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Malone G, Abdelsayed G, Bligh F, Al Qattan F, Syed S, Varatharajullu P, Msellati A, Mwipatayi D, Azhar M, Malone A, Fatimi SH, Conway C, Hameed A. Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy. J Anat 2022; 242:29-49. [PMID: 35445389 PMCID: PMC9773170 DOI: 10.1111/joa.13675] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/25/2022] Open
Abstract
Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop in flow and pumping power leading to failure of the LVAD, if left unattended. If a clot becomes dislodged and circulates in the bloodstream, it may disturb the flow or occlude the blood vessels in vital organs and cause internal damage that could be fatal, for example, ischemic stroke. That is why patients with LVADs are on anti-coagulant medication. However, the anti-coagulants can cause a set of issues for the patient-an example of gastrointestinal (GI) bleeding is given in illustration. On account of this, these devices are only used as a last resort in clinical practice. It is, therefore, necessary to develop devices with better mechanics of blood flow, performance and hemocompatibility. This paper discusses the development of LVADs through landmark clinical trials in detail and describes the evolution of device design to reduce the risk of pump thrombosis and achieve better hemocompatibility. Whilst driveline infection, right heart failure and arrhythmias have been recognised as LVAD-related complications, this paper focuses on complications related to pump thrombosis, especially blood coagulopathy in detail and potential strategies to mitigate this complication. Furthermore, it also discusses the LVAD implantation techniques and their anatomical challenges.
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Affiliation(s)
- Grainne Malone
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Gerges Abdelsayed
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Fianait Bligh
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Fatma Al Qattan
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland,School of Pharmacy and Biomolecular SciencesRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Saifullah Syed
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | | | - Augustin Msellati
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Daniela Mwipatayi
- School of MedicineRCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Maimoona Azhar
- Department of SurgerySt. Vincent's University Hospital, Dublin 4DublinIreland
| | - Andrew Malone
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland
| | - Saulat H. Fatimi
- Department of Cardiothoracic SurgeryAga Khan University HospitalKarachiPakistan
| | - Claire Conway
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College Dublin (TCD)DublinIreland
| | - Aamir Hameed
- Tissue Engineering Research Group (TERG)Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin 2DublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College Dublin (TCD)DublinIreland
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Ono M, Yamaguchi O, Ohtani T, Kinugawa K, Saiki Y, Sawa Y, Shiose A, Tsutsui H, Fukushima N, Matsumiya G, Yanase M, Yamazaki K, Yamamoto K, Akiyama M, Imamura T, Iwasaki K, Endo M, Ohnishi Y, Okumura T, Kashiwa K, Kinoshita O, Kubota K, Seguchi O, Toda K, Nishioka H, Nishinaka T, Nishimura T, Hashimoto T, Hatano M, Higashi H, Higo T, Fujino T, Hori Y, Miyoshi T, Yamanaka M, Ohno T, Kimura T, Kyo S, Sakata Y, Nakatani T. JCS/JSCVS/JATS/JSVS 2021 Guideline on Implantable Left Ventricular Assist Device for Patients With Advanced Heart Failure. Circ J 2022; 86:1024-1058. [PMID: 35387921 DOI: 10.1253/circj.cj-21-0880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Kenji Yamazaki
- Advanced Medical Research Institute, Hokkaido Cardiovascular Hospital
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Teruhiko Imamura
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University
| | - Miyoko Endo
- Department of Nursing, The University of Tokyo Hospital
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Koichi Kashiwa
- Department of Medical Engineering, The University of Tokyo Hospital
| | - Osamu Kinoshita
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Kaori Kubota
- Department of Transplantation Medicine, Osaka University Graduate School of Medicine
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroshi Nishioka
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center
| | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Hospital
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Yumiko Hori
- Department of Nursing and Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Loforte A, Gliozzi G, Mariani C, Cavalli GG, Martin-Suarez S, Pacini D. Ventricular assist devices implantation: surgical assessment and technical strategies. Cardiovasc Diagn Ther 2021; 11:277-291. [PMID: 33708499 PMCID: PMC7944211 DOI: 10.21037/cdt-20-325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022]
Abstract
Along with the worldwide increase in continuous left ventricular assist device (LVAD) strategy adoption, more and more patients with demanding anatomical and clinical features are currently referred to heart failure (HF) departments for treatment. Thus surgeons have to deal, technically, with re-entry due to previous cardiac surgery procedures, porcelain aorta, peripheral vascular arterial disease, concomitant valvular or septal disease, biventricular failure. New surgical techniques and surgical tools have been developed to offer acceptable postoperative outcomes to all mechanical circulatory support recipients. Several less invasive and/or thoracotomic approaches for surgery combined with various LVAD inflow and outflow graft alternative anastomotic sites for system placement have been reported and described to solve complex clinical scenarios. Surgical techniques have been upgraded with further technical tips to preserve the native anatomy in case of re-entry for heart transplantation, myocardial recovery or device explant. The current continuous-flow miniaturized and intrapericardial devices provide versatility and technical advantages. However, the surgical planning requires a careful multidisciplinary evaluation which must be driven by a dedicated and well-trained Heart Failure team. Biventricular assist device (BVAD) implantation by adoption of the newer radial pumps might be a challenge. However, the results are encouraging thus remaining a valid option. This paper reviews and summarizes LVAD preoperative assessment and current surgical techniques for implantation.
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Affiliation(s)
- Antonio Loforte
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Gregorio Gliozzi
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Carlo Mariani
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Sofia Martin-Suarez
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Davide Pacini
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Bologna University, Bologna, Italy
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Abstract
The Dor procedure was historically used to restore the geometry of the heart in a patient with a left ventricular (LV) aneurysm via reduction and reshaping of the LV with an aneurysmectomy. Unfortunately, morbidity and mortality remain high with this procedure, with many patients little to no recovery of their ejection fraction while developing severe diastolic failure, often requiring further support; however, the natural history of these patients remains largely unknown. Heart transplant has long been considered the most durable of treatment for patients with end-stage heart failure (HF), but because of the scarcity of donor hearts, the implantation of left ventricular assist devices (LVAD) for mechanical circulatory support has also proven to be an essential tool in the treatment of the advanced heart failure patient. While various techniques for LVAD implantation have been well outlined, there is very limited literature on placement of a VAD in patients with a history of LV aneurysmectomy or Dor procedures, particularly with regard to the challenging aspects of apical cannulation in those with prior apical ventriculotomy and patch placement. In this series, we describe three patients with a history of LV aneurysmectomy procedures who underwent Heartware ventricular assist device (HVAD) implantations for end-stage HF.
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Bejko J, Tarzia V, Gerosa G, Bottio T. Use of the Jarvik 2000 to facilitate left ventricular assist device placement in challenging apex anatomy. J Heart Lung Transplant 2016; 35:1049-51. [DOI: 10.1016/j.healun.2016.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/10/2016] [Accepted: 05/18/2016] [Indexed: 11/26/2022] Open
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Nipro extra-corporeal left ventricular assist device fitting after left ventricular reconstruction with mitral valve plasty. J Artif Organs 2015; 18:361-4. [PMID: 25971993 DOI: 10.1007/s10047-015-0837-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
Both left ventricular assist device and left ventricular reconstruction are treatment choices for severe heart failure conditions. Our institution performed a left ventricular assist device installation following a left ventricular reconstruction procedure on a 42-year-old male patient who presented with dilated cardiomyopathy and low cardiac output syndrome. A mitral valve plasty was used to correct the acute mitral valve regurgitation and we performed a Nipro extra-corporeal left ventricular assist device installation on post-operative day 14. Due to the left ventricular reconstruction that the patient had in a previous operation, we needed to attach an apical cuff on posterior apex, insert the inflow cannula with a large curve, and shift the skin insertion site laterally to the left. We assessed the angle between the cardiac longitudinal axis and the inflow cannula using computed tomography. The patient did not complain of any subjective symptoms of heart failure. Although Nipro extra-corporeal left ventricular assist device installation after left ventricular reconstruction has several difficulties historically, we have experienced a successful case.
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Patil NP, Popov AF, Simon AR. Left Ventricular Assist Device Implantation With Dor Procedure via Bilateral Limited Thoracotomy. Artif Organs 2015; 39:641-2. [PMID: 25810147 DOI: 10.1111/aor.12429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nikhil Prakash Patil
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
| | - Aron Frederick Popov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - André Rüdiger Simon
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Fatullayev J, Butters T, Sabashnikov A, Garcia Saez D, Mohite PN, Edwards G, Hoegerle B, Wahlers T, Popov AF, Simon AR. Left ventricular assist device implantation with concomitant left ventricular reconstruction without patchplasty. J Artif Organs 2014; 17:370-2. [PMID: 25103222 DOI: 10.1007/s10047-014-0785-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
Abstract
In this case report, we describe a 66-year-old patient with a massive LV aneurism which resulted after myocardial infarction. Due to severe LV function impairment, it was decided to perform left ventricular reconstruction surgery and, at the same time, left ventricular assist device implantation as a bridge to transplantation. The entire procedure was completed without using any patch material. The patient had an uneventful recovery and was discharged home after 18 days. After 1-year follow-up no adverse events were observed.
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Affiliation(s)
- Javid Fatullayev
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK,
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Palmen M, Verwey HF, Haeck MLA, Holman ER, Schalij MJ, Klautz RJM. Implantation of a left ventricular assist device in patients with a complex apical anatomy. Ann Thorac Surg 2013. [PMID: 23176931 DOI: 10.1016/j.athoracsur.2012.05.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Implantation of a left ventricular assist device can be challenging in patients with an altered apical anatomy after cardiac surgery or as the result of the presence of a calcified apical aneurysm. In this paper we present 2 cases with a challenging apical anatomy and introduce a new surgical technique facilitating left ventricular assist device implantation in these patients.
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Affiliation(s)
- Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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