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Nativi-Nicolau J, Yilmaz A, Dasgupta N, Macey R, Cochrane J, Peatman J, Summers C, Luth J, Zolty R. Six-minute walk test as clinical end point in cardiomyopathy clinical trials, including ATTR-CM: a systematic literature review. J Comp Eff Res 2024; 13:e230158. [PMID: 38869839 PMCID: PMC11234454 DOI: 10.57264/cer-2023-0158] [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] [Indexed: 06/14/2024] Open
Abstract
Aim: The six-minute walk test (6MWT) is a common measure of functional capacity in patients with heart failure (HF). Primary clinical study end points in cardiomyopathy (CM) trials, including transthyretin-mediated amyloidosis with CM (ATTR-CM), are often limited to hospitalization and mortality. Objective: To investigate the relationship between the 6MWT and hospitalization or mortality in CM, including ATTR-CM. Method: A PRISMA-guided systematic literature review was conducted using search terms for CM, 6MWT, hospitalization and mortality. Results: Forty-one studies were identified that reported 6MWT data and hospitalization or mortality data for patients with CM. The data suggest that a greater 6MWT distance is associated with a reduced risk of hospitalization or mortality in CM. Conclusion: The 6MWT is an accepted alternative end point in CM trials, including ATTR-CM.
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Affiliation(s)
| | - Ali Yilmaz
- Division of Cardiovascular Imaging, University Hospital Münster, 48149, Münster, Germany
| | - Noel Dasgupta
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Richard Macey
- Adelphi Values PROVETM, Bollington, Cheshire, UK, SK10 5JB
| | - James Cochrane
- Adelphi Values PROVETM, Bollington, Cheshire, UK, SK10 5JB
| | - Judith Peatman
- Adelphi Values PROVETM, Bollington, Cheshire, UK, SK10 5JB
| | - Catherine Summers
- Medical Affairs Department, Alnylam Pharmaceuticals, Cambridge, MA 02142, USA
| | - Jennifer Luth
- Medical Affairs Department, Alnylam Pharmaceuticals, Cambridge, MA 02142, USA
| | - Ronald Zolty
- Division of Cardiovascular Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE 68198 USA
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2
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Arduini M, Pham J, Marsden AL, Chen IY, Ennis DB, Dual SA. Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support. Front Cardiovasc Med 2022; 9:895291. [PMID: 35979018 PMCID: PMC9376255 DOI: 10.3389/fcvm.2022.895291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Despite being responsible for half of heart failure-related hospitalizations, heart failure with preserved ejection fraction (HFpEF) has limited evidence-based treatment options. Currently, a substantial clinical issue is that the disease etiology is very heterogenous with no patient-specific treatment options. Modeling can provide a framework for evaluating alternative treatment strategies. Counterpulsation strategies have the capacity to improve left ventricular diastolic filling by reducing systolic blood pressure and augmenting the diastolic pressure that drives coronary perfusion. Here, we propose a framework for testing the effectiveness of a soft robotic extra-aortic counterpulsation strategy using a patient-specific closed-loop hemodynamic lumped parameter model of a patient with HFpEF. The soft robotic device prototype was characterized experimentally in a physiologically pressurized (50–150 mmHg) soft silicone vessel and modeled as a combination of a pressure source and a capacitance. The patient-specific model was created using open-source software and validated against hemodynamics obtained by imaging of a patient (male, 87 years, HR = 60 bpm) with HFpEF. The impact of actuation timing on the flows and pressures as well as systolic function was analyzed. Good agreement between the patient-specific model and patient data was achieved with relative errors below 5% in all categories except for the diastolic aortic root pressure and the end systolic volume. The most effective reduction in systolic pressure compared to baseline (147 vs. 141 mmHg) was achieved when actuating 350 ms before systole. In this case, flow splits were preserved, and cardiac output was increased (5.17 vs. 5.34 L/min), resulting in increased blood flow to the coronaries (0.15 vs. 0.16 L/min). Both arterial elastance (0.77 vs. 0.74 mmHg/mL) and stroke work (11.8 vs. 10.6 kJ) were decreased compared to baseline, however left atrial pressure increased (11.2 vs. 11.5 mmHg). A higher actuation pressure is associated with higher systolic pressure reduction and slightly higher coronary flow. The soft robotic device prototype achieves reduced systolic pressure, reduced stroke work, slightly increased coronary perfusion, but increased left atrial pressures in HFpEF patients. In future work, the framework could include additional physiological mechanisms, a larger patient cohort with HFpEF, and testing against clinically used devices.
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Affiliation(s)
- Mattia Arduini
- Department of Radiology, Stanford University, Palo Alto, CA, United States
| | - Jonathan Pham
- Mechanical Engineering, Stanford University, Palo Alto, CA, United States
| | - Alison L. Marsden
- Department of Bioengineering, Stanford University, Palo Alto, CA, United States
- Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Ian Y. Chen
- Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
- Division of Medicine (Cardiology), Veterans Affairs Health Care System, Palo Alto, CA, United States
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Palo Alto, CA, United States
- Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
- Division of Radiology, Veterans Affairs Health Care System, Palo Alto, CA, United States
| | - Seraina A. Dual
- Department of Radiology, Stanford University, Palo Alto, CA, United States
- Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
- *Correspondence: Seraina A. Dual
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3
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Kapur NK, Esposito ML, Whitehead E. Aortix™: a novel intra-aortic entrainment pump. Future Cardiol 2020; 17:283-291. [PMID: 33353421 DOI: 10.2217/fca-2020-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Use of short-term mechanical circulatory support pumps for cardiogenic shock, decompensated heart failure and high-risk coronary intervention is growing. The Aortix™ device (Procyrion, TX, USA) is the first axial-flow pump positioned in the aorta and is designed to provide short-term hemodynamic support. This review discusses the field of continuous flow aortic pumps and focuses specifically on emerging preclinical and clinical data supporting the development of these technologies.
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Affiliation(s)
- Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Michele L Esposito
- The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Evan Whitehead
- The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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4
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Attaran SH, Niroomand-Oscuii H, Ghalichi F. Local hemodynamic analysis of the C-Pulse Device by 3D fluid-structure interaction simulation. Future Cardiol 2020; 16:297-308. [PMID: 32228240 DOI: 10.2217/fca-2019-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: C-Pulse is a new, nonblood contacting device based on the concept of counter-pulsation that is designed for long-term implantation. However, there is a lack of comprehensive investigation of the pressure and velocity fields under the action of C-Pulse. Aim: In this paper, we aim to conduct a numerical simulation of the underlying mechanism of the device in order to analyze its performance and related undesirable issues. Materials & methods: A 3D finite element model is utilized to simulate the mechanism of the blood pumping. Results & conclusion: The simulation well reproduced the essential characteristics of the C-Pulse. Preliminary results were in a reasonable range while a couple of irregular flow patterns were identified.
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Affiliation(s)
| | | | - Farzan Ghalichi
- Department of Biomedical Engineering, Sahand University of Technology, Tabriz, Iran
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5
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Wu T, Khir AW, Kütting M, Du X, Lin H, Zhu Y, Hsu PL. A review of implantable pulsatile blood pumps: Engineering perspectives. Int J Artif Organs 2020; 43:559-569. [PMID: 32037940 DOI: 10.1177/0391398820902470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It has been reported that long-term use of continuous-flow mechanical circulatory support devices (CF-MCSDs) may induce complications associated with diminished pulsatility. Pulsatile-flow mechanical circulatory support devices (PF-MCSDs) have the potential of overcoming these shortcomings with the advance of technology. In order to promote in-depth understanding of PF-MCSD technology and thus encourage future mechanical circulatory support device innovations, engineering perspectives of PF-MCSD systems, including mechanical designs, drive mechanisms, working principles, and implantation strategies, are reviewed in this article. Some emerging designs of PF-MCSDs are introduced, and possible elements for next-generation PF-MCSDs are identified.
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Affiliation(s)
- Tingting Wu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Ashraf W Khir
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK
| | | | - Xinli Du
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK
| | - Hao Lin
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Yuxin Zhu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Po-Lin Hsu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
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6
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Salutary Effects of the PULVAD, a Novel Implantable Counterpulsation Assist Device, on Cardiac Mechanoenergetics. ASAIO J 2019; 65:473-480. [DOI: 10.1097/mat.0000000000000838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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7
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Bourke JP, Bueser T, Quinlivan R. Interventions for preventing and treating cardiac complications in Duchenne and Becker muscular dystrophy and X-linked dilated cardiomyopathy. Cochrane Database Syst Rev 2018; 10:CD009068. [PMID: 30326162 PMCID: PMC6517009 DOI: 10.1002/14651858.cd009068.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The dystrophinopathies include Duchenne muscular dystrophy (DMD), Becker muscular dystrophy (BMD), and X-linked dilated cardiomyopathy (XLDCM). In recent years, co-ordinated multidisciplinary management for these diseases has improved the quality of care, with early corticosteroid use prolonging independent ambulation, and the routine use of non-invasive ventilation signficantly increasing survival. The next target to improve outcomes is optimising treatments to delay the onset or slow the progression of cardiac involvement and so prolong survival further. OBJECTIVES To assess the effects of interventions for preventing or treating cardiac involvement in DMD, BMD, and XLDCM, using measures of change in cardiac function over six months. SEARCH METHODS On 16 October 2017 we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE and Embase, and on 12 December 2017, we searched two clinical trials registries. We also searched conference proceedings and bibliographies. SELECTION CRITERIA We considered only randomised controlled trials (RCTs), quasi-RCTs and randomised cross-over trials for inclusion. In the Discussion, we reviewed open studies, longitudinal observational studies and individual case reports but only discussed studies that adequately described the diagnosis, intervention, pretreatment, and post-treatment states and in which follow-up lasted for at least six months. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the titles and abstracts identified from the search and performed data extraction. All three authors assessed risk of bias independently, compared results, and decided which trials met the inclusion criteria. They assessed the certainty of evidence using GRADE criteria. MAIN RESULTS We included five studies (N = 205) in the review; four studies included participants with DMD only, and one study included participants with DMD or BMD. All studied different interventions, and meta-analysis was not possible. We found no studies for XLDCM. None of the trials reported cardiac function as improved or stable cardiac versus deteriorated.The randomised first part of a two-part study of perindopril (N = 28) versus placebo (N = 27) in boys with DMD with normal heart function at baseline showed no difference in the number of participants with a left ventricular ejection fraction (LVEF%) of less than 45% after three years of therapy (n = 1 in each group; risk ratio (RR) 1.04, 95% confidence interval (CI) 0.07 to 15.77). This result is uncertain because of study limitations, indirectness and imprecision. In a non-randomised follow-up study, after 10 years, more participants who had received placebo from the beginning had reduced LVEF% (less than 45%). Adverse event rates were similar between the placebo and treatment groups (low-certainty evidence).A study comparing treatment with lisinopril versus losartan in 23 boys newly diagnosed with Duchenne cardiomyopathy showed that after 12 months, both were equally effective in preserving or improving LVEF% (lisinopril 54.6% (standard deviation (SD) 5.19), losartan 55.2% (SD 7.19); mean difference (MD) -0.60% CI -6.67 to 5.47: N = 16). The certainty of evidence was very low because of very serious imprecision and study limitations (risk of bias). Two participants in the losartan group were withdrawn due to adverse events: one participant developed an allergic reaction, and a second exceeded the safety standard with a fall in ejection fraction greater than 10%. Authors reported no other adverse events related to the medication (N = 22; very low-certainty evidence).A study comparing idebenone versus placebo in 21 boys with DMD showed little or no difference in mean change in cardiac function between the two groups from baseline to 12 months; for fractional shortening the mean change was 1.4% (SD 4.1) in the idebenone group and 1.6% (SD 2.6) in the placebo group (MD -0.20%, 95% CI -3.07 to 2.67, N = 21), and for ejection fraction the mean change was -1.9% (SD 9.8) in the idebenone group and 0.4% (SD 5.5) in the placebo group (MD -2.30%, 95% CI -9.18 to 4.58, N = 21). The certainty of evidence was very low because of study limitations and very serious imprecision. Reported adverse events were similar between the treatment and placebo groups (low-certainty evidence).A multicentre controlled study added eplerenone or placebo to 42 patients with DMD with early cardiomyopathy but preserved left ventricular function already established on ACEI or ARB therapy. Results showed that eplerenone slowed the rate of decline of magnetic resonance (MR)-assessed left ventricular circumferential strain at 12 months (eplerenone group median 1.0%, interquartile range (IQR) 0.3 to -2.2; placebo group median 2.2%, IQR 1.3 to -3.1%; P = 0.020). The median decline in LVEF over the same period was also less in the eplerenone group (-1.8%, IQR -2.9 to 6.0) than in the placebo group (-3.7%, IQR -10.8 to 1.0; P = 0.032). We downgraded the certainty of evidence to very low for study limitations and serious imprecision. Serious adverse events were reported in two patients given placebo but none in the treatment group (very low-certainty evidence).A randomised placebo-controlled study of subcutaneous growth hormone in 16 participants with DMD or BMD showed an increase in left ventricular mass after three months' treatment but no significant improvement in cardiac function. The evidence was of very low certainty due to imprecision, indirectness, and study limitations. There were no clinically significant adverse events (very low-certainty evidence).Some studies were at risk of bias, and all were small. Therefore, although there is some evidence from non-randomised data to support the prophylactic use of perindopril for cardioprotection ahead of detectable cardiomyopathy, and for lisinopril or losartan plus eplerenone once cardiomyopathy is detectable, this must be considered of very low certainty. Findings from non-randomised studies, some of which have been long term, have led to the use of these drugs in daily clinical practice. AUTHORS' CONCLUSIONS Based on the available evidence from RCTs, early treatment with ACE inhibitors or ARBs may be comparably beneficial for people with a dystrophinopathy; however, the certainty of evidence is very low. Very low-certainty evidence indicates that adding eplerenone might give additional benefit when early cardiomyopathy is detected. No clinically meaningful effect was seen for growth hormone or idebenone, although the certainty of the evidence is also very low.
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Affiliation(s)
- John P Bourke
- Freeman HospitalDepartment of CardiologyFreeman RoadNewcastle Upon TyneUKNE7 DN
| | - Teofila Bueser
- King's College LondonFlorence Nightingale Faculty of Nursing & MidwiferyLondonUKSE1 8WA
| | - Rosaline Quinlivan
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery and Great Ormond StreetMRC Centre for Neuromuscular Diseases and Dubowitz Neuromuscular CentrePO Box 114LondonUKWC1B 3BN
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8
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9
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Numerical modeling of a prototype cardiac assist device by implementing fluid-structure interaction. Artery Res 2018. [DOI: 10.1016/j.artres.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Campos Arias D, Londono F, Rodríguez Moliner T, Georgakopoulos D, Stergiopulos N, Segers P. Hemodynamic Impact of the C-Pulse Cardiac Support Device: A One-Dimensional Arterial Model Study. Artif Organs 2017; 41:E141-E154. [PMID: 28548693 DOI: 10.1111/aor.12922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/22/2016] [Accepted: 01/04/2017] [Indexed: 01/09/2023]
Abstract
The C-Pulse is a novel extra-aortic counter-pulsation device to unload the heart in patients with heart failure. Its impact on overall hemodynamics, however, is not fully understood. In this study, the function of the C-Pulse heart assist system is implemented in a one-dimensional (1-D) model of the arterial tree, and central and peripheral pressure and flow waveforms with the C-Pulse turned on and off were simulated. The results were studied using wave intensity analysis and compared with in vivo data measured non-invasively in three patients with heart failure and with invasive data measured in a large animal (pig). In all cases the activation of the C-Pulse was discernible by the presence of a diastolic augmentation in the pressure and flow waveforms. Activation of the device initiates a forward traveling compression wave, whereas a forward traveling expansion wave is associated to the device relaxation, with waves exerting an action in the coronary and the carotid vascular beds. We also found that the stiffness of the arterial tree is an important determinant of action of the device. In settings with reduced arterial compliance, the same level of aortic compression demands higher values of external pressure, leading to stronger hemodynamic effects and enhanced perfusion. We conclude that the 1-D model may be used as an efficient tool for predicting the hemodynamic impact of the C-Pulse system in the entire arterial tree, complementing in vivo observations.
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Affiliation(s)
- Daimé Campos Arias
- IBiTech-bioMMeda, Ghent University, Ghent, Belgium.,Universidad Tecnológica de La Habana José Antonio Echeverría (Cujae), Biomechanics and Biomaterials Research Group, Havana, Cuba
| | | | - Tania Rodríguez Moliner
- Universidad Tecnológica de La Habana José Antonio Echeverría (Cujae), Biomechanics and Biomaterials Research Group, Havana, Cuba
| | | | - Nikos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology (LHTC), Ecole Polytechnique Fédérale de Lausanne, Lausanne Switzerland
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11
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Exo-organoplasty interventions: A brief review of past, present and future directions for advance heart failure management. Biomed Pharmacother 2017; 88:162-172. [PMID: 28103510 DOI: 10.1016/j.biopha.2017.01.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a debilitating disease in which abnormal function of the heart leads to imbalance of blood demand to tissues and organs. The pathogenesis of HF is very complex and various factors can contribute including myocardial infarction, ischemia, hypertension and genetic cardiomyopathies. HF is the leading cause of death and its prevalence is expected to increase in parallel with the population age. Different kind of therapeutic approaches including lifestyle modification, medication and pacemakers are used for HF patients in NYHA I-III functional class. However, for advance stage HF patient's (NYHA IV), ventricle assist devices are clinically use and stem cells are under active investigation. Most of these therapies leads to modest symptoms relief and have no significant role in long-term survival rate. Currently there is no effective treatment for advance HF except heart transplantation, which is still remain clinically insignificant because of donor pool limitation. As HF is a result of multiple etiologies therefore multi-functional therapeutic platform is needed. Exo-organoplasty interventions are studied from almost one century. The major goals of these interventions are to treat various kind of heart disease from outside the heart muscle without having direct contact with blood. Various kind of interventions (devices and techniques) are developed in this arena with the passage of time. The purpose of this review is to describe the theory behind intervention devices, the devices themselves, their clinical results, advantages and limitations. Furthermore, to present a future multi-functional therapeutic platform (ASD) for advance stage HF management.
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12
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Efficacy of Subcutaneous Electrocardiogram Leads for Synchronous Timing During Chronic Counterpulsation Therapy. ASAIO J 2016; 63:134-138. [PMID: 27984317 DOI: 10.1097/mat.0000000000000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Counterpulsation devices (CPDs) require an accurate, reliable electrocardiogram (ECG) waveform for triggering inflation and deflation. Surface electrodes are for short-term use, and transvenous/epicardial leads require invasive implant procedure. A subcutaneous ECG lead configuration was developed as an alternative approach for long-term use with timing mechanical circulatory support (MCS) devices. In this study, efficacy testing was completed by simultaneously recording ECG waveforms from clinical-grade epicardial (control) and subcutaneous (test) leads in chronic ischemic heart failure calves implanted with CPD for up to 30 days. Sensitivity and specificity of CPD triggering by R-wave detection was quantified for each lead configuration. The subcutaneous leads provided 98.9% positive predictive value and 98.9% sensitivity compared to the epicardial ECG leads. Lead migration (n = 1) and fracture (n = 1) were observed in only 2 of 40 implanted leads, without adversely impacting triggering efficacy due to lead redundancy. These findings demonstrate the efficacy of subcutaneous ECG leads for long-term CPD timing and potential use as an alternative method for MCS device timing.
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13
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Full-Support LVAD Implantation in a C-Pulse Heart Assist System Recipient with Deteriorating Chronic Heart Failure: Is It Feasible and Safe? ASAIO J 2016; 62:e55-e57. [PMID: 26978707 DOI: 10.1097/mat.0000000000000365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Heart failure is a progressive disease with limited treatment options. The C-Pulse Heart Assist System (Eden Prairie, MN) is an extravascular, diastolic counterpulsation circulatory support device for patients with refractory NHYA Class III/ambulatory class IV heart failure. It comprises a balloon-cuff which is implanted around the ascending aorta that is synchronised to inflate during ventricular diastole. The system eliminates the need for systemic anticoagulation and significantly reduces the risk of bleeding and overcomes the problem of device thrombosis. However, clinical efficacy is dependent on maintenance of residual myocardial function. We describe a case of a patient who presented with ischemic cardiomyopathy in end-stage heart failure and received the C-Pulse System. Due to deterioration in cardiac function, the system had to be upgraded to a full-support left ventricular assist device (LVAD) after 4 months. However, the aorta ascendens was short and the outflow graft of the HeartWare LVAD had to be anastomosed to the cuff balloon region of the aorta. Our experience showed in this case that the inflatable cuff action did not compromise the structural integrity of the aortic wall.
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14
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Black MC, Schumer EM, Rogers M, Trivedi J, Slaughter MS. Sunshine Heart C-Pulse: device for NYHA Class III and ambulatory Class IV heart failure. Future Cardiol 2016; 12:521-31. [PMID: 27580008 DOI: 10.2217/fca-2016-0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Advanced heart failure (HF) patients not meeting criteria for ventricular assist device or heart transplant with life-limiting symptoms are limited to medical and resynchronization therapy. The Sunshine Heart C-Pulse, based on intra-aortic balloon pump physiology, provides implantable, on-demand, extra-aortic counterpulsation, which reduces afterload and improves cardiac perfusion in New York Heart Association Class III and ambulatory Class IV HF. The C-Pulse reduces New York Heart Association Class, improves 6-min walk distances, inotrope requirements and HF symptom questionnaires. Advantages include shorter operative times without cardiopulmonary bypass, no reported strokes or thrombosis and no need for anticoagulation. Driveline exit site infections, inability to provide full circulatory support and poor function with intractable arrhythmias remain concerns. Current randomized controlled studies will evaluate long-term efficacy and safety compared with medical and resynchronization therapy.
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Affiliation(s)
- Matthew C Black
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Erin M Schumer
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Michael Rogers
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Jaimin Trivedi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
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15
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Trumble DR. A Muscle-Powered Counterpulsation Device for Tether-Free Cardiac Support: Form and Function1. J Med Device 2016. [DOI: 10.1115/1.4033115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Dennis R. Trumble
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
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16
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Kontogiannis CD, Malliaras K, Kapelios CJ, Mason JW, Nanas JN. Continuous internal counterpulsation as a bridge to recovery in acute and chronic heart failure. World J Transplant 2016; 6:115-124. [PMID: 27011909 PMCID: PMC4801787 DOI: 10.5500/wjt.v6.i1.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/11/2015] [Accepted: 01/22/2016] [Indexed: 02/05/2023] Open
Abstract
Cardiac recovery from cardiogenic shock (CS) and end-stage chronic heart failure (HF) remains an often insurmountable therapeutic challenge. The counterpulsation technique exerts numerous beneficial effects on systemic hemodynamics and left ventricular mechanoenergetics, rendering it attractive for promoting myocardial recovery in both acute and chronic HF. Although a recent clinical trial has questioned the clinical effectiveness of short-term hemodynamic support with intra-aortic balloon pump (IABP, the main representative of the counterpulsation technique) in CS complicating myocardial infarction, the issue remains open to further investigation. Moreover, preliminary data suggest that long-term IABP support in patients with end-stage HF is safe and may mediate recovery of left- or/and right-sided cardiac function, facilitating long-term weaning from mechanical support or enabling the application of other permanent, life-saving solutions. The potential of long-term counterpulsation could possibly be enhanced by implementation of novel, fully implantable counterpulsation devices.
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Schulz A, Krabatsch T, Schmitto JD, Hetzer R, Seidel M, Dohmen PM, Hotz H. Preliminary Results From the C-Pulse OPTIONS HF European Multicenter Post-Market Study. Med Sci Monit Basic Res 2016; 22:14-9. [PMID: 26887528 PMCID: PMC4792223 DOI: 10.12659/msmbr.896959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The C-Pulse® System is an extra-aortic balloon counterpulsation device. It is used to treat patients with heart failure disease in NYHA functional class III or ambulatory class IV. Material/Methods We present preliminary site-reported 6-month data from 3 centers in Germany as part of the prospective observational post-market OPTIONS HF study. Results Between May 2013 and March 2014, the C-Pulse System was implanted in 8 patients (7 male) with a mean age of 61.6±9.3 years. Four had ischemic and 4 had non-ischemic cardiomyopathy. No stroke, myocardial infarction, major bleeding, or major infection due to the device were reported. One patient developed non-device-related refractory tachycardia with worsening heart failure 12 h after surgery and underwent left ventricular assist device implantation. Within 6 months of observation, functional status improved from NYHA III to II in 5 patients, and 2 remained in NYHA III. Mean left ventricular ejection fraction increased from 24.3±7.9% to 44.5±4.5% (p<0.0001). Mean Kansas City Cardiomyopathy Questionnaire overall score improved from 28.6±19.1 to 59.1±22.5 (p=0.0183). Six-minute walk test was performed in 6 out of 7 patients at follow-up. The mean distance improved from 252.0±85.1 m to 279.2±87.5 m (p>0.05). One patient was weaned off the device after 6 months of support. Conclusions The C-Pulse System provides a therapeutic option for patients with moderate-to-severe heart failure and seems to improve quality of life and cardiac function over time.
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Affiliation(s)
- Antonia Schulz
- Cardio Centrum Berlin, Academic Teaching Institution of Charité, Medical University Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Roland Hetzer
- Cardio Centrum Berlin, Academic Teaching Institution of Charité, Medical University Berlin, Berlin, Germany
| | - Mirko Seidel
- Department of Cardiology, Unfallkrankenhaus Berlin, Academic Teaching Hospital of Charité, Medical University Berlin, Berlin, Germany
| | - Pascal M Dohmen
- Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany
| | - Holger Hotz
- Cardio Centrum Berlin, Academic Teaching Institution of Charité, Medical University Berlin, Berlin, Germany
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18
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Gafoor S, Franke J, Lam S, Reinartz M, Bertog S, Vaskelyte L, Hofmann I, Sievert H. Devices in heart failure--the new revolution. Circ J 2015; 79:237-44. [PMID: 25744737 DOI: 10.1253/circj.cj-14-1354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Heart failure is a growing epidemic, with more patients living longer and suffering from this disease. There is a growing segment of patients who have persistent symptoms despite pharmacologic therapy. In an era when transplants are rare, the need for devices and interventions that can assist ventricular function is paramount. This review goes through the devices used in heart failure, including left ventricular reconstruction, aortic counterpulsation, short-term mechanical circulatory support, long-term mechanical circulatory support, and right heart interventions.
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Affiliation(s)
- Sameer Gafoor
- CardioVascular Center Frankfurt (CVC), Frankfurt, Germany
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19
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Hayward C, Jansz P. Mechanical circulatory support for the failing heart – progress, pitfalls and promises. Heart Lung Circ 2015; 24:527-31. [PMID: 25797325 DOI: 10.1016/j.hlc.2015.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Christopher Hayward
- Heart Failure and Transplant Unit, St Vincent's Hospital and Victor Chang Cardiac Research Institute, Sydney.
| | - Paul Jansz
- Heart Failure and Transplant Unit, St Vincent's Hospital and Victor Chang Cardiac Research Institute, Sydney
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