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Bounader K, Flécher E. End-stage heart failure: The future of heart transplant and artificial heart. Presse Med 2024; 53:104191. [PMID: 37898310 DOI: 10.1016/j.lpm.2023.104191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/10/2023] [Accepted: 10/02/2023] [Indexed: 10/30/2023] Open
Abstract
In the last decades, outcomes significantly improved for both heart transplantation and LVAD. Heart transplantation remains the gold standard for the treatment of end stage heart failure and will remain for many years to come. The most relevant limitations are the lack of grafts and the effects of long-term immunosuppressive therapy that involve infectious, cancerous and metabolic complications despite advances in immunosuppression management. Mechanical circulatory support has an irreplaceable role in the treatment of end-staged heart failure, as bridge to transplant or as definitive implantation in non-transplant candidates. Although clinical results do not overcome those of HTx, improvement in the new generation of devices may help to reach the equipoise between the two therapies. This review will go through the evolution, current status and perspectives of both therapeutics.
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Affiliation(s)
- Karl Bounader
- Department of Cardiac Surgery, La Pitié Sâlpétrière Charles Foix Hospital, Paris, France
| | - Erwan Flécher
- Department of Vascular and Cardio-Thoracic Surgery, Rennes University Hospital, Rennes, France.
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Pearman M, Emmanuel S, Jansz P, Watson A, Connellan M, Iyer A, Barua S, Hayward CS. Comparing left ventricular assist device inflow cannula angle between median sternotomy and thoracotomy using 3D reconstructions. Artif Organs 2022. [PMID: 36582131 DOI: 10.1111/aor.14492] [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: 08/28/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation via thoracotomy has many potential advantages compared to conventional sternotomy, including improved inflow cannula (IFC) positioning. We compared the difference in IFC angles, postoperative, and long-term outcomes for patients with LVADs implanted via thoracotomy and sternotomy. METHODS A single-center, retrospective analysis of 14 patients who underwent thoracotomy implantation was performed and matched with 28 patients who underwent sternotomy LVAD implantations for a total of 42 patients. Inclusion required a minimum LVAD support duration of 30 days and excluded concomitant procedures. A postoperative CT-chest was used to measure the angle the between the IFC and mitral valve in two-dimensions and results were compared with three-dimensional reconstruction using the same CT chest. Outcome data were extracted from medical records. RESULTS There was no significant difference in gender, INTERMACS score, BMI, or age between the two groups. Median cardiopulmonary bypass time was longer in the thoracotomy group compared to the sternotomy group, 107 min (86-122) versus 76 min (56-93), p < 0.01. 3D reconstructions revealed less deviation of the IFC away from the mitral valve in devices implanted via thoracotomy compared to sternotomy, median (IQR) angle 16.3° (13.9°-21.0°) versus 23.2° (17.9°-26.4°), p < 0.01. Rates of pump thrombosis, stroke, and gastrointestinal bleeding were not significantly different. CONCLUSIONS Devices implanted via thoracotomy demonstrated less deviation away from mitral valve. However, there was no difference in morbidity between the two approaches. 3D reconstruction of the heart is an innovative technique to measure angulation and is clinically advantageous when compared to 2D imaging.
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Affiliation(s)
- Madeleine Pearman
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, Chippendale, New South Wales, Australia
| | - Sam Emmanuel
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, Chippendale, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, Kensington, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Paul Jansz
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, Chippendale, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, Kensington, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Alasdair Watson
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia
| | - Mark Connellan
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia
| | - Arjun Iyer
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia
| | - Sumita Barua
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, Kensington, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - Christopher Simon Hayward
- St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, Kensington, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
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Schreiber C, Dieterlen MT, Garbade J, Borger MA, Sieg F, Spampinato R, Dobrovie M, Meyer AL. Validation of mitral regurgitation reversibility in patients with HeartMate 3 implantation. Artif Organs 2021; 46:106-116. [PMID: 34398476 DOI: 10.1111/aor.14053] [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: 01/20/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/27/2022]
Abstract
The resolution of functional mitral valve regurgitation (MR) in patients awaiting left ventricular assist device (LVAD) implantation is discussed controversially. The present study analyzed MR and echocardiographic parameters of the third-generation LVAD HeartMate 3 (HM3) over 3 years. Of 135 LVAD patients (with severe MR, n = 33; with none, mild, or moderate MR, n = 102), data of transthoracic echocardiography were included preoperatively to LVAD implantation, up to 1 month postoperatively, and at 1, 2, and 3 years after LVAD implantation. Demographic data and clinical characteristics were collected. Severe MR was reduced immediately after LVAD implantation in all patients. The echocardiographic parameters left ventricular end-diastolic diameter (P < .001), right ventricular end-diastolic diameter (P < .001), tricuspid annular plane systolic excursion (P < .001), and estimated pulmonary artery pressure (P < .001) decreased after HM3 implantation independently from the grade of MR prior to implantation and remained low during the 2 years follow-up period. Following LVAD implantation, right heart failure, ventricular arrhythmias, ischemic stroke as well as pump thrombosis and bleeding events were comparable between the groups. The incidences of death and cardiac death did not differ between the patient groups. Furthermore, the Kaplan-Meier analysis showed that survival was comparable between the groups (P = .073). HM3 implantation decreases preoperative severe MR immediately after LVAD implantation. This effect is long-lasting in most patients and reinforces the LVAD implantation without MR surgery. The complication rates and survival were comparable between patients with and without severe MR.
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Affiliation(s)
- Constantin Schreiber
- Heart Center, HELIOS Clinic, Clinic of Cardiac Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- Heart Center, HELIOS Clinic, Clinic of Cardiac Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Jens Garbade
- Heart Center, HELIOS Clinic, Clinic of Cardiac Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Michael A Borger
- Heart Center, HELIOS Clinic, Clinic of Cardiac Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Franz Sieg
- Heart Center, HELIOS Clinic, Clinic of Cardiac Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Ricardo Spampinato
- Heart Center, HELIOS Clinic, Clinic of Cardiac Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Monica Dobrovie
- Heart Center, HELIOS Clinic, Clinic of Cardiac Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Anna L Meyer
- Department of Cardiac Surgery, University Hospital, Heidelberg, Germany
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