1
|
Hussen NM, Workie DL, Biresaw HB. Survival time to complications of congestive heart failure patients at Felege Hiwot comprehensive specialized referral hospital, Bahir Dar, Ethiopia. PLoS One 2022; 17:e0276440. [PMID: 36264946 PMCID: PMC9584442 DOI: 10.1371/journal.pone.0276440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUNDS Congestive heart failure is a serious chronic condition when the heart's muscles become too damaged and a condition in which one or both ventricles cannot pump sufficient blood to meet the metabolic needs of the body. This study aimed to identify factors affecting the complications time of congestive heart failure patients treated from January 2016 to December 2019 at Felege Hiwot comprehensive specialized referral hospital in Bahir Dar, Ethiopia. METHODS A hospital-based retrospective data collection was collected from the medical charts of 218 randomly selected congestive heart failure patients. The Kaplan-Meier curve and the Cox proportional hazards model were used to compare and identify the factors associated with time to complication in patients with congestive heart failure. RESULTS The median complication time of congestive heart failure patients was 22 months [95% CI: 21.98-28.01]. About 194 (88.99%) of the patients were complicated. The Kaplan-Meier curve depicts the survival probability of complicated patients decreasing as the complication time increases. The hazard ratios for serum sodium concentration, left ventricular ejection fraction, patients from rural areas, age of patients, serum hemoglobin concentration, and New York heart association classes I, II, and III were given 0.94 [95% CI: 0.90-1.00], 0.74 [95% CI: 0.65-0.85], 0.75 [95% CI: 0.68-0.84], 1.28 [95% CI: 1.12-1.46], 0.89 [95% CI: 0.85-0.94], 0.44 [95% CI: 0.36-0.53], 0.54 [95% CI: 0.47-0.62] and 0.73 [95% CI: 0.65-0.81] respectively, and they are statistically associated with the complication time of congestive heart failure patients. CONCLUSIONS The median complication time of congestive heart failure patients was 22 months. This study strongly suggests that healthcare awareness should be strengthened earlier about the potential complications for patients with lower serum sodium concentrations below the threshold and aged congestive heart failure patients to reduce the risk of developing complications.
Collapse
|
2
|
Almutawa DA, Almuammar M, Elshafie MM, Aljuraiban GS, Alnafisah A, Abulmeaty MMA. Survival and Nutritional Status of Male and Female Heart Transplant Patients Based on the Nutritional Risk Index. Nutrients 2020; 12:nu12123868. [PMID: 33348880 PMCID: PMC7766250 DOI: 10.3390/nu12123868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
Malnutrition among heart-transplant patients may affect survival. The aim was to investigate the survival and nutrition status among male and female heart transplant patients who underwent transplantation, before and 1 year after surgery based on the nutritional risk index (NRI). The medical records of ninety heart-transplant patients (2009–2014) from the King Faisal Specialist Hospital, Riyadh, were reviewed. The assessment included demographic data, anthropometric measurements, and NRI calculation. Moreover, postoperative data included the length of stay and survival. Paired t-test and survival analysis by Kaplan–Meier (KM) curves were used. A total of 90 patients (males 77.78%) were included. The prevalence of malnutrition in the preoperative phase by NRI was 60% (7.78% as severe; 40% as moderate, and 12.22% mild NRI scores). After 1 year, body mass index (BMI) and NRI increased significantly (p < 0.001). Furthermore, NRI was significantly different between men and women (p < 0.01), while KM survival curves were insignificantly different (p = 0.67). Recipients with postoperative moderate or severe nutritional risk (NRI < 97.5) had significantly shorter survival in the first-year post-transplantation (HR = 0.82; 95% CI, 0.75–0.89; p < 0.001). Our findings indicate that the NRI after 1 year of transplant correlated significantly with mortality. Besides, there was no significant gender difference regarding survival; however, malnutrition and low survival were more prominent among women.
Collapse
Affiliation(s)
- Deema A. Almutawa
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Health Sciences Department, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - May Almuammar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
| | - Mona Mohamed Elshafie
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Al Ghad International College of Applied Medical Sciences, Riyadh 12467, Saudi Arabia
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
| | - Alaa Alnafisah
- Clinical Nutrition Department, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia;
| | - Mahmoud M. A. Abulmeaty
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Obesity Management and Research Unit, Medical Physiology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
- Correspondence: ; Tel.: +966-5-4815-5983
| |
Collapse
|
3
|
Hong Y, Seese L, Hickey G, Chen S, Mathier MA, Kilic A. Left ventricular assist device implantation in patients with a history of malignancy. J Card Surg 2020; 35:2224-2231. [PMID: 32720438 DOI: 10.1111/jocs.14723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study evaluates the impact of a history of malignancy on outcomes of left ventricular assist device (LVAD) implantation. METHODS Adult patients with a preimplant history of malignancy who underwent LVAD implantation between 2006 and 2018 were included. The primary outcome was post-LVAD survival. RESULTS A total of 250 patients underwent LVAD implant during the study period, including 37 (14.8%) patients with a history of malignancy. Of these 37 patients, five (13.5%) had active malignancy at the time of LVAD implantation, and seven had more than one type of cancer. The median disease-free duration before LVAD was 3.5 years (interquartile range [IQR] 1.0-7.75 years). The most common types of malignancy included urologic (n = 20; 45.5%), skin (n = 7, 15.9%), and leukemia or lymphoma (n = 6; 13.6%). Median follow-up was 244 (IQR, 126-571) days and 313 (IQR 127-738) days for those with and without a history of malignancy, respectively (P = .49). Unadjusted post-LVAD survival was reduced in those with a malignancy history (2-year survival 53.4% vs 66.9%; P = .01), a finding that persisted after risk-adjustment (hazard ratio 1.89, 95% confidence interval, 1.13-3.14; P = .01). Only one (2.7%) patient died post-LVAD from their cancer. CONCLUSIONS Although a history of malignancy is associated with reduced survival after LVAD implantation, more than half of the patients are alive at 2 years. This combined with the fact that most do not die from causes directly related to their cancer suggest that LVAD implantation is reasonable to perform in carefully selected patients with a history of malignancy.
Collapse
Affiliation(s)
- Yeahwa Hong
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laura Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gavin Hickey
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shangzhen Chen
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael A Mathier
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
4
|
Hong Y, Seese L, Hickey G, Mathier M, Thoma F, Kilic A. Preoperative prealbumin does not impact outcomes after left ventricular assist device implantation. J Card Surg 2020; 35:1029-1036. [PMID: 32237175 DOI: 10.1111/jocs.14522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This single-center, the retrospective study evaluates the impact of preoperative serum prealbumin levels on outcomes after left ventricular assist device (LVAD) implantation. METHODS Adults undergoing LVAD implantation, with a recorded preoperative prealbumin level, between 2004 to 2018 were included. Primary outcomes included rates of 1-year survival and secondary outcomes included rates of postimplant adverse events. Threshold regression and restricted cubic splines were utilized to identify a cut-point to dichotomize prealbumin level. Prealbumin was also evaluated as a continuous variable. Multivariable logistic regression was used for risk-adjustment. RESULTS A total of 333 patients were included. Patients were dichotomized according to an optimal prealbumin threshold of 15 mg/dL: 47.4% (n = 158) had levels below and 52.6% (n = 175) had levels above this threshold, respectively. The rates of postimplant adverse events, including bleeding, infection, stroke, renal failure, and right heart failure, were similar between the groups (all P > .05). Furthermore, the rates of cardiac transplantation and device explantation were also similar (all P > .05). Unadjusted survival was comparable between the groups at 30-days, 90-days, and 1-year following LVAD implantation (all P > .05). In addition, lower prealbumin did not impact risk-adjusted 1-year mortality when modeled either as a categorical (OR, 1.08; 95% CI, 0.48-2.12; P = .82) or continuous variable (OR, 1.99; 95% CI, 0.73-2.34; P = .96). CONCLUSIONS This study demonstrates that lower prealbumin levels were not predictive of increased post-LVAD morbidity or mortality. Although an established marker of nutritional and inflammatory status, the role of prealbumin in patient selection or prognostication appears limited in LVAD patients.
Collapse
Affiliation(s)
- Yeahwa Hong
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laura Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gavin Hickey
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael Mathier
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
5
|
Lerman DT, Hamilton KW, Byrne D, Lee DF, Zeitler K, Claridge T, Gray J, Minamoto GY. The impact of infection among left ventricular assist device recipients on post-transplantation outcomes: A retrospective review. Transpl Infect Dis 2018; 20:e12995. [PMID: 30199584 DOI: 10.1111/tid.12995] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/11/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Left ventricular assist device (LVAD) infections are common, and the consequences of LVAD infections on orthotopic heart transplantation (OHT) outcomes are not well described. AIMS The aim of this study was to describe clinical characteristics and evaluate risk factors for developing LVAD infections, and examine outcomes of LVAD-specific infections (VSI) after OHT. METHODS We retrospectively investigated the records of 74 consecutive patients at two institutions who had undergone LVAD placement and subsequent OHT between January 2007 and December 2012. RESULTS Forty-six of 74 (62%) LVAD recipients who underwent OHT had pre-transplant infections, and 18 (24%) had LVAD-specific infection (VSI), of which 71% were caused by gram-negative organisms. Of pre-transplant non-LVAD infections, Clostridium difficile infection (CDI) was the most common (26%) followed by urinary tract infection (UTI, 16%) and pneumonia (PNA 15%). Univariate analysis comparing subjects with VSI to those without VSI showed a significant association with time spent outside the hospital prior to transplantation (median 231.8 days vs 142.2 days, P < 0.03) and total time between VAD placement and OHT (244.0 days and 150.5 days, P < 0.002). Logistic regression was performed and significant predictors for VAD-related infection were age and the presence of diabetes, with type of device as an effect modifier. Six months post-OHT survival was not significantly affected by the presence of VSI prior to transplant. There was a trend toward an association between the presence of any infection and post-transplant rejection (P < 0.09). There were 10 post-transplant deaths by 6 months. Of these deaths, 4/10 (40%) were cardiopulmonary and 6/10 (60%) were related to infections. CONCLUSIONS Advanced age and presence of diabetes were predictors of VSI, as well as type of VAD device, although device choice is likely affected by many clinical factors including age and comorbidities, as well as institution-specific preferences. VSI was not associated with a decrease in 6-month post-OHT survival. However, infections remain the major causes of death by 6 months post-transplant. Certain infections are associated with an increased risk of rejection, which merits further investigation.
Collapse
Affiliation(s)
- Dana T Lerman
- Departments of Medicine, Division of Infectious Diseases at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Keith W Hamilton
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dana Byrne
- Cooper University Hospital, Camden, New Jersey
| | - Doreen F Lee
- Departments of Medicine, Division of Infectious Diseases at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Tamara Claridge
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jaime Gray
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace Y Minamoto
- Departments of Medicine, Division of Infectious Diseases at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
6
|
Verma S, Bassily E, Leighton S, Mhaskar R, Sunjic I, Martin A, Rihana N, Jarmi T, Bassil C. Renal Function and Outcomes With Use of Left Ventricular Assist Device Implantation and Inotropes in End-Stage Heart Failure: A Retrospective Single Center Study. J Clin Med Res 2017; 9:596-604. [PMID: 28611860 PMCID: PMC5458657 DOI: 10.14740/jocmr3039w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 12/29/2022] Open
Abstract
Background Left ventricular assist device (LVAD) and inotrope therapy serve as a bridge to transplant (BTT) or as destination therapy in patients who are not heart transplant candidates. End-stage heart failure patients often have impaired renal function, and renal outcomes after LVAD therapy versus inotrope therapy have not been evaluated. Methods In this study, 169 patients with continuous flow LVAD therapy and 20 patients with continuous intravenous inotrope therapy were analyzed. The two groups were evaluated at baseline and at 3 and 6 months after LVAD or inotrope therapy was started. The incidence of acute kidney injury (AKI), need for renal replacement therapy (RRT), BTT rate, and mortality for 6 months following LVAD or inotrope therapy were studied. Results between the groups were compared using Mann-Whitney U test and Chi-square with continuity correction or Fischer’s exact at the significance level of 0.05. Results Mean glomerular filtration rate (GFR) was not statistically different between the two groups, with P = 0.471, 0.429, and 0.847 at baseline, 3 and 6 months, respectively. The incidence of AKI, RRT, and BTT was not statistically different. Mortality was less in the inotrope group (P < 0.001). Conclusion Intravenous inotrope therapy in end-stage heart failure patients is non-inferior for mortality, incidence of AKI, need for RRT, and renal function for 6-month follow-up when compared to LVAD therapy. Further studies are needed to compare the effectiveness of inotropes versus LVAD implantation on renal function and outcomes over a longer time period.
Collapse
Affiliation(s)
- Sean Verma
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Emmanuel Bassily
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Shane Leighton
- Center for Evidence Based Medicine and Health Outcomes Research, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Center for Evidence Based Medicine and Health Outcomes Research, University of South Florida, Tampa, FL, USA
| | - Igor Sunjic
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Angel Martin
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Nancy Rihana
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Tambi Jarmi
- Department of Nephrology and Hypertension, University of South Florida, Tampa, FL, USA
| | - Claude Bassil
- Department of Nephrology and Hypertension, University of South Florida, Tampa, FL, USA
| |
Collapse
|
7
|
Serum Brain Natriuretic Peptide Concentration 60 Days After Surgery as a Predictor of Long-Term Prognosis in Patients Implanted With a Left Ventricular Assist Device. ASAIO J 2016; 61:e36-9. [PMID: 26120957 PMCID: PMC4487874 DOI: 10.1097/mat.0000000000000237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mechanical circulatory support by a left ventricular assist device (LVAD) is used to bridge patients with advanced heart failure to transplant or as a definitive treatment. We retrospectively sought predictors of long-term outcome in a cohort of 83 patients who had undergone LVAD treatment. We subjected perioperative clinical data of patients to statistical analysis to establish parameters associated with all-cause mortality, and the cutoff values, sensitivity, and specificity of those that had a statistically significant relation with survival. Mean follow-up was 717 days (standard deviation, 334 days; range, 17-1,592 days). Fourteen patients (16.8%) died, but nine (10.8%) were weaned from support. Serum brain natriuretic peptide (BNP) concentration measured 60 days after implantation was significantly associated with all-cause mortality. The optimal BNP cutoff value to predict death during LVAD support was 322 pg/ml, with a sensitivity of 71.4% and specificity of 79.8%. Two-year survival was 92.0% in those with 60 days serum BNP concentration <322 pg/ml compared with 70.5% in those in whom it was ≥322 pg/ml (p = 0.003). The relation between BNP and survival likely reflects recovery of native myocardial function and improvements in global health and should assist clinicians in the on-going management of long-term LVAD therapy.
Collapse
|
8
|
Serum Brain Natriuretic Peptide Concentration 60 Days After Surgery as a Predictor of Long-Term Prognosis in Patients Implanted With a Left Ventricular Assist Device. ASAIO J 2015. [DOI: 10.1097/mat.0000000000000234] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
9
|
Morgan JA, Nemeh HW, Paone G. Should left ventricular assist devices be implanted in patients seventy years of age and older: a comparative analysis. Heart Surg Forum 2015; 17:E182-6. [PMID: 25179968 DOI: 10.1532/hsf98.2014386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and above and compared results to outcomes in LVAD recipients below seventy years of age. METHODS From March 2006 through June 2012, 130 patients underwent implantation of either a HeartMate II (HM II; Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Four patients underwent device exchanges and were excluded. Of the remaining 126 patients, 6 (4.7%) were ≥70 years of age. Patients in the age group ≥70 years were compared to the group of patients < 70 years for perioperative mortality, long-term survival and incidence of postoperative complications. RESULTS Mean age was 72.2 ± 2.3 (70-75) years for the older group and 52.8 ± 11.4 (18-69) years for the younger group (P < .001). There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, dialysis, hepatic function, preoperative ventilation or previous cardiac surgery between the groups (P = NS). There was no significant difference in survival between the groups, with survival at 6 months, 1 year, and 2 years of 100%, 100% and 66.7% respectively for the older groups, versus 88.6%, 81.3% and 76.7% for the younger group (P = .634). There was no significant difference in postoperative bleeding requiring re-exploration, driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding or readmissions within thirty days (P = NS). CONCLUSIONS These data demonstrate similar short- and long-term results for the two groups of recipients of LVAD implantation. RESULTS support the use of long-term mechanical circulatory support in carefully selected elderly patients.
Collapse
Affiliation(s)
- Jeffrey A Morgan
- Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Hassan W Nemeh
- Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
10
|
Texier G, Rhondali W, Meunier-Lafay E, Dellinger A, Gérard C, Morel V, Filbet M. [Palliative care for patients with heart failure]. Ann Cardiol Angeiol (Paris) 2014; 63:253-261. [PMID: 24485825 DOI: 10.1016/j.ancard.2014.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/04/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Heart failure is a common disease and its progression to end-stage heart failure is responsible of high mortality. The aim of this retrospective study was to assess the access to integrated palliative care to the usual management, 6 months prior to their death, and especially during the last hospitalization. PATIENTS AND METHODS A retrospective study was performed in patients who died of heart failure in 2009 in two hospitals. The analysis was performed on 20 cases of each institution. The records of consecutive patients were included in an anti-chronological order from 31st December 2009. RESULTS For their last hospitalization, 37 patients (93%) were hospitalized in emergency. Within 3 days prior to death, the most frequent symptoms were dyspnea (n=33, 82%), and pain (n=30, 75%). Therapeutic most frequently used were oxygen (n=31, 77%) and analgesics (n=30, 75%). No patient was seen by a psychologist. The decision to limit treatment for comfort care was reported for 24 patients (60%) and the median of the average time between the decision and death was 2 days (Q1-Q3, 1-5 days). CONCLUSION Patients with terminal heart failure have many symptoms often requiring multidisciplinary care. This type of study relating practices shows that there is still a lot to do to integrate palliative care in the usual management of patients with heart failure.
Collapse
Affiliation(s)
- G Texier
- Équipe mobile de soins palliatifs, Hôtel-Dieu, centre hospitalier de Pontchaillou, 35000 Rennes, France
| | - W Rhondali
- Centre de soins palliatifs Pavillon 1K, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, États-Unis; Laboratoire EA 4129, santé-individu-société, université Lyon-1, 69008 Lyon, France.
| | - E Meunier-Lafay
- Centre hospitalier William-Morey, 71100 Chalon-sur-Saône, France; Fondation Hôtel-Dieu du Creusot, 71200 Le Creusot, France
| | - A Dellinger
- Centre hospitalier William-Morey, 71100 Chalon-sur-Saône, France
| | - C Gérard
- Fondation Hôtel-Dieu du Creusot, 71200 Le Creusot, France
| | - V Morel
- Équipe mobile de soins palliatifs, Hôtel-Dieu, centre hospitalier de Pontchaillou, 35000 Rennes, France
| | - M Filbet
- Centre de soins palliatifs Pavillon 1K, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| |
Collapse
|
11
|
Kato TS, Kitada S, Yang J, Wu C, Takayama H, Naka Y, Farr M, Mancini DM, Schulze PC. Relation of preoperative serum albumin levels to survival in patients undergoing left ventricular assist device implantation. Am J Cardiol 2013; 112:1484-8. [PMID: 23891248 DOI: 10.1016/j.amjcard.2013.06.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 06/16/2013] [Accepted: 06/16/2013] [Indexed: 01/09/2023]
Abstract
Hypoalbuminemia has been recognized as a prognostic indicator in patients with heart failure. We aimed to investigate the association of hypoalbuminemia with postoperative mortality in patients undergoing left ventricular assist device (LVAD) implantation. We studied 272 consecutive patients undergoing LVAD implantation from 2000 to 2010 at our institution. Preoperative clinical characteristics and laboratory variables associated with mortality were analyzed. Postoperative survival of patients with preoperative hypoalbuminemia (<3.5 g/dl, n = 125) and those with normal albumin concentration (≥3.5 g/dl, n = 147) was compared. Survival after LVAD surgery was better in patients with normal albumin levels compared with those with hypoalbuminemia before surgery (3 and 12 months: 93.2% vs 82.4% and 88.4% vs 75.2%, respectively, p <0.001). Multivariate analysis revealed that preoperative albumin was independently associated with mortality after LVAD implantation (hazard ratio 0.521, 95% confidence interval 0.290 to 0.934; p = 0.029.) Furthermore, the impact of normalization of albumin levels during LVAD support on postoperative survival was analyzed in both groups. Subgroup analysis of patients with preoperative hypoalbuminemia and postoperative normalization of albumin levels (n = 81) showed improved survival compared with those who remained hypoalbuminemia (n = 44) or those who had decreasing albumin levels during LVAD support (n = 40; 3-month survival: 92.6% vs 63.6% and 65.0%; p <0.01). In conclusion, preoperative hypoalbuminemia is associated with poor prognosis after LVAD surgery. Postoperative normalization of albumin level is associated with improved survival. Attention to albumin levels by correcting nutrition, inflammation, and hepatic function could be an effective way to improve prognosis in patients evaluated for LVAD implantation.
Collapse
Affiliation(s)
- Tomoko S Kato
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Pulsatile vs. continuous flow in ventricular assist device therapy. Best Pract Res Clin Anaesthesiol 2013; 26:105-15. [PMID: 22910084 DOI: 10.1016/j.bpa.2012.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/14/2012] [Indexed: 12/15/2022]
Abstract
A left ventricular assist device (LVAD) is an important treatment option for a patient with end-stage heart failure. Both continuous and non-pulsatile devices are available, each with different effects on a patient's physiology. In general, these effects are not clinically significant with the exception of bleeding events which are more common with continuous-flow devices in some series. Both devices increase survival beyond medical management. Continuous-flow devices are smaller and are associated with less overall morbidity than pulsatile devices.
Collapse
|
13
|
Montgomery TD, Cohen AE, Garnick J, Spadafore J, Boldea E. Nutrition Assessment, Care, and Considerations of Ventricular Assist Device Patients. Nutr Clin Pract 2012; 27:352-62. [DOI: 10.1177/0884533612444537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
14
|
|
15
|
Adamson RM, Stahovich M, Chillcott S, Baradarian S, Chammas J, Jaski B, Hoagland P, Dembitsky W. Clinical strategies and outcomes in advanced heart failure patients older than 70 years of age receiving the HeartMate II left ventricular assist device: a community hospital experience. J Am Coll Cardiol 2011; 57:2487-95. [PMID: 21679851 DOI: 10.1016/j.jacc.2011.01.043] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 01/06/2011] [Accepted: 01/06/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The primary objective of this study was to determine outcomes in left ventricular assist device (LVAD) patients older than age 70 years. BACKGROUND Food and Drug Administration approval of the HeartMate II (Thoratec Corporation, Pleasanton, California) LVAD for destination therapy has provided an attractive option for older patients with advanced heart failure. METHODS Fifty-five patients received the HeartMate II LVAD between October 5, 2005, and January 1, 2010, as part of either the bridge to transplantation or destination therapy trials at a community hospital. Patients were divided into 2 age groups: ≥ 70 years of age (n = 30) and < 70 years of age (n = 25). Outcome measures including survival, length of hospital stay, adverse events, and quality of life were compared between the 2 groups. RESULTS Pre-operatively, all patients were in New York Heart Association functional class IV refractory to maximal medical therapy. Kaplan-Meier survival for patients ≥ 70 years of age (97% at 1 month, 75% at 1 year, and 70% at 2 years) was not statistically different from patients <7 0 years of age (96% 1 month, 72% at 1 year, and 65% at 2 years, p = 0.806). Average length of hospital stay for the ≥ 70-year age group was 24 ± 15 days, similar to that of the < 70-year age group (23 ± 14 days, p = 0.805). There were no differences in the incidence of adverse events between the 2 groups. Quality of life and functional status improved significantly in both groups. CONCLUSIONS The LVAD patients ≥ 70 years of age have good functional recovery, survival, and quality of life at 2 years. Advanced age should not be used as an independent contraindication when selecting a patient for LVAD therapy at experienced centers.
Collapse
|
16
|
Affiliation(s)
- Deborah J Kozik
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
| | | |
Collapse
|
17
|
New prioritization of heart transplant candidates on mechanical circulatory support in an era of severe donor shortage. J Heart Lung Transplant 2010; 29:989-96. [PMID: 20570532 DOI: 10.1016/j.healun.2010.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 04/06/2010] [Accepted: 05/01/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Nearly all patients receiving heart transplantation (HTx) in Germany are now those listed in urgent status. In this study we review urgency-based allocation policy for HTx candidates with ventricular assist devices (VADs). METHODS We retrospectively studied 345 adult candidates for de novo HTx. Group U (n = 160) comprised patients primarily listed in urgent status without VAD. Group VAD-45 (n = 167) comprised patients with intended bridging to HTx who survived >45 days after VAD implantation (after initial drop in survival rates). Among these patients, those who died of stroke or were awarded urgent status due to difficulties of coagulation management (thrombus formation, thromboembolism and bleeding) in the first year after VAD implantation were assigned to Group COAG (n = 36), and those who died or were awarded urgent status due to device-related infection in the same period were assigned to Group INF (n = 31). Actuarial survival rates were studied in each group. RESULTS Survival rates during support in Group VAD-45 were comparable to those during urgent status in Group U. Bridge-to-transplant rate was 63.9% in Group COAG and 58.1% in Group INF. The post-transplant 3-year survival rate of 85.3% in Group COAG was significantly higher than that in Group INF (46.8%, p < 0.01) and Group U (62.4%, p < 0.05). CONCLUSIONS Patients who have a VAD for >45 days should be awarded some priority for urgent HTx, which is currently prohibited in Germany. Patients listed in urgent status due to difficulties of coagulation management should be prioritized over those listed for device-related infection to make effective use of limited resources.
Collapse
|
18
|
Yang N, Deutsch S, Paterson EG, Manning KB. Numerical Study of Blood Flow at the End-to-Side Anastomosis of a Left Ventricular Assist Device for Adult Patients. J Biomech Eng 2009; 131:111005. [PMID: 20353256 DOI: 10.1115/1.3212114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We use an implicit large eddy simulation (ILES) method based on a finite volume approach to capture the turbulence in the anastomoses of a left ventricular assist device (LVAD) to the aorta. The order-of-accuracy of the numerical schemes is computed using a two-dimensional decaying Taylor–Green vortex. The ILES method is carefully validated by comparing to documented results for a fully developed turbulent channel flow at Reτ=395. Two different anastomotic flows (proximal and distal) are simulated for 50% and 100% LVAD supports and the results are compared with a healthy aortic flow. All the analyses are based on a planar aortic model under steady inflow conditions for simplification. Our results reveal that the outflow cannulae induce high exit jet flows in the aorta, resulting in turbulent flow. The distal configuration causes more turbulence in the aorta than the proximal configuration. The turbulence, however, may not cause any hemolysis due to low Reynolds stresses and relatively large Kolmogorov length scales compared with red blood cells. The LVAD support causes an acute increase in flow splitting in the major branch vessels for both anastomotic configurations, although its long-term effect on the flow splitting remains unknown. A large increase in wall shear stress is found near the cannulation sites during the LVAD support. This work builds a foundation for more physiologically realistic simulations under pulsatile flow conditions.
Collapse
Affiliation(s)
- Ning Yang
- Department of Bioengineering, Pennsylvania State University, University Park, PA 16802
| | - Steven Deutsch
- Applied Research Laboratory and Department of Bioengineering, Pennsylvania State University, University Park, PA 16802
| | - Eric G. Paterson
- Applied Research Laboratory and Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16802
| | - Keefe B. Manning
- Department of Bioengineering, Pennsylvania State University, University Park, PA 16802
| |
Collapse
|
19
|
Spillner J, Kopp R, Finocchiaro T, Behbahani M, Rossaint R, Steinseifer U, Behr M, Autschbach R. [Assisted circulation: an overview from a clinical perspective]. BIOMED ENG-BIOMED TE 2009; 54:255-67. [PMID: 19807289 DOI: 10.1515/bmt.2009.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A higher grade cardiac failure is associated with poor prognosis. In addition to medical conservative treatment and traditional cardiac surgery, in the past years different forms of an assisted circulation evolved. Short-term devices serve to bridge an acute life-threatening situation. The chosen system is dependent on the anticipated clinical course. It is possible to fall back on slightly assisting techniques up to a complete takeover of the cardiac pump function. In the case of severe cardiac failure, the question for transplantation has to be addressed because transplantation is the treatment of choice to date. For an assisted circulation in cases of chronic congestive failure, devices of different generations are available. First generation pulsatile systems are used for assistance of the left ventricle and results have been shown to be superior to medical therapy (REMATCH). With second generation continuous-flow systems, results regarding infections, thromboembolism and also quality of life appear to be further improved. Contact-free centrifugal pumps as third generation systems are in clinical evaluation. So-called "total artificial hearts" are successfully used for bridge-to-transplantation. Taken together, a graded safe treatment of cardiac failure is available today. In the near future, it could be possible to reach results similar to those of cardiac transplantation.
Collapse
Affiliation(s)
- Jan Spillner
- Klinik für Thorax-, Herz- und Gefässchirurgie, Universitätsklinikum RWTH Aachen, Aachen, Deutschland.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Alba AC, Rao V, Ivanov J, Ross HJ, Delgado DH. Usefulness of the INTERMACS Scale to Predict Outcomes After Mechanical Assist Device Implantation. J Heart Lung Transplant 2009; 28:827-33. [DOI: 10.1016/j.healun.2009.04.033] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 03/18/2009] [Accepted: 04/01/2009] [Indexed: 12/01/2022] Open
|
21
|
Who should be delisted from urgent heart transplantation in Germany? ASAIO J 2009; 55:452-5. [PMID: 19625953 DOI: 10.1097/mat.0b013e3181ac646c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
When German heart transplant candidates receive a ventricular assist device (VAD), the indication for Eurotransplant urgency listing is no longer given unless assist device complications occur. We studied survival rates in these patients and compared them with those of patients with urgency listing. The study cohort consists of 377 heart transplant candidates who were listed in urgent status or received a VAD in our center between 2000 and 2007. We defined the following patient groups: group U (n = 193), patients listed in urgent status primarily; group VADinT (n = 219), patients actively listed without urgency (transplantable) after VAD implantation, and group VADinU (n = 99), patients listed in urgent status after VAD implantation. The survival rates during urgent status in groups U and VADinU and those during VAD support without urgency listing in group VADinT were studied. The survival curves of groups U and VADinU were similar, and 1-month survival rates were 97.7% and 95.9%, respectively. One-month survival rate in group VADinT (85.9%) was worse than in group U (p < 0.0001). Survival rates in patients in urgent status both with and without VAD are satisfactory. However, patients with a VAD in "transplantable" status should be rescued under an urgency-based resource allocation algorithm.
Collapse
|
22
|
Aissaoui N, Diebold B, Fagon JY, Leprince P. Is the Thoratec paracorporeal ventricular assist device a primary or secondary device to support patients with refractory cardiogenic shock? Arch Cardiovasc Dis 2009; 102:473-5. [PMID: 19664566 DOI: 10.1016/j.acvd.2009.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 06/05/2009] [Indexed: 11/29/2022]
|
23
|
Sandner SE, Zimpfer D, Zrunek P, Rajek A, Schima H, Dunkler D, Grimm M, Wolner E, Wieselthaler GM. Renal function and outcome after continuous flow left ventricular assist device implantation. Ann Thorac Surg 2009; 87:1072-8. [PMID: 19324130 DOI: 10.1016/j.athoracsur.2009.01.022] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 01/03/2009] [Accepted: 01/06/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Renal dysfunction as a risk factor with the use of left ventricular assist devices (LVAD) is controversial. We determined the effect of renal function on outcomes after continuous flow LVAD implantation. METHODS Eighty-six patients with advanced heart failure undergoing continuous flow LVAD implantation as bridge to transplantation from November 1998 to July 2007 were retrospectively analyzed. Renal function was assessed using the Modification of Diet in Renal Disease study-derived glomerular filtration rates (GFR [mL x min(-1) x 1.73 m(-2)]). Patients were categorized into two groups based on pre-LVAD GFR: those with normal renal function (GFR > 60, n = 46), and those with renal dysfunction (GFR < 60, n = 40). RESULTS Post-LVAD survival at 1, 3, and 6 months for GFR greater than 60 was 91.3%, 79.9%, 72.6%, respectively, and for GFR less than 60, it was 92.5%, 66.5%, 47.9%, respectively (p = 0.038). Bridge-to-transplant rate was lower for GFR less than 60 than for GFR greater than 60 (40.0% versus 63.0%, p = 0.033). For GFR less than 60, GFR improved on LVAD support: implant to month 6, 41.7 +/- 11.5 to 62.7 +/- 25.0 (p = 0.021). Post-LVAD survival was improved in GFR less than 60 patients who after LVAD implantation recovered renal function to GFR greater than 60 (p < 0.001). Patients with post-LVAD renal failure had significantly lower post-LVAD survival regardless of pre-LVAD renal function (p < 0.001). CONCLUSIONS Patients with renal dysfunction have poorer outcomes after continuous flow LVAD implantation. However, renal function improves after LVAD implantation and is associated with improved survival. Our data underscore the importance of end-organ function in patient selection for LVAD therapy.
Collapse
Affiliation(s)
- Sigrid E Sandner
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Sandner SE, Zimpfer D, Zrunek P, Rajek A, Schima H, Dunkler D, Zuckermann AO, Wieselthaler GM. Age and Outcome After Continuous-Flow Left Ventricular Assist Device Implantation as Bridge to Transplantation. J Heart Lung Transplant 2009; 28:367-72. [DOI: 10.1016/j.healun.2009.01.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 11/01/2008] [Accepted: 01/14/2009] [Indexed: 11/28/2022] Open
|
25
|
Campos Rubio V. Criterios hemodinámicos y funcionales de indicación de una asistencia en la insuficiencia cardíaca aguda (shock cardiogénico). CIRUGIA CARDIOVASCULAR 2009. [DOI: 10.1016/s1134-0096(09)70153-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
26
|
Right Heart Dysfunction After Left Ventricular Assist Device Implantation: A Comparison of the Pulsatile HeartMate I and Axial-Flow HeartMate II Devices. Ann Thorac Surg 2008; 86:832-40; discussion 832-40. [DOI: 10.1016/j.athoracsur.2008.05.016] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 04/30/2008] [Accepted: 05/05/2008] [Indexed: 11/23/2022]
|
27
|
Emergency use of wearable left ventricular assist devices in patients not eligible for heart transplantation. Transplant Proc 2008; 40:1993-5. [PMID: 18675110 DOI: 10.1016/j.transproceed.2008.05.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We reviewed our experience concerning the clinical outcomes of emergency implantation of left ventricular assist devices (LVAD) in patients not eligible for heart transplantation (HTX). PATIENTS AND METHODS Between January 1998 and September 2006, 62 patients were referred for emergency HTX including 35 (55%) who received cardiac allografts; 9 (14%) died on the waiting list. The other 18 subjects (31%) did not meet listing criteria due to pulmonary hypertension with massive transpulmonary gradients (TPG), severe diabetes, or another factor; 7 patients had wearable LVAD implants and the remaining 11 who had contraindications both to HTX and to LVAD implantation remained on medical therapy. RESULTS Twelve month actuarial survivals were 47% in LVAD G1 vs 1% in medical therapy G2 (P< .005). Four G1 patients died either due to cerebrovascular vascular episodes or to thromboembolic events. The beneficial use of LVAD in 3 patients led to consistent improvement in hemodynamic performance allowing listing for HTX. Two of them have been successfully transplanted; 1 is still waiting. Due to refractory heart failure, 90% of G2 died within the first months after evaluation. CONCLUSION Our limited experience indicated that emergency use of LVAD ensued a satisfactory outcome allowing better actuarial survival.
Collapse
|
28
|
Cooper BT, Roszelle BN, Long TC, Deutsch S, Manning KB. The 12cc Penn State Pulsatile Pediatric Ventricular Assist Device: Fluid Dynamics Associated With Valve Selection. J Biomech Eng 2008; 130:041019. [DOI: 10.1115/1.2939342] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The mortality rate for infants awaiting a heart transplant is 40% because of the extremely limited number of donor organs. Ventricular assist devices (VADs), a common bridge-to-transplant solution in adults, are becoming a viable option for pediatric patients. A major obstacle faced by VAD designers is thromboembolism. Previous studies have shown that the interrelated flow characteristics necessary for the prevention of thrombosis in a pulsatile VAD are a strong inlet jet, a late diastolic recirculating flow, and a wall shear rate greater than 500s−1. Particle image velocimetry was used to compare the flow fields in the chamber of the 12cc Penn State pediatric pulsatile VAD using two mechanical heart valves: Björk–Shiley monostrut (BSM) tilting disk valves and CarboMedics (CM) bileaflet valves. In conjunction with the flow evaluation, wall shear data were calculated and analyzed to help quantify wall washing. The major orifice inlet jet of the device containing BSM valves was more intense, which led to better recirculation and wall washing than the three jets produced by the CM valves. Regurgitation through the CM valve served as a significant hindrance to the development of the rotational flow.
Collapse
Affiliation(s)
- Benjamin T. Cooper
- Department of Bioengineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA 16802
| | - Breigh N. Roszelle
- Department of Bioengineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA 16802
| | - Tobias C. Long
- Department of Bioengineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA 16802
| | - Steven Deutsch
- Department of Bioengineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA 16802
| | - Keefe B. Manning
- Department of Bioengineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA 16802
| |
Collapse
|
29
|
The 12 cc Penn State Pulsatile Pediatric Ventricular Assist Device: Flow Field Observations at a Reduced Beat Rate With Application to Weaning. ASAIO J 2008; 54:325-31. [DOI: 10.1097/mat.0b013e3181695cfe] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
30
|
Eshelman AK, Mason S, Nemeh H, Williams C. LVAD destination therapy: applying what we know about psychiatric evaluation and management from cardiac failure and transplant. Heart Fail Rev 2008; 14:21-8. [DOI: 10.1007/s10741-007-9075-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 11/28/2007] [Indexed: 01/08/2023]
|
31
|
von Bayern MP, Cadeiras M, Deng MC. Destination therapy: does progress depend on left ventricular assist device development? Heart Fail Clin 2007; 3:349-67. [PMID: 17723941 DOI: 10.1016/j.hfc.2007.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The role of therapy using mechanical circulatory support devices has evolved rapidly over the last two decades. New developments in the field achieved smaller adverse events, but, currently, only minor improvements in survival were observed in published observational data. The authors discuss the development of mechanical circulatory support devices as a "destination therapy" option for patients who have end-stage heart failure and are ineligible for heart transplantation as it relates to left ventricular assist device development.
Collapse
|
32
|
Fundarò P, Fundarò C. Left ventricular remodelling and outcomes after surgery: pathophysiological insights for a modern surgical approach to ischaemic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2007; 7:781-4. [PMID: 17060802 DOI: 10.2459/01.jcm.0000250864.48283.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
33
|
Ashraf O. Left ventricular assist device in heart failure. J Thorac Cardiovasc Surg 2006; 131:1211-2; author reply 1212. [PMID: 16678632 DOI: 10.1016/j.jtcvs.2005.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 12/06/2005] [Accepted: 12/12/2005] [Indexed: 11/23/2022]
|
34
|
Reply to the Editor. J Thorac Cardiovasc Surg 2006. [DOI: 10.1016/j.jtcvs.2006.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|