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Estep JD, Nicoara A, Cavalcante J, Chang SM, Cole SP, Cowger J, Daneshmand MA, Hoit BD, Kapur NK, Kruse E, Mackensen GB, Murthy VL, Stainback RF, Xu B. Recommendations for Multimodality Imaging of Patients With Left Ventricular Assist Devices and Temporary Mechanical Support: Updated Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:820-871. [PMID: 39237244 DOI: 10.1016/j.echo.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Affiliation(s)
| | | | - Joao Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | | | | | - Brian D Hoit
- Case Western Reserve University, Cleveland, Ohio
| | | | - Eric Kruse
- University of Chicago, Chicago, Illinois
| | | | | | | | - Bo Xu
- Cleveland Clinic, Cleveland, Ohio
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2
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Nicoara A, Skubas N, Ad N, Finley A, Hahn RT, Mahmood F, Mankad S, Nyman CB, Pagani F, Porter TR, Rehfeldt K, Stone M, Taylor B, Vegas A, Zimmerman KG, Zoghbi WA, Swaminathan M. Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. J Am Soc Echocardiogr 2020; 33:692-734. [PMID: 32503709 DOI: 10.1016/j.echo.2020.03.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intraoperative transesophageal echocardiography is a standard diagnostic and monitoring tool employed in the management of patients undergoing an entire spectrum of cardiac surgical procedures, ranging from "routine" surgical coronary revascularization to complex valve repair, combined procedures, and organ transplantation. Utilizing a protocol as a starting point for imaging in all procedures and all patients enables standardization of image acquisition, reduction in variability in quality of imaging and reporting, and ultimately better patient care. Clear communication of the echocardiographic findings to the surgical team, as well as understanding the impact of new findings on the surgical plan, are paramount. Equally important is the need for complete understanding of the technical steps of the surgical procedures being performed and the complications that may occur, in order to direct the postprocedure evaluation toward aspects directly related to the surgical procedure and to provide pertinent echocardiographic information. The rationale for this document is to outline a systematic approach describing how to apply the existing guidelines to questions on cardiac structure and function specific to the intraoperative environment in open, minimally invasive, or hybrid cardiac surgery procedures.
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Affiliation(s)
| | | | - Niv Ad
- White Oak Medical Center and University of Maryland, Silver Spring, Maryland
| | - Alan Finley
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Bradley Taylor
- University of Maryland Medical Center, Baltimore, Maryland
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3
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Intracardiac Echocardiography for Diagnosis and Management of Left Ventricular Assist Device Inlet Obstruction. ASAIO J 2014; 60:e1-2. [DOI: 10.1097/mat.0000000000000142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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4
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Elhussein TA, Hutchison SJ. Acute Mitral Regurgitation: Unforeseen New Complication of the Impella LP 5.0 Ventricular Assist Device and Review of Literature. Heart Lung Circ 2014; 23:e100-4. [DOI: 10.1016/j.hlc.2013.10.098] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 10/25/2013] [Accepted: 10/27/2013] [Indexed: 11/16/2022]
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5
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Role of echocardiography in the perioperative management of mechanical circulatory assistance. Best Pract Res Clin Anaesthesiol 2012; 26:199-216. [DOI: 10.1016/j.bpa.2012.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 02/01/2012] [Indexed: 11/23/2022]
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6
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Patel KM, Sherwani SS, Baudo AM, Salvacion A, Herborn J, Soong W, Kendall MC. The Use of Transesophageal Echocardiography for Confirmation of Appropriate Impella 5.0 Device Placement. Anesth Analg 2012; 114:82-5. [DOI: 10.1213/ane.0b013e3182367a7d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Rasalingam R, Johnson SN, Bilhorn KR, Huang PH, Makan M, Moazami N, Pérez JE. Transthoracic Echocardiographic Assessment of Continuous-Flow Left Ventricular Assist Devices. J Am Soc Echocardiogr 2011; 24:135-48. [DOI: 10.1016/j.echo.2010.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Indexed: 10/18/2022]
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8
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Left Ventricular Assist Devices and Other Devices for End-Stage Heart Failure: Utility of Echocardiography. Curr Cardiol Rep 2010; 12:257-64. [DOI: 10.1007/s11886-010-0102-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Kirkpatrick JN. Using Echo to Evaluate Patients With Left Ventricular Assist Devices (LVADs): Adding Non-Invasive PVR Into the Diagnostic Toolbox. J Am Soc Echocardiogr 2009; 22:1063-6. [DOI: 10.1016/j.echo.2009.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Catena E, Paino R, Milazzo F, Colombo T, Marianeschi S, Lanfranconi M, Aresta F, Bruschi G, Russo C, Vitali E. Mechanical Circulatory Support for Patients With Fulminant Myocarditis: The Role of Echocardiography To Address Diagnosis, Choice of Device, Management, and Recovery. J Cardiothorac Vasc Anesth 2009; 23:87-94. [DOI: 10.1053/j.jvca.2008.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Indexed: 11/11/2022]
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Kirkpatrick JN, Keane MG. Future potential of echocardiography in heart failure. Future Cardiol 2008; 4:299-319. [PMID: 19804334 DOI: 10.2217/14796678.4.3.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Echocardiography represents a convenient, portable and noninvasive method to provide important anatomic and physiologic information to inform the management of heart failure patients. Traditional echo assessments include diagnostic, etiologic and prognostic data from ventricular size, geometry and performance. Newer echocardiographic techniques are receiving greater utilization, however, and promise to further enhance diagnostic abilities in heart failure. This article reviews traditional anatomic assessments, echo-based cardiac hemodynamics, 3D echocardiography, quantification of myocardial tissue mechanics and hand-carried echocardiography. These developments in echocardiography underlie future trends toward echo objectivity, improved imaging of patients with poor acoustic windows, miniaturization and simplicity in focused exams and the expanded application of old and new techniques.
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Affiliation(s)
- James N Kirkpatrick
- Hospital of the University of Pennsylvania, 9th Floor, Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104, USA.
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12
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Chumnanvej S, Wood MJ, MacGillivray TE, Melo MFV. Perioperative echocardiographic examination for ventricular assist device implantation. Anesth Analg 2007; 105:583-601. [PMID: 17717209 DOI: 10.1213/01.ane.0000278088.22952.82] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ventricular assist devices (VADs) are systems for mechanical circulatory support of the patient with severe heart failure. Perioperative transesophageal echocardiography is a major component of patient management, and important for surgical and anesthetic decision making. In this review we present the rationale and available data for a comprehensive echocardiographic assessment of patients receiving a VAD. In addition to the standard examination, device-specific pre-, intra-, and postoperative considerations are essential to the echocardiographic evaluation. These include: (a) the pre-VAD insertion examination of the heart and large vessels to exclude significant aortic regurgitation, tricuspid regurgitation, mitral stenosis, patent foramen ovale, or other cardiac abnormality that could lead to right-to-left shunt after left VAD placement, intracardiac thrombi, ventricular scars, pulmonic regurgitation, pulmonary hypertension, pulmonary embolism, and atherosclerotic disease in the ascending aorta; and to assess right ventricular function; and (b) the post-VAD insertion examination of the device and reassessment of the heart and large vessels. The examination of the device aims to confirm completeness of device and heart deairing, cannulas alignment and patency, and competency of device valves using two-dimensional, and color, continuous and pulsed wave Doppler modalities. The goal for the heart examination after implantation should be to exclude aortic regurgitation, or an uncovered right-to-left shunt; and to assess right ventricular function, left ventricular unloading, and the effect of device settings on global heart function. The variety of VAD models with different basic and operation principles requires specific echocardiographic assessment targeted to the characteristics of the implanted device.
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Affiliation(s)
- Siriluk Chumnanvej
- Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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Lauten A, Strauch JT, Groetzner J, Wahlers T. Myocardial Failure Caused by Traumatic Dissection of Left Coronary System?Ventricular Recovery with Temporary Circulatory Support. J Card Surg 2007; 22:238-9. [PMID: 17488429 DOI: 10.1111/j.1540-8191.2007.00400.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of a patient suffering from massive myocardial infarction after traumatic dissection of the left coronary system. The dissection involved the left coronary artery including peripheral segments of the coronary circulation. The patient was revascularized; however, she could not be weaned from cardiopulmonary bypass thereafter. An Impella microaxial hemopump was implanted and the patient's left ventricular function markedly improved during the following days. Eight days later hemodynamics had stabilized far enough to explant the device, after explantation the patient remained hemodynamically stable and free of inotropic support. The report intends to emphasize the potential of the myocardium to recover even after extensive infarction under temporary ventricular support and takes the Impella microaxial hemopump into consideration as a device that is technically easy to implant with no injury to the ventricle and thus associated with good properties for weaning. Surgeons should consider the device as short-term support in borderline indications.
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Affiliation(s)
- Alexander Lauten
- Department of Cardiothoracic and Vascular Surgery, Friedrich Schiller University Jena, Jena, Germany.
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Abstract
OBJECTIVE Mechanical support of the circulation is necessary when heart failure becomes refractory to medical support and is typically applied when organ dysfunction occurs as a result of hypoperfusion. However, in timing the intervention, it is important to apply mechanical support before multiple organ failure occurs. The objective of this work is to review the current strategies for mechanical circulatory support in patients with refractory cardiac failure. DESIGN A review of the use of mechanical circulatory support is presented for patients with refractory cardiac failure. PATIENTS Data are taken from human studies that were selected to best exemplify the results that may be obtained from various forms of mechanical circulatory support. INTERVENTIONS Commonly applied forms of mechanical support include mechanical ventilatory support, intraaortic balloon counterpulsation, and hemodialysis or ultrafiltration. If these measures fail, mechanical support of the circulation with ventricular assist devices is possible in specialized centers with expertise in the implantation and management of these devices. The decision to pursue mechanical circulatory support in the critically ill patient is based on the cause of acute decompensation, the potential reversibility of the condition, and the possibility for other treatments to improve the underlying condition or, in highly selected cases, heart transplantation. Newer forms of ventricular assistance that require less surgery are becoming available and may allow use in a broader range of critically ill patients. MAIN RESULTS There is a range of means to mechanically support the circulation in patients with advanced heart failure. CONCLUSIONS A variety of means to support the circulation have found application in the treatment of patients with refractory heart failure. More work is required to best identify populations who will benefit from the therapy and to refine the therapy to reduce associated risks.
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Affiliation(s)
- John P Boehmer
- Department of Medicine, The Pennsylvania State University College of Medicine, The Penn State Hershey Medical Center, Hershey, PA, USA
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LaRocca GM, Shimbo D, Rodriguez CJ, Stewart A, Naka Y, Weinberger J, Homma S, Pizzarello R. The Impella Recover LP 5.0 Left Ventricular Assist Device: A Bridge to Coronary Artery Bypass Grafting and Cardiac Transplantation. J Am Soc Echocardiogr 2006; 19:468.e5-7. [PMID: 16581490 DOI: 10.1016/j.echo.2005.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Indexed: 10/24/2022]
Affiliation(s)
- Gina M LaRocca
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
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Strauch JT, Franke UFW, Breuer M, Wippermann J, Wittwer T, Madershahian N, Kaluza M, Wahlers T. Technical feasibility of Impella Recover 100 microaxial left ventricular assist device placement after biologic aortic valve replacement (21 mm) for postcardiotomy failure. J Thorac Cardiovasc Surg 2006; 130:1715-6. [PMID: 16308023 DOI: 10.1016/j.jtcvs.2005.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 07/22/2005] [Accepted: 08/01/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Justus T Strauch
- Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller University, Jena, Germany.
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Catena E, Barosi A, Milazzo F, Paino R, Pelenghi S, Garatti A, Colombo T, Vitali E. Three-Dimensional Echocardiographic Assessment of a Patient Supported by Intravascular Blood Pump Impella Recover 100. Echocardiography 2005; 22:682-5. [PMID: 16174125 DOI: 10.1111/j.1540-8175.2005.40064.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Impella Recover 100 is an intravascular microaxial blood pump designed for short-term circulatory support in conditions of reduced left ventricular function. Two-dimensional echocardiography is a consolidated tool to study and monitor patients undergoing circulatory support. Three-dimensional (3D) echocardiography is emerging as a source of more accurate analysis in heart morphology and function. We described the use of 3D echocardiography in a patient who underwent Impella recover 100 support for postcardiotomy shock. 3D echocardiography allowed complete visualization of the pump and provided excellent intraoperative assessment of the complex spatial location into the left ventricle.
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Affiliation(s)
- Emanuele Catena
- Cardiothoracic Anesthesiology Division, Department of Cardio-Thoracic Surgery A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy.
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