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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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2
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Gambato M, Scotti N, Borsari G, Zambon Bertoja J, Gabrieli JD, De Cassai A, Cester G, Navalesi P, Quaia E, Causin F. Chest X-ray Interpretation: Detecting Devices and Device-Related Complications. Diagnostics (Basel) 2023; 13:599. [PMID: 36832087 PMCID: PMC9954842 DOI: 10.3390/diagnostics13040599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
This short review has the aim of helping the radiologist to identify medical devices when interpreting a chest X-ray, as well as looking for their most commonly detectable complications. Nowadays, many different medical devices are used, often together, especially in critical patients. It is important for the radiologist to know what to look for and to remember the technical factors that need to be considered when checking each device's positioning.
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Affiliation(s)
- Marco Gambato
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Nicola Scotti
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Giacomo Borsari
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Jacopo Zambon Bertoja
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | | | - Alessandro De Cassai
- Anesthesia and Intensive Care Unit, University Hospital of Padova, 35121 Padua, Italy
| | - Giacomo Cester
- Department of Neuroradiology, University Hospital of Padova, 35121 Padua, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
- Institute of Radiology, University Hospital of Padova, 35121 Padua, Italy
| | - Francesco Causin
- Department of Neuroradiology, University Hospital of Padova, 35121 Padua, Italy
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3
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Noly PE, Duggal N, Jiang M, Nordsletten D, Bonini M, Lei I, Ela AAE, Haft JW, Pagani FD, Cascino TM, Tang PC. Role of the mitral valve in left ventricular assist device pathophysiology. Front Cardiovasc Med 2022; 9:1018295. [PMID: 36386343 PMCID: PMC9649705 DOI: 10.3389/fcvm.2022.1018295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/29/2022] [Indexed: 08/27/2023] Open
Abstract
Functional mitral regurgitation (MR) in the setting of heart failure results from progressive dilatation of the left ventricle (LV) and mitral annulus. This leads to leaflet tethering with posterior displacement. Contrary to common assumptions, MR often does not resolve with LVAD decompression of the LV alone. The negative impact of significant (moderate-severe) mitral regurgitation in the LVAD setting is becoming better recognized in terms of its harmful effect on right heart function, pulmonary vascular resistance and hospital readmissions. However, controversies remain regarding the threshold for intervention and management. At present, there are no consensus indications for the repair of significant mitral regurgitation at the time of LVAD implantation due to the conflicting data regarding potential adverse effects of MR on clinical outcomes. In this review, we summarize the current understanding of MR pathophysiology in patients supported with LVAD and potential future management strategies.
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Affiliation(s)
- Pierre-Emmanuel Noly
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Neal Duggal
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Mulan Jiang
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - David Nordsletten
- Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | - Mia Bonini
- Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | - Ienglam Lei
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ashraf Abou El Ela
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jonathan W. Haft
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Francis D. Pagani
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Thomas M. Cascino
- Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Paul C. Tang
- Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
- Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
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4
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LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement. J Clin Med 2022; 11:jcm11123542. [PMID: 35743611 PMCID: PMC9225013 DOI: 10.3390/jcm11123542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of patients. In the first part of this review, we discuss the historical background, current evidence on the incidence and assessment of LVAD-mediated cardiac recovery, and out-comes including quality of life after LVAD support withdrawal. In the second part, we discuss current and future opportunities to promote LVAD-mediated reverse remodeling and improve our pathophysiological understanding of HF and recovery for the benefit of the greater HF population.
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5
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Does Cardiac Catheterization Facilitate Hemodynamic Optimization of Pediatric Patients on Continuous-Flow Ventricular Assist Devices? ASAIO J 2022; 68:584-591. [DOI: 10.1097/mat.0000000000001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stapor M, Pilat A, Gackowski A, Misiuda A, Gorkiewicz-Kot I, Kaleta M, Kleczynski P, Zmudka K, Legutko J, Kapelak B, Wierzbicki K. Echo-guided left ventricular assist device speed optimisation for exercise maximisation. Heart 2022; 108:1055-1062. [PMID: 35314453 PMCID: PMC9209671 DOI: 10.1136/heartjnl-2021-320495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Current generation left ventricular assist devices (LVADs) operate with a fixed rotation speed and no automated speed adjustment function. This study evaluates the concept of physiological pump speed optimisation based on aortic valve opening (AVO) imaging during a cardiopulmonary exercise test (CPET). Methods This prospective crossover study (NCT05063006) enrolled patients with implanted third-generation LVADs with hydrodynamic bearing. After resting speed optimisation, patients were randomised to a fixed-modified speed or modified-fixed speed CPET sequence. Fixed speed CPET maintained baseline pump settings. During the modified speed CPET, the LVAD speed was continuously altered to preserve periodic AVO. Results We included 22 patients, the mean age was 58.4±7 years, 4.5% were women and 54.5% had ischaemic cardiomyopathy. Exertional AVO assessment was feasible in all subjects. Maintaining periodic AVO allowed to safely raise the pump speed from 2900 (IQR 2640–3000) to 3440 revolutions per minute (RPM) (IQR 3100–3700; p<0.001). As a result, peak oxygen consumption increased from 11.1±2.4 to 12.8±2.8 mL/kg/min (p<0.001) and maximum workload from 1.1 (IQR 0.9–1.5) to 1.2 W/kg (IQR 0.9–1.7; p=0.028). The Borg scale exertion level decreased from 15.2±1.5 to 13.5±1.2 (p=0.005). Conclusions Transthoracic AVO imaging is possible during CPETs in patients with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance and augments peak oxygen consumption and maximum workload.
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Affiliation(s)
- Maciej Stapor
- Department of Interventional Cardiology, John Paul II Hospital, Krakow, Malopolska, Poland
| | - Adam Pilat
- Department of Automatic Control and Robotics, AGH University of Science and Technology, Krakow, Poland
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Agnieszka Misiuda
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | - Izabela Gorkiewicz-Kot
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Michal Kaleta
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Pawel Kleczynski
- Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Krzysztof Zmudka
- Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
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7
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Bowen DJ, Yalcin YC, Strachinaru M, McGhie JS, van den Bosch AE, Soliman OI, Caliskan K. Right ventricular functional assessment by 2D multi-plane echocardiography prior to left ventricular assist device implantation. Echocardiography 2021; 39:7-19. [PMID: 34877695 PMCID: PMC9300057 DOI: 10.1111/echo.15191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/27/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Right ventricular (RV) failure post left ventricular assist device (LVAD) implantation is associated with increased morbidity and mortality. A novel RV multi‐plane imaging method using two‐dimensional echocardiography and electronic plane rotation (MPE) was used to quantify RV function prior to LVAD implantation and to identify potential added value in this patient population. Methods In twenty‐five end‐stage heart failure patients (age 58.9 ± 6.8 years, 76% male), systolic function of four different RV walls (lateral, anterior, inferior and inferior coronal) were evaluated from one focussed apical view using MPE. Results Feasibility of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (RV‐S') measurements were high (84–100%), with lower TAPSE values measured in the inferior (14.2 ± 4.6 mm) and inferior coronal (12.3 ± 5.0 mm) walls compared to the lateral (16.3 ± 4.5 mm) and anterior walls (16.0 ± 4.5 mm). RV wall longitudinal strain (RV‐LS) measurement was most feasible in the lateral wall (80%; mean: –12.1 ± 4.2%). TAPSE and RV‐LS values were significantly reduced in patients compared to matched healthy individuals (p = <0.001). Seven (28%) patients who developed moderate to severe RV failure (RVF) early post‐implant (≤30 days) had lower pre‐implant values across all multi‐plane parameters compared to those without significant post‐implant RVF, notably four‐wall averaged TAPSE (11.1 ± 3.4 mm vs 15.9 ± 4.0 mm; p = 0.02). Conclusion 2D MPE was highly feasible for RV wall quantification pre‐LVAD surgery, detecting differences in regional wall function. This novel method comprehensively quantifies RV wall function and could complement current pre‐LVAD screening protocols.
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Affiliation(s)
- Daniel J Bowen
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yunus C Yalcin
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mihai Strachinaru
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jackie S McGhie
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Osama I Soliman
- Department of Cardiology, College of Medicine, Nursing and Health Sciences, National University of Galway, Galway, Ireland
| | - Kadir Caliskan
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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8
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Hagendorff A, Helfen A, Flachskampf FA, Ewen S, Kruck S, La Rosée K, Knierim J, Voigt JU, Kreidel F, Fehske W, Brandt R, Zahn R, Knebel F. Manual zur Indikation und Durchführung spezieller echokardiographischer Anwendungen. DER KARDIOLOGE 2021. [PMCID: PMC8521495 DOI: 10.1007/s12181-021-00509-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Das zweite Manual zur Indikation und Durchführung der Echokardiographie bezieht sich auf spezifische Anwendungen der Echokardiographie und besondere Fragestellungen bei speziellen Patientengruppen. Dabei stehen v. a. praktische Aspekte im Vordergrund. Methodisch etabliert sind die transösophageale Echokardiographie, die Stressechokardiographie und die Kontrastechokardiographie. Bei nahezu allen echokardiographischen Untersuchungen spielen aktuell 3‑D-Echokardiographie und Deformationsbildgebung eine Rolle. Das gesamte Spektrum der echokardiographischen Möglichkeiten wird derzeit in Notfall- und Intensivmedizin, bei der Überwachung und Führung von Katheterinterventionen, bei strukturellen Herzerkrankungen, bei herzchirurgischen Operationen, bei der Nachsorge von kardialen Unterstützungssystemen, bei kongenitalen Vitien im Erwachsenenalter und bei der Versorgung von hochinfektiösen Patienten in Pandemiezeiten angewandt. Die diagnostischen Fortschritte der konventionellen und modernen echokardiographischen Anwendungen stehen im Fokus dieses Manuals. Die 3‑D-Echokardiographie zur Charakterisierung der kardialen Morphologie und die Deformationsbildgebung zur Objektivierung der kardialen Funktion sind bei vielen Indikationen im klinischen Alltag etabliert. Die Stressechokardiographie zur Ischämie‑, Vitalitäts- und Vitiendiagnostik, die Bestimmung der koronaren Flussreserve und die Kontrastechokardiographie bei der linksventrikulären Wandbewegungsanalyse und kardialen Tumordetektion finden zunehmend klinische Anwendung. Wie für die konventionelle Echokardiographie im ersten Manual der Echokardiographie 2009 beschrieben, erfordert der Einsatz moderner echokardiographischer Verfahren die standardisierte Dokumentation und Akquisition bestimmter Bildsequenzen bei optimierter Geräteeinstellung, da korrekte und reproduzierbare Auswertungen nur bei guter Bildqualität möglich sind.
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Affiliation(s)
- Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Deutschland
| | - Andreas Helfen
- Medizinische Klinik I, Katholisches Klinikum Lünen Werne GmbH St. Marien-Hospital Lünen, Lünen, Deutschland
| | - Frank A. Flachskampf
- Department of Medical Sciences, Universität Uppsala, und Klinisk fysiologi och kardiologi, Uppsala University Hospital, Uppsala, Schweden
| | - Sebastian Ewen
- Klinik für Innere Medizin III – Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Sebastian Kruck
- Cardio Centrum Ludwigsburg Bietigheim, Ludwigsburg, Deutschland
| | - Karl La Rosée
- Gemeinschaftspraxis Dr. La Rosée & Prof. Dr. Müller, Bonn, Deutschland
| | - Jan Knierim
- Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Deutschland
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Gasthuisberg und Department of Cardiovascular Sciences, Cath. University Leuven, Leuven, Belgien
| | - Felix Kreidel
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Wolfgang Fehske
- Klinik III für Innere Medizin, Universitätsklinikum Köln – Herzzentrum, Universität zu Köln, Köln, Deutschland
| | - Roland Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B – Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein, Deutschland
- Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland
| | - Fabian Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland
- Sana Klinikum Lichtenberg, Berlin, Deutschland
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9
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Tang PC, Duggal NM, Haft JW, Romano MA, Bolling SF, El Ela AA, Wu X, Colvin MM, Aaronson KD, Pagani FD. Left Ventricular Assist Device Implantation in Patients with Preoperative Severe Mitral Regurgitation. ASAIO J 2021; 67:1139-1147. [PMID: 34570728 PMCID: PMC11177295 DOI: 10.1097/mat.0000000000001379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We examined cardiac features associated with residual mitral regurgitation (MR) following continuous-flow left ventricular assist device (cfLVAD) implant. From 2003 to 2017, 134 patients with severe MR underwent cfVLAD implant without mitral valve (MV) intervention. Echocardiographic (echo) assessment occurred pre-cfLVAD, early post-cfLVAD, and at last available echo. Ventricular and atrial volumes were calculated from established formulas and normalized to be predicted. Cluster analysis based on preoperative normalized left ventricular and atrial volumes, and MV height identified grades 1, 2, and 3 with progressively larger cardiac chamber sizes. Median early echo follow-up was 0.92 (0.55, 1.45) months and the last follow-up was 15.12 (5.28, 38.28) months. Mitral regurgitation improved early after cfLVAD by 2.10 ± 1.16 grades (p < 0.01). Mitral regurgitation severity at the last echocardiogram positively correlated with the preoperative left ventricular volume (p = 0.014, R = 0.212), left atrial volume (p = 0.007, R = 0.233), MV anteroposterior height (p = 0.032, R = 0.185), and MV mediolateral diameter (p = 0.043, R = 0.175). Morphologically, smaller grade 1 hearts were correlated with MR resolution at the late follow-up (p = 0.023). Late right ventricular failure (RVF) at the last clinical follow-up was less in grade 1 (4/48 [8.3%]) compared with grades 2 and 3 (26/86 [30.2%]), p = 0.004). Grade 1 cardiac dimensions correlates with improvement in severe MR and had less late RVF.
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Affiliation(s)
- Paul C. Tang
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Neal M. Duggal
- Department of Anesthesiology, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Jonathan W. Haft
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Matthew A. Romano
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Steven F. Bolling
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Ashraf Abou El Ela
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Xiaoting Wu
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Monica M. Colvin
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Keith D. Aaronson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
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10
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Tang PC, Duggal NM, Haft JW, Aaronson KD, Pagani FD. Fate of preoperative moderate mitral regurgitation following left ventricular assist device implantation. J Card Surg 2021; 36:1843-1849. [PMID: 33604994 PMCID: PMC11196981 DOI: 10.1111/jocs.15428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examined for improvements in preoperative moderate mitral regurgitation following continuous-flow left ventricular assist device (cfLVAD) implantation. METHODS From 2006 to 2020, 190 patients with moderate MR underwent cfVLAD implant without concomitant mitral valve (MV) surgery. Cardiac dimensions and contractility, as well as valve function, were assessed with an echocardiogram (echo) pre-cfLVAD, and at approximately 1 month post-cfLVAD. Outcomes were determined by retrospective chart review. RESULTS Median echo follow-up was 0.94 (0.53, 1.38) months. Residual significant moderate or greater MR was present in 30/190 (15.8%) on follow-up. Patients with significant residual MR had larger preoperative left ventricular internal diameters in diastole (74.4 ± 8.7 vs. 71.1.0 ± 9.1 mm, p = .034). Significant residual MR was associated with higher preoperative mean pulmonary artery pressures (OR = 1.055, p = .035) and pulmonary capillary wedge pressures (OR = 1.060, p = .034). Significant residual MR on echo was not associated with any survival difference (p = .325). The 1, 5, and 10 year survival were 89.9%, 55.2%, and 34.2%, respectively. CONCLUSIONS For patients with moderate MR undergoing LVAD implantation, the likelihood of significant residual MR is low and mitral intervention in this population is not recommended. However, select patients with larger preoperative left heart dimensions and pulmonary vascular pressures may be at risk for persistent residual MR.
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Affiliation(s)
- Paul C. Tang
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Neal M. Duggal
- Department of Anesthesiology, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Jonathan W. Haft
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Keith D. Aaronson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
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11
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Dandel M, Javier MFDM, Javier Delmo EM, Loebe M, Hetzer R. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure. Cardiovasc Diagn Ther 2021; 11:226-242. [PMID: 33708495 DOI: 10.21037/cdt-20-288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although complete myocardial recovery after ventricular assist device (VAD) implantation is rather seldom, systematic search for recovery is worthwhile because for recovered patients weaning from VADs is feasible and can provide survival benefits with long-term freedom from heart failure (HF) recurrence, even if a chronic cardiomyopathy was the primary cause for the drug-refractory HF necessitating left ventricular (LVAD) or biventricular support (as bridge-to-transplantation or definitive therapy) and even if recovery remains incomplete. LVAD patients explanted for myoacardial recovery compared to those transplanted from LVAD support showed similar survival rates and a significant proportion of explanted patients can achieve cardiac and physical functional capacities that are within the normal range of healthy controls. In apparently sufficiently recovered patients, a major challenge remains still the pre-explant prediction of the weaning success which is meanwhile reliably possible for experienced clinicians. In weaning candidates, the combined use of certain echocardiography and right heart catheterization parameters recorded before VAD explantation can predict post-weaning cardiac stability with good accuracy. However, in the absence of standardization or binding recommendations, the protocols for assessment of native cardiac improvement and also the weaning criteria differ widely among centers. Currently there are still only few larger studies on myocardial recovery assessment after VAD implantation. Therefore, the weaning practice relies mostly on small case series, local practice patterns, and case reports, and the existing knowledge, as well as the partially differing recommendations which are based mainly on expert opinions, need to be periodically systematised. Addressing these shortcomings, our review aims to summarize the evidence and expert opinion on the evaluation of cardiac recovery during mechanical ventricular support by paying special attention to the reliability of the methods and parameters used for assessment of myocardial recovery and the challenges met in both evaluation of recovery and weaning decision making.
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Affiliation(s)
- Michael Dandel
- Department of Cardiology, Cardio Centrum Berlin, Berlin, Germany
| | | | | | - Matthias Loebe
- Thoracic Transplant and Mechanical Support, Miami Transplant Institute, Memorial Jackson Health System, University of Miami, Miami, Florida, USA
| | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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12
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Echocardiography for left ventricular assist device implantation and evaluation: an indispensable tool. Heart Fail Rev 2021; 27:891-902. [PMID: 33428013 DOI: 10.1007/s10741-021-10073-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Echocardiography is an indispensable tool in the evaluation, placement, management and follow-up of patients with left ventricular assist devices (LVAD). While transoesophageal echocardiography is the ideal tool in guiding the implantation procedure, transthoracic echocardiography is essential during the initial evaluation, patient selection and in the post-operative follow-up. This review attempts to summarize which parameters the echocardiographic assessment should focused on during each step. In particular, during the pre-operative assessment, it is of paramount importance to assess the presence of aortic regurgitation and most importantly to evaluate right ventricular function, since it is one of the strongest predictor of post-implant right ventricular failure. During the procedure, through transoesophageal echocardiography, it is possible to confirm the correct placement of the inflow cannula, to assess right ventricular function and to guide the choice of the right pump speed. Transthoracic echocardiographic is an essential part in the patient's follow-up once the LVAD has been implanted, in order to attest the onset of possible complications.
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Strachinaru M, Bowen DJ, Constatinescu A, Manintveld OC, Brugts JJ, Geleijnse ML, Caliskan K. Transhepatic echocardiography: a novel approach for imaging in left ventricle assist device patients with difficult acoustic windows. Eur Heart J Cardiovasc Imaging 2020; 21:491-497. [PMID: 32025715 PMCID: PMC7167747 DOI: 10.1093/ehjci/jeaa002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/22/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS A significant proportion of left ventricle assist device (LVAD) patients have very difficult transthoracic echocardiographic images. The aim of this study was to find an echocardiographic window which would provide better visualization of the heart in LVAD patients with limited acoustic windows. METHODS AND RESULTS Based on the anatomic relationships in LVAD patients, a right intercostal transhepatic approach was proposed. By using a computer simulator, we searched for the appropriate probe orientation. Further, 15 ambulatory LVAD patients (age 56 ± 15 years, 73% males) underwent two echocardiographic studies: one normal transthoracic echocardiography following the institutional protocol (Echo 1) and a second study which included the transhepatic approach (Echo 2). The two exams were performed by two different sonographers and the results validated by a third observer for agreement. The transhepatic intercostal window was feasible in all patients, with an image quality allowing good visualization of structures in 93%. Precise quantification of the left ventricular (LV) and right ventricular (RV) function was achieved more often in the Echo 2 (10 vs. 3 patients for LV, P = 0.03 and 14 vs. 8 patients for RV, P = 0.04). A significant difference existed also in the quantification of the LVAD inflow cannula flow by pulsed Doppler (11 patients in Echo 2 vs. 3 patients in Echo 1, P = 0.009). CONCLUSION This is the first study describing a new echocardiographic window in LVAD patients. The transhepatic window may provide better quantification of left and RV dimensions and function and improvement in Doppler interrogation of the inflow cannula.
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Affiliation(s)
- Mihai Strachinaru
- Department of Cardiology, Erasmus MC University Medical Center, Office Rg 427 PB 2040, 3000 CA Rotterdam, The Netherlands
| | - Daniel J Bowen
- Department of Cardiology, Erasmus MC University Medical Center, Office Rg 427 PB 2040, 3000 CA Rotterdam, The Netherlands
| | - Alina Constatinescu
- Department of Cardiology, Erasmus MC University Medical Center, Office Rg 427 PB 2040, 3000 CA Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center, Office Rg 427 PB 2040, 3000 CA Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center, Office Rg 427 PB 2040, 3000 CA Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, Erasmus MC University Medical Center, Office Rg 427 PB 2040, 3000 CA Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Center, Office Rg 427 PB 2040, 3000 CA Rotterdam, The Netherlands
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14
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Gargani L. Left ventricular assist device and echocardiography: no more sadness. Eur Heart J Cardiovasc Imaging 2020; 21:jeaa059. [PMID: 32293674 DOI: 10.1093/ehjci/jeaa059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1, 56124 Pisa, Italy
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15
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Stenberg R, Shenvi C. Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Ann Emerg Med 2020; 76:34-41. [PMID: 32111507 DOI: 10.1016/j.annemergmed.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Robert Stenberg
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC.
| | - Christina Shenvi
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
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16
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Schaefer JJ, Sajgalik P, Kushwaha SS, Olson LJ, Stulak JM, Johnson BD, Schirger JA. Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics. Int J Artif Organs 2020; 43:452-460. [PMID: 31984834 DOI: 10.1177/0391398819899403] [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: 01/03/2023]
Abstract
HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = -.57, p < .01; r = -.38, p < .05; r = -.59, p < .01; r = -.47, p = .01 and r = -.53, p < .01, respectively). The pulsatility index derived from the EPC controller was associated with the significant risk of re-hospitalization within 1 and 2 years after the implantation of left ventricular assist device; hazard ratio = 0.557 with 95% confidence interval (0.315-0.983), p = .04 and hazard ratio = .579 (0.341-0.984), p = .04. A higher pulsatility index at discharge was associated with greater volume unloading, lower pulmonary pressures, and lower risk of all-cause re-hospitalizations within 1 and 2 years post-surgery. As such, pump-derived data may provide additional value in predicting left ventricular assist device hemodynamics.
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Affiliation(s)
- Jacob J Schaefer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Pavol Sajgalik
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sudhir S Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Lyle J Olson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - John A Schirger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Hong E, Naseem T. Color Doppler Artifact Masking Iatrogenic Aortic Valve Injury Related to an Impella Device. J Cardiothorac Vasc Anesth 2019; 33:1584-1587. [DOI: 10.1053/j.jvca.2018.09.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Indexed: 11/11/2022]
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18
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Hwang KY, Hwang NC. Facilitating noncardiac surgery for the patient with left ventricular assist device: A guide for the anesthesiologist. Ann Card Anaesth 2019; 21:351-362. [PMID: 30333327 PMCID: PMC6206808 DOI: 10.4103/aca.aca_239_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The introduction of left ventricular assist device (LVAD) has improved survival rates for patients with end-stage heart failure. Two categories of VADs exist: one generates pulsatile flow and the other produces nonpulsatile continuous flow. Survival is better for patients with continuous-flow LVADs. With improved survival, more of such patients now present for noncardiac surgery (NCS). This review, written for the general anesthesiologists, addresses the perioperative considerations when the patient undergoes NCS. For best outcomes, a multidisciplinary approach is essential in perioperative management of the patient.
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Affiliation(s)
- Kai-Yin Hwang
- Department of Anaesthesiology, Singapore General Hospital, 1 Hospital Drive, Singapore 169608, Singapore
| | - Nian-Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, 1 Hospital Drive, Singapore 169608; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore, 5 Hospital Drive, Singapore 169609, Singapore
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19
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Evaluation of Cardiac Recovery in Ventricular Assist Device Recipients: Particularities, Reliability, and Practical Challenges. Can J Cardiol 2018; 35:523-534. [PMID: 30935643 DOI: 10.1016/j.cjca.2018.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/08/2018] [Accepted: 11/22/2018] [Indexed: 01/01/2023] Open
Abstract
In carefully selected patients with ventricular assist devices (VADs), good long-term results after device weaning and explantation can be achieved when reverse remodelling and improvement of native cardiac function occur. Monitoring of cardiac size, geometry, and function after initial VAD implantation is necessary to identify such patients. Formal guidelines for recovery assessment in patients with VADs do not exist, and protocols for recovery assessment and criteria for device weaning and explantation vary among centres. Barriers to evaluation of cardiac recovery include technical problems in obtaining echo images in patients with VADs, time restrictions for necessary VAD reductions/interruptions during assessment, and regurgitant flow patterns that occur with interruption of continuous flow VADs. The few larger studies addressing cardiac recovery after VAD implantation employed varied study designs, limiting interpretation. Current clinical practice is guided largely by local practice patterns, case reports, and small case series, and the available body of research-consisting mostly of expert opinions-has not been systematically addressed. This summary reviews evidence and expert opinion on VAD-promoted cardiac recovery assessment, its reliability, and associated challenges.
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20
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Maxwell C, Whitener G. Mitral Intervention with LVAD: Preparing for Recovery. Semin Cardiothorac Vasc Anesth 2018; 23:134-139. [PMID: 30014773 DOI: 10.1177/1089253218788081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Left ventricular assist device (LVAD) insertion is an increasingly common treatment of advanced heart failure. Insertion guidelines suggest regurgitant lesions of the mitral valve should not be addressed. However, recent evidence suggests that mitral regurgitation may not necessarily improve with LVAD insertion, and such patients may have worse outcomes. Thus, practice variability is high given the discrepancy between traditional thinking and new evidence that unrepaired mitral regurgitation may increase perioperative mortality. Additionally, the challenges of LVADs can make transesophageal echocardiography evaluation and assessment of mitral valve pathology difficult.
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21
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Lairez O, Delmas C, Fournier P, Cassol E, Méjean S, Pascal P, Petermann A, Dambrin C, Minville V, Carrié D, Rousseau H, Galinier M, Roncalli J, Marcheix B, Berry I. Feasibility and accuracy of gated blood pool SPECT equilibrium radionuclide ventriculography for the assessment of left and right ventricular volumes and function in patients with left ventricular assist devices. J Nucl Cardiol 2018; 25:625-634. [PMID: 27905008 DOI: 10.1007/s12350-016-0670-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Because the RV is not assisted, its function is a critical determinant of the hemodynamic and contributes significantly to postoperative morbidity and mortality. We evaluated the feasibility and the accuracy of tomographic-equilibrium radionuclide ventriculography (t-ERV) for the assessment of patients with LVADs. METHODS Twenty-four patients with LVAD underwent t-ERV. Because of the limited acoustic window, transthoracic echocardiography (TTE) was only feasible in 19 patients. Functional evaluation including six-minute walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac multidetector computed tomography (MDCT). Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later. RESULTS Reliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume, and RV ejection fraction (RVEF) was 0.900 (P = .001), 0.911 (P = .001), 0.765 (P = .021), 0.728 (P = .042), 0.875 (P = .004), and 0.781 (P = .023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = .027). A cut-off value of 40% for RVEF measured by t-ERV could discriminate patients with poor functional status (P = .048 for NYHA stage; P = .016 for 6MWT and P = .007 for POC). CONCLUSION t-ERV is a simple, reproducible, and an accurate technique for the assessment of RV function in patients with LVADs and warrants consideration in the evaluation and monitoring of symptomatic patients.
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Affiliation(s)
- Olivier Lairez
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France.
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
| | - Clément Delmas
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Emmanuelle Cassol
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Simon Méjean
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Pierre Pascal
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Antoine Petermann
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Radiology, Toulouse University Hospital, Toulouse, France
| | - Camille Dambrin
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Department of Cardiac Surgery, Toulouse University Hospital, Toulouse, France
| | - Vincent Minville
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Department of Anesthesiology, Toulouse University Hospital, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Hervé Rousseau
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Department of Radiology, Toulouse University Hospital, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Jérôme Roncalli
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Bertrand Marcheix
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Department of Cardiac Surgery, Toulouse University Hospital, Toulouse, France
| | - Isabelle Berry
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
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Gasparovic H, Kopjar T, Saeed D, Cikes M, Svetina L, Petricevic M, Lovric D, Milicic D, Biocina B. De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation. Ann Thorac Surg 2017; 104:704-711. [DOI: 10.1016/j.athoracsur.2017.01.114] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/21/2016] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
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Liu G, Zhou J, Sun H, Zhang Y, Chen H, Hu S. Effects of Cone-Shaped Bend Inlet Cannulas of an Axial Blood Pump on Thrombus Formation: An Experiment and Simulation Study. Med Sci Monit 2017; 23:1655-1661. [PMID: 28379938 PMCID: PMC5389533 DOI: 10.12659/msm.903421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Cannula shape and connection style influence the risk of thrombus formation in the blood pump by varying the blood flow characteristics inside the pump. Inlet cannulas should be designed based on the need for anatomical fit and reducing the risk of thrombus generation in the blood pump. The effects on thrombus formation of the cone-shaped bend inlet cannulas of axial blood pumps should be studied. Material/Methods The cannulas were designed as cone-shaped, with 1 bent section connecting 2 straight sections. Both the silicone tube and novel cone-shaped cannula were simulated for comparison. The flow fields of a blood pump with inlet cannula were simulated by computational fluid dynamics (CFD) at flows of 2.0, 2.5, and 3.0 liters per minute (lpm), with pump rotational speeds of 7500, 8000, and 8500 rpm, respectively. Then, 6 two-dimensional (2D) particle image velocimetry (PIV) tests were conducted and the velocity distributions were analyzed. Results A low-velocity region was located inside the pump entrance when a soft silicone tube was used. At 8500 rpm and 3.0 lpm working condition, the minimum velocity inside the pump with cone-shaped cannulas was 2.5×10−1 m/s. The cone-shaped cannulas eliminated the low-velocity region inside the pump. Both CFD and PIV results showed that the low-velocity region did not spread to the entrance of the blood pump within the flow range from 2.0 lpm to 7.0 lpm. Conclusions The designed cone-shaped bent cannulas can eliminate the low-velocity region inside the blood pump and reduce the risk of thrombus formation in the blood pump.
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Affiliation(s)
- Guangmao Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China (mainland)
| | - Jianye Zhou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China (mainland)
| | - Hansong Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China (mainland)
| | - Yan Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China (mainland)
| | - Haibo Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China (mainland)
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China (mainland)
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Sezai A, Niino T, Osaka S, Yaoita H, Arimoto M, Hata H, Shiono M. New Treatment for Percutaneous Sites in Patients with a Ventricular Assist Device: Nihon University Crystal Violet Method. Ann Thorac Cardiovasc Surg 2016; 22:246-50. [PMID: 27086670 DOI: 10.5761/atcs.oa.15-00250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Infection of the percutaneous site of a ventricular assist device (VAD) is a challenging complication. We report our experience with crystal violet Solbase (Nihon University crystal violet method) for prevention of driveline or cannula infections in VAD patients. PATIENTS AND METHODS The crystal violet method was used in 10 patients (prophylaxis in nine and treatment in one). Eight patients had an extracorporeal VAD (Nipro) and two had an implantable VAD (Heart Mate II). RESULTS The infection-free period was 4-623 days (mean: 144.2 ± 222.9 days). All eight patients with an extracorporeal VAD died, while the two patients with an implantable VAD (Heart Mate II) survived. Infection was improved in a patient with MRSA, and the results of bacteriological examination were always negative in the patients receiving prophylaxis. The two patients with an implantable VAD had no infection for 2 and 20 months after implantation. CONCLUSION These findings suggest that the Nihon University crystal violet method is effective for prevention and treatment of driveline or cannula infections in patients with a VAD.
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Affiliation(s)
- Akira Sezai
- The Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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25
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Ujeyl A, Krüger M. [Rise of the machines? Left ventricular assist devices for treatment of severe heart failure]. Herz 2015; 40:972-9. [PMID: 26530283 DOI: 10.1007/s00059-015-4365-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of left ventricular assist devices (LVAD) as a treatment for severe heart failure has gained momentum in recent years. Even at this stage the number of worldwide LVAD implantations far exceeds the volume of heart transplantations in view of the chronic shortage of donor organs. Third generation continuous flow assist devices have helped to improve survival, quality of life and symptom burden of heart failure patients in comparison to a regimen of optimal medication management. Alongside bridging to transplantation, destination therapy has become an established strategy of LVAD implantation. A careful patient selection process is crucial for a good clinical outcome after device implantation and risk assessment for postoperative right ventricular failure is of particular importance in this context. The rate of hospitalization during LVAD support is still high, despite the step-wise attempts to widen the indications to less severely ill heart failure patients. An effective perioperative and postoperative management will help to lower the incidence of complications (e.g. bleeding, infections, thromboembolic events and right ventricular failure) and to improve the encouraging results of mechanical circulatory support.
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Affiliation(s)
- A Ujeyl
- Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland.
| | - M Krüger
- Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland
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