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Jimeno-San Martín L, Goñi-Viguria R, Bengoechea L, Fernandez E, Mendiluce N, Romero C, Rábago G, Regaira-Martínez E. Postoperative management and nursing care after implantation of a total artificial heart: Scoping review. ENFERMERIA INTENSIVA 2024; 35:213-228. [PMID: 37743167 DOI: 10.1016/j.enfie.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION End-stage heart failure (HF) is a condition whose only successful long-term treatment, with a survival of more than 10 years, is heart transplantation. However, limited organ availability and the progressive increase in the number of patients with advanced HF have served as an impetus for the development of implantable mechanical assistive devices. AIM To provide an overview of postoperative management and nursing care after the implementation of a Total Artificial Heart (TAH). METHODS A scoping review was carried out by consulting the PUBMED, CINAHL, and COCHRANE databases. From all the documents located, information was extracted on the date of publication, country of publication, type of study, and results of interest to answer the research question. In addition, the degree of recommendation was identified. RESULTS Twenty-three documents were included in the scoping review. Results were classified in relation to: 1) description of the CAT SynCardia®; 2) nursing care in the immediate postoperative period (management of the device and management of hematological, infectious, nephrological, nutritional complications, related to immobilization, sleep-rest disturbances, psychological disorders, and patient and family education); and 3) follow-up at home. CONCLUSIONS The complexity of implantation of the TAH, the multiple related complications that can arise during this process, both in the immediate post-operative and late, require a standardised and multidisciplinary management. The absence of standardised protocols raises the need for future studies to measure the effectiveness of care in patients with TAH. A multidisciplinary approach is crucial. Nurses must acquire autonomy and involvement in decision-making and develop competencies to address the patient's and family's physiological and psychosocial needs.
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Affiliation(s)
- L Jimeno-San Martín
- Servicio de Cirugía Cardiaca, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - R Goñi-Viguria
- Área de Críticos, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
| | - L Bengoechea
- Área de Críticos, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - E Fernandez
- Hospitalización en Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - N Mendiluce
- Hospitalización en Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - C Romero
- Área de Críticos, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - G Rábago
- Servicio de Cirugía Cardiaca, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - E Regaira-Martínez
- Área de Desarrollo Profesional e Investigación en Enfermería, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Guo R, Wen Y, Xu Y, Jia R, Zou S, Lu S, Liu G, Cui K. The impact of exercise training for chronic heart failure patients with cardiac resynchronization therapy: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25128. [PMID: 33787595 PMCID: PMC8021321 DOI: 10.1097/md.0000000000025128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/15/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT). METHODS PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software. RESULTS Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41-33.23; P < .00001, I2 = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41-122.48; P = .01, I2 = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO2) (MD 3.05 ml/kg/minute, 95% CI 2.53-3.56; P < .00001, I2 = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44-8.49; P = .006, I2 = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD -19.96, 95% CI -21.57 to -18.34; P < .00001, I2 = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group. CONCLUSION During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.
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Affiliation(s)
- Ran Guo
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Yi Wen
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Ying Xu
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Ruikun Jia
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Song Zou
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Sijie Lu
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Guobin Liu
- Department of Cardiology, The First People's Hospital of Jintang County, Sichuan, China
| | - Kaijun Cui
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
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In vitro performance investigation of SynCardia™ Freedom® driver via patient simulator mock loop. Int J Artif Organs 2016; 39:502-508. [PMID: 27768204 DOI: 10.5301/ijao.5000524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE The gold standard therapy for patients with advanced heart failure is heart transplant. The gap between donors and patients in waiting lists promoted the development of circulatory support devices, such as the total artificial heart (TAH). Focusing on in vitro tests performed with CardioWest™ TAH (CW) driven by the SynCardia Freedom® portable driver (FD) the present study goals are: i) prove the reliability of a hydraulic circuit used as patient simulator to replicate a quasi-physiological scenario for various hydrodynamic conditions, ii) investigate the hydrodynamic performance of the CW FD, iii) help clinicians in possible interpretation of clinical cases outcomes. METHODS In vitro tests were performed using a mechanic-hydraulic patient simulator. Cardiac output (CO), CW ventricles filling, atrial, ventricles, aortic and pulmonary artery pressures were measured for different values of vascular resistance in both systemic (SVR) and pulmonary (PVR) physiological range. RESULTS After increasing the PVR, the left atrial pressure decreased according to the expected physiological trend, while aortic pressure remained almost stable, proving the ability of the simulator to mimic a physiological scenario. Unexpectedly, the mean pulmonary artery pressure (PPA) was found to increase above 30 mmHg in the range of physiological PVR (2.6 WU) and for constant CO. CONCLUSIONS The increase in PPA is probably associated with the pre-set driving setup of the FD. The finding suggests a possible explanation of the clinical course of a patient who experienced complications soon after being supported by the FD, with the occurrence of dyspnea and pulmonary edema despite a high cardiac index.
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Gerosa G, Gallo M, Bottio T, Tarzia V. Successful heart transplant after 1374 days living with a total artificial heart. Eur J Cardiothorac Surg 2016; 49:e88-9. [DOI: 10.1093/ejcts/ezv469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/09/2015] [Indexed: 11/13/2022] Open
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Exercise programs for LVAD supported patients: A snapshot from the ESC affiliated countries. Int J Cardiol 2015; 201:215-9. [DOI: 10.1016/j.ijcard.2015.08.081] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 11/20/2022]
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Cardiopulmonary exercise testing responses to different external portable drivers in a patient with a CardioWest Total Artificial Heart. J Artif Organs 2015; 19:188-91. [PMID: 26497137 DOI: 10.1007/s10047-015-0868-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
Management of patients treated with CardioWest Total Artificial Heart (CW-TAH) as a bridge to heart transplantation (HTx) is complicated by difficulties in determining the optimal timing of transplantation. We present a case of a 53-year-old man supported as an outpatient with a CW-TAH, whose condition deteriorated following exchange of the portable driver. The patient was followed-up with serial cardiopulmonary exercise testing (CPET) which demonstrated a fall of peak VO2 to below 12 ml/kg/min following driver substitution, and the patient was subsequently treated with urgent orthotopic HTx. This case highlights the potential utility of CPET as a means for monitoring and indicating timing of HTx in patients with CW-TAH, as well as the potential for clinical deterioration following portable driver substitution.
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Compostella L, Russo N, Setzu T, Bottio T, Compostella C, Tarzia V, Livi U, Gerosa G, Iliceto S, Bellotto F. A Practical Review for Cardiac Rehabilitation Professionals of Continuous-Flow Left Ventricular Assist Devices. J Cardiopulm Rehabil Prev 2015; 35:301-11. [DOI: 10.1097/hcr.0000000000000113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tarzia V, Buratto E, Gallo M, Bortolussi G, Bejko J, Dal Lin C, Torregrossa G, Bianco R, Bottio T, Gerosa G. Surgical implantation of the CardioWest Total Artificial Heart. Ann Cardiothorac Surg 2014; 3:624-5. [PMID: 25512906 DOI: 10.3978/j.issn.2225-319x.2014.08.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/19/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Vincenzo Tarzia
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Edward Buratto
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Michele Gallo
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Giacomo Bortolussi
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Jonida Bejko
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Carlo Dal Lin
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Gianluca Torregrossa
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Roberto Bianco
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Tomaso Bottio
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
| | - Gino Gerosa
- 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Australia
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Compostella L, Russo N, Setzu T, Compostella C, Bellotto F. Exercise performance of chronic heart failure patients in the early period of support by an axial-flow left ventricular assist device as destination therapy. Artif Organs 2013; 38:366-73. [PMID: 24117945 DOI: 10.1111/aor.12172] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Axial-flow left ventricular assist devices (LVADs) are increasingly used as destination therapy in end-stage chronic heart failure (CHF), as they improve survival and quality of life. Their effect on exercise tolerance in the early phase after implantation is still unclear. The aim of this study was to evaluate the effect of LVADs on the exercise capacity of a group of CHF patients within 2 months after initiation of circulatory support. Cardiopulmonary exercise test data were collected for 26 consecutive LVAD-implanted CHF patients within 2 months of initiation of assistance; the reference group consisted of 30 CHF patients not supported by LVAD who were evaluated after an episode of acute heart failure. Both LVAD and reference groups showed poor physical performance; LVAD patients achieved lower workload (LVAD: 36.3 ± 9.0 W, reference: 56.6 ± 18.2 W, P < 0.001) but reached a similar peak oxygen uptake (peak VO2 ; LVAD: 12.5 ± 3.0 mL/kg/min, reference: 13.6 ± 2.9 mL/kg/min, P = ns) and similar percentages of predicted peak VO2 (LVAD: 48.8 ± 13.9%, reference: 54.2 ± 15.3%, P = ns). While the values of the O2 uptake efficiency slope were 12% poorer in LVAD patients than in reference patients (1124.2 ± 226.3 vs. 1280.2 ± 391.1; P = ns), the kinetics of VO2 recovery after exercise were slightly better in LVAD patients (LVAD: 212.5 ± 62.5, reference: 261.1 ± 80.2 sec, P < 0.05). In the first 2 months after initiation of circulatory support, axial-flow LVAD patients are able to sustain a low-intensity workload; though some cardiopulmonary exercise test parameters suggest persistence of a marked physical deconditioning, their cardiorespiratory performance is similar to that of less compromised CHF patients, possibly due to positive hemodynamic effects beginning to be produced by the assist device.
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Affiliation(s)
- Leonida Compostella
- Preventive Cardiology and Rehabilitation, Istituto Codivilla Putti, Cortina d'Ampezzo
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Current World Literature. Curr Opin Cardiol 2012; 27:318-26. [DOI: 10.1097/hco.0b013e328352dfaf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current World Literature. Curr Opin Anaesthesiol 2012; 25:260-9. [DOI: 10.1097/aco.0b013e3283521230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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