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The impact of preoperative kidney replacement therapy on kidney outcome and survival in patients with left ventricular assist device. Ren Fail 2023; 45:2157285. [PMID: 36763000 PMCID: PMC9930763 DOI: 10.1080/0886022x.2022.2157285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Left ventricular assist device (LVAD) has been highlighted as a new treatment option in the end-stage heart failure (HF). Kidney outcome after LVAD in severe cardiorenal syndrome (CRS) patients requiring kidney replacement therapy (KRT) is unclear. We investigated the impact of preoperative KRT on kidney function and survival in LVAD patients with severe CRS. A total of 50 patients followed up for at least 1 year after LVAD implantation was analyzed. The primary outcomes were estimated glomerular filtration rate and survival rate. Patients were divided into two groups depending on in-hospital KRT before LVAD implantation: the control group (n = 33) and the KRT group (n = 17). Postoperative KRT was performed for 76.5% of patients in the KRT group, and all of them discontinued KRT before discharge. There were no statistically significant differences in the degree of eGFR decline in survivors according to preoperative KRT. Although there were no statistically significant differences in the degree of eGFR decline in survivors regardless of preoperative KRT, old age (β -0.94, p < 0.01), preexisting chronic kidney disease (β -21.89, p < 0.01), and high serum creatinine (β -13.95, p < 0.01) were identified as independent predictors of post-LVAD eGFR decline. Mortality rate was higher, and more patients progressed to end-stage kidney disease in KRT group than control group. However, LVAD still can be considered as the treatment option in end-stage HF patients with severe CRS requiring KRT, especially in those with young age and previous normal kidney function.
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Kislitsina ON, D Rich J, Wilcox JE, E Vorovich E, Wu T, Churyla A, S Harap R, Andrei AC, McCarthy PM, Yancy CW, Pham DT. Propensity Score-Matched Comparison of Right Ventricular Strain in Women and Men Before and After Left Ventricular Assist Device Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:102-110. [PMID: 35275496 DOI: 10.1177/15569845221081937] [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
Objective: Adverse events following left ventricular assist device (LVAD) implantation are more common in women than in men, but the impact of gender differences on right ventricular (RV) failure is not well defined. Therefore, we calculated RV strain before and after LVAD implantation in matched groups of men and women to determine if gender differences in RV failure after LVAD might account for the gender differences in overall outcomes. Methods: RV free wall longitudinal strain (FWS) and fractional area change were calculated preoperatively and 3 months postoperatively using speckle-tracking echocardiography analysis. A total of 172 patients (86 women, 86 men) were then propensity score matched (1:1) for comparison. Results: Although women had higher preoperative CHA2DS2-VASc scores and more frequent moderate mitral regurgitation than men (P = 0.018), the preoperative hemodynamic parameters were similar. Preoperative RV-FWS was -6.7% in women and -6.0% in men (P = 0.65). Postoperatively, women had more progression to severe tricuspid regurgitation (TR) than men (15% vs 7%, P = 0.06). At 3 months the RV-FWS was -7.7% in women and -7.0% in men (P = 0.59). Postoperative TR was moderate-severe in 20% of women and in 9% of men (P = 0.001). Women had a higher incidence of venous thromboembolism, cardiac arrhythmias, and bleeding compared with men. Women also had higher mortality rates at discharge and 30 days after surgery, but the survival rates at 5 years were similar. Conclusions: RV strain measurements track standard hemodynamic and echocardiographic parameters and confirm that gender differences in outcomes following LVAD implantation are not related to gender differences in RV failure rates.
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Affiliation(s)
- Olga N Kislitsina
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA.,Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
| | - Jonathan D Rich
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Jane E Wilcox
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Esther E Vorovich
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Tingqing Wu
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Andrei Churyla
- Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
| | - Rebecca S Harap
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Adin-Christian Andrei
- Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
| | - Clyde W Yancy
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Duc Thin Pham
- Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
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Mariani S, Hanke JS, Li T, Merzah AS, Chatterjee A, Deniz E, Haverich A, Schmitto JD, Dogan G. Device profile of the heartware HVAD system as a bridge-to-transplantation in patients with advanced heart failure: overview of its safety and efficacy. Expert Rev Med Devices 2019; 16:1003-1015. [DOI: 10.1080/17434440.2019.1696674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin Sarah Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Anamika Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ezin Deniz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D. Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Survival and Functional Status After Bridge-to-Transplant with a Left Ventricular Assist Device. ASAIO J 2019; 65:661-667. [DOI: 10.1097/mat.0000000000000874] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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DeFilippis EM, Truby LK, Garan AR, Givens RC, Takeda K, Takayama H, Naka Y, Haythe JH, Farr MA, Topkara VK. Sex-Related Differences in Use and Outcomes of Left Ventricular Assist Devices as Bridge to Transplantation. JACC-HEART FAILURE 2019; 7:250-257. [DOI: 10.1016/j.jchf.2019.01.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 12/19/2022]
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Catheter Ablation of Ventricular Tachycardia in Patients With a Ventricular Assist Device: A Systematic Review of Procedural Characteristics and Outcomes. JACC Clin Electrophysiol 2018; 5:39-51. [PMID: 30678785 DOI: 10.1016/j.jacep.2018.08.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This is a systematic review summarizing the procedural characteristics and outcomes of ventricular assist device (VAD)-related ventricular tachycardia (VT) ablation. BACKGROUND Drug-refractory VT refractory commonly develops post-VAD implantation. Procedural and outcome data come from small series or case reports. METHODS An electronic search was performed using major databases. Primary outcomes were VT recurrence, mortality, and cardiac transplantation. Secondary endpoints were acute procedural success and procedural complications. RESULTS Eighteen studies were included, with a total of 110 patients (mean age 59.6 ± 11 years, 89% men; VT storm 34%). Scar-related re-entry was the predominant mechanism of VT (90.3%) and cannula-related VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8% of cases; there were no reports of catheter entrapment. Noninducibility of clinical VT was achieved in 77.9%; procedural complications occurred in 9.4%. At a mean follow-up of 263.5 ± 267.0 days, VT recurred in 43.6%, 23.4% underwent cardiac transplant, and 48.1% died. There were no procedural-related deaths and no death was directly related to ventricular arrhythmia. In follow-up, there was a significant reduction in implantable cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation allowed VT storm termination in 90% of patients. CONCLUSIONS VAD-related VT is predominantly related to pre-existing intrinsic myocardial scar rather than inflow cannula site insertion. Catheter ablation is a reasonable treatment strategy, albeit with expectedly high rate of recurrence, transplantation, and mortality related to severe underlying disease.
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New, but still the same old story. J Thorac Cardiovasc Surg 2018; 156:1528-1529. [PMID: 29779640 DOI: 10.1016/j.jtcvs.2018.04.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 11/23/2022]
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Gender differences and outcomes in left ventricular assist device support: The European Registry for Patients with Mechanical Circulatory Support. J Heart Lung Transplant 2018; 37:61-70. [DOI: 10.1016/j.healun.2017.06.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 01/20/2023] Open
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Kimura M, Nawata K, Kinoshita O, Yamauchi H, Itoda Y, Imamura T, Hatano M, Kinugawa K, Ono M. Cerebrovascular Accident Rate Is Different Between Centrifugal and Axial-Flow Pumps, but Survival and Driveline Infection Rates Are Similar. Transplant Proc 2017; 49:121-124. [DOI: 10.1016/j.transproceed.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Turer DM, Koch KL, Koelling TM, Wu AH, Pagani FD, Haft JW. Comparing the Effectiveness of an Axial and a Centrifugal Left Ventricular Assist Device in Ventricular Unloading. ASAIO J 2016; 62:652-656. [DOI: 10.1097/mat.0000000000000420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Al-Sarie M, Rauf A, Kfoury AG, Catino A, Wever-Pinzon J, Bonios M, Horne BD, Diakos NA, Wever-Pinzon O, McKellar SH, Kelkhoff A, McCreath L, Fang J, Stehlik J, Selzman CH, Drakos SG. Myocardial Structural and Functional Response After Long-Term Mechanical Unloading With Continuous Flow Left Ventricular Assist Device. JACC-HEART FAILURE 2016; 4:570-576. [DOI: 10.1016/j.jchf.2016.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 01/17/2023]
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Tuncer O, Kemaloğlu C, Erbasan O, Gölbaşı İ, Türkay C, Bayezid Ö. Outcomes and Readmissions After Continuous Flow Left Ventricular Assist Device: Heartmate II Versus Heartware Ventricular Assist Device. Transplant Proc 2016; 48:2157-61. [DOI: 10.1016/j.transproceed.2016.03.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 03/01/2016] [Indexed: 10/21/2022]
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Longitudinal structural, functional, and cellular myocardial alterations with chronic centrifugal continuous-flow left ventricular assist device support. J Heart Lung Transplant 2016; 36:722-731. [PMID: 27373819 DOI: 10.1016/j.healun.2016.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/15/2016] [Accepted: 05/18/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Left ventricular assist device (LVAD) support triggers adaptations within failing hearts. The HeartWare (HeartWare International, Inc., Framingham, MA) LVAD exhibits different flow profiles and afterload dependence compared with previous-generation devices, which may alter remodelling patterns. We sought to characterize myocardial adaptation to third-generation centrifugal-flow LVADs at a functional, hemodynamic, and structural level in addition to profiling transcriptomal changes using next-generation sequencing platforms. METHODS We studied 37 patients supported with the HeartWare device with paired measurements of invasive hemodynamics, serial longitudinal left ventricular (LV) and right ventricular (RV) 3-dimensional echocardiography, and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) measurements. Paired samples for comparison of histologic myocardial cellular size and transcriptomal profiling were performed on specimens taken at pump implant and transplantation. RESULTS The mean support duration was 280 ± 163 days. Mechanical unloading after HeartWare support resulted in reduced filling pressures (mean pulmonary capillary wedge pressure 27.1 ± 6.6 to 14.8 ± 5.1 mm Hg, p < 0.0001). Mean LV cardiomyocyte cell size decreased from 2,789.7 ± 671.8 to 2,290.8 ± 494.2 μm2 (p = 0.02). LV and RV ejection fractions improved significantly (24% ± 8% to 35% ± 9% [p < 0.001] and 35% ± 11% to 40% ± 8% [p < 0.02], respectively). NT-proBNP levels fell 4.8-fold by Day 90 after support, consistent with a decrease in LV wall stress. Despite these concordant beneficial findings, the microRNA transcriptome did not change significantly across the group. CONCLUSIONS Reverse remodelling is evident at multiple levels with chronic HeartWare support in the absence of changes in the microRNA transcriptome. Successful myocardial unloading is associated with a decrease in wall stress, regression of cardiomyocyte hypertrophy, and an improvement in LV and RV ejection fractions.
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Hanke JS, Rojas SV, Avsar M, Bara C, Ismail I, Haverich A, Schmitto JD. HeartWare left ventricular assist device for the treatment of advanced heart failure. Future Cardiol 2016; 12:17-26. [DOI: 10.2217/fca.15.58] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The importance of mechanical circulatory support in the therapy of advanced heart failure is steadily growing. The rapid developments in the field of mechanical support are characterized by continuous miniaturization and enhanced performance of the assist devices, providing increased pump durability and prolonged patient survival. The HeartWare left ventricular assist device system (HeartWare Inc., Framingham, MA, USA) is a mechanical ventricular assist device with over 8000 implantations worldwide. Compared with other available assist devices it is smaller in size and used in a broad range of patients. The possibility of minimally invasive procedures is one of the major benefits of the device – allowing implants and explants, as well as exchanges of the device with reduced surgical impact. We present here a review of the existing literature on the treatment of advanced heart failure using the HeartWare left ventricular assist device system.
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Affiliation(s)
- Jasmin S Hanke
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sebastian V Rojas
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Bara
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Issam Ismail
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hannover Medical School, Hannover, Germany
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Abstract
For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term "cardiac surgery". The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with "solid ground" for up-to-date decision-making in cardiac surgery.
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Kosaka R, Yasui K, Nishida M, Kawaguchi Y, Maruyama O, Yamane T. Optimal Bearing Gap of a Multiarc Radial Bearing in a Hydrodynamically Levitated Centrifugal Blood Pump for the Reduction of Hemolysis. Artif Organs 2014; 38:818-22. [DOI: 10.1111/aor.12383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ryo Kosaka
- Human Technology Research Institute; National Institute of Advanced Industrial Science and Technology (AIST); Tsukuba Ibaraki Japan
| | - Kazuya Yasui
- Department of Mechanical Engineering; Tokyo University of Science; Noda Chiba Japan
| | - Masahiro Nishida
- Human Technology Research Institute; National Institute of Advanced Industrial Science and Technology (AIST); Tsukuba Ibaraki Japan
| | - Yasuo Kawaguchi
- Department of Mechanical Engineering; Tokyo University of Science; Noda Chiba Japan
| | - Osamu Maruyama
- Human Technology Research Institute; National Institute of Advanced Industrial Science and Technology (AIST); Tsukuba Ibaraki Japan
| | - Takashi Yamane
- Department of Mechanical Engineering; Kobe University; Kobe Hyogo Japan
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Ghodsizad A, Brehm C, Koerner MM, Elbanayosy A. Invited commentary. Ann Thorac Surg 2014; 97:512-3. [PMID: 24484793 DOI: 10.1016/j.athoracsur.2013.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Ali Ghodsizad
- Penn State Hershey Medical Center, Heart and Vascular Institute, Penn State College of Medicine, 500 University Dr, Hershey, PA17033-0850
| | - Christoph Brehm
- Penn State Hershey Medical Center, Heart and Vascular Institute, Penn State College of Medicine, 500 University Dr, Hershey, PA17033-0850
| | - Michael M Koerner
- Penn State Hershey Medical Center, Heart and Vascular Institute, Penn State College of Medicine, 500 University Dr, Hershey, PA17033-0850
| | - Aly Elbanayosy
- Penn State Hershey Medical Center, Heart and Vascular Institute, Penn State College of Medicine, 500 University Dr, Hershey, PA17033-0850.
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