outflow grafts were placed closer to the aortic roots than those patients without de novo AI.
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Affiliation(s)
- Patpilai Kasinpila
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Sandra Kong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Robyn Fong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Rohan Shad
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Alexander D Kaiser
- Departments of Bioengineering, Stanford University, Stanford, Calif; Pediatrics (Cardiology), Stanford University, Stanford, Calif
| | - Alison L Marsden
- Pediatrics (Cardiology), Stanford University, Stanford, Calif; Institute for Computational and Mathematical Engineering, Stanford University, Stanford, Calif
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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17
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Belkin MN, Imamura T, Fujino T, Kanelidis AJ, Holzhauser L, Ebong I, Narang N, Blair JE, Nathan S, Paul JD, Shah AP, Chung BB, Nguyen A, Smith B, Kalantari S, Raikhelkar J, Ota T, Jeevanandam V, Kim G, Burkhoff D, Sayer G, Uriel N. Transcatheter Aortic Valve Replacement in Left Ventricular Assist Device Patients with Aortic Regurgitation. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2019.1706793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Paprotny M, Ruschitzka F, Lüders B, Wilhelm MJ, Aser R, Bettex D, Flammer AJ, Rudiger A, Winnik S. Pulsatile arterial blood pressure mimicking aortic valve opening during continuous-flow LVAD support: a case report. J Cardiothorac Surg 2019; 14:219. [PMID: 31852537 PMCID: PMC6921524 DOI: 10.1186/s13019-019-1039-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular assist devices (LVAD) have become a common treatment option in advanced heart failure. Lack of aortic valve opening during left ventricular unloading is a common complication and associated with a worse outcome. Maintaining a minimum pulse pressure is an important goal during the early postoperative period after LVAD implantation since it is commonly seen as secure sign of aortic valve opening. AIMS/OBJECTIVE We report a case of an LVAD-supported patient with early permanent closure of the aortic valve despite a pulse pressure > 15 mmHg at all times following LVAD implantation. We demonstrate how careful assessment of the invasive arterial blood pressure curve can indicate aortic valve closure irrespective of pulsatile blood flow. METHOD A 69-year old male patient with terminal ischemic cardiomyopathy was referred for long-term mechanical circulatory support. Due to mild aortic regurgitation both an aortic bioprosthesis and a continuous-flow left ventricular assist device were implanted. Postoperative echocardiography documented a patent aortic bioprosthesis and an acceptable residual systolic left ventricular contractility. During invasive arterial blood pressure monitoring repetitive transient slight blood pressure decreases followed by slight blood pressure increases coincided with programmed LVAD flushing cycles. Permanent pulsatile flow with a pulse pressure of ≥15 mmHg conveyed systolic opening of the aortic valve. Echocardiography, however, proved early permanent aortic valve closure. In retrospect, transformation of the automated LVAD flushing cycles into visible changes of the arterial blood pressure curve during invasive blood pressure monitoring is indicative of ejection of the complete cardiac output through LVAD itself, and therefore an early clinical sign of aortic valve closure. DISCUSSION/CONCLUSION We present this interesting didactic case to highlight caveats during the early postoperative period after LVAD implantation. Moreover, this case demonstrates that careful and differentiated observation of the arterial blood pressure waveform provides crucial information in this unique and growing patient population of continuous-flow LVAD support.
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Affiliation(s)
- Matthias Paprotny
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Frank Ruschitzka
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Bernd Lüders
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Markus J Wilhelm
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Raed Aser
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas J Flammer
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alain Rudiger
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Winnik
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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19
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Noly PE, Pagani FD, Noiseux N, Stulak JM, Khalpey Z, Carrier M, Maltais S. Continuous-Flow Left Ventricular Assist Devices and Valvular Heart Disease: A Comprehensive Review. Can J Cardiol 2019; 36:244-260. [PMID: 32036866 DOI: 10.1016/j.cjca.2019.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/17/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022] Open
Abstract
Mechanical circulatory support with implantable durable continuous-flow left ventricular assist devices (CF-LVADs) represents an established surgical treatment option for patients with advanced heart failure refractory to guideline-directed medical therapy. CF-LVAD therapy has been demonstrated to offer significant survival, functional, and quality-of-life benefits. However, nearly one-half of patients with advanced heart failure undergoing implantation of a CF-LVAD have important valvular heart disease (VHD) present at the time of device implantation or develop VHD during support that can lead to worsening right or left ventricular dysfunction and result in development of recurrent heart failure, more frequent adverse events, and higher mortality. In this review, we summarize the recent evidence related to the pathophysiology and treatment of VHD in the setting of CF-LAVD support and include a review of the specific valve pathologies of aortic insufficiency (AI), mitral regurgitation (MR), and tricuspid regurgitation (TR). Recent data demonstrate an increasing appreciation and understanding of how VHD may adversely affect the hemodynamic benefits of CF-LVAD support. This is particularly relevant for MR, where increasing evidence now demonstrates that persistent MR after CF-LVAD implantation can contribute to worsening right heart failure and recurrent heart failure symptoms. Standard surgical interventions and novel percutaneous approaches for treatment of VHD in the setting of CF-LVAD support, such as transcatheter aortic valve replacement or transcatheter mitral valve repair, are available, and indications to intervene for VHD in the setting of CF-LVAD support continue to evolve.
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Affiliation(s)
- Pierre-Emmanuel Noly
- Department of Cardiac Surgery, Montréal Heart Institute, Montréal, Québec, Canada
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nicolas Noiseux
- Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - John M Stulak
- Department of Cardiac Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Zain Khalpey
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Michel Carrier
- Department of Cardiac Surgery, Montréal Heart Institute, Montréal, Québec, Canada
| | - Simon Maltais
- Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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20
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Mondal S, Dawood M, Bandyopadhyay D, Taylor BS, Tanaka K, Gupta A. Transcatheter aortic valve replacement: A potential option for aortic insufficiency management in patients with left ventricular assist device. IJC HEART & VASCULATURE 2019; 26:100425. [PMID: 31763439 PMCID: PMC6864334 DOI: 10.1016/j.ijcha.2019.100425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Samhati Mondal
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
- Corresponding author.
| | - Murtaza Dawood
- Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, United States
| | - Dhrubajyoti Bandyopadhyay
- Department of Medicine, Icahn School of Medicine at Mount Sinai/ Mount Sinai St. Luke’s Roosevelt, NY, United States
| | - Bradley S. Taylor
- Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, United States
| | - Kenichi Tanaka
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Anuj Gupta
- Department of Cardiology, University of Maryland School of Medicine, Baltimore, MD, United States
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21
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Moderate Aortic Insufficiency with a Left Ventricular Assist Device Portends a Worse Long-Term Survival. ASAIO J 2019; 66:780-785. [DOI: 10.1097/mat.0000000000001071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Short-term results with transcatheter aortic valve replacement for treatment of left ventricular assist device patients with symptomatic aortic insufficiency. J Heart Lung Transplant 2019; 38:920-926. [DOI: 10.1016/j.healun.2019.03.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/17/2022] Open
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23
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Barac YD, Castleberry AW, Patel CB, McCartney SL, Schroder JN. Aortic valve ring annuloplasty is an option in left ventricular assist device patients. J Thorac Cardiovasc Surg 2019; 157:e381-e383. [PMID: 30635192 DOI: 10.1016/j.jtcvs.2018.10.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/16/2018] [Accepted: 10/26/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Yaron D Barac
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC.
| | - Anthony W Castleberry
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Chetan B Patel
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC
| | - Sharon L McCartney
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
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24
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Akiyama D, Nishimura T, Sumikura H, Iizuka K, Mizuno T, Tsukiya T, Takewa Y, Ono M, Tatsumi E. Accurate Method of Quantification of Aortic Insufficiency During Left Ventricular Assist Device Support by Thermodilution Analysis: Proof of Concept and Validation by a Mock Circulatory System. Artif Organs 2018; 42:954-960. [DOI: 10.1111/aor.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Daichi Akiyama
- Department of Artificial Organs; National Cerebral and Cardiovascular Center Research Institute; Osaka Japan
- Department of Cardiac Surgery; University of Tokyo Hospital; Tokyo Japan
| | - Takashi Nishimura
- Department of Cardiac Surgery; Tokyo Metropolitan Geriatric Hospital; Tokyo Japan
| | - Hirohito Sumikura
- Department of Science and Engineering, Division of Electronic and Mechanical Engineering; School of Science and Engineering, Tokyo Denki University; Saitama Japan
| | - Kei Iizuka
- Department of Artificial Organs; National Cerebral and Cardiovascular Center Research Institute; Osaka Japan
| | - Toshihide Mizuno
- Department of Artificial Organs; National Cerebral and Cardiovascular Center Research Institute; Osaka Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs; National Cerebral and Cardiovascular Center Research Institute; Osaka Japan
| | - Yoshiaki Takewa
- Department of Artificial Organs; National Cerebral and Cardiovascular Center Research Institute; Osaka Japan
| | - Minoru Ono
- Department of Cardiac Surgery; University of Tokyo Hospital; Tokyo Japan
| | - Eisuke Tatsumi
- Department of Artificial Organs; National Cerebral and Cardiovascular Center Research Institute; Osaka Japan
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25
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Device Management and Flow Optimization on Left Ventricular Assist Device Support. Crit Care Clin 2018; 34:453-463. [DOI: 10.1016/j.ccc.2018.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Liao S, Neidlin M, Li Z, Simpson B, Gregory SD. Ventricular flow dynamics with varying LVAD inflow cannula lengths: In-silico evaluation in a multiscale model. J Biomech 2018; 72:106-115. [PMID: 29567308 DOI: 10.1016/j.jbiomech.2018.02.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/14/2018] [Accepted: 02/28/2018] [Indexed: 01/17/2023]
Abstract
Left ventricular assist devices are associated with thromboembolic events, which are potentially caused by altered intraventricular flow. Due to patient variability, differences in apical wall thickness affects cannula insertion lengths, potentially promoting unfavourable intraventricular flow patterns which are thought to be correlated to the risk of thrombosis. This study aimed to present a 3D multiscale computational fluid dynamic model of the left ventricle (LV) developed using a commercial software, Ansys, and evaluate the risk of thrombosis with varying inflow cannula insertion lengths in a severely dilated LV. Based on a HeartWare HVAD inflow cannula, insertion lengths of 5, 19, 24 and 50 mm represented cases of apical hypertrophy, typical ranges of apical thicknesses and an experimental length, respectively. The risk of thrombosis was evaluated based on blood washout, residence time, instantaneous blood stagnation and a pulsatility index. By introducing fresh blood to displace pre-existing blood in the LV, after 5 cardiac cycles, 46.7%, 45.7%, 45.1% and 41.8% of pre-existing blood remained for insertion lengths of 5, 19, 24 and 50 mm, respectively. Compared to the 50 mm insertion, blood residence time was at least 9%, 7% and 6% higher with the 5, 19 and 24 mm insertion lengths, respectively. No instantaneous stagnation at the apex was observed directly after the E-wave. Pulsatility indices adjacent to the cannula increased with shorter insertion lengths. For the specific scenario studied, a longer insertion length, relative to LV size, may be advantageous to minimise thrombosis by increasing LV washout and reducing blood residence time.
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Affiliation(s)
- Sam Liao
- Queensland University of Technology (QUT), Institute of Health and Biomedical Innovation (IHBI), Kelvin Grove, QLD 4059, Australia; Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD 4032, Australia; Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany.
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany
| | - Zhiyong Li
- Queensland University of Technology (QUT), Institute of Health and Biomedical Innovation (IHBI), Kelvin Grove, QLD 4059, Australia
| | - Benjamin Simpson
- Department of Engineering, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, United Kingdom
| | - Shaun D Gregory
- Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD 4032, Australia; School of Engineering, Griffith University, Southport, QLD 4215, Australia
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Kozarek K, Minhaj MM, Chaney MA, D'Ancona G, Pasic M, Carrel T, Cotter EH. Transcatheter Aortic Valve Replacement for Left Ventricular Assist Device-Induced Aortic Insufficiency. J Cardiothorac Vasc Anesth 2018; 32:1982-1990. [PMID: 29699845 DOI: 10.1053/j.jvca.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Katherine Kozarek
- Department of Anesthesiology, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL
| | - Mohammed M Minhaj
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
| | | | - Miralem Pasic
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
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28
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Dokollari A, Cameli M, Sassi CG, Davoli G, Scolletta S, Ricci C, Lucatelli P, Mondillo S, Maccherini M. Case Report: Aortic Valve Replacement After JARVIK 2000 Left Ventricular Assist Device Implantation in Long-Time Survivor With Severe Aortic Valve Regurgitation. Transplant Proc 2017; 49:729-732. [PMID: 28457382 DOI: 10.1016/j.transproceed.2017.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are limited clinical records in the literature regarding aortic valve replacement in left ventricular assist device (L-VAD) patients. Previously we had two cases of severe aortic valve regurgitation in patients with L-VAD support treated with Corvalve prosthesis insertion and Amplatzer closure procedure. Both patients died a few days after the procedure from complications not related to the procedure itself. PATIENT HISTORY The patient was a male with previous coronary artery bypass graft surgery in 2001 that was complicated with postischemic dilated cardiomyopathy with severe heart failure (ejection fraction [EF], 20%). Cardiac resynchronization therapy was biventricular-pacemaker and cardiac defibrillator implantation in 2009 for recurrent ventricular arrhythmia. L-VAD implantation (Jarvik 2000) with graft apposition in descending thoracic aorta through left thoracotomy access and retro-auricolar cable was performed in October 2013. In 2015 the patient underwent surgical aortic valve replacement with bioprothesis due to progressive worsening of the aortic valve regurgitation. The Jarvik 2000 outflow was occluded with vascular ball occluder inserted via right axillary artery under fluoroscopy before CEC installation. The recovery was without major complications. DISCUSSION Long-time survivors with Jarvik 2000 are increasing in number and such late complication is expected to become a main future issue. Our previous experience with the interventional approach was delusive. Due to the fatal consequences in similar patients with nonsurgical approaches, we opted for surgical aortic valve replacement. At the moment, the international literature does not describe safe approaches regarding aortic valve replacement in patients with Jarvik 2000 L-VAD. This case shows that surgical valve replacement could be managed with success according to the described specific technique.
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Affiliation(s)
- A Dokollari
- Department of Cardiac Surgery, University of Siena, Siena, Italy.
| | - M Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - C G Sassi
- Department of Cardiac Surgery, University of Siena, Siena, Italy
| | - G Davoli
- Department of Cardiac Surgery, University of Siena, Siena, Italy
| | - S Scolletta
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Siena, Italy
| | - C Ricci
- Interventional Radiology, Policlinico Santa Maria alle Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - P Lucatelli
- Interventional Radiology, Policlinico Santa Maria alle Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - S Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - M Maccherini
- Department of Cardiac Surgery, University of Siena, Siena, Italy
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Gasparovic H, Kopjar T, Saeed D, Cikes M, Svetina L, Petricevic M, Lovric D, Milicic D, Biocina B. De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation. Ann Thorac Surg 2017; 104:704-711. [DOI: 10.1016/j.athoracsur.2017.01.114] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/21/2016] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
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Left Ventricular Assist Devices: Challenges Toward Sustaining Long-Term Patient Care. Ann Biomed Eng 2017; 45:1836-1851. [DOI: 10.1007/s10439-017-1858-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022]
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31
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Percutaneous Transcatheter Interventions for Aortic Insufficiency in Continuous-Flow Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis. ASAIO J 2017; 63:117-122. [DOI: 10.1097/mat.0000000000000447] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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32
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Percutaneous Transcatheter Implantable Gadgets for De Novo Aortic Valve Regurgitation After Left Ventricular Assist Device Implant: Pushing the Limits or a Feasible Bailout? ASAIO J 2017; 63:115-116. [PMID: 28169845 DOI: 10.1097/mat.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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33
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Grinstein J, Kruse E, Sayer G, Fedson S, Kim GH, Jorde UP, Juricek C, Ota T, Jeevanandam V, Lang RM, Uriel N. Accurate Quantification Methods for Aortic Insufficiency Severity in Patients With LVAD. JACC Cardiovasc Imaging 2016; 9:641-51. [DOI: 10.1016/j.jcmg.2015.06.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 10/22/2022]
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34
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Grinstein J, Kruse E, Sayer G, Fedson S, Kim GH, Sarswat N, Adatya S, Ota T, Jeevanandam V, Mor-Avi V, Lang RM, Uriel N. Novel echocardiographic parameters of aortic insufficiency in continuous-flow left ventricular assist devices and clinical outcome. J Heart Lung Transplant 2016; 35:976-85. [PMID: 27373822 DOI: 10.1016/j.healun.2016.05.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the prognostic performance of novel echocardiographic (transthoracic echocardiography, or TTE) parameters for grading aortic insufficiency (AI) severity in patients with continuous-flow left ventricular assist devices (CF-LVADs). The development of AI after CF-LVAD implantation is common, although the clinical significance remains unclear. We previously described novel TTE parameters that outperformed traditional TTE parameters in grading AI severity in these patients. METHODS CF-LVAD patients with varying degrees of AI (N = 57) underwent Doppler TTE of the LVAD outflow cannula. Patients had AI severity graded by the novel parameters (systolic/diastolic velocity ratio and the diastolic acceleration of the LVAD outflow cannula) and the traditional vena contracta. The prognostic performance of novel and traditional AI parameters was determined by comparing rates of congestive heart failure re-admission, need for aortic valve intervention, urgent transplantation and death (composite end-points) for each parameter. RESULTS Grading AI severity using novel AI parameters led to reclassification of 32% of patients from trace/mild AI to moderate or greater AI (N = 18). Using traditional AI parameters, there was no difference in the occurrence of the composite end-point between the moderate or greater group and the trace/mild group (1.50 vs 1.18 events/person, p = 0.46). With the novel AI parameters, there were significantly more events in the patients with moderate or greater AI compared to those with trace/mild AI (1.57 vs 0.13 events/person, p = 0.002). Novel parameters also better predicted the need for aortic valve intervention, urgent transplantation or death than traditional methods (p = 0.024 vs p = 0.343). CONCLUSIONS In patients with CF-LVADs, traditional parameters tend to underestimate AI severity and future cardiac events. Novel AI TTE parameters are better able to discriminate AI severity and predict clinically meaningful outcomes.
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Affiliation(s)
- Jonathan Grinstein
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Eric Kruse
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Gabriel Sayer
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Savitri Fedson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Gene H Kim
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Nitasha Sarswat
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Sirtaz Adatya
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Valluvan Jeevanandam
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Nir Uriel
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.
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35
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Ushijima T, Tanoue Y, Ide T, Okano S, Oda Y, Tominaga R. Disuse Atrophy of the Aortic Valve After Left Ventricular Assist Device Implantation. Ann Thorac Surg 2016; 101:742-4. [DOI: 10.1016/j.athoracsur.2015.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/03/2015] [Accepted: 03/10/2015] [Indexed: 10/22/2022]
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36
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Smith EM, Franzwa J. Chronic outpatient management of patients with a left ventricular assist device. J Thorac Dis 2016; 7:2112-24. [PMID: 26793331 DOI: 10.3978/j.issn.2072-1439.2015.10.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The use of mechanical circulatory support (MCS) as treatment for advanced heart failure (HF) has grown exponentially over the past 15 years. The continuous flow left ventricular assist device (CF-LVAD) has become the most used form of MCS in advanced HF, especially since approval of use as destination therapy (DT) and with the lack of organ availability. Long-term survival has improved and diligent outpatient management is thus particularly critical to achieve optimal outcomes. This review will discuss outpatient management strategies for patients with HF and a left ventricular assist device (LVAD).
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Affiliation(s)
- Elisa M Smith
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA ; 2 Cardiomyopathy Treatment Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jennifer Franzwa
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA ; 2 Cardiomyopathy Treatment Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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37
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Opening of Aortic Valve During Exercise Is Key to Preventing Development of Aortic Insufficiency During Ventricular Assist Device Treatment. ASAIO J 2015; 61:514-9. [DOI: 10.1097/mat.0000000000000247] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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38
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da Rocha e Silva JG, Meyer AL, Eifert S, Garbade J, Mohr FW, Strueber M. Influence of aortic valve opening in patients with aortic insufficiency after left ventricular assist device implantation. Eur J Cardiothorac Surg 2015; 49:784-7. [DOI: 10.1093/ejcts/ezv204] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 05/04/2015] [Indexed: 11/14/2022] Open
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40
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Imamura T, Kinugawa K, Nitta D, Inaba T, Maki H, Hatano M, Kinoshita O, Nawata K, Kyo S, Ono M. Opening of Native Aortic Valve Accomplished After Left Ventricular Assist Device Implantation in Patients With Insufficient Preoperative Beta-Blocker Treatment. Int Heart J 2015; 56:303-8. [DOI: 10.1536/ihj.14-330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Daisuke Nitta
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Osamu Kinoshita
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo
| | - Kan Nawata
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo
| | - Shunei Kyo
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Minoru Ono
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo
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Imamura T, Kinugawa K, Fujino T, Inaba T, Maki H, Hatano M, Kinoshita O, Nawata K, Kyo S, Ono M. Aortic insufficiency in patients with sustained left ventricular systolic dysfunction after axial flow assist device implantation. Circ J 2014; 79:104-11. [PMID: 25381791 DOI: 10.1253/circj.cj-14-0944] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved. METHODS AND RESULTS We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for ≥6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35%) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65%) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55% vs. 8%; P<0.001). CONCLUSIONS Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome.
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Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
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Mini right thoracotomy as an approach to aortic valve closure in an assist device patient. ASAIO J 2014; 61:96-7. [PMID: 25303797 DOI: 10.1097/mat.0000000000000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This case report concerns a patient status post left ventricular assist device placement that was complicated by new onset severe aortic valve insufficiency. After almost 2 years with his device, the patient had a syncopal episode and had worsening aortic valve regurgitation on echocardiography. The patient underwent an aortic valve closure via the right second intercostal space, which represents a new approach to managing these patients surgically and avoiding repeat sternotomies and further right ventricle injury.
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