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Patel M, Tated RCP, Maheta DK, Agrawal SP, Frishman WH, Aronow WS. Exploring Atrial Shunt Therapy for Heart Failure: A Comprehensive Review of the Atrial Coronary Sinus Shunt. Cardiol Rev 2024:00045415-990000000-00312. [PMID: 39145658 DOI: 10.1097/crd.0000000000000775] [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] [Indexed: 08/16/2024]
Abstract
Heart failure is a prevalent and severe medical condition characterized by the heart's inability to pump blood efficiently, leading to poor circulation and symptoms such as pulmonary congestion. Despite advancements in medical treatments, many patients continue to experience significant symptoms with reduced quality of life. This article explores the left atrial coronary sinus shunt as an innovative interventional strategy to address hemodynamic issues in heart failure. The shunt aims to decrease left atrial pressure and alleviate pulmonary congestion by creating a connection between the left atrium and the coronary sinus.
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Affiliation(s)
- Manav Patel
- From the Department of Medicine, Smt. NHLMMC, Ahmedabad, India
| | | | | | - Siddharth Pravin Agrawal
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI
| | | | - Wilbert S Aronow
- Department of Medicine, New York Medical College, Valhalla, NY
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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Albulushi A, Al-Riyami MB, Al-Rawahi N, Al-Mukhaini M. Effectiveness of mechanical circulatory support devices in reversing pulmonary hypertension among heart transplant candidates: A systematic review. Curr Probl Cardiol 2024; 49:102579. [PMID: 38653439 DOI: 10.1016/j.cpcardiol.2024.102579] [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: 04/13/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Pulmonary hypertension (PH) poses a significant challenge in the selection of candidates for heart transplantation, impacting their eligibility and post-transplant outcomes. Mechanical circulatory support (MCS) devices, particularly left ventricular assist devices (LVADs), have emerged as a therapeutic option to manage PH in this patient population. This systematic review aims to evaluate the effectiveness of MCS devices in reversing fixed pulmonary hypertension in heart transplant candidates. METHODS A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Web of Science, to identify studies that evaluated the effectiveness of MCS devices in reversing fixed pulmonary hypertension in heart transplant candidates. Data on pulmonary vascular resistance, PH reversal, heart transplant eligibility, and post-transplant outcomes were extracted and synthesized. RESULTS The review included studies that demonstrated the potential of MCS devices, especially LVADs, to significantly reduce pulmonary vascular resistance and reverse fixed pulmonary hypertension in heart transplant candidates. These findings suggest that MCS devices can improve transplant eligibility and may positively impact post-transplant survival rates. However, the literature also indicates a need for further comparative studies to optimize MCS device selection and treatment protocols. CONCLUSION MCS devices, particularly LVADs, play a crucial role in the management of fixed pulmonary hypertension in heart transplant candidates, improving their eligibility for transplantation and potentially enhancing post-transplant outcomes. Future research should focus on comparative effectiveness studies to guide clinical decision-making and optimize patient care in this challenging clinical scenario.
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Affiliation(s)
- Arif Albulushi
- Division of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman.
| | - Mohammed B Al-Riyami
- Division of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | - Najib Al-Rawahi
- Division of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | - Mohammed Al-Mukhaini
- Division of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
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3
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Loyaga-Rendon RY, Acharya D, Jani M, Lee S, Trachtenberg B, Manandhar-Shrestha N, Leacche M, Jovinge S. Predicting Survival of End-Stage Heart Failure Patients Receiving HeartMate-3: Comparing Machine Learning Methods. ASAIO J 2024; 70:22-30. [PMID: 37913499 DOI: 10.1097/mat.0000000000002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
HeartMate 3 is the only durable left ventricular assist devices (LVAD) currently implanted in the United States. The purpose of this study was to develop a predictive model for 1 year mortality of HeartMate 3 implanted patients, comparing standard statistical techniques and machine learning algorithms. Adult patients registered in the Society of Thoracic Surgeons, Interagency Registry for Mechanically Assisted Circulatory Support (STS-INTERMACS) database, who received primary implant with a HeartMate 3 between January 1, 2017, and December 31, 2019, were included. Epidemiological, clinical, hemodynamic, and echocardiographic characteristics were analyzed. Standard logistic regression and machine learning (elastic net and neural network) were used to predict 1 year survival. A total of 3,853 patients were included. Of these, 493 (12.8%) died within 1 year after implantation. Standard logistic regression identified age, Model End Stage Liver Disease (MELD)-XI score, right arterial (RA) pressure, INTERMACS profile, heart rate, and etiology of heart failure (HF), as important predictor factors for 1 year mortality with an area under the curve (AUC): 0.72 (0.66-0.77). This predictive model was noninferior to the ones developed using the elastic net or neural network. Standard statistical techniques were noninferior to neural networks and elastic net in predicting 1 year survival after HeartMate 3 implantation. The benefit of using machine-learning algorithms in the prediction of outcomes may depend on the type of dataset used for analysis.
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Affiliation(s)
- Renzo Y Loyaga-Rendon
- From the Advanced Heart Failure and Transplant Cardiology Section, Spectrum Health, Grand Rapids, Michigan
| | - Deepak Acharya
- Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, Arizona
| | - Milena Jani
- From the Advanced Heart Failure and Transplant Cardiology Section, Spectrum Health, Grand Rapids, Michigan
| | - Sangjin Lee
- From the Advanced Heart Failure and Transplant Cardiology Section, Spectrum Health, Grand Rapids, Michigan
| | | | | | - Marzia Leacche
- Cardiothoracic Surgery Division, Spectrum Health, Grand Rapids, Michigan
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Dandel M. Cardiological Challenges Related to Long-Term Mechanical Circulatory Support for Advanced Heart Failure in Patients with Chronic Non-Ischemic Cardiomyopathy. J Clin Med 2023; 12:6451. [PMID: 37892589 PMCID: PMC10607800 DOI: 10.3390/jcm12206451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Long-term mechanical circulatory support by a left ventricular assist device (LVAD), with or without an additional temporary or long-term right ventricular (RV) support, is a life-saving therapy for advanced heart failure (HF) refractory to pharmacological treatment, as well as for both device and surgical optimization therapies. In patients with chronic non-ischemic cardiomyopathy (NICM), timely prediction of HF's transition into its end stage, necessitating life-saving heart transplantation or long-term VAD support (as a bridge-to-transplantation or destination therapy), remains particularly challenging, given the wide range of possible etiologies, pathophysiological features, and clinical presentations of NICM. Decision-making between the necessity of an LVAD or a biventricular assist device (BVAD) is crucial because both unnecessary use of a BVAD and irreversible right ventricular (RV) failure after LVAD implantation can seriously impair patient outcomes. The pre-operative or, at the latest, intraoperative prediction of RV function after LVAD implantation is reliably possible, but necessitates integrative evaluations of many different echocardiographic, hemodynamic, clinical, and laboratory parameters. VADs create favorable conditions for the reversal of structural and functional cardiac alterations not only in acute forms of HF, but also in chronic HF. Although full cardiac recovery is rather unusual in VAD recipients with pre-implant chronic HF, the search for myocardial reverse remodelling and functional improvement is worthwhile because, for sufficiently recovered patients, weaning from VADs has proved to be feasible and capable of providing survival benefits and better quality of life even if recovery remains incomplete. This review article aimed to provide an updated theoretical and practical background for those engaged in this highly demanding and still current topic due to the continuous technical progress in the optimization of long-term VADs, as well as due to the new challenges which have emerged in conjunction with the proof of a possible myocardial recovery during long-term ventricular support up to levels which allow successful device explantation.
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Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK), 10785 Berlin, Germany
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5
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Kilic A, Kwon JH, Grady KL, Singletary BA, Kilic A, Everitt M, Cleveland J, Cantor RS, Blackmon S, Breathett K, McKellar S, Keebler M, Kirklin JK, Stehlik J. Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis. J Heart Lung Transplant 2023; 42:1214-1222. [PMID: 37040860 DOI: 10.1016/j.healun.2023.04.001] [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: 09/02/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND We sought to quantify the impact of pre- and postoperative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. METHODS Primary durable LVAD implants between 2012 and 2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and postimplant adverse events (AEs) on HRQOL as assessed by the EQ-5D visual analog scale (VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) at 6 months and 3 years. RESULTS Of 22,230 patients, 9,888 had VAS and 10,552 had KCCQ reported at 6 months, and 2,170 patients had VAS and 2,355 had KCCQ reported at 3 years postimplant. VAS improved from a mean of 38.2 ± 28.3 to 70.7 ± 22.9 at 6 months and from 40.1 ± 27.8 to 70.3 ± 23.1 at 3 years. KCCQ improved from 28.2 ± 23.9 to 64.3 ± 23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ± 23.7 at 3 years. Preimplant variables, including baseline VAS, had small effect sizes on HRQOL while postimplant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years. CONCLUSIONS AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.
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Affiliation(s)
- Arman Kilic
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
| | - Jennie H Kwon
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kathleen L Grady
- Departments of Surgery and Medicine. Northwestern University, Chicago, Illinois
| | - Brandon A Singletary
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ahmet Kilic
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Melanie Everitt
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Joseph Cleveland
- Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shanda Blackmon
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - Stephen McKellar
- Division of Cardiovascular and Thoracic Surgery, Intermountain Medical Center, Murray, Utah
| | - Mary Keebler
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
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Desai K, Ngai J. Are Ventricular Assist Devices Leading the Way in Patients With Advanced Heart Failure? J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00202-1. [PMID: 37120326 DOI: 10.1053/j.jvca.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Krupa Desai
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY
| | - Jennie Ngai
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY.
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7
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Roehm B, Hedayati S, Vest AR, Gulati G, Miao J, Tighiouart H, Weiner DE, Inker LA. Long-Term Changes in Estimated Glomerular Filtration Rate in Left Ventricular Assist Device Recipients: A Longitudinal Joint Model Analysis. J Am Heart Assoc 2023; 12:e025993. [PMID: 36734339 PMCID: PMC9973635 DOI: 10.1161/jaha.122.025993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023]
Abstract
Background Advanced kidney disease is often a relative contraindication to left ventricular assist device (LVAD) implantation because of concerns for poor outcomes including worsening kidney disease. Data are lacking on long-term changes and sex-based differences in estimated glomerular filtration rate (eGFR), with published data limited by potential bias introduced by the competing risks of death and heart transplantation. Methods and Results We conducted a longitudinal analysis of 288 adults receiving durable continuous-flow LVADs from January 2010 to December 2017 at a single center. A joint model was constructed to evaluate change in eGFR over 2 years, the prespecified primary outcome, adjusted for the competing risks of death and heart transplantation. Median baseline eGFR was 60 mL/min per 1.73 m2 (interquartile range 42-78). At 2 years, 74 patients died and 104 received a heart transplant. In unadjusted analysis, LVAD recipients had a modest initial increase in eGFR of ≈2 mL/min per 1.73 m2 within the first 6 months after implantation, followed by a decrease in eGFR below baseline values at 1 and 2 years. Men experienced an eGFR decline of 5 to 10 mL/min per 1.73 m2 over the first year which then stabilized, while women had an ≈5 mL/min per 1.73 m2 increase in eGFR within the first 6 months followed by decline towards baseline eGFR levels (interaction P=0.005). Conclusions Estimated GFR remains relatively stable in most patients following LVAD implantation. Larger studies are needed to investigate sex-based differences in eGFR and to evaluate eGFR trajectory and mortality in LVAD recipients with lower eGFR.
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Affiliation(s)
- Bethany Roehm
- Division of NephrologyUniversity of Texas Southwestern Medical CenterDallasTX
| | - Susan Hedayati
- Division of NephrologyUniversity of Texas Southwestern Medical CenterDallasTX
| | | | | | | | - Hocine Tighiouart
- Tufts Medical CenterInstitute for Clinical Research and Health Policy StudiesBostonMA
- Tufts University, Tufts Clinical and Translational Science InstituteBostonMA
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8
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Chivukula VK, Loera G, Dragoljic D, Martinez J, Beckman JA, Li S, Mahr C, Aliseda A. A Computational Hemodynamics Approach to Left Ventricular Assist Device (LVAD) Optimization Validated in a Large Patient Cohort. ASAIO J 2022; 68:932-939. [PMID: 34743140 DOI: 10.1097/mat.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With increasing use of left ventricular assist devices (LVAD) it is critical to devise strategies to optimize LVAD speed while controlling mean arterial pressure (MAP) and flow according to patient physiology. The complex interdependency between LVAD speed, MAP, and flow frequently makes optimization difficult under clinical conditions. We propose a method to guide this procedure in silico, narrowing the conditions to test clinically. A computational model of the circulatory network that simulates HF and LVAD support, incorporating LVAD pressure-flow curves was applied retrospectively to anonymized patient hemodynamics data from the University of Washington Medical Center. MAP management on 61 patient-specific computational models with a target of 70 mm Hg, resulting flow for a given LVAD speed was analyzed, and compared to a target output of 5 L/min. Before performing virtual MAP management, 51% had a MAP>70 mm Hg and CO>5 L/min, and 33% had a MAP>70 mm Hg and CO<5 L/min. After changing systemic resistance to meet the MAP target (without adjusting LVAD speed), 84% of cases resulted in CO higher than 5 L/min, with a median CO of 6.79 L/min, using the computational predictive model. Blood pressure management alone is insufficient in meeting both MAP and CO targets, due to the risk of hypervolemia, and requires appropriate LVAD speed optimization to achieve both targets, while preserving right heart health. Such computational tools can narrow down conditions to be tested for each patient, providing significant insight into the pump-patient interplay. LVAD hemodynamic optimization has the potential to reduce complications and improve outcomes.
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Affiliation(s)
| | - Gavin Loera
- Department of Biomedical Engineering, University of North Texas, Denton, Texas
| | - Dina Dragoljic
- Department of Biomedical Engineering, Florida Institute of Technology, Melbourne, Florida
| | - Jasmine Martinez
- Department of Biomedical Engineering, Florida Institute of Technology, Melbourne, Florida
| | | | - Song Li
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
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Roth S, M'Pembele R, Stroda A, Voit J, Lurati Buse G, Sixt SU, Westenfeld R, Polzin A, Rellecke P, Tudorache I, Hollmann MW, Boeken U, Akhyari P, Lichtenberg A, Huhn R, Aubin H. Days alive and out of hospital after left ventricular assist device implantation. ESC Heart Fail 2022; 9:2455-2463. [PMID: 35513994 PMCID: PMC9288752 DOI: 10.1002/ehf2.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
Aims Implantation of left ventricular assist devices (LVADs) as a bridge to transplant or as destination therapy is increasing. The selection of suitable patients and outcome assessment belong to the key challenges. Mortality has traditionally been a focus of research in this field, but literature on quality of life is very limited. This study aimed to identify perioperative factors influencing patients' life as measured by days alive and out of hospital (DAOH) in the first year after LVAD implantation. Methods and results This retrospective single‐centre cohort study screened 227 patients who underwent LVAD implantation at the University Hospital Duesseldorf, Germany, between 2010 and 2020. First, the influence of 10 prespecified variables on DAOH was investigated by univariate analysis. Second, multivariate quantile regression was conducted including all factors with significant influence on DAOH in the univariate model. Additionally, the impact of all variables on 1 year mortality was investigated using Kaplan–Meier curves to oppose DAOH and mortality. In total, 221 patients were included into analysis. As pre‐operative factors, chronic kidney disease (CKD), pre‐operative mechanical circulatory support (pMCS), and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) stadium < 3 were associated with lower DAOH at 1 year [CKD: 280 (155–322) vs. 230 (0–219), P = 0.0286; pMCS: 294 (155–325) vs. 243 (0–293), P = 0.0004; INTERMACS 1: 218 (0–293) vs. INTERMACS 2: 264 (6–320) vs. INTERMACS 3: 299 (228–325) vs. INTERMACS 4: 313 (247–332), P ≤ 0.0001]. Intra‐operative additional implantation of a right ventricular assist device (RVAD) was also associated with lower DAOH [RVAD: 290 (160–325) vs. 174 (0–277), P ≤ 0.0001]. As post‐operative values that were associated with lower DAOH, dialysis and tracheotomy could be identified [dialysis: 300 (252–326) vs. 186 (0–300), P ≤ 0.0001; tracheotomy: 292 (139–325) vs. 168 (0–269), P ≤ 0.0001]. Multivariate analysis revealed that all of these factors besides pMCS were independently associated with DAOH. According to Kaplan–Meier analysis, only post‐operative dialysis was significantly associated with increased mortality at 1 year (survival: no dialysis 89.4% vs. dialysis 70.1%, hazard ratio: 0.56, 95% confidence interval: 0.33–0.94; P = 0.031). Conclusions The results of this study indicate that there can be a clear discrepancy between hard endpoints such as mortality and more patient‐centred outcomes reflecting life impact. DAOH may relevantly contribute to a more comprehensive selection process and outcome assessment in LVAD patients.
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Affiliation(s)
- Sebastian Roth
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - René M'Pembele
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexandra Stroda
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Josephine Voit
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Giovanna Lurati Buse
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan U Sixt
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center (AUMC), Location AMC, Amsterdam, The Netherlands
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Ragnar Huhn
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.,Department of Anesthesiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
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Rangel BSDS, Biselli B, Quintanilha NR, Avila MS, Pêgo-Fernandes PM, Jatene FB, Kalil Filho R, Ferreira SMA. Early reduction of pulmonary arterial hypertension in patients using a long-term mechanical ventricular assistance device: a cross-sectional study. SAO PAULO MED J 2022; 140:505-508. [PMID: 35584527 PMCID: PMC9671249 DOI: 10.1590/1516-3180.2021.0944.r2.18032022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Severe pulmonary arterial hypertension (PAH) is a contraindication for heart transplantation (HT). It has been correlated with increased early and late mortality, mainly associated with right ventricular failure. Ventricular assistance devices (VADs) can promote reduction of intracardiac pressures and consequent reduction of PAH over the medium and long terms, thus enabling future candidature for HT. The diminution of early pulmonary pressure within this scenario remains unclear. OBJECTIVE To evaluate the reduction of PAH and correlate data from right catheterization with the earliness of this reduction. DESIGN AND SETTING Cross-sectional study in a general hospital in São Paulo, Brazil. METHODS This was a retrospective analysis on the medical records of patients undergoing VAD implantation in a single hospital. Patients for whom VAD had been indicated as a bridge to candidature for HT due to their condition of constant PAH were selected. RESULTS Four patients with VADs had constantly severe PAH. Their mean pulmonary artery systolic pressure (PASP) before VAD implantation was 66 mmHg. Over the 30-day period after the procedure, all the patients evolved with a drop in PASP to below 60 mmHg. Their new average was 36 mmHg, which was a drop of close to 50% from baseline values. The one-year survival of this sample was 100%. CONCLUSION VAD implantation can reduce PAH levels. Early reduction occurred in all patients. Thus, use of VAD is an important bridge tool for enabling candidature for HT among patients with constantly severe PAH.
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Affiliation(s)
- Bruno Soares da Silva Rangel
- MD. Attending Physician, Hospital Sírio-Libânes (HSL), São Paulo (SP), Brazil; and Attending Physician, Hospital Vila Nova Star, São Paulo (SP), Brazil
| | - Bruno Biselli
- MD. Attending Physician, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil; and Attending Physician, Hospital Sírio-Libânes (HSL), São Paulo (SP), Brazil
| | - Nádia Romanelli Quintanilha
- MD. Attending Physician, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil
| | - Mônica Samuel Avila
- MD, PhD. Attending Physician, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil; and Attending Physician, Hospital Sírio-Libânes (HSL), São Paulo (SP), Brazil
| | - Paulo Manuel Pêgo-Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Program, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil; and Cardiothoracic Surgeon, Hospital Sírio-Libânes (HSL), São Paulo (SP), Brazil
| | - Fabio Biscegli Jatene
- MD, PhD. Full Professor, Cardiovascular Surgery Division, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; and Cardiovascular Surgeon, Hospital Sírio-Libanês (HSL), São Paulo (SP), Brazil
| | - Roberto Kalil Filho
- MD, PhD. Full Professor, Cardiology Division, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; and General Director, Cardiology Center, Hospital Sírio-Libanês (HSL), São Paulo (SP), Brazil
| | - Silvia Moreira Ayub Ferreira
- MD, PhD. Attending Physician, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil; and Attending Physician, Hospital Sírio-Libânes (HSL), São Paulo (SP), Brazil
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11
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Coniglio AC, Patel CB, Kittleson M, Schlendorf K, Schroder JN, DeVore AD. Innovations in Heart Transplantation: A Review. J Card Fail 2021; 28:467-476. [PMID: 34752907 DOI: 10.1016/j.cardfail.2021.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 01/15/2023]
Abstract
Advanced heart failure affects tens of thousands of people in the United States alone with high morbidity and mortality. Cardiac transplantation offers the best treatment strategy but has been historically limited by donor availability. Recently, there have been significant advances in organ allocation, donor-recipient matching, organ preservation and expansion of the donor pool. The current heart allocation system prioritizes the sickest patients to minimize waitlist mortality. Advances in donor organ selection including predicted heart mass calculations and more sophisticated antibody detection methods for allosensitized patients offer more effective matching of donors and recipients. Innovations in organ preservation such as with organ preservation systems have geographically widened the donor pool. The use of hepatitis C donors is possible with the advent of effective direct-acting antiviral agents to cure donor-transmitted hepatitis C. Finally, further expansion of the donor pool is occurring with the utilization of higher-risk donors with advanced age, medical comorbidities, and left ventricular dysfunction and advances in donation after circulatory death. This review provides an update on the new technologies and transplantation strategies that serve to widen the donor pool and more effectively match donors and recipients so that heart transplant candidates may derive the best outcomes from heart transplantation.
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Affiliation(s)
- Amanda C Coniglio
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Chetan B Patel
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | | | | | - Jacob N Schroder
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Adam D DeVore
- Department of Medicine, Duke University School of Medicine, Durham, NC.
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12
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Pacheco C, Mullen KA, Coutinho T, Jaffer S, Parry M, Van Spall HG, Clavel MA, Edwards JD, Sedlak T, Norris CM, Dhukai A, Grewal J, Mulvagh SL. THE CANADIAN WOMEN’S HEART HEALTH ALLIANCE ATLAS ON THE EPIDEMIOLOGY, DIAGNOSIS, AND MANAGEMENT OF CARDIOVASCULAR DISEASE IN WOMEN -- CHAPTER 5: SEX- AND GENDER-UNIQUE MANIFESTATIONS OF CARDIOVASCULAR DISEASE. CJC Open 2021; 4:243-262. [PMID: 35386135 PMCID: PMC8978072 DOI: 10.1016/j.cjco.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
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13
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Larsson J, Kristensen SL, Madelaire C, Schou M, Rossing K, Boesgaard S, Køber L, Gustafsson F. Socioeconomic Disparities in Referral for Invasive Hemodynamic Evaluation for Advanced Heart Failure: A Nationwide Cohort Study. Circ Heart Fail 2021; 14:e008662. [PMID: 34461745 DOI: 10.1161/circheartfailure.121.008662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Factors determining referral for advanced heart failure (HF) evaluation are poorly studied. We studied the influence of socioeconomic aspects on the referral process in Denmark, which has a taxpayer-funded national health care system. METHODS We identified all patients aged 18 to 75 years with a first diagnosis of HF during 2010 to 2018. Hospitalized patients had to be discharged alive and were then followed for the outcome of undergoing a right heart catheterization (RHC) used as a surrogate marker of advanced HF work-up. RESULTS Of 36 637 newly diagnosed patients with HF, 680 (1.9%) underwent RHC during the follow-up period (median time to RHC of 280 days [interquartile range, 73-914]). Factors associated with a higher likelihood of RHC included the highest versus lowest household income quartile (HR, 1.56 [95% CI, 1.19-2.06]; P=0.001), being diagnosed with HF at a tertiary versus nontertiary hospital (HR, 1.68 [95% CI, 1.37-2.05]; P<0.001) and during a hospitalization versus outpatient visit (HR, 1.67 [95% CI, 1.42-1.95]; P<0.001). Level of education, occupational status, and distance to tertiary hospital were not independently associated with RHC. Older age, cancer, and a psychiatric diagnosis were independently associated with a decreased probability of RHC. CONCLUSIONS Higher household income, HF diagnosis during hospitalization, and first admission at a tertiary hospital were associated with increased likelihood of subsequent referral for RHC independent of other demographic and clinical variables. Greater attention may be required to ensure timely referral for advanced HF therapies in lower income groups.
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Affiliation(s)
- Johan Larsson
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | - Søren L Kristensen
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | | | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark (M.S.)
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | - Søren Boesgaard
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
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14
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Hollander SA, Kaufman BD, Bui C, Gregori B, Murray JM, Sacks L, Ryan KR, Ma M, Rosenthal DN, Char D. Compassionate Deactivation of Pediatric Ventricular Assist Devices: A Review of 14 Cases. J Pain Symptom Manage 2021; 62:523-528. [PMID: 33910026 DOI: 10.1016/j.jpainsymman.2021.01.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Compassionate deactivation (CD) of ventricular assist device (VAD) support is a recognized option for children when the burden of therapy outweighs the benefits. OBJECTIVES To describe the prevalence, indications, and outcomes of CD of children supported by VADs at the end of life. METHODS Review of cases of CD at our institution between 2011 and 2020. To distinguish CD from other situations where VAD support is discontinued, patients were excluded from the study if they died during resuscitation (including extracorporeal membrane oxygenation), experienced brain or circulatory death prior to deactivation, or experienced a non-survivable brain injury likely to result in imminent death regardless of VAD status. RESULTS Of 24 deaths on VAD, 14 (58%) were CD. Median age was 5.7 (interquartile range (IQR) 0.6, 11.6) years; 6 (43%) had congenital heart disease; 4 (29%) were on a device that can be used outside of the hospital. CD occurred after 40 (IQR: 26, 75) days of support; none while active transplant candidates. CD discussions were initiated by the caregiver in 6 (43%) cases, with the remainder initiated by a medical provider. Reasons for CD were multifactorial, including end-organ injury, infection, and stroke. CD occurred with endotracheal extubation and/or discontinuation of inotropes in 12 (86%) cases, and death occurred within 10 (IQR: 4, 23) minutes of CD. CONCLUSION CD is the mode of death in more than half of our VAD non-survivors and is pursued for reasons primarily related to noncardiac events. Caregivers and providers both initiate CD discussions. Ventilatory and inotropic support is often withdrawn at time of CD with ensuing death.
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Affiliation(s)
- Seth A Hollander
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA.
| | - Beth D Kaufman
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Christine Bui
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Bianca Gregori
- Department of Social Work, Lucile Packard Children's Hospital Stanford (B.G.), Palo Alto, California, USA
| | - Jenna M Murray
- Solid Organ Transplant Services, Lucile Packard Children's Hospital Stanford (J.M.M), Palo Alto, California, USA
| | - Loren Sacks
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Kathleen R Ryan
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine (M.M.), Palo Alto, California, USA
| | - David N Rosenthal
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Danton Char
- Department of Anesthesia, Stanford University School of Medicine (D.C.), Palo Alto, California, USA
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15
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Herr JJ, Ravichandran A, Sheikh FH, Lala A, Chien CV, Hsiao S, Srivastava A, Pedrotty D, Nowaczyk J, Tompkins S, Ahmed S, Xiang F, Forest S, Tong MZ, D'souza B. Practices of Referring Patients to Advanced Heart Failure Centers. J Card Fail 2021; 27:1251-1259. [PMID: 34146684 DOI: 10.1016/j.cardfail.2021.05.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Therapies for advanced heart failure (AHF) improve the likelihood of survival in a growing population of patients with stage D heart failure (HF). Successful implementation of these therapies is dependent upon timely and appropriate referrals to AHF centers. METHODS We performed a retrospective analysis of patients referred to 9 AHF centers for evaluation for AHF therapies. Patients' demographics, referring providers' characteristics, referral circumstances, and evaluation outcomes were collected. RESULTS The majority of referrals (n = 515) were male (73.4%), and a majority of those were in the advanced state of the disease: very low left ventricular ejection fraction (<20% in 51.5%); 59.4% inpatient; and high risk Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles (74.5% profile 1-3). HF cardiologists (49.1%) were the most common originating referral source; the least common (4.9%) were electrophysiologists. Common clinical triggers for referral included worsening HF (30.0%), inotrope dependence (19.6%), hospitalization (19.4%), and cardiogenic shock (17.8%). Most commonly, AHF therapies were not offered because patients were too sick (38.0%-45.1%) or for psychosocial reasons (20.3%-28.6%). Compared to non-HF cardiologists, patients referred by HF cardiologists were offered an AHF therapy more often (66.8% vs 58.4%, P = 0.0489). Of those not offered any AHF therapy, 28.4% received home inotropic therapy, and 14.5% were referred to hospice. CONCLUSIONS In this multicenter review of AHF referrals, HF cardiologists referred the most patients despite being a relatively small proportion of the overall clinician population. Late referral was prevalent in this high-risk patient population and correlates with worsened outcomes, suggesting a significant need for broad clinician education regarding the benefits, triggers and appropriate timing of referral to AHF centers for optimal patient outcomes.
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Affiliation(s)
- Jared J Herr
- Sutter Health CPMC Center for Advanced Heart Failure Therapies, California Pacific Medical Center, San Francisco, California.
| | | | - Farooq H Sheikh
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Anuradha Lala
- Department of Population Health Science and Policy, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher V Chien
- Division of Cardiology, University of North Carolina, Durham, North Carolina
| | - Stephanie Hsiao
- Sutter Health CPMC Center for Advanced Heart Failure Therapies, California Pacific Medical Center, San Francisco, California
| | - Ajay Srivastava
- Section of Advanced Heart Failure, Department of Cardiology, Scripps Clinic, San Diego, California
| | - Dawn Pedrotty
- Department of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer Nowaczyk
- Section of Advanced Heart Failure, Department of Cardiology, Scripps Clinic, San Diego, California
| | | | - Sara Ahmed
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Fei Xiang
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Stephen Forest
- Department of Cardiothoracic Surgery, Montefiore Medical Center, New York, New York
| | - Michael Z Tong
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Benjamin D'souza
- Department of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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16
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Stacy J, Khazanie P. Health Insurance and Left Ventricular Assist Device Outcomes: Focus on the Patient Journey, Not the Destination. Circ Heart Fail 2021; 14:e008558. [PMID: 33993720 PMCID: PMC8133467 DOI: 10.1161/circheartfailure.121.008558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John Stacy
- Department of Medicine, The University of Colorado School of Medicine, Aurora, CO
| | - Prateeti Khazanie
- Division of Cardiology, Department of Medicine, The University of Colorado School of Medicine, Aurora, CO
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17
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Edelson JB, Edwards JJ, Katcoff H, Mondal A, Reza N, Hanff TC, Griffis H, Mazurek JA, Wald J, Owens AT, Burstein DS, Atluri P, O’Connor MJ, Goldberg LR, Zamani P, Groeneveld PW, Rossano JW, Lin KY, Birati EY. An Increasing Burden of Disease: Emergency Department Visits Among Patients With Ventricular Assist Devices From 2010 to 2017. J Am Heart Assoc 2021; 10:e018035. [PMID: 33543642 PMCID: PMC7955344 DOI: 10.1161/jaha.120.018035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/10/2020] [Indexed: 12/14/2022]
Abstract
Background With a growing population of patients supported by ventricular assist devices (VADs) and the improvement in survival of this patient population, understanding the healthcare system burden is critical to improving outcomes. Thus, we sought to examine national estimates of VAD-related emergency department (ED) visits and characterize their demographic, clinical, and outcomes profile. Additionally, we tested the hypotheses that resource use increased and mortality improved over time. Methods and Results This retrospective database analysis uses encounter-level data from the 2010 to 2017 Nationwide Emergency Department Sample. The primary outcome was mortality. From 2010 to 2017, >880 million ED visits were evaluated, with 44 042 VAD-related ED visits identified. The annual mean visits were 5505 (SD 4258), but increased 16-fold from 2010 to 2017 (824 versus 13 155). VAD-related ED visits frequently resulted in admission (72%) and/or death (3.0%). Median inflation-adjusted charges were $25 679 (interquartile range, $7450, $63 119) per encounter. The most common primary diagnoses were cardiac (22%), and almost 30% of encounters were because of bleeding, stroke, or device complications. From 2010 to 2017, admission and mortality decreased from 82% to 71% and 3.4% to 2.4%, respectively (P for trends <0.001, both). Conclusions We present the first study using national-level data to characterize the growing ED resource use and financial burden of patients supported by VAD. During the past decade, admission and mortality rates decreased but remain substantial; in 2017 ≈1 in every 40 VAD ED encounters resulted in death, making it critical that clinical decision-making be optimized for patients with VAD to maximize good outcomes.
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Affiliation(s)
- Jonathan B. Edelson
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPA
| | - Jonathan J. Edwards
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Hannah Katcoff
- Department of Biomedical Health Informatics, Healthcare Analytics Unitthe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Antara Mondal
- Department of Biomedical Health Informatics, Healthcare Analytics Unitthe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Nosheen Reza
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Thomas C. Hanff
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Heather Griffis
- Department of Biomedical Health Informatics, Healthcare Analytics Unitthe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Jeremy A. Mazurek
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Joyce Wald
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Anjali T. Owens
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Danielle S. Burstein
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Pavan Atluri
- Department of Biomedical Health Informatics, Healthcare Analytics Unitthe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Matthew J. O’Connor
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Lee R. Goldberg
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Payman Zamani
- Cardiothoracic SurgeryPerelman School of MedicinePhiladelphiaPA
| | - Peter W. Groeneveld
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPA
- General Internal Medicine DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Joseph W. Rossano
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
| | - Kimberly Y. Lin
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Edo Y. Birati
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
- Cardiovascular DivisionPoriya Medical CenterBar Ilan UniversityRamat GanIsrael
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18
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Durable Continuous-Flow Mechanical Circulatory Support: State of the Art. HEARTS 2021. [DOI: 10.3390/hearts2010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Implantable mechanical circulatory support (MCS) systems for ventricular assist device (VAD) therapy have emerged as an important strategy due to a shortage of donor organs for heart transplantation. A growing number of patients are receiving permanent assist devices, while fewer are undergoing heart transplantation (Htx). Continuous-flow (CF) pumps, as devices that can be permanently implanted, show promise for the treatment of both young and old patients with heart failure (HF). Further improvement of these devices will decrease adverse events, enable pulse modulation of continuous blood flow, and improve automatic remote monitoring. Ease of use for patients could also be improved. We herein report on the current state of the art regarding implantable CF pumps for use as MCS systems in the treatment of advanced refractory HF.
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19
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Hamdan R, Kadri Z, Charif F. [To be a female with heart failure in the Middle-East]. Ann Cardiol Angeiol (Paris) 2021; 70:62. [PMID: 32873377 DOI: 10.1016/j.ancard.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022]
Affiliation(s)
- R Hamdan
- Cardiology department, Beirut Cardiac Institute, Beirut, Liban.
| | - Z Kadri
- Cardiology department, Hôtel-Dieu de France Hospital, Beirut, Liban
| | - F Charif
- Pulmonary department, Beirut Cardiac Institute, Beirut, Liban
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20
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Moghaddam N, van Diepen S, So D, Lawler PR, Fordyce CB. Cardiogenic shock teams and centres: a contemporary review of multidisciplinary care for cardiogenic shock. ESC Heart Fail 2021; 8:988-998. [PMID: 33452763 PMCID: PMC8006679 DOI: 10.1002/ehf2.13180] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
Cardiogenic shock (CS) portends high morbidity and mortality in the contemporary era. Despite advances in temporary mechanical circulatory supports (MCS), their routine use in CS to improve outcomes has not been established. Delays in diagnosis and timely delivery of care, disparities in accessing adjunct therapies such revascularization or MCS, and lack of a systematic approach to care of CS contribute to the poor outcomes observed in CS patients. There is growing interest for developing a standardized multidisciplinary team-based approach in the management of CS. Recent prospective studies have shown feasibility of CS teams in improving survival across a spectrum of CS presentations. Herein, we will review the rationale for CS teams focusing on evidence supporting its use in streamlining care, optimizing revascularization strategies, and patient identification and MCS selection. The proposed structure and flow of CS teams will be outlined. An in-depth analysis of four recent studies demonstrating improved outcomes with CS teams is presented. Finally, we will explore potential implementation hurdles and future directions in refining and widespread implementation of dedicated cross-specialty CS teams.
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Affiliation(s)
- Nima Moghaddam
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean van Diepen
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Derek So
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Au SL, Ho CS. Cardiac implantable therapeutic medical devices: A narrative review. JOURNAL OF ACUTE DISEASE 2021. [DOI: 10.4103/2221-6189.316672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Koh CH. Commercial Air Travel for Passengers With Cardiovascular Disease: Recommendations for Common Conditions. Curr Probl Cardiol 2020; 46:100768. [PMID: 33348221 DOI: 10.1016/j.cpcardiol.2020.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
The exponential growth of commercial flights has resulted in an explosion of air travelers over the last few decades, including passengers with a wide range of cardiovascular conditions. Notwithstanding the ongoing COVID-19 pandemic that had set back the aviation industry for the next 1-2 years, air travel is expected to rebound fully by 2024. Guidelines and evidence-based recommendations for safe air travel in this group vary, and physicians often encounter situations where opinions and assessments on fitness for flights are sought. This article aims to provide an updated suite of recommendations for the aeromedical disposition of passenger with common cardiovascular conditions, such as ischemic heart disease, congestive heart failure, valvular heart disease, cardiomyopathies, and common arrhythmias.
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Affiliation(s)
- Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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23
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Givertz MM, DeFilippis EM, Colvin M, Darling CE, Elliott T, Hamad E, Hiestand BC, Martindale JL, Pinney SP, Shah KB, Vierecke J, Bonnell M. HFSA/SAEM/ISHLT clinical expert consensus document on the emergency management of patients with ventricular assist devices. J Heart Lung Transplant 2020; 38:677-698. [PMID: 31272557 DOI: 10.1016/j.healun.2019.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 01/21/2023] Open
Abstract
Mechanical circulatory support is now widely accepted as a viable long-term treatment option for patients with end-stage heart failure (HF). As the range of indications for the implantation of ventricular assist devices grows, so does the number of patients living in the community with durable support. Because of their underlying disease and comorbidities, in addition to the presence of mechanical support, these patients are at a high risk for medical urgencies and emergencies (Table 1). Thus, it is the responsibility of clinicians to understand the basics of their emergency care. This consensus document represents a collaborative effort by the Heart Failure Society of America, the Society for Academic Emergency Medicine, and the International Society for Heart and Lung Transplantation (ISHLT) to educate practicing clinicians about the emergency management of patients with ventricular assist devices. The target audience includes HF specialists and emergency medicine physicians, as well as general cardiologists and community-based providers.
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Affiliation(s)
- Michael M Givertz
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ersilia M DeFilippis
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Monica Colvin
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Chad E Darling
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Tonya Elliott
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Eman Hamad
- Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Brian C Hiestand
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | | | - Keyur B Shah
- VCU Pauley Heart Center, Richmond, Virginia, USA
| | - Juliane Vierecke
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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24
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Emani S, Burkhoff D, Lilly SM. Interatrial shunt devices for the treatment of heart failure. Trends Cardiovasc Med 2020; 31:427-432. [DOI: 10.1016/j.tcm.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/14/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
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25
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Taleb I, Wever-Pinzon J, Wang W, Koliopoulou A, Dranow E, Yu T, Yin L, McKellar SH, Stehlik J, Fang JC, Wever-Pinzon O, Selzman CH, Drakos SG. Outcomes of Asian-Americans Implanted With Left Ventricular Assist Devices: An Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Analysis. Heart Lung Circ 2020; 29:1226-1233. [DOI: 10.1016/j.hlc.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/20/2019] [Accepted: 11/17/2019] [Indexed: 01/18/2023]
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26
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Waldenburger N, Steinecke M, Peters L, Jünemann F, Bara C, Zimmermann T. Depression, anxiety, fear of progression, and emotional arousal in couples after left ventricular assist device implantation. ESC Heart Fail 2020; 7:3022-3028. [PMID: 32725771 PMCID: PMC7524127 DOI: 10.1002/ehf2.12927] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/12/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022] Open
Abstract
AIMS Left ventricular assist device (LVAD) is a common treatment option for patients with heart failure waiting for a donor heart. Living with an LVAD is associated with many burdens and worries. Patients often depend on the support of their relatives, usually their spouses. This can also put a strain on the spouses and be associated with psychological stress for both. In couples, communication proves to be an important form of emotional support. Besides verbal aspects of communication, the extent of emotional arousal (f0 ) that is vocally encoded plays an essential role as a non-verbal aspect of communication. This study aims to investigate the psychological impact of LVAD on couples in investigating to what extent depression, anxiety, and fear of progression (FoP) differ between patients and partners, the intrapersonal and interpersonal associations of anxiety, depression, and FoP, and differences in emotional arousal. METHODS AND RESULTS In this cross-sectional study, male LVAD patients and their female partners (N = 21 couples) responded to self-report questionnaires on depression, anxiety, and FoP. Emotional arousal (f0 ) was evaluated during social support interactions between both spouses. Female partners experienced more anxiety than male patients (P = 0.016). No differences occurred in depression (P = 0.967) and FoP (P = 0.084). Regarding intrapersonal associations, for patients, correlations appeared between anxiety and depression (r = 0.859, P = 0.000), anxiety and FoP (r = 0.730, P = 0.000), and depression and FoP (r = 0.608, P = 0.004). For caregivers, correlations appeared between anxiety and depression (r = 0.906, P = 0.000), anxiety and FoP (r = 0.665, P = 0.001), and depression and FoP (r = 0.734, P = 0.000). Regarding interpersonal associations, correlations were found between patient's anxiety and caregiver's anxiety (r = 0.461, P = 0.041), caregiver's depression (r = 0.510, P = 0.018), and caregiver's FoP (r = 0.524, P = 0.015). Non-significant correlations were found for caregiver's anxiety and patient's FoP (r = 0.404, P = 0.078) and patient's depression (r = 0.286, P = 0.236). Patient's depression was associated with caregiver's FoP (r = 0.526, P = 0.017), but not with caregiver's depression (r = 0.337, P = 0.146). No significant correlations were found between caregiver's depression and patient's FoP (r = 0.386, P = 0.084) and patient's depression (r = 0.337, P = 0.146). Patient's and caregiver's FoP showed significant associations (r = 0.482, P = 0.027). Patient's and partner's f0 were interrelated. Patient's f0 was positively related with his own and his partner's psychological distress. Partner's f0 showed associations to her own depression and FoP. CONCLUSIONS Findings indicate that women of LVAD patients are burdened similarly or even to a greater extent than men themselves. Women's psychological distress has an impact on patients' psychological distress and vice versa. Early interventions for both patient and partner represent a necessary intervention target.
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Affiliation(s)
- Nina Waldenburger
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Marnie Steinecke
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Luisa Peters
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Finja Jünemann
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany.,Integrated Research and Treatment Center Transplantation IFB-Tx, Hanover Medical School, Hanover, Germany
| | - Christoph Bara
- Department of Heart-, Thoracic-, Transplant- and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany
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27
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Darling CE, Martindale JL, Hiestand BC, Bonnell M, Colvin M, DeFilippis EM, Elliott T, Hamad E, Pinney SP, Shah KB, Vierecke J, Givertz MM. An Emergency Medicine-focused Summary of the HFSA/SAEM/ISHLT Clinical Consensus Document on the Emergency Management of Patients With Ventricular Assist Devices. Acad Emerg Med 2020; 27:618-629. [PMID: 32176420 DOI: 10.1111/acem.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/24/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
Mechanical circulatory support is increasingly used as a long-term treatment option for patients with end-stage heart failure. Patients with implanted ventricular assist devices are at high risk for a range of diverse medical urgencies and emergencies. Given the increasing prevalence of mechanical circulatory support devices, this expert clinical consensus document seeks to help inform emergency medicine and prehospital providers regarding the approach to acute medical and surgical conditions encountered in these complex patients.
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Affiliation(s)
- Chad E. Darling
- UMass Memorial Medical Center UMass Medical School Worcester MA
| | | | | | | | | | | | | | - Eman Hamad
- Temple University Hospital Philadelphia PA
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28
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Melvinsdottir I, Foley DP, Hess T, Gunnarsson SI, Kohmoto T, Hermsen J, Johnson MR, Murray D, Dhingra R. Heart and kidney transplant: should they be combined or subsequent? ESC Heart Fail 2020; 7:2734-2743. [PMID: 32608197 PMCID: PMC7524231 DOI: 10.1002/ehf2.12864] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/25/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023] Open
Abstract
AIMS End-stage heart failure patients often present with severe kidney failure and have limited treatment options. We compared the clinical characteristics and outcomes among end-stage heart and kidney failure patients who underwent combined heart and kidney transplant (HKTx) with those who underwent kidney transplant after heart transplant (KAH). METHODS AND RESULTS All patients from 2007-2016 who underwent combined HKTx (n = 715) and those who underwent KAH (n = 130) using the United Network for Organ Sharing database were included. Kaplan-Meier curves and Cox models compared survivals and identified predictors of death. Number of combined HKTx performed annually in United States increased from 59 in 2007 to 146 in 2016 whereas KAH decreased from 34 in 2007 to 6 in 2016. Among KAH patients, average wait time for kidney transplant was 3.0 years, time to dialysis or to kidney transplant after heart transplant did not differ with varying severity of kidney disease at baseline (P for both >0.05). Upon follow-up (mean 3.5 ± 2.7 years), 151 patients died. In multivariable models, patients who underwent combined HKTx had 4.7-fold greater risk of death [95% confidence interval (CI) 2.4-9.4) than KAH patients upon follow up. A secondary analysis using calculation of survival only after kidney transplant for KAH patients still conferred higher risk for combined HKTx patients [hazard ratio (HR) 2.6 95% CI 1.33-5.15]. In subgroup analyses after excluding patients on dialysis (HR 3.99 95% CI 1.98-8.04) and analysis after propensity matching for age, gender, and glomerular filtration rate (HR 3.01 95% CI 1.40-6.43) showed similar and significantly higher risk for combined HKTx patients compared with KAH patients. Lastly, these results also remained unchanged after excluding transplant centres who performed only one type of procedure preferentially, i.e. HKTx or KAH (HR 4.70 95% CI 2.35-9.42). CONCLUSIONS National registry data show continual increase in combined HKTx performed annually in the United States but inferior survival compared with KAH patients. Differences in patient characteristics or level of kidney dysfunction at baseline do not explain these poor outcomes among HKTx patients compared with KAH patients. Consensus guidelines are greatly needed to identify patients who may benefit more from dual organ transplants.
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Affiliation(s)
- Inga Melvinsdottir
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - David P Foley
- Division of Transplantation, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Timothy Hess
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Sverrir I Gunnarsson
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Takushi Kohmoto
- Division of Cardiac Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Cardiac Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Joshua Hermsen
- Division of Cardiac Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Maryl R Johnson
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - David Murray
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Ravi Dhingra
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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29
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Ruiz‐Cano MJ, Morshuis M, Koster A, Lauenroth V, Prashovikj E, Gummert J, Paluszkiewicz L. Risk factors of early right ventricular failure in patients undergoing LVAD implantation with intermediate Intermacs profile for advanced heart failure. J Card Surg 2020; 35:1832-1839. [DOI: 10.1111/jocs.14696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maria J. Ruiz‐Cano
- Thorax and Cardiovascular Surgery, Heart and Diabetes Center Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Michiel Morshuis
- Thorax and Cardiovascular Surgery, Heart and Diabetes Center Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Andreas Koster
- Thorax and Cardiovascular Surgery, Heart and Diabetes Center Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Volker Lauenroth
- Thorax and Cardiovascular Surgery, Heart and Diabetes Center Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Emir Prashovikj
- Thorax and Cardiovascular Surgery, Heart and Diabetes Center Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Jan Gummert
- Thorax and Cardiovascular Surgery, Heart and Diabetes Center Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Lech Paluszkiewicz
- Thorax and Cardiovascular Surgery, Heart and Diabetes Center Ruhr‐University Bochum Bad Oeynhausen Germany
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30
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Li S, Zimpfer D, Mahr C. Commentary: Transcending acceptable, moving toward optimal: Standardizing surgical configurations of ventricular assist device therapy. J Thorac Cardiovasc Surg 2020; 162:1566-1567. [PMID: 32534746 DOI: 10.1016/j.jtcvs.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Song Li
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Wash
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Claudius Mahr
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Wash.
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31
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Mangi MA, Nesheiwat Z, Kahloon R, Moukarbel GV. CardioMEMS TM System in the Daily Management of Heart Failure: Review of Current Data and Technique of Implantation. Expert Rev Med Devices 2020; 17:637-648. [PMID: 32500762 DOI: 10.1080/17434440.2020.1779588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Heart failure (HF) leads to significant morbidity and mortality and imposes a large economic burden. Although there have been several advances in HF monitoring and management, HF-rehospitalization remains a significant problem. Remote monitoring of HF to detect early signs of decompensation has emerged in past years as an option to prevent or reduce the incidence of HF rehospitalization. The CardioMEMSTM HF system is a wireless pulmonary artery (PA) pressure monitoring system that detects changes in PA pressure and transmits data to the healthcare provider. Since changes in PA pressure happen early in the course of HF decompensation, the CardioMEMSTM system allows the provider to institute timely intensification of HF therapies to alter the course. In trial and registry data, the use of the CardioMEMSTM HF system has been associated with reduction in HF hospitalization, improvement in quality of life, symptoms, and physical activity. AREAS COVERED This review will focus on the available data supporting its utilization in patients with HF. EXPERT OPINION CardioMEMSTM is relatively safe and cost-effective, reduces heart failure hospitalization rates, and fits into intermediate to high-value medical care.
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Affiliation(s)
- Muhammad Asif Mangi
- Department of Medicine, University of Toledo College of Medicine and Life Sciences , Toledo, Ohio, USA
| | - Zeid Nesheiwat
- Department of Medicine, University of Toledo College of Medicine and Life Sciences , Toledo, Ohio, USA
| | - Rehan Kahloon
- Department of Medicine, University of Tennessee College of Medicine Chattanooga , Chattanooga, Tennessee, USA
| | - George V Moukarbel
- Department of Medicine, University of Toledo College of Medicine and Life Sciences , Toledo, Ohio, USA
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32
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Magoon R, Jose J, Kohli JK, Kashav R. Altered RV Mechanics Post-LVAD Insertion: a Physiological Perspective! Braz J Cardiovasc Surg 2020; 35:407-408. [PMID: 32549114 PMCID: PMC7299600 DOI: 10.21470/1678-9741-2020-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rohan Magoon
- Atal Bihari Vajpayee Institute of Medical Sciences Department of Cardiac Anaesthesia New Delhi India Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India. E-mail:
| | - Jes Jose
- Atal Bihari Vajpayee Institute of Medical Sciences Department of Anaesthesia New Delhi India Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Jasvinder Kaur Kohli
- Atal Bihari Vajpayee Institute of Medical Sciences Department of Cardiac Anaesthesia New Delhi India Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India. E-mail:
| | - Ramesh Kashav
- Atal Bihari Vajpayee Institute of Medical Sciences Department of Cardiac Anaesthesia New Delhi India Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India. E-mail:
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33
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Avant LC, Kezar CE, Swetz KM. Advances in Cardiopulmonary Life-Support Change the Meaning of What It Means to be Resuscitated. Palliat Med Rep 2020; 1:67-71. [PMID: 34223459 PMCID: PMC8241316 DOI: 10.1089/pmr.2020.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 01/10/2023] Open
Abstract
As options for advanced cardiopulmonary support proliferate, the use of mechanical circulatory support, such as left ventricular assist device as destination therapy (LVAD-DT), is becoming increasingly commonplace. In the current case, a patient was hospitalized for complications related to his LVAD-DT requests "full code" status, despite a clinician's warning that performing chest compressions may damage the LVAD device or vascular structures leading to poor outcome. This discussion explores the ethical and legal considerations regarding a patient request for cardiopulmonary resuscitation when limited options for survival or further treatment are available.
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Affiliation(s)
- Leslie C. Avant
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Carolyn E. Kezar
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Keith M. Swetz
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
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34
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A New Paradigm in Mechanical Circulatory Support: 100-Patient Experience. Ann Thorac Surg 2020; 109:1370-1377. [DOI: 10.1016/j.athoracsur.2019.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/18/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022]
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35
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Risk Assessment in Patients with a Left Ventricular Assist Device Across INTERMACS Profiles Using Bayesian Analysis. ASAIO J 2020; 65:436-441. [PMID: 30688695 DOI: 10.1097/mat.0000000000000910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Current risk stratification models to predict outcomes after a left ventricular assist device (LVAD) are limited in scope. We assessed the performance of Bayesian models to stratify post-LVAD mortality across various International Registry for Mechanically Assisted Circulatory Support (INTERMACS or IM) Profiles, device types, and implant strategies. We performed a retrospective analysis of 10,206 LVAD patients recorded in the IM registry from 2012 to 2016. Using derived Bayesian algorithms from 8,222 patients (derivation cohort), we applied the risk-prediction algorithms to the remaining 2,055 patients (validation cohort). Risk of mortality was assessed at 1, 3, and 12 months post implant according to disease severity (IM profiles), device type (axial versus centrifugal) and strategy (bridge to transplantation or destination therapy). Fifteen percentage (n = 308) were categorized as IM profile 1, 36% (n = 752) as profile 2, 33% (n = 672) as profile 3, and 15% (n = 311) as profile 4-7 in the validation cohort. The Bayesian algorithms showed good discrimination for both short-term (1 and 3 months) and long-term (1 year) mortality for patients with severe HF (Profiles 1-3), with the receiver operating characteristic area under the curve (AUC) between 0.63 and 0.74. The algorithms performed reasonably well in both axial and centrifugal devices (AUC, 0.68-0.74), as well as bridge to transplantation or destination therapy indication (AUC, 0.66-0.73). The performance of the Bayesian models at 1 year was superior to the existing risk models. Bayesian algorithms allow for risk stratification after LVAD implantation across different IM profiles, device types, and implant strategies.
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36
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Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices. ASAIO J 2020; 66:373-380. [DOI: 10.1097/mat.0000000000001009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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37
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Miller L, Birks E, Guglin M, Lamba H, Frazier OH. Use of Ventricular Assist Devices and Heart Transplantation for Advanced Heart Failure. Circ Res 2020; 124:1658-1678. [PMID: 31120817 DOI: 10.1161/circresaha.119.313574] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There are only 2 treatments for the thousands of patients who progress to the most advanced form of heart failure despite the application of guideline-based medical therapy, use of ventricular assist devices and heart transplantation. There has been a great deal of progress in both of these therapies that have led to improved outcomes including significant improvement in survival and functional capacity. Heart transplantation offers the best short- and long-term survival for patients with end-stage heart failure, and the majority of these recipients achieve relatively limitless functional capacity for their age. However, the chronic shortage of available donors limits the number of recipients in the United States to an only 2500 patients/y or only a fraction of potential candidates. The significant improvement in outcomes now possible with durable ventricular assist devices has led to a significant increase in their use, which now exceeds the volume of heart transplants in the United States, with the greatest growth in use for those not considered to be candidates for heart transplantation, previously referred to as destination therapy. This article will review the substantial progress that has taken place for both of these life-saving treatment options, as well as the future directions.
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Affiliation(s)
- Leslie Miller
- From the Division of Cardiovascular Medicine, Texas Heart Institute, Houston (L.M., H.L., O.H.F.)
| | - Emma Birks
- Division of Cardiology, University of Louisville, KY (E.B.)
| | - Maya Guglin
- Division of Cardiology, University of Kentucky, Lexington (M.G.)
| | - Harveen Lamba
- From the Division of Cardiovascular Medicine, Texas Heart Institute, Houston (L.M., H.L., O.H.F.)
| | - O H Frazier
- From the Division of Cardiovascular Medicine, Texas Heart Institute, Houston (L.M., H.L., O.H.F.)
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38
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Guglin M, Zucker MJ, Borlaug BA, Breen E, Cleveland J, Johnson MR, Panjrath GS, Patel JK, Starling RC, Bozkurt B. Evaluation for Heart Transplantation and LVAD Implantation. J Am Coll Cardiol 2020; 75:1471-1487. [DOI: 10.1016/j.jacc.2020.01.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
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39
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Rapid Development of Bleeding Esophageal Varices after Placement of Continuous Flow Left Ventricular Assist Device. Case Reports Hepatol 2019; 2019:8410420. [PMID: 31781429 PMCID: PMC6875215 DOI: 10.1155/2019/8410420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022] Open
Abstract
We describe a patient with compensated cirrhosis and portal hypertension who underwent continuous flow LVAD implantation. Shortly after LVAD implantation, the patient developed new onset bleeding esophageal varices and ultimately had a fatal outcome. Our experience suggests that even well-compensated cirrhotic patients with significant portal hypertension are at risk of variceal bleeding after LVAD placement.
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40
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Quader M, Goodreau AM, Johnson RM, Wolfe LG, Feldman GM. Impact of renal function recovery utilizing left ventricular assist device support. J Card Surg 2019; 35:100-107. [DOI: 10.1111/jocs.14320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Mohammed Quader
- Department of Surgery, Division of Cardio‐thoracic Surgery Virginia Commonwealth University Richmond Virginia
| | - Adam M. Goodreau
- Department of Surgery, Division of Cardio‐thoracic Surgery Virginia Commonwealth University Richmond Virginia
| | - Ryan M. Johnson
- Department of Surgery, Division of Cardio‐thoracic Surgery Virginia Commonwealth University Richmond Virginia
| | - Luke G. Wolfe
- Department of Surgery, Division of Cardio‐thoracic Surgery Virginia Commonwealth University Richmond Virginia
| | - George M. Feldman
- Department of Medicine, Division of Nephrology Virginia Commonwealth University Richmond Virginia
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41
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Miller PE, Caraballo C, Ravindra NG, Mezzacappa C, McCullough M, Gruen J, Levin A, Reinhardt S, Ali A, Desai NR, Ahmad T. Clinical Implications of Respiratory Failure in Patients Receiving Durable Left Ventricular Assist Devices for End-Stage Heart Failure. Circ Heart Fail 2019; 12:e006369. [DOI: 10.1161/circheartfailure.119.006369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:
The impact of respiratory failure on patients undergoing left ventricular assist device (LVAD) implantation is not well understood, especially since these patients were excluded from landmark clinical trials. We sought to evaluate the associations between immediate preimplant and postimplant respiratory failure on outcomes in advanced heart failure patients undergoing LVAD implantation.
Methods and Results:
We included all patients in the Interagency Registry for Mechanically Assisted Circulatory Support who were implanted with continuous-flow LVADs from 2008 to 2016. Of the 16 362 patients who underwent continuous-flow LVAD placement, 906 (5.5%) required preimplant intubation within 48 hours before implantation, and 1001 (6.1%) patients developed respiratory failure within 1 week after implantation. A higher proportion of patients requiring preimplant intubation were Interagency Registry for Mechanically Assisted Circulatory Support profile 1, required mechanical circulatory support, and presented with cardiac arrest or myocardial infarction (
P
<0.001, all). At 1 year, 54.3% of patients intubated preimplant were alive without transplant, 20.1% had been transplanted, and 24.2% died before transplant. Patients requiring preimplant intubation had higher rates of postimplant complications, including bleeding, stroke, and right ventricular assist device implantation (
P
<0.01 for all). Among Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients, preimplant intubation incurred additional risk of death at 1 year compared with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients not intubated (hazard ratio, 1.37 [95% CI, 1.13–1.65];
P
=0.001). After multivariable analysis, both preimplant intubation (hazard ratio, 1.20 [95% CI, 1.03–1.41];
P
=0.021) and respiratory failure within 1 week (hazard ratio, 2.54 [95% CI, 2.26–2.85];
P
<0.001) were associated with higher all-cause 1-year mortality.
Conclusions:
Respiratory failure both before and after LVAD implantation identifies an advanced heart failure population with significantly worse 1-year mortality. This data might be helpful in counseling patients and their families about expectations about life with an LVAD.
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Affiliation(s)
- P. Elliott Miller
- Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
- Yale National Clinician Scholars Program (P.E.M.), Yale University School of Medicine, New Haven, CT
| | - Cesar Caraballo
- Center for Outcomes Research & Evaluation (CORE) (C.C., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
| | - Neal G. Ravindra
- Department of Molecular Biophysics and Biochemistry (N.G.R.), Yale University School of Medicine, New Haven, CT
- Integrated Graduate Program in Physical and Engineering Biology (N.G.R.), Yale University School of Medicine, New Haven, CT
| | - Catherine Mezzacappa
- Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT
| | - Megan McCullough
- Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT
| | - Jadry Gruen
- Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT
| | - Andrew Levin
- Department of Internal Medicine (C.M., M.M., J.G., A.L.), Yale University School of Medicine, New Haven, CT
| | - Samuel Reinhardt
- Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
| | - Ayyaz Ali
- Section of Cardiovascular Surgery (A.A.), Yale University School of Medicine, New Haven, CT
| | - Nihar R. Desai
- Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
- Center for Outcomes Research & Evaluation (CORE) (C.C., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
| | - Tariq Ahmad
- Section of Cardiovascular Medicine (P.E.M., S.R., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
- Center for Outcomes Research & Evaluation (CORE) (C.C., N.R.D., T.A.), Yale University School of Medicine, New Haven, CT
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Calculation of the ALMA Risk of Right Ventricular Failure After Left Ventricular Assist Device Implantation. ASAIO J 2019; 64:e140-e147. [PMID: 29746312 DOI: 10.1097/mat.0000000000000800] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Right ventricular failure after continuous-flow left ventricular assist device (LVAD) implantation is still an unsolved issue and remains a life-threatening event for patients. We undertook this study to determine predictors of the patients who are candidates for isolated LVAD therapy as opposed to biventricular support (BVAD). We reviewed demographic, echocardiographic, hemodynamic, and laboratory variables for 258 patients who underwent both isolated LVAD implantation and unplanned BVAD because of early right ventricular failure after LVAD insertion, between 2006 and 2017 (LVAD = 170 and BVAD = 88). The final study patients were randomly divided into derivation (79.8%, n = 206) and validation (20.1%, n = 52) cohorts. Fifty-seven preoperative risk factors were compared between patients who were successfully managed with an LVAD and those who required a BVAD. Nineteen variables demonstrated statistical significance on univariable analysis. Multivariable logistic regression analysis identified destination therapy (odds ratio [OR] 2.0 [1.7-3.9], p = 0.003), a pulmonary artery pulsatility index <2 (OR 3.3 [1.7-6.1], p = 0.001), a right ventricle/left ventricle end-diastolic diameter ratio >0.75 (OR 2.7 [1.5-5.5], p = 0.001), an right ventricle stroke work index <300 mm Hg/ml/m (OR 4.3 [2.5-7.3], p < 0.001), and a United Network for Organ Sharing modified Model for End-Stage Liver Disease Excluding INR score >17 (OR 3.5 [1.9-6.9], p < 0.001) as the major predictors of the need for BVAD. Using these data, we propose a simple risk calculator to determine the suitability of patients for isolated LVAD support in the era of continuous-flow mechanical circulatory support devices.
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Left Ventricular Assist Device Inflow Cannula Insertion Depth Influences Thrombosis Risk. ASAIO J 2019; 66:766-773. [DOI: 10.1097/mat.0000000000001068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Impact of Diabetes Mellitus on Survival in Patients Bridged to Transplantation with Left Ventricular Assist Devices in the United States. ASAIO J 2019; 65:587-592. [DOI: 10.1097/mat.0000000000000896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lindvall C, Udelsman B, Malhotra D, Brovman EY, Urman RD, D'Alessandro DA, Tulsky JA. In-hospital mortality in older patients after ventricular assist device implantation: A national cohort study. J Thorac Cardiovasc Surg 2019; 158:466-475.e4. [DOI: 10.1016/j.jtcvs.2018.10.142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/10/2018] [Accepted: 10/17/2018] [Indexed: 01/24/2023]
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46
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Berg DD, Vaduganathan M, Upadhyay GA, Singh JP, Mehra MR, Stewart GC. Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Systems. J Am Coll Cardiol 2019; 71:1483-1493. [PMID: 29598870 DOI: 10.1016/j.jacc.2018.01.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 01/11/2023]
Abstract
Recent progress and evolution in device engineering, surgical implantation practices, and periprocedural management have advanced the promise of durable support with left ventricular assist systems (LVAS) in patients with stage D heart failure. With greater uptake of LVAS globally, a growing population of LVAS recipients have pre-existing cardiac implantable electronic devices (CIEDs). Strategies for optimal clinical management of CIEDs in patients with durable LVAS are evolving, and clinicians will increasingly face complex decisions regarding implantation, programming, deactivation, and removal of CIEDs. Traditional decision-making pathways for CIEDs may not apply to LVAS-supported patients, as few patients die of arrhythmic causes and many arrhythmias may be well tolerated. Given limited data, treatment decisions must be individualized and made collaboratively among electrophysiologists, advanced heart failure specialists, and patients and their caregivers. Large, prospective, well-conducted studies are needed to better understand the contemporary utility of CIEDs in patients with newer-generation LVAS.
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Affiliation(s)
- David D Berg
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Gaurav A Upadhyay
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mandeep R Mehra
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Garrick C Stewart
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
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47
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Givertz MM, DeFilippis EM, Colvin M, Darling CE, Elliott T, Hamad E, Hiestand BC, Martindale JL, Pinney SP, Shah KB, Vierecke J, Bonnell M. HFSA/SAEM/ISHLT Clinical Expert Consensus Document on the Emergency Management of Patients with Ventricular Assist Devices. J Card Fail 2019; 25:494-515. [DOI: 10.1016/j.cardfail.2019.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
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48
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Eisen HJ. Left Ventricular Assist Devices (LVADS): History, Clinical Application and Complications. Korean Circ J 2019; 49:568-585. [PMID: 31243930 PMCID: PMC6597447 DOI: 10.4070/kcj.2019.0161] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities which may limit survival post-transplant. For these patients, left ventricular assist devices (LVADs) offer an alternative that can improve survival as well as exercise tolerance and quality of life. These devices have continued to improve as technology has improved with substantially improved durability of the devices and fewer post-implant complications. Pump thrombosis, stroke, gastrointestinal bleeding and arrhythmias post-implant have become less common with the newest devices, making destination therapy where ventricular assist device are implanted permanently in patients with advanced heart failure, a reality and an appropriate option for many patients. This may offer an opportunity for long term survival in many patients. As the first of the totally implantable devices are introduced and go to clinical trials, LVADs may be introduced that may truly be alternatives to cardiac transplantation in selected patients. Post-implant right ventricular failure remains a significant complication and better ways to identify patients at risk as well as to manage this complication must be developed.
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Affiliation(s)
- Howard J Eisen
- Heart and Vascular Institute, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA.
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Abstract
Heart failure is a progressive condition that continues to increase in both incidence and prevalence despite pharmacologic treatment. The high rate of morbidity and mortality associated with advanced heart failure has led to exploration of additional treatments, which include surgical interventions to improve outcomes. Heart transplant remains the gold standard but, because of the persistent donor shortage and increasing number of patients with advanced heart failure, mechanical circulatory support is gaining acceptance and can be used as a bridge to heart transplant for those eligible or as destination therapy.
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Affiliation(s)
- Candice Falls
- Internal Medicine-Cardiology, University of Kentucky, 1000 South Limestone Pavilion A 08.176, Lexington, KY, USA.
| | - Andrew R Kolodziej
- Gill Heart Institute, University of Kentucky, 900 South Limestone, CTW 320, Lexington, KY 40536, USA
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50
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Kiernan MS, Katz JN. Operating in the Dark: When Is Surgery Necessary for Left Ventricular Assist Device Hemolysis? Circ Heart Fail 2019; 9:CIRCHEARTFAILURE.116.003141. [PMID: 27166249 DOI: 10.1161/circheartfailure.116.003141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael S Kiernan
- From the Division of Cardiology, Tufts Cardiovascular Center, Boston, MA (M.S.K.); and Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.).
| | - Jason N Katz
- From the Division of Cardiology, Tufts Cardiovascular Center, Boston, MA (M.S.K.); and Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.)
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