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Rohde S, de By TMMH, Bogers AJJC, Schweiger M. Myocardial recovery in children supported with a durable ventricular assist device-a systematic review. Eur J Cardiothorac Surg 2023; 64:ezad263. [PMID: 37498565 PMCID: PMC10560320 DOI: 10.1093/ejcts/ezad263] [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: 02/11/2023] [Revised: 06/18/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVES A small percentage of paediatric patients supported with a ventricular assist device (VAD) can have their device explanted following myocardial recovery. The goal of this systematic review is to summarize the current literature on the clinical course in these children after weaning. METHODS A systematic literature search was performed on 27 May 2022 using Embase, Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Google Scholar to include all literature on paediatric patients supported by a durable VAD during the last decade. Overlapping study cohorts and registry-based studies were filtered out. RESULTS Thirty-seven articles were included. Eighteen of them reported on the incidence of recovery in cohort studies, with an overall incidence rate of 8.7% (81/928). Twenty-two of the included articles reported on clinical outcomes after VAD explantation (83 patients). The aetiologies varied widely and were not limited to diseases with a natural transient course like myocarditis. Most of the patients in the included studies (70; 84.3%) were supported by a Berlin Heart EXCOR, and in 66.3% (55/83), only the left ventricle had to be supported. The longest follow-up period was 19.1 years, and multiple studies reported on long-term myocardial recovery. Fewer than half of the reported deaths had a cardiac cause. CONCLUSIONS Myocardial recovery during VAD support is dependent on various contributing components. The interactions among patient-, device-, time- and hospital-related factors are complex and not yet fully understood. Long-term recovery after VAD support is achievable, even after a long duration of VAD support, and even in patients with aetiologies different from myocarditis or post-cardiotomy heart failure. More research is needed on this favourable outcome after VAD support.
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Affiliation(s)
- Sofie Rohde
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martin Schweiger
- Children′s Hospital Zurich, Pediatric Heart Centre, Department for Congenital Heart Surgery, Zurich, Switzerland
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Ibrahim M, Acker MA, Szeto W, Gutsche J, Williams M, Atluri P, Woods M, Richards T, Gardner TJ, McGarvey J, Epler M, Wald J, Rame E, Birati E, Bermudez C. Proposal for a trial of early left ventricular venting during venoarterial extracorporeal membrane oxygenation for cardiogenic shock. JTCVS OPEN 2021; 8:393-400. [PMID: 36004109 PMCID: PMC9390694 DOI: 10.1016/j.xjon.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 07/26/2021] [Indexed: 11/07/2022]
Abstract
Objective Patients with profound cardiogenic shock may require venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for circulatory support most commonly via the femoral vessels. The rate of cardiac recovery in this population remains low, possibly because peripheral VA-ECMO increases ventricular afterload. Whether direct ventricular unloading in peripheral VA-ECMO enhances cardiac recovery is unknown, but is being more frequently utilized. A randomized trial is warranted to evaluate the clinical effectiveness of percutaneous left ventricle venting to enhance cardiac recovery in the setting of VA-ECMO. Methods We describe the rationale, design, and initial testing of a randomized controlled trial of VA-ECMO with and without percutaneous left ventricle venting using a percutaneous micro-axial ventricular assist device. Results This is an ongoing prospective randomized controlled trial in adult patients with primary cardiac failure presenting in cardiogenic shock requiring peripheral VA-ECMO, designed to test the safety and effectiveness of percutaneous left ventricle venting in improving the rate of cardiac recovery. Conclusions The results of this nonindustry-sponsored trial will provide critical information on whether left ventricle unloading in peripheral VA-ECMO is safe and effective.
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Das S, Gordián-Vélez WJ, Ledebur HC, Mourkioti F, Rompolas P, Chen HI, Serruya MD, Cullen DK. Innervation: the missing link for biofabricated tissues and organs. NPJ Regen Med 2020; 5:11. [PMID: 32550009 PMCID: PMC7275031 DOI: 10.1038/s41536-020-0096-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/29/2020] [Indexed: 12/15/2022] Open
Abstract
Innervation plays a pivotal role as a driver of tissue and organ development as well as a means for their functional control and modulation. Therefore, innervation should be carefully considered throughout the process of biofabrication of engineered tissues and organs. Unfortunately, innervation has generally been overlooked in most non-neural tissue engineering applications, in part due to the intrinsic complexity of building organs containing heterogeneous native cell types and structures. To achieve proper innervation of engineered tissues and organs, specific host axon populations typically need to be precisely driven to appropriate location(s) within the construct, often over long distances. As such, neural tissue engineering and/or axon guidance strategies should be a necessary adjunct to most organogenesis endeavors across multiple tissue and organ systems. To address this challenge, our team is actively building axon-based "living scaffolds" that may physically wire in during organ development in bioreactors and/or serve as a substrate to effectively drive targeted long-distance growth and integration of host axons after implantation. This article reviews the neuroanatomy and the role of innervation in the functional regulation of cardiac, skeletal, and smooth muscle tissue and highlights potential strategies to promote innervation of biofabricated engineered muscles, as well as the use of "living scaffolds" in this endeavor for both in vitro and in vivo applications. We assert that innervation should be included as a necessary component for tissue and organ biofabrication, and that strategies to orchestrate host axonal integration are advantageous to ensure proper function, tolerance, assimilation, and bio-regulation with the recipient post-implant.
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Affiliation(s)
- Suradip Das
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Wisberty J. Gordián-Vélez
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA USA
| | | | - Foteini Mourkioti
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Panteleimon Rompolas
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - H. Isaac Chen
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Mijail D. Serruya
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA USA
| | - D. Kacy Cullen
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA USA
- Axonova Medical, LLC., Philadelphia, PA USA
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Gu K, Guan Z, Chang Y, Gao B, Ling Y, Song Z, Wan F. Hemodynamic effects of pulsatile unloading of left ventricular assist devices (LVAD) on intraventricular flow and ventricular stress. J Biomech 2020; 103:109425. [DOI: 10.1016/j.jbiomech.2019.109425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 12/21/2022]
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Steiner J, Wiafe S, Camuso J, Milley K, Wooster LT, Bailey CS, Thomas SS, D'Alessandro DA, Garcia JP, Lewis GD. Predicting Success: Left Ventricular Assist Device Explantation Evaluation Protocol Using Comprehensive Cardiopulmonary Exercise Testing. Circ Heart Fail 2019; 10:CIRCHEARTFAILURE.116.003694. [PMID: 27998882 DOI: 10.1161/circheartfailure.116.003694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Johannes Steiner
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Stephanie Wiafe
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Janice Camuso
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Katherine Milley
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Luke T Wooster
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Cole S Bailey
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Sunu S Thomas
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - David A D'Alessandro
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Jose P Garcia
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Gregory D Lewis
- From the Division of Cardiovascular Medicine, Department of Medicine (J.S., L.T.W., C.S.B., S.S.T., G.D.L.) and Division of Cardiothoracic Surgery, Department of Surgery (S.W., J.C., K.M., D.A.D., J.P.G.), Harvard Medical School, Massachusetts General Hospital, Boston.
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Gu K, Zhang Z, Chang Y, Gao B, Wan F. Computational analysis of the hemodynamic characteristics under interaction influence of β-blocker and LVAD. Biomed Eng Online 2018; 17:178. [PMID: 30509276 PMCID: PMC6276231 DOI: 10.1186/s12938-018-0602-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Hemodynamic characteristics of the interaction influence among support level and model of LVAD, and coupling β-blocker has not been reported. Methods In this study, the effect of support level and model of LVAD on cardiovascular hemodynamic characteristics is investigated. In addition, the effect of β-blocker on unloading with LVAD is analyzed to elucidate the mechanism of LVAD coupling β-blocker. A multi-scale model from cell level to system level is proposed. Moreover, LVAD coupling β-blocker has been researching to explain the hemodynamics of cardiovascular system. Results Myocardial force was decreased along with the increase of support level of LVAD, and co-pulse mode was the lowest among the three support modes. Additionally, the β-blocker combined with LVAD significantly reduced the left ventricular volume compared with LVAD support without β-blocker. However, the left ventricular pressure under both cases has no significant difference. External work of right ventricular was increased along with the growth of support level of only LVAD. The LVAD under co-pulse mode achieved the lowest right-ventricular EW among the three support modes. Conclusions Co-pulse mode with β-blocker could be an optimal strategy for promoting cardiac structure and function recovery.
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Affiliation(s)
- Kaiyun Gu
- Peking University Third Hospital, Peking University Health Science Center, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Zhe Zhang
- Peking University Third Hospital, Peking University Health Science Center, 49 North Garden Rd, Haidian District, Beijing, 100191, China.
| | - Yu Chang
- College of Life Science & Bio-Engineering, Beijing University of Technology, Beijing, 100124, China.
| | - Bin Gao
- College of Life Science & Bio-Engineering, Beijing University of Technology, Beijing, 100124, China
| | - Feng Wan
- Peking University Third Hospital, Peking University Health Science Center, 49 North Garden Rd, Haidian District, Beijing, 100191, China
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Kennedy-Lydon T, Rosenthal N. Cardiac regeneration: All work and no repair? Sci Transl Med 2017; 9:9/383/eaad9019. [PMID: 28356512 DOI: 10.1126/scitranslmed.aad9019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
Structural changes in the developing heart may influence the limited regenerative capacity of the adult heart. We examine how the workload exerted on the adult mammalian heart may limit regenerative capability and discuss recent therapies that demonstrate beneficial effects through unloading the heart.
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Affiliation(s)
| | - Nadia Rosenthal
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK.,Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria, Australia.,The Jackson Laboratory, Bar Harbor, ME, USA
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Cardiac Recovery During Long-Term Left Ventricular Assist Device Support. J Am Coll Cardiol 2016; 68:1540-53. [DOI: 10.1016/j.jacc.2016.07.743] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022]
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Sunagawa G, Byram N, Karimov JH, Horvath DJ, Moazami N, Starling RC, Fukamachi K. The Contribution to Hemodynamics Even at Very Low Pump Speeds in the HVAD. Ann Thorac Surg 2016; 101:2260-4. [PMID: 26912300 DOI: 10.1016/j.athoracsur.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/25/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND We recently reported using bench testing that the Thoratec HeartMate II at 6,000 rpm contributed to hemodynamics when the heart had not recovered well, making weaning assessment questionable. In this bench study, we characterized hemodynamics and pump flow of the HeartWare HVAD at 1,800 rpm, the lowest speed commonly used to assess clinical recovery. METHODS The HVAD was operated in a mock loop at 1,800, 2,400, and 3,000 rpm. We acquired pressure-flow curves in each steady state. In pulsatile mode with the pneumatic ventricle (heart simulator) activated, pump flow, total flow, and aortic pressure (AoP) data were obtained under conditions simulating normal heart function or heart failure. RESULTS A large regurgitant flow during diastole was confirmed during normal heart function at 1,800 rpm support; however, the net flow was zero, and there was no difference in mean AoP between 1,800 rpm support and no HVAD support. In contrast, in the heart failure condition, HVAD flow at 1,800 rpm significantly contributed to mean AoP and total flow, because there was less regurgitant flow. CONCLUSIONS Similar to the results for the HeartMate II at 6,000 rpm, we found that the net pump flow generated by the HeartWare HVAD at 1,800 rpm depends on the degree of residual left ventricular (LV) function. In the setting of improved LV function, at 1,800 rpm we noted a large regurgitant flow. Although this "marker" can serve as a useful indicator for recovery, assessing recovery at this speed is flawed unless measures are taken to prevent regurgitant flow.
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Affiliation(s)
- Gengo Sunagawa
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicole Byram
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamshid H Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - David J Horvath
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nader Moazami
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Randall C Starling
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
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Sunagawa G, Byram N, Karimov JH, Horvath DJ, Moazami N, Starling RC, Fukamachi K. In vitro hemodynamic characterization of HeartMate II at 6000 rpm: Implications for weaning and recovery. J Thorac Cardiovasc Surg 2015. [DOI: 10.1016/j.jtcvs.2015.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Percutaneous Fluoroscopic-Guided Endomyocardial Delivery in an Experimental Model of Left Ventricular Assist Device Support. J Cardiovasc Transl Res 2015; 8:381-4. [PMID: 26149227 DOI: 10.1007/s12265-015-9642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
Endomyocardial delivery in the setting of active left ventricular assist device (LVAD) support has rarely been studied. The objective was to establish a protocol for endomyocardial injections during LVAD support without compromising mechanical circulation. LVAD implantation was performed in four pigs. A curved needle catheter was percutaneously inserted into the right carotid artery and positioned into the left ventricle under fluoroscopic guidance. In the setting of increasing LVAD flows (2.3-3.1 l/min), percutaneous methylene blue dye administration into the myocardium proceeded without complications in all pigs. Transection of excised hearts revealed an anterior, lateral, inferior, and septal wall distribution of methylene blue documenting injections in all four regions of the left ventricle. Ex vivo, the catheter could be maneuvered close to the LVAD inflow cannula despite augmentation of LVAD flow up to 5 l/min. Endomyocardial injections during LVAD support was found to be feasible and safe with the curved needle catheter.
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Abstract
Remarkable advances in the technological capacity of modern medicine now permit the use of mechanical organ failure support deployed primarily to save life. Such technology serves as a bridge to either recovery or, when feasible, organ transplantation. However, when effective treatment options are exhausted, technological advances can be burdensome bridges to death. This paper briefly reviews the principles of management of life-threatening critical illness and the corresponding biological aspects of life, death, and organ donation, which are both informed and complicated by these technological and scientific achievements.
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Affiliation(s)
- Sam D Shemie
- Division of Critical Care and Extracorporeal Life Support Program, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada; The Bertram Loeb Chair in Organ and Tissue Donation, Faculty of Arts, University of Ottawa, Ottawa, Ontario, Canada; Deceased Donation, Canadian Blood Services, Ottawa, Ontario, Canada
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Halbreiner MS, Cruz V, Starling R, Soltesz E, Smedira N, Moravec C, Moazami N. Myocardial recovery: a focus on the impact of left ventricular assist devices. Expert Rev Cardiovasc Ther 2014; 12:589-600. [DOI: 10.1586/14779072.2014.909729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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