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Straccia A, Chassagne F, Barbour MC, Beckman J, Li S, Mahr C, Aliseda A. A Computational Investigation of the Effects of Temporal Synchronization of Left Ventricular Assist Device Speed Modulation with the Cardiac Cycle on Intraventricular Hemodynamics. Ann Biomed Eng 2024; 52:1763-1778. [PMID: 38517620 DOI: 10.1007/s10439-024-03489-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: 10/20/2023] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
Patients with advanced heart failure are implanted with a left ventricular assist device (LVAD) as a bridge-to-transplantation or destination therapy. Despite advances in pump design, the risk of stroke remains high. LVAD implantation significantly alters intraventricular hemodynamics, where regions of stagnation or elevated shear stresses promote thrombus formation. Third generation pumps incorporate a pulsatility mode that modulates rotational speed of the pump to enhance in-pump washout. We investigated how the timing of the pulsatility mode with the cardiac cycle affects intraventricular hemodynamic factors linked to thrombus formation. Computational fluid dynamics simulations with Lagrangian particle tracking to model platelet behavior in a patient-specific left ventricle captured altered intraventricular hemodynamics due to LVAD implantation. HeartMate 3 incorporates a pulsatility mode that modulates the speed of the pump every two seconds. Four different timings of this pulsatility mode with respect to the cardiac cycle were investigated. A strong jet formed between the mitral valve and inflow cannula. Blood stagnated in the left ventricular outflow tract beneath a closed aortic valve, in the near-wall regions off-axis of the jet, and in a large counterrotating vortex near the anterior wall. Computational results showed good agreement with particle image velocimetry results. Synchronization of the pulsatility mode with peak systole decreased stasis, reflected in the intraventricular washout of virtual contrast and Lagrangian particles over time. Temporal synchronization of HeartMate 3 pulsatility with the cardiac cycle reduces intraventricular stasis and could be beneficial for decreasing thrombogenicity.
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Affiliation(s)
- Angela Straccia
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
| | | | - Michael C Barbour
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Jennifer Beckman
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Song Li
- Institute for Advanced Cardiac Care, Medical City Healthcare, Dallas, TX, USA
| | - Claudius Mahr
- Institute for Advanced Cardiac Care, Medical City Healthcare, Dallas, TX, USA
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
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Gallone G, Ibero J, Morley-Smith A, Monteagudo Vela M, Fiorelli F, Konicoff M, Edwards G, Raj B, Shanmuganathan M, Pidello S, Frea S, De Ferrari GM, Panoulas V, Stock U, Bowles C, Dunning J, Riesgo Gil F. Association of Renin-Angiotensin-Aldosterone System Inhibitors With Clinical Outcomes, Hemodynamics, and Myocardial Remodeling Among Patients With Advanced Heart Failure on Left Ventricular Assist Device Support. J Am Heart Assoc 2024; 13:e032617. [PMID: 38686903 PMCID: PMC11179874 DOI: 10.1161/jaha.123.032617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND We evaluated the potential benefits of renin-angiotensin-aldosterone system inhibitors (RAASi) in patients with left ventricular assist device support. METHODS AND RESULTS A total of 165 consecutive patients undergoing left ventricular assist device implant and alive at 6-month on support were studied. RAASi status after 6-month visit along with clinical reasons for nonprescription/uptitration were retrospectively assessed. The primary outcome was a composite of heart failure hospitalization or cardiovascular death between 6 and 24 months after left ventricular assist device implant. Remodeling and hemodynamic outcomes were explored by studying the association of RAASi new prescription/uptitration versus unmodified therapy at 6-month visit with the change in echocardiographic parameters and hemodynamics between 6 and 18 months. After the 6-month visit, 76% of patients were on RAASi. Patients' characteristics among those receiving and not receiving RAASi were mostly similar. Of 85 (52%) patients without RAASi new prescription/uptitration at 6-month visit, 62% had no apparent clinical reason. RAASi were independently associated with the primary outcome (adjusted hazard ratio, 0.31 [95% CI, 0.16-0.69]). The baseline rates of optimal echocardiographic profile (neutral interventricular septum, mitral regurgitation less than mild, and aortic valve opening) and hemodynamic profile (cardiac index ≥2.2 L/min per m2, wedge pressure <18 mm Hg, and right atrial pressure <12 mm Hg) were similar between groups. At 18 months, patients receiving RAASi new prescription/uptitration at 6 months had higher rates of optimal hemodynamic profile (57.5% versus 37.0%; P=0.032) and trends for higher rates of optimal echocardiographic profile (39.6% versus 22.9%; P=0.055) compared with patients with 6-month unmodified therapy. Optimal 18-month hemodynamic and echocardiographic profiles were associated with the primary outcome (log-rank=0.022 and log-rank=0.035, respectively). CONCLUSIONS RAASi are associated with improved outcomes and improved hemodynamics among mechanically unloaded patients.
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Affiliation(s)
- Guglielmo Gallone
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
- Division of Cardiology, Cardiovascular and Thoracic Department Città della Salute e della Scienza Hospital Turin Italy
| | - Javier Ibero
- Department of Medical Sciences University of Turin Turin Italy
| | - Andrew Morley-Smith
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Maria Monteagudo Vela
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Francesca Fiorelli
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Mailen Konicoff
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Gemma Edwards
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Binu Raj
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Mayooran Shanmuganathan
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Stefano Pidello
- Division of Cardiology, Cardiovascular and Thoracic Department Città della Salute e della Scienza Hospital Turin Italy
| | - Simone Frea
- Division of Cardiology, Cardiovascular and Thoracic Department Città della Salute e della Scienza Hospital Turin Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department Città della Salute e della Scienza Hospital Turin Italy
| | - Vasileios Panoulas
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
- Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London United Kingdom
| | - Ulrich Stock
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Christopher Bowles
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - John Dunning
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Fernando Riesgo Gil
- Cardiothoracic Transplantation Harefield Hospital, Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
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Zhao S, Liu C, Wang J, Wang H, Luo T, Hao X, Yang X, Wen M, Han J, Zhang H, Gong M. CH-VAD left ventricular assist implantation combined with the Bentall procedure and coronary artery bypass grafting. ESC Heart Fail 2024. [PMID: 38520316 DOI: 10.1002/ehf2.14769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/01/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024] Open
Abstract
Left ventricular assist device (LVAD) implantation is an effective alternative treatment to heart transplantation, especially for end-stage heart failure patients who are ineligible for or unable to await a heart transplant. This report describes a complex and innovative surgery where LVAD implantation was performed alongside multiple concomitant cardiac and aortic procedures. A 62-year-old male patient with complicated comorbidities developed acute myocardial infarction and subsequent refractory advanced heart failure. Given his critically ill condition and intractable anatomical malformations, the CH-VAD left ventricular assist system implantation was performed concomitantly with the Bentall procedure, coronary artery bypass grafting, tricuspid valvuloplasty, and foramen ovale closure. The patient was successfully discharged. This case details the medical decision-making process and surgical strategy and demonstrates the feasibility of LVAD implantation combined with multiple additional cardiac and aortic procedures in expert cardiac centres. Success relies on experienced cardiac surgeons and a multidisciplinary LVAD Heart Team, ensuring excellence in surgical techniques, preoperative evaluation, post-operative care, and rehabilitation.
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Affiliation(s)
- Shuanglei Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Chongyang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Jun Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Hong Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Tiange Luo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Xiaoyan Hao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Xian Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Mingxiu Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Jie Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Hongjia Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
| | - Ming Gong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, China
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Kaya E, Kocabaş U, Şimşek E, Nalbantgil S, Engin Ç, Özbaran M, Akilli A. Effect of Aortic Valve Opening Pattern on Endothelial Function After Continuous-Flow Left Ventricular Assist Device Implantation. ASAIO J 2023; 69:e429-e436. [PMID: 37773149 DOI: 10.1097/mat.0000000000002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
This study aimed to evaluate the effects of aortic valve opening patterns on endothelial functions in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation. This study included 43 patients who underwent CF-LVAD implantation and 35 patients with heart failure reduced ejection fraction (HFrEF; control group). The CF-LVAD group was divided into three subgroups based on aortic valve opening patterns: open with each beat, intermittently opening, and not opening groups. Flow-mediated dilatation (FMD) and pulsatility index (PI) were compared before and 3 months after CF-LVAD implantation. Cardiopulmonary exercise test (CPET) and 6 minute walk test (6-MWT) scores were measured at baseline and follow-up in the CF-LVAD group. The mean FMD and PI of patients in the CF-LVAD group reduced 3 months after implantation. Patients with intermittently opening and not opening aortic valves had worse endothelial function at follow-up. Before and 3 months after implantation FMD% did not significantly differ in patients whose aortic valves were open with each beat (4.72 ± 1.06% vs. 4.67 ± 1.16%, p = 0.135). Pulsatility index changes paralleled FMD changes. Cardiopulmonary exercise test and 6-MWT scores improved after implantation but without significant differences between subgroups. Maintaining normal aortic valve function after CF-LVAD implantation may reduce endothelial dysfunction; however, larger studies are needed for long-term clinical effects.
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Affiliation(s)
- Ersin Kaya
- From the Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Umut Kocabaş
- Department of Cardiology, Baskent University, Izmir, Turkey
| | - Evrim Şimşek
- From the Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sanem Nalbantgil
- From the Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Çağatay Engin
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Azem Akilli
- From the Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
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Guglin M, Rao RA. Aortic Thrombosis in Patients on Mechanical Circulatory Support: A Systematic Literature Review. Heart Lung Circ 2023; 32:926-937. [PMID: 37202310 DOI: 10.1016/j.hlc.2023.04.295] [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: 11/06/2022] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Aortic valve (AV) thrombosis is an uncommon but ominous complication in patients managed with mechanical circulatory support (MCS) devices. In this systematic review, we summarised the data on clinical presentations and outcomes in such patients. METHODS We searched articles on PubMed and Google Scholar, reporting at least one adult patient with aortic thrombosis on MCS support and where the individual patient data could be extracted. We grouped the patients by the type of MCS (temporary or durable), and the type of the AV (prosthetic, surgically modified, or native) RESULTS: We identified reports on six patients with aortic thrombus on short-term MCS, and on 41 patients on durable left ventricular assist devices (LVADs). On temporary MCS, AV thrombus typically causes no symptoms and is found incidentally pre- or intra-operatively. For those with durable MCS, the occurrence of aortic thrombus forming on prosthetic or surgically modified valves appears to be more related to the intervention on the valve, rather than from the presence of LVAD. The mortality in this group was 18%. In patients with native AV on durable LVAD support, 60% of patients presented with acute myocardial infarction, acute stroke, or acute heart failure, and mortality in this cohort was 45%. In terms of management, heart transplantation was most successful. CONCLUSIONS While the outcomes of aortic thrombosis were good in patients where temporary MCS was used in the setting of aortic valve surgery, patients with native AV who develop this complication on durable LVAD have high morbidity and mortality. Cardiac transplantation should be strongly considered in eligible candidates because other therapies provide inconsistent results.
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Affiliation(s)
- Maya Guglin
- Indiana University School of Medicine, Division of Cardiovascular Disease, Krannert Institute of Cardiology, Indianapolis, IN, USA.
| | - Roopa A Rao
- Indiana University School of Medicine, Division of Cardiovascular Disease, Krannert Institute of Cardiology, Indianapolis, IN, USA
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Rate of thromboembolic and bleeding events in patients undergoing concomitant aortic valve surgery with left ventricular assist device implantation. Int J Cardiol 2022; 359:39-45. [DOI: 10.1016/j.ijcard.2022.04.041] [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] [Received: 11/01/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 01/14/2023]
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Yu XY, Shi JW, Zang YR, Zhang JM, Liu ZG. Factors influencing the functional status of aortic valve in ovine models supported by continuous-flow left ventricular assist device. Artif Organs 2022; 46:1334-1345. [PMID: 35167127 PMCID: PMC9310577 DOI: 10.1111/aor.14207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
Objectives An acute animal experiment was performed to observe factors influencing the functional status of the aortic valve functional status after continuous‐flow left ventricular assist device (CF‐LVAD) implantation in an ovine model, and a physiologic predictive model was established. Methods A CF‐LVAD model was established in Small Tail Han sheep. The initial heart rate (HR) was set to 60 beats/min, and grouping was performed at an interval of 20 beats/min. In all groups, the pump speed was started from 2000 rpm and was gradually increased by 50–100 rpm. A multi‐channel physiological recorder recorded the HR, aortic pressure, central venous pressure, and left ventricular systolic pressure (LVSP). A double‐channel ultrasonic flowmeter was used to obtain real‐time artificial vascular blood flow (ABF). A color Doppler ultrasound device was applied to assess the aortic valve functional status. Multivariate dichotomous logistic regression was used to screen significant variables for predicting the functional status of the aortic valve. Results Observational studies showed that ABF and the risk of aortic valve closure (AVC) were positively correlated with pump speed at the same HR. Meanwhile, the mean arterial pressure (MAP) was unaltered or slightly increased with increased pump speed. When the pump speed was constant, an increase in HR was associated with a decrease in the size of the aortic valve opening. This phenomenon was accompanied by an initial transient increase in the ABF and MAP, which subsequently decreased. Statistical analysis showed that the AVC was associated with increased pump speed (OR = 1.02, 95% CI = 1.01–1.04, p = 0.001), decreased LVSP (OR = 0.95, 95% CI = 0.91–0.98, p = 0.003), and decreased pulse pressure (OR = 0.82, 95% CI = 0.68–0.96, p = 0.026). ABF or MAP was negatively associated with the risk of AVC (OR < 1). The prediction model of AVC after CF‐LVAD implantation exhibited good differentiation (AUC = 0.973, 95% CI = 0.978–0.995) and calibration performance (Hosmer–Lemeshow χ2 = 9.834, p = 0.277 > 0.05). Conclusions The pump speed, LVSP, ABF, MAP, and pulse pressure are significant predictors of the risk of AVC. Predictive models built from these predictors yielded good performance in differentiating aortic valve opening and closure after CF‐LVAD implantation.
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Affiliation(s)
- Xin-Yi Yu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, China
| | - Jian-Wei Shi
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, China
| | - Yi-Rui Zang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, China
| | - Jie-Min Zhang
- Laboratory Animal Center, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, China
| | - Zhi-Gang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, China
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Krysiński M, Gawlikowski M, Biełka A, Krysińska M, Małyszek-Tumidajewicz J, Copik I, Pacholewicz J, Zembala M, Zembala M. Early detection of HVAD pump thrombosis based on technical analysis and power consumption measurements. Artif Organs 2022; 46:1142-1148. [PMID: 34978725 DOI: 10.1111/aor.14163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/26/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Continuous-flow left ventricular assist devices (LVAD) have been extensively used in a strategy of bridge to orthotopic heart transplant and destination therapy. The usage of LVAD, however, is not free from limitations such as device-related adverse events, including pump thrombosis (PT). We aimed to develop an algorithm of early PT detection based on the maintenance parameters monitored by the implanted device. METHODS We analyzed log files of 101 patients implanted with HeartWare pump (HVAD) with 18 PT events among them. For signal processing, we used Open-High-Low-Close format transformation and Typical Price (TP) technical analysis indicator. Model parameters were tuned with 5-fold cross-validation and the final performance was measured on a separate group of patients. RESULTS Our algorithm achieved 100% sensitivity and 100% specificity of indications. In the final evaluation alarms preceded the clinical acknowledgement of events by 2 days and 20 hours on average. In the worst-case scenario, an alarm was raised 1 day and 8 hours prior to the event. CONCLUSIONS Proposed algorithm could be installed to work directly with the device controller and provide clinicians with automatic readings analysis, raising an alarm when there is a high probability of thromboembolism. Early event detection could enable better thrombosis management and improve prognosis in patients implanted with HVAD.
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Affiliation(s)
| | - Maciej Gawlikowski
- Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Agnieszka Biełka
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Małgorzata Krysińska
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Justyna Małyszek-Tumidajewicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Izabela Copik
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jerzy Pacholewicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Michał Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
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Castrodeza J, Ortiz-Bautista C, Fernández-Avilés F. Continuous-flow left ventricular assist device: Current knowledge, complications, and future directions. Cardiol J 2021; 29:293-304. [PMID: 34967940 PMCID: PMC9007493 DOI: 10.5603/cj.a2021.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
Long-term continuous-flow left ventricular assist devices have become a real alternative to heart transplantation in patients with advanced heart failure, achieving a promising 2-year event-free survival rate with new-generation devices. Currently, this technology has spread throughout the world, and any cardiologist or cardiac surgeon should be familiar with its fundamentals and its possible complications as well as the advances made in recent years. The aim of this review is to describe current knowledge, management of complications, and future directions of this novel heart-failure therapy.
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Affiliation(s)
- Javier Castrodeza
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain.
| | - Carlos Ortiz-Bautista
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER - CV), Spain
- Universidad Complutense, Madrid, Spain
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10
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Use of sacubitril-valsartan in blood pressure control with left ventricular assist devices. J Heart Lung Transplant 2020; 39:1499-1501. [DOI: 10.1016/j.healun.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022] Open
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Neutrophil to Lymphocyte Ratio Is Related to Thrombotic Complications and Survival in Continuous Flow Left Ventricular Assist Devices. ASAIO J 2020; 66:199-204. [DOI: 10.1097/mat.0000000000000971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bouzas-Cruz N, Gonzalez-Fernandez O, Ferrera-Durán C, Woods A, Robinson-Smith N, Tovey S, Jungschleger J, Booth K, Shah A, Parry G, MacGowan GA, Schueler S. Initial conservative management strategy of HeartWare left ventricular assist device thrombosis with intravenous heparin or bivalirudin. Int J Artif Organs 2019; 43:444-451. [DOI: 10.1177/0391398819896585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction and objectives: Pump thrombosis is a serious left ventricular assist device complication, though there are no guidelines regarding its treatment. The main aim of this study was to describe a strategy of intravenous anticoagulation as the initial treatment in these patients and then to compare intravenous heparin with bivalirudin. Methods: All consecutive patients who received a HeartWare left ventricular assist device from July 2009 to March 2019 were retrospectively analysed. Patients developing a pump thrombosis were selected, and treatment, outcomes and complications were recorded. Results: During this period of time (116 months), 220 patients underwent HeartWare left ventricular assist device implantation and 57 developed pump thrombosis, with an incidence rate of first pump thrombosis of 0.17 events per patient-year of support (incidence rate of all episodes of pump thrombosis: 0.30 events per patient-year of support). All the patients were initially treated medically, predominantly with either intravenous heparin (n = 26) or bivalirudin (n = 16). Patients treated with bivalirudin during the first pump thrombosis episode had less subsequent re-thrombosis episodes (18.7% vs 57.7%, p < 0.05). In addition, percentage time in therapeutic range was greater for bivalirudin compared with heparin (68.5% ± 16.9% vs 37.4% ± 31.0%, p < 0.01). During the first pump thrombosis episode, 26.3% of the patients needed surgery (left ventricular assist device exchange (n = 8), transplant (n = 6) or decommissioning (n = 1)). The overall survival at 1 year was 61.4%, and there was no significant difference in survival. Conclusion: Left ventricular assist device thrombosis is a serious life-threatening complication; hence, we propose an initial conservative management of pump thrombosis with enhanced intravenous anticoagulation with either intravenous heparin or bivalirudin, with surgery reserved for refractory cases.
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Affiliation(s)
- Noelia Bouzas-Cruz
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
- University of Santiago de Compostela, Santiago, Spain
| | | | - Carlos Ferrera-Durán
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Andrew Woods
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
| | | | - Sian Tovey
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jérôme Jungschleger
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Karen Booth
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Asif Shah
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Gareth Parry
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Guy A MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
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13
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Granegger M, Choi Y, Locher B, Aigner P, Hubmann EJ, Lemme F, Cesarovic N, Hübler M, Schweiger M. Comparative analysis of cardiac mechano-energetics in isolated hearts supported by pulsatile or rotary blood pumps. Sci Rep 2019; 9:20058. [PMID: 31882656 PMCID: PMC6934785 DOI: 10.1038/s41598-019-56344-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 12/10/2019] [Indexed: 12/02/2022] Open
Abstract
The previously more frequently implanted pulsatile blood pumps (PBPs) showed higher recovery rates than the currently preferred rotary blood pumps (RBPs), with unclear causality. The aim of this study was to comparatively assess the capability of PBPs and RPBs to unload the left ventricle and maintain cardiac energetics as a possible implication for recovery. An RBP and a heartbeat synchronized PBP were alternately connected to isolated porcine hearts. Rotational speed of RBPs was set to different support levels. For PBP support, the start of ejection was phased to different points during the cardiac cycle, prescribed as percentage delays from 0% to 90%. Cardiac efficiency, quantified by the ratio of external work over myocardial oxygen consumption, was determined. For RBP support, higher degrees of RBP support correlated with lower left atrial pressures (LAP) and lower cardiac efficiency (r = 0.91 ± 0.12). In contrast, depending on the phase delay of a PBP, LAP and cardiac efficiency exhibited a sinusoidal relationship with the LAP minimum at 90% and efficiency maximum at 60%. Phasing of a PBP offers the possibility to maintain a high cardiac efficiency and simultaneously unload the ventricle. These results warrant future studies investigating whether optimized cardiac energetics promotes functional recovery with LVAD therapy.
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Affiliation(s)
- Marcus Granegger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland. .,Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Young Choi
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Benedikt Locher
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Emanuel J Hubmann
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Frithjof Lemme
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, Department of Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Hübler
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Schweiger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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14
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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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15
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Aigner P, Schweiger M, Fraser K, Choi Y, Lemme F, Cesarovic N, Kertzscher U, Schima H, Hübler M, Granegger M. Ventricular Flow Field Visualization During Mechanical Circulatory Support in the Assisted Isolated Beating Heart. Ann Biomed Eng 2019; 48:794-804. [PMID: 31741229 PMCID: PMC6949310 DOI: 10.1007/s10439-019-02406-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/07/2019] [Indexed: 01/17/2023]
Abstract
Investigations of ventricular flow patterns during mechanical circulatory support are limited to in vitro flow models or in silico simulations, which cannot fully replicate the complex anatomy and contraction of the heart. Therefore, the feasibility of using echocardiographic particle image velocimetry (Echo-PIV) was evaluated in an isolated working heart setup. Porcine hearts were connected to an isolated, working heart setup and a left ventricular assist device (LVAD) was implanted. During different levels of LVAD support (unsupported, partial support, full support), microbubbles were injected and echocardiographic images were acquired. Iterative PIV algorithms were applied to calculate flow fields. The isolated heart setup allowed different hemodynamic situations. In the unsupported heart, diastolic intra-ventricular blood flow was redirected at the heart’s apex towards the left ventricular outflow tract (LVOT). With increasing pump speed, large vortex formation was suppressed, and blood flow from the mitral valve directly entered the pump cannula. The maximum velocities in the LVOT were significantly reduced with increasing support. For the first time, cardiac blood flow patterns during LVAD support were visualized and quantified in an ex vivo model using Echo-PIV. The results reveal potential regions of stagnation in the LVOT and, in future the methods might be also used in clinical routine to evaluate intraventricular flow fields during LVAD support.
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Affiliation(s)
- P Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, AKH-4L, 1090, Vienna, Austria. .,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
| | - M Schweiger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - K Fraser
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Y Choi
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - F Lemme
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - N Cesarovic
- Division of Surgical Research, Department of Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - U Kertzscher
- Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - H Schima
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, AKH-4L, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - M Hübler
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Granegger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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16
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Dell'Aquila AM, Welp H. Stroke on Left Ventricular Assist Device: Moving From the Preoperative Patient Stratification to the Postoperative Prevention. Ann Thorac Surg 2019; 109:987. [PMID: 31400336 DOI: 10.1016/j.athoracsur.2019.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Angelo M Dell'Aquila
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany.
| | - Henryk Welp
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
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17
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Luc JG, Tchantchaleishvili V, Phan K, Dunlay SM, Maltais S, Stulak JM. Medical Therapy As Compared To Surgical Device Exchange for Left Ventricular Assist Device Thrombosis: A Systematic Review and Meta-Analysis. ASAIO J 2019; 65:307-317. [DOI: 10.1097/mat.0000000000000833] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Hohmann S, Veltmann C, Duncker D, König T, Berliner D, Hanke J, Dogan G, Chatterjee A, Feldmann C, Lynch B, Burkhoff D, Haverich A, Bauersachs J, Schmitto JD. Initial experience with telemonitoring in left ventricular assist device patients. J Thorac Dis 2019; 11:S853-S863. [PMID: 31183165 DOI: 10.21037/jtd.2018.10.37] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Left ventricular assist devices (LVAD) are increasingly used in patients with end stage heart failure. The HeartAssist 5 and aVAD LVADs offer telemetric monitoring capabilities. Here we report our initial single centre experience with the largest telemonitoring cohort of LVAD patients. Methods Eleven patients (9 males) received a telemonitoring-capable LVAD and were included in our telemonitoring cohort. Waveforms and alarm data were obtained from the telemonitoring system and hospital records were reviewed for clinical data. Results Mean age at LVAD implantation was 59±5.1 years (mean ± standard deviation). Seven patients had non-ischemic cardiomyopathy and 4 patients had ischemic cardiomyopathy. Median LVEF at implant was 16% (IQR, 15-20%). The total follow-up time was 2,438 patient-days. A total of 6,216 alarm messages were generated in 11 patients. Most common were low flow alarms due to hypovolemia, followed by low flow alarms because of suspected pump thrombosis. One patient died during follow-up, one received a cardiac transplant and one had the LVAD explanted because of pump thrombosis. Pump thrombosis was suspected in 5 patients with 8 episodes of sudden flow decreases and laboratory signs of haemolysis. Conclusions Real-time telemonitoring of LVAD pump flow, motor speed and power consumption is a promising tool in the follow-up of LVAD recipients. Trending pump flow over hours or days can assist in the early detection of complications, especially flow reductions due to hypovolemia and LVAD thrombosis. Further studies are warranted to delineate the impact of remote monitoring on patients' prognosis.
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Affiliation(s)
- Stephan Hohmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Christian Veltmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Thorben König
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jasmin Hanke
- 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
| | - Anamika Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christina Feldmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Daniel Burkhoff
- Presbyterian Hospital, Columbia University, New York City, NY, USA
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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19
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Clifford R, Robson D, Gross C, Moscato F, Schima H, Jansz P, Macdonald PS, Hayward CS. Beat‐to‐beat detection of aortic valve opening in HeartWare left ventricular assist device patients. Artif Organs 2018; 43:458-466. [DOI: 10.1111/aor.13381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Rachel Clifford
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
- St. Vincent's Clinical School, University of New South Wales Sydney Australia
| | - Desiree Robson
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
| | - Christoph Gross
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research Vienna Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research Vienna Austria
| | - Heinrich Schima
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research Vienna Austria
- Department of Cardiac Surgery Medical University of Vienna Vienna Austria
| | - Paul Jansz
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
| | - Peter S. Macdonald
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
- St. Vincent's Clinical School, University of New South Wales Sydney Australia
- Victor Chang Cardiac Research Institute Darlinghurst New South Wales Australia
| | - Christopher S. Hayward
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
- St. Vincent's Clinical School, University of New South Wales Sydney Australia
- Victor Chang Cardiac Research Institute Darlinghurst New South Wales Australia
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20
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Long-Term Continuous-Flow Left Ventricular Assist Device Support After Left Ventricular Outflow Tract Closure. ASAIO J 2018; 65:558-564. [PMID: 30074962 DOI: 10.1097/mat.0000000000000856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aortic valve insufficiency can be addressed during continuous-flow left ventricular assist device (CF-LVAD) implantation by performing aortic valve repair or replacement, or patch closure of the left ventricular outflow tract (LVOT). However, few studies have examined the safety of long-term CF-LVAD support after LVOT closure. From November 2003 through March 2016, 16 patients with advanced chronic heart failure underwent CF-LVAD implantation and concomitant LVOT closure for severe aortic insufficiency. We compared their long-term outcomes with those of 510 CF-LVAD recipients without concomitant LVOT closure. Total support time was 26.1 patient-years in the LVOT-closure group and 938.6 patient-years in the CF-LVAD-only group. Survival at 30 days, 6 months, 1 year, and 2 years was similar for CF-LVAD-only patients (90.4%, 80.6%, 74.3%, 67.5%) and LVOT-closure patients (81.3%, 81.3%, 75.0%, 68.8%; p = 0.59). There were no deaths related to LVOT closure. The event rate per patient-year for neurologic dysfunction (ND) was 0.23 in the LVOT-closure group (6 ND events) and 0.20 in the CF-LVAD-only group (136 ND events; p = 0.97). We conclude that for select patients with aortic insufficiency who are undergoing CF-LVAD implantation, LVOT closure produces acceptable outcomes and, therefore, is a viable option.
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21
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Stone ME, Pawale A, Ramakrishna H, Weiner MM. Implantable Left Ventricular Assist Device Therapy-Recent Advances and Outcomes. J Cardiothorac Vasc Anesth 2017; 32:2019-2028. [PMID: 29338999 DOI: 10.1053/j.jvca.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Marc E Stone
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Mount Sinai Medical Center, New York, NY
| | - Amit Pawale
- Department of Cardiac Surgery, Mount Sinai Medical Center, New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ.
| | - Menachem M Weiner
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Mount Sinai Medical Center, New York, NY
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22
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Botta L, De Chiara B, Macera F, Cannata A, Costetti A, Voltolini A, Moreo A, Cipriani M, Frigerio M, Russo CF. HeartWare-HVAD for end-stage heart failure: a review of clinical experiences with ≥50 patients. Expert Rev Med Devices 2017; 14:423-437. [DOI: 10.1080/17434440.2017.1325318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Luca Botta
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Benedetta De Chiara
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Francesca Macera
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Aldo Cannata
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Alessandro Costetti
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Alessandra Voltolini
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Antonella Moreo
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Manlio Cipriani
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Maria Frigerio
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
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23
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Myocardial Recovery Strategy with Decommissioning for the HeartWare Left Ventricular Assist Device. ASAIO J 2017; 63:299-304. [DOI: 10.1097/mat.0000000000000523] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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