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Załucka L, Świerżyńska E, Orczykowski M, Dutkowski K, Szymański J, Kuriata J, Dąbrowski R, Kołsut P, Szumowski Ł, Sterliński M. Ventricular Arrhythmias in Left Ventricular Assist Device Patients-Current Diagnostic and Therapeutic Considerations. SENSORS (BASEL, SWITZERLAND) 2024; 24:1124. [PMID: 38400282 PMCID: PMC10893394 DOI: 10.3390/s24041124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Left ventricular assist devices (LVAD) are used in the treatment of advanced left ventricular heart failure. LVAD can serve as a bridge to orthotopic heart transplantation or as a destination therapy in cases where orthotopic heart transplantation is contraindicated. Ventricular arrhythmias are frequently observed in patients with LVAD. This problem is further compounded as a result of diagnostic difficulties arising from presently available electrocardiographic methods. Due to artifacts from LVAD-generated electromagnetic fields, it can be challenging to assess the origin of arrhythmias in standard ECG tracings. In this article, we will review and discuss common mechanisms, diagnostics methods, and therapeutic strategies for ventricular arrhythmia treatment, as well as numerous problems we face in LVAD implant patients.
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Affiliation(s)
- Laura Załucka
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Ewa Świerżyńska
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 61 Zwirki I Wigury Street, 02-091 Warsaw, Poland
| | - Michał Orczykowski
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Krzysztof Dutkowski
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Jarosław Szymański
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Jarosław Kuriata
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Rafał Dąbrowski
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Piotr Kołsut
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Łukasz Szumowski
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Maciej Sterliński
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
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Performance of the Jarvik 2000 left ventricular assist device on mid-term hemodynamics and exercise capacity. J Artif Organs 2021; 25:204-213. [PMID: 34826019 DOI: 10.1007/s10047-021-01302-3] [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: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
The hemodynamic and exercise capacity performance of the Jarvik 2000 left ventricular assist device (LVAD), which is generally used in patients with small body size and relatively preserved cardiac function, is not well understood. We retrospectively examined 18 patients implanted with the Jarvik 2000 LVAD. Pump rotation speed was optimized by the hemodynamic ramp test one year after implantation based on the criteria of mean pulmonary capillary wedge pressure (PCWP) < 18 mmHg, mean right atrial pressure (RAP) < 12 mmHg, and cardiac index (CI) > 2.2 L/min/m2 as well as echocardiographic parameters. Exercise capacity was assessed by cardiopulmonary exercise test in an optimized setting. To investigate the impacts of larger body surface area (BSA) and extremely impaired pre-implantation cardiac function on hemodynamics and exercise capacity, two correlation analyses based on BSA and original CI were performed. At a pump speed of 9500 ± 707 rpm, the mean pulmonary artery pressure, PCWP, RAP, and CI were 17 ± 5 mmHg, 9 ± 5 mmHg, 6 ± 4 mmHg, and 2.82 ± 0.54 L/min/m2, respectively. Only one patient failed to achieve the hemodynamic criteria. The peak VO2 and VE/VCO2 slope were 12.9 ± 3.1 mL/min/kg and 37.7 ± 15.0, respectively. There was an inverse correlation between original CI and heart rate (r = -0.60, p = 0.01), and a weak correlation between BSA and PCWP (r = 0.43, p = 0.08). Based on this study, the overall performance of the Jarvik 2000 device was acceptable, and the patients' body size and original cardiac function had minimum effect on the performance of this device.
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In Vitro Benchmarking Study of Ventricular Assist Devices in Current Clinical Use. J Card Fail 2020; 26:70-79. [DOI: 10.1016/j.cardfail.2019.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 01/26/2023]
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4
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Left Ventricular Hemodynamics with an Implanted Assist Device: An In Vitro Fluid Dynamics Study. Ann Biomed Eng 2019; 47:1799-1814. [DOI: 10.1007/s10439-019-02273-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/12/2019] [Indexed: 10/27/2022]
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New methodologies to accurately assess circulating active transforming growth factor-β1 levels: implications for evaluating heart failure and the impact of left ventricular assist devices. Transl Res 2018; 192:15-29. [PMID: 29175264 PMCID: PMC5811316 DOI: 10.1016/j.trsl.2017.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 02/08/2023]
Abstract
Transforming growth factor-β1 (TGF-β1) has been used as a biomarker in disorders associated with pathologic fibrosis. However, plasma TGF-β1 assessment is confounded by the significant variation in reported normal values, likely reflecting variable release of the large pool of platelet TGF-β1 after blood drawing. Moreover, current assays measure only total TGF-β1, which is dominated by the latent form of TGF-β1 rather than the biologically active form. To address these challenges, we developed methodologies to prevent ex vivo release of TGF-β1 and to quantify active TGF-β1. We then used these techniques to measure TGF-β1 in healthy controls and patients with heart failure (HF) before and after insertion of left ventricular assist devices (LVAD). Total plasma TGF-β1 was 1.0 ± 0.60 ng/mL in controls and 3.76 ± 1.55 ng/mL in subjects with HF (P < 0.001), rising to 5.2 ± 2.3 ng/mL following LVAD placement (P = 0.006). These results were paralleled by the active TGF-β1 values; controls had 3-16 pg/mL active TGF-β1, whereas levels were 2.7-fold higher in patients with HF before, and 4.2-fold higher after, LVAD implantation. Total TGF-β1 correlated with levels of the platelet-derived protein thrombospondin-1 (r = 0.87; P < 0.001), suggesting that plasma TGF-β1 may serve as a surrogate indicator of in vivo platelet activation. von Willebrand factor high molecular weight multimers correlated inversely with TGF-β1 levels (r = -0.63; P = 0.023), suggesting a role for shear forces in loss of these multimers and platelet activation. In conclusion, accurate assessment of circulating TGF-β1 may provide a valuable biomarker for in vivo platelet activation and thrombotic disorders.
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Hosseinipour M, Gupta R, Bonnell M, Elahinia M. Rotary mechanical circulatory support systems. J Rehabil Assist Technol Eng 2017; 4:2055668317725994. [PMID: 31186935 PMCID: PMC6453075 DOI: 10.1177/2055668317725994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/20/2017] [Indexed: 12/25/2022] Open
Abstract
A detailed survey of the current trends and recent advances in rotary mechanical
circulatory support systems is presented in this paper. Rather than clinical reports, the
focus is on technological aspects of these rehabilitating devices as a reference for
engineers and biomedical researchers. Existing trends in flow regimes, flow control, and
bearing mechanisms are summarized. System specifications and applications of the most
prominent continuous-flow ventricular assistive devices are provided. Based on the flow
regime, pumps are categorized as axial flow, centrifugal flow, and mixed flow. Unique
characteristics of each system are unveiled through an examination of the structure,
bearing mechanism, impeller design, flow rate, and biocompatibility. A discussion on the
current limitations is provided to invite more studies and further improvements.
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Affiliation(s)
- Milad Hosseinipour
- Dynamic and Smart Systems Laboratory, The University of Toledo, Toledo, OH, USA.,Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Rajesh Gupta
- Cardiovascular Medicine Division, The University of Toledo Medical Center, Toledo, OH, USA
| | - Mark Bonnell
- Cardiothoracic Surgery Division, The University of Toledo Medical Center, Toledo, OH, USA
| | - Mohammad Elahinia
- Dynamic and Smart Systems Laboratory, The University of Toledo, Toledo, OH, USA
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Wedi E, Bounnah M, Memeo R, Jung C. Combined Endoscopic and Surgical Treatment of Severe Gastrointestinal Bleeding in a Patient with Heart Assist Device under Therapeutic Anticoagulation. Clin Endosc 2017; 50:598-601. [PMID: 28565729 PMCID: PMC5719906 DOI: 10.5946/ce.2017.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/16/2017] [Accepted: 03/30/2017] [Indexed: 11/14/2022] Open
Abstract
Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.
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Affiliation(s)
- Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, Göttingen University Hospital, Göttingen, Germany.,Department of Gastroenterology, Nouvel Hôpital Civil, University Hospitals, Strasbourg, France
| | - Mohamed Bounnah
- Medicine Department, Exploration and Digestive Endoscopy Unit, Public Hospital Establishment Mohamed Boudiaf, El Khroub, Algeria
| | - Riccardo Memeo
- Department of Surgery, Nouvel Hôpital Civil and IHU Strasbourg, University Hospitals, Strasbourg, France.,Hepatobiliary Unit, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Carlo Jung
- Department of Gastroenterology and Gastrointestinal Oncology, Göttingen University Hospital, Göttingen, Germany.,Department of Gastroenterology, Nouvel Hôpital Civil, University Hospitals, Strasbourg, France
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An Implantable Intravascular Pressure Sensor for a Ventricular Assist Device. MICROMACHINES 2016; 7:mi7080135. [PMID: 30404311 PMCID: PMC6190440 DOI: 10.3390/mi7080135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/04/2016] [Accepted: 07/29/2016] [Indexed: 11/16/2022]
Abstract
The aim of this study is to investigate the intravascular application of a micro-electro-mechanical system (MEMS) pressure sensor to directly measure the hemodynamic characteristics of a ventricular assist device (VAD). A bio- and hemo-compatible packaging strategy is implemented, based on a ceramic thick film process. A commercial sub-millimeter piezoresistive sensor is attached to an alumina substrate, and a double coating of polydimethylsiloxane (PDMS) and parylene-C is applied. The final size of the packaged device is 2.6 mm by 3.6 mm by 1.8 mm. A prototype electronic circuit for conditioning and read-out of the pressure signal is developed, satisfying the VAD-specific requirements of low power consumption (less than 14.5 mW in continuous mode) and small form factor. The packaged sensor has been submitted to extensive in vitro tests. The device displayed a temperature-independent sensitivity (12 μ V/V/mmHg) and good in vitro stability when exposed to the continuous flow of saline solution (less than 0.05 mmHg/day drift after 50 h). During in vivo validation, the transducer has been successfully used to record the arterial pressure waveform of a female sheep. A small, intravascular sensor to continuously register the blood pressure at the inflow and the outflow of a VAD is developed and successfully validated in vivo.
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Gastrointestinal Bleeding during Continuous-Flow Left Ventricular Assist Device Support is Associated with Lower Rates of Cardiac Transplantation. ASAIO J 2016; 61:635-9. [PMID: 26366686 DOI: 10.1097/mat.0000000000000279] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Gastrointestinal bleeding (GIB) remains a significant problem after continuous-flow left ventricular assist device (CF-LVAD) implantation. We hypothesized that the subsequent need for blood transfusions in patients with GIB may reduce rates of cardiac transplantation. We performed a retrospective review of 232 patients implanted with the HeartMate II (HM II) CF-LVAD from June 2005 through May 2013 at our center to determine risk factors for GIB and assess its effect on cardiac transplantation. Over a total LVAD follow-up time of 364 person-years, 62 GIB episodes occurred in 49 patients (27%), for an event rate of 0.45 gastrointestinal bleeds/patient-year of LVAD support. Women made up 15% of our cohort, yet contributed 29% of the GIB (p = 0.06). Survival at 6 month, 1 year, and 2 years was not statistically different in patients who developed GIB and those who did not (77% vs 78%, 74% vs 71%, and 61% vs 54%, respectively). In transplant-eligible patients, GIB was associated with a 27% lower rate of cardiac transplantation (rate ratio 0.73, p < 0.05). Although the mechanism behind this finding is unclear, GIB appears to be linked to higher transfusion rates, which may cause the development of subsequent allosensitization.
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Simulation of an Inlet Structure of an Implantable Axial Blood Pump. BIOMEDICAL ENGINEERING-MEDITSINSKAYA TEKNIKA 2016. [DOI: 10.1007/s10527-016-9578-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Bonacchi M, Harmelin G, Bugetti M, Sani G. Mechanical Ventricular Assistance as Destination Therapy for End-Stage Heart Failure: Has it Become a First Line Therapy? Front Surg 2015; 2:35. [PMID: 26284251 PMCID: PMC4523055 DOI: 10.3389/fsurg.2015.00035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/14/2015] [Indexed: 12/04/2022] Open
Abstract
Patients with end-stage heart failure have poor quality of life and prognosis. Therapeutic options are scarce and are not available for all. Only few patients can be transplanted every year. Several medical and surgical strategies have shown limited ability to influence prognosis and quality of life. In the past years, technological progress has realized devices capable of providing appropriate hemodynamic stabilization and recovery of secondary organ failure. Recently, these devices have been assessed as definitive treatment for patients who do not qualify for transplantation or/and instead to transplantation (“destination therapy”). This indication is increasingly considered following the results of newest clinical study reporting long-term survival without device correlated adverse events using last generation devices, and acceptable quality of life. The current knowledge about destination therapy and some original data from the DAVID Study (an Italian multicenter prospective study designed to evaluate the patient’s survival rate and quality of life of patients implanted with these new devices as long-term support or destination therapy) are summarized herein.
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Affiliation(s)
- Massimo Bonacchi
- Cardiac Surgery, Department of Experimental and Clinical Medicine, University of Florence , Florence , Italy
| | - Guy Harmelin
- Cardiac Surgery, Department of Experimental and Clinical Medicine, University of Florence , Florence , Italy
| | - Marco Bugetti
- Cardiac Surgery, Department of Experimental and Clinical Medicine, University of Florence , Florence , Italy
| | - Guido Sani
- Cardiac Surgery, Department of Experimental and Clinical Medicine, University of Florence , Florence , Italy
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Nguyen T, Argueta-Morales IR, Guimond S, Clark W, Ceballos A, Osorio R, Divo EA, De Campli WM, Kassab AJ. Computational analysis of pediatric ventricular assist device implantation to decrease cerebral particulate embolization. Comput Methods Biomech Biomed Engin 2015. [PMID: 26214744 DOI: 10.1080/10255842.2015.1062478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Stroke is the most devastating complication after ventricular assist device (VAD) implantation with a 19% incidence and 65% mortality in the pediatric population. Current pediatric VAD technology and anticoagulation strategies alone are suboptimal. VAD implantation assisted by computational methods (CFD) may contribute reducing the risk of cerebral embolization. Representative three-dimensional aortic arch models of an infant and a child were generated. An 8 mm VAD outflow-graft (VAD-OG) anastomosed to the aorta was rendered and CFD was applied to study blood flow patterns. Particle tracks, originating in the VAD, were computed with a Lagrangian phase model and the percentage of particles entering the cerebral vessels was calculated. Eight implantation configurations (infant = 5 and child = 3) and 5 particle sizes (0.5, 1, 2, 3, and 4 mm) were considered. For the infant model, percentage of particles entering the cerebral vessels ranged from 15% for a VAD-OG anastomosed at 90° to the aorta, to 31% for 30° VAD-OG anastomosis (overall percentages: X(2) = 10,852, p < 0.0001). For the child model, cerebral embolization ranged from 9% for the 30° VAD-OG anastomosis to 15% for the 60° anastomosis (overall percentages: χ(2) = 10,323, p < 0.0001). Using detailed CFD calculations, we demonstrate that the risk of stroke depends significantly on the VAD implantation geometry. In turn, the risk probably depends on patient-specific anatomy. CFD can be used to optimize VAD implantation geometry to minimize stroke risk.
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Affiliation(s)
- ThuyTien Nguyen
- a Department of Mechanical and Aerospace Engineering, College of Engineering and Computer Science, University of Central Florida , Orlando , FL , USA
| | - I Ricardo Argueta-Morales
- b The Heart Center, Cardiothoracic Surgery , Arnold Palmer Hospital for Children , Orlando , FL , USA
| | - Stephen Guimond
- a Department of Mechanical and Aerospace Engineering, College of Engineering and Computer Science, University of Central Florida , Orlando , FL , USA
| | - William Clark
- a Department of Mechanical and Aerospace Engineering, College of Engineering and Computer Science, University of Central Florida , Orlando , FL , USA
| | - Andres Ceballos
- a Department of Mechanical and Aerospace Engineering, College of Engineering and Computer Science, University of Central Florida , Orlando , FL , USA
| | - Ruben Osorio
- a Department of Mechanical and Aerospace Engineering, College of Engineering and Computer Science, University of Central Florida , Orlando , FL , USA
| | - Eduardo A Divo
- a Department of Mechanical and Aerospace Engineering, College of Engineering and Computer Science, University of Central Florida , Orlando , FL , USA.,c Department of Mechanical Engineering , Embry-Riddle Aeronautical University , Daytona Beach , FL , USA
| | - William M De Campli
- a Department of Mechanical and Aerospace Engineering, College of Engineering and Computer Science, University of Central Florida , Orlando , FL , USA.,b The Heart Center, Cardiothoracic Surgery , Arnold Palmer Hospital for Children , Orlando , FL , USA.,d College of Medicine , University of Central Florida , Orlando , FL , USA
| | - Alain J Kassab
- a Department of Mechanical and Aerospace Engineering, College of Engineering and Computer Science, University of Central Florida , Orlando , FL , USA
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Comparison Between Bench-Top and Computational Modelling of Cerebral Thromboembolism in Ventricular Assist Device Circulation. Cardiovasc Eng Technol 2015; 6:242-55. [DOI: 10.1007/s13239-015-0230-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
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Pozzi M, Giraud R, Tozzi P, Bendjelid K, Robin J, Meyer P, Obadia JF, Banfi C. Long-term continuous-flow left ventricular assist devices (LVAD) as bridge to heart transplantation. J Thorac Dis 2015; 7:532-42. [PMID: 25922736 DOI: 10.3978/j.issn.2072-1439.2015.01.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 11/12/2014] [Indexed: 12/24/2022]
Abstract
Heart transplantation (HTx) is the treatment of choice for end-stage heart failure but the limited availability of heart's donors still represents a major issue. So long-term mechanical circulatory support (MCS) has been proposed as an alternative treatment option to assist patients scheduled on HTx waiting list bridging them for a variable time period to cardiac transplantation-the so-called bridge-to-transplantation (BTT) strategy. Nowadays approximately 90% of patients being considered for MCS receive a left ventricular assist device (LVAD). In fact, LVAD experienced several improvements in the last decade and the predominance of continuous-flow over pulsatile-flow technology has been evident since 2008. The aim of the present report is to give an overview of continuous-flow LVAD utilization in the specific setting of the BTT strategy taking into consideration the most representative articles of the scientific literature and focusing the attention on the evolution, clinical outcomes, relevant implications on the HTx strategy and future perspectives of the continuous-flow LVAD technology.
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Affiliation(s)
- Matteo Pozzi
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Raphaël Giraud
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Piergiorgio Tozzi
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Karim Bendjelid
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Jacques Robin
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Philippe Meyer
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Jean François Obadia
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Carlo Banfi
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
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15
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Cheng A, Williamitis CA, Slaughter MS. Comparison of continuous-flow and pulsatile-flow left ventricular assist devices: is there an advantage to pulsatility? Ann Cardiothorac Surg 2014; 3:573-81. [PMID: 25512897 DOI: 10.3978/j.issn.2225-319x.2014.08.24] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Continuous-flow left ventricular assist devices (CFVAD) are currently the most widely used type of mechanical circulatory support as bridge-to-transplant and destination therapy for end-stage congestive heart failure (HF). Compared to the first generation pulsatile-flow left ventricular assist devices (PFVADs), CFVADs have demonstrated improved reliability and durability. However, CFVADs have also been associated with certain complications thought to be linked with decreased arterial pulsatility. Previous studies comparing CFVADs and PFVADs have presented conflicting results. It is important to understand the outcome differences between CFVAD and PFVAD in order to further advance the current VAD technology. METHODS In this review, we compared the outcomes of CFVADs and PFVADs and examined the need for arterial pulsatility for the future generation of mechanical circulatory support. RESULTS CVADs offer advantages of smaller size, increased reliability and durability, and subsequent improvements in survival. However, with the increasing duration of long-term support, it appears that CFVADs may have specific complications and a lower rate of left ventricular recovery associated with diminished pulsatility, increased pressure gradients on the aortic valve and decreased compliance in smaller arterial vessels. PFVAD support or pulsatility control algorithms in CFVADs could be beneficial and potentially necessary for long term support. CONCLUSIONS Given the relative advantages and disadvantages of CFVADs and PFVADs, the ultimate solution may lie in incorporating pulsatility into current and emerging CFVADs whilst retaining their existing benefits. Future studies examining physiologic responses, end-organ function and LV remodeling at varying degrees of pulsatility and device support levels are needed.
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Affiliation(s)
- Allen Cheng
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky 40202, USA
| | - Christine A Williamitis
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky 40202, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky 40202, USA
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16
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Derk G, Laks H, Biniwale R, Patel S, De LaCruz K, Mazor E, Williams R, Valdovinos J, Levi DS, Reardon L, Aboulhosn J. Novel techniques of mechanical circulatory support for the right heart and Fontan circulation. Int J Cardiol 2014; 176:828-32. [DOI: 10.1016/j.ijcard.2014.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/02/2014] [Indexed: 11/16/2022]
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17
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Holley CT, Harvey L, John R. Left ventricular assist devices as a bridge to cardiac transplantation. J Thorac Dis 2014; 6:1110-9. [PMID: 25132978 DOI: 10.3978/j.issn.2072-1439.2014.06.46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 06/30/2014] [Indexed: 11/14/2022]
Abstract
Heart failure remains a significant cause of morbidity and mortality, affecting over five million patients in the United States. Continuous-flow left ventricular assist devices (LVAD) have become the standard of care for patients with end stage heart failure. This review highlights the current state of LVAD as a bridge to transplant (BTT) in patients requiring mechanical circulatory support (MCS).
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Affiliation(s)
| | - Laura Harvey
- University of Minnesota Department of Surgery, Minneapolis, MN 55455, USA
| | - Ranjit John
- University of Minnesota Department of Surgery, Minneapolis, MN 55455, USA
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18
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Martinez SC, Fansler D, Lau J, Novak EL, Joseph SM, Kleiger RE. Characteristics of the electrocardiogram in patients with continuous-flow left ventricular assist devices. Ann Noninvasive Electrocardiol 2014; 20:62-8. [PMID: 25041228 DOI: 10.1111/anec.12181] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Electrocardiograms (ECGs) are routinely obtained in patients with advanced congestive heart failure (CHF) before and after surgical implantation with a left-ventricular assist device (LVAD). As the number of patients with CHF is increasing, it is necessary to characterize the changes present in the ECG of patients with LVADs. METHODS ECGs of 43 patients pre- and postimplantation of a HeartMate II LVAD were compared to characterize the presence of an LVAD using the following six criteria (LVADS2 ): low limb-lead voltage, ventricular pacing, artifact (electrical), duration of the QRS > 120 milliseconds, ST-elevation in the lateral leads, and splintering of the QRS complex. Additionally, 50 ECGs of non-LVAD patients coded as "lateral myocardial infarction (MI)" and 50 ECGs coded as "ventricular pacing" were chosen at random and scored. Odds ratios were calculated using Fisher's exact test. Logistic regression models were built to predict the presence of an LVAD in all patients. RESULTS Univariate analysis of the pre- and post-LVAD ECGs confirmed that all criteria except the "Duration of QRS > 120 milliseconds" characterized the ECG of a patient with an LVAD. Electrical artifact and low limb-lead voltage yielded the greatest association with an LVAD-ECG. CONCLUSIONS The ECG of a patient with end-stage CHF significantly changes with LVAD implantation. The LVADS2 criteria provide a framework towards characterizing and establishing a new baseline of the ECG in a patient with a continuous-flow LVAD.
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Affiliation(s)
- Sara C Martinez
- Cardiovascular Division, Department of Internal Medicine, School of Medicine, Washington University, Saint Louis, MO
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19
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Gutsche JT, Atluri P, Augoustides JG. Treatment of ventricular assist-device-associated gastrointestinal bleeding with hormonal therapy. J Cardiothorac Vasc Anesth 2014; 27:939-43. [PMID: 24054188 DOI: 10.1053/j.jvca.2013.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Jacob T Gutsche
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA.
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20
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Ricardo Argueta-Morales I, Tran R, Ceballos A, Clark W, Osorio R, Divo EA, Kassab AJ, DeCampli WM. Mathematical Modeling of Patient-Specific Ventricular Assist Device Implantation to Reduce Particulate Embolization Rate to Cerebral Vessels. J Biomech Eng 2014; 136:1816493. [DOI: 10.1115/1.4026498] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 01/16/2014] [Indexed: 11/08/2022]
Abstract
Stroke is the most devastating complication after ventricular assist device (VAD) implantation, with an incidence of 14%–47% despite improvements in device design and anticoagulation. This complication continues to limit the widespread implementation of VAD therapy. Patient-specific computational fluid dynamics (CFD) analysis may elucidate ways to reduce this risk. A patient-specific three-dimensional model of the aortic arch was generated from computed tomography. A 12 mm VAD outflow-graft (VAD-OG) “anastomosed” to the aorta was rendered. CFD was applied to study blood flow patterns. Particle tracks, originating from the VAD, were computed with a Lagrangian phase model and percentage of particles entering the cerebral vessels was calculated. Twelve implantation configurations of the VAD-OG and three particle sizes (2, 4, and 5 mm) were considered. Percentage of particles entering the cerebral vessels ranged from 6% for the descending aorta VAD-OG anastomosis, to 14% for the ascending aorta at 90 deg VAD-OG anastomosis. Values were significantly different among all configurations (X2 = 3925, p < 0.0001). Shallower and more cephalad anastomoses prevented formation of zones of recirculation in the ascending aorta. In this computational model and within the range of anatomic parameters considered, the percentage of particles entering the cerebral vessels from a VAD-OG is reduced by nearly 60% by optimizing outflow-graft configuration. Ascending aorta recirculation zones, which may be thrombogenic, can also be eliminated. CFD methods coupled with patient-specific anatomy may aid in identifying the optimal location and angle for VAD-OG anastomosis to minimize stroke risk.
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Affiliation(s)
- I. Ricardo Argueta-Morales
- The Heart Center at Arnold Palmer Hospital for Children, Cardiothoracic Surgery, 92 West Miller St., Orlando, FL 32806
| | - Reginald Tran
- Mechanical and Aerospace Engineering Department, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816
| | - Andres Ceballos
- Mechanical and Aerospace Engineering Department, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816
| | - William Clark
- Mechanical and Aerospace Engineering Department, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816
| | - Ruben Osorio
- Mechanical and Aerospace Engineering Department, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816
| | - Eduardo A. Divo
- Mechanical and Aerospace Engineering Department, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816
- Mechanical Engineering Department, Embry-Riddle Aeronautical University, 600 South Clyde Morris Blvd., Daytona Beach, FL 32114
| | - Alain J. Kassab
- Mechanical and Aerospace Engineering Department, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816
| | - William M. DeCampli
- The Heart Center at Arnold Palmer Hospital for Children, Cardiothoracic Surgery, 92 West Miller St., Orlando, FL 32806
- Medical Education Department, College of Medicine, University of Central Florida, 6850 Lake Nona Blvd., Orlando, FL 32827
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WU HUACHUN, GONG GAO, WANG ZHIQIANG, HU YEFA, SONG CHUNSHENG. STRUCTURAL DESIGN AND NUMERICAL SIMULATION OF THE DIFFUSER FOR MAGLEV AXIAL BLOOD PUMP. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414500456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hydraulic performance is an especially important factor for maglev axial blood pumps that have been used in patients with heart disease. Most maglev axial blood pumps basically consist of a straightener, an impeller and a diffuser. The diffuser plays a key role in the performance of the maglev axial blood pump to provide an adequate pressure head and increase the hydraulic efficiency. Maglev axial blood pumps with various structural diffusers exhibit different hydraulic performance. In this study, computational fluid dynamics (CFD) analysis was performed to quantify hydrodynamic in a maglev axial blood pump with a flow rate of 6 L/min against a pressure head of 100 mmHg to optimize the diffuser structure. First, we design the prototype of diffuser structure based on traditional design method, establish blood flow channel models using commercial software ANSYS FLUENT. Specifically, compare the performance of pump with the diffusers of different parameters, such as the leading edge blade angle, blade-thickness and blade-number. The results show that the diffuser structures with the thickening blade by arc airfoil law, blade-number of 6, leading edge blade angle of 24°, and trailing edge blade angle of 90° exhibited the best hydraulic performance which could be utilized in the optimization design of maglev axial blood pumps.
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Affiliation(s)
- HUACHUN WU
- Department of Mechanical Engineering, School of Mechanical and Electronic Engineering, Wuhan University of Technology, Wuhan 430070, P. R. China
| | - GAO GONG
- Department of Mechanical Engineering, School of Mechanical and Electronic Engineering, Wuhan University of Technology, Wuhan 430070, P. R. China
| | - ZHIQIANG WANG
- Department of Mechanical Engineering, School of Mechanical and Electronic Engineering, Wuhan University of Technology, Wuhan 430070, P. R. China
| | - YEFA HU
- Department of Mechanical Engineering, School of Mechanical and Electronic Engineering, Wuhan University of Technology, Wuhan 430070, P. R. China
| | - CHUNSHENG SONG
- Department of Mechanical Engineering, School of Mechanical and Electronic Engineering, Wuhan University of Technology, Wuhan 430070, P. R. China
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22
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Imamura T, Kinugawa K, Kato N, Muraoka H, Fujino T, Inaba T, Maki H, Kinoshita O, Hatano M, Kyo S, Ono M. Late-Onset Right Ventricular Failure in Patients With Preoperative Small Left Ventricle After Implantation of Continuous Flow Left Ventricular Assist Device. Circ J 2014; 78:625-33. [DOI: 10.1253/circj.cj-13-1201] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Naoko Kato
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Hironori Muraoka
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Osamu Kinoshita
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Shunei Kyo
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Minoru Ono
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo
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23
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24
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Bonacchi M, Harmelin G, Sani G. The actual role of cardiocirculatory assistance in heart-failure treatment as destination therapy and bridge to life. Heart Fail Clin 2013; 10:S13-25. [PMID: 24262349 DOI: 10.1016/j.hfc.2013.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with end-stage heart failure have poor quality of life and a poor prognosis, and are usually burdened by symptoms at rest, need for frequent hospital admissions, complex pharmacologic therapies, and 1-year mortality rate of about 50%. Therapeutic options are scarce and not amenable to all. Only few patients can be transplanted. In recent years, technological progress has made available mechanical devices capable of providing short/medium- and long-term circulatory assistance. Clinical evidence of long-term survival without device-related adverse events using latest-generation small axial pumps allows evaluation of its use in patients with contraindications or inaccessibility to transplantation.
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Affiliation(s)
- Massimo Bonacchi
- Cardiac Surgery, Department of Medical-Surgical Critical Care, University of Firenze, Largo Brambilla, 3, Florence 50134, Italy; University Cardiac Surgery, Largo Brambilla, 3, Florence 50134, Italy.
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25
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Taghavi S, Ward C, Jayarajan SN, Gaughan J, Wilson LM, Mangi AA. Surgical technique influences HeartMate II left ventricular assist device thrombosis. Ann Thorac Surg 2013; 96:1259-1265. [PMID: 23968757 DOI: 10.1016/j.athoracsur.2013.05.081] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/13/2013] [Accepted: 05/24/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thrombosis of the HeartMate II (HM2 [Thoratec Corporation, Pleasanton, CA]) is a potentially devastating complication. While attention has been focused on anticoagulation strategies to prevent this complication, the impact of surgical technique has not been assessed. METHODS Patients undergoing HM2 implantation at two institutions were reviewed. Pump thrombosis (PT) was defined as a clinical syndrome that included more than 30% elevation in pump power, more than 30% elevation in lactate dehydrogenase, and greater than 20% decrease in hemoglobin with the presence of thrombus in the HM2 stator or rotor, or both, at explant or autopsy. A blinded clinician reviewed dimensions and angles of the HM2 obtained from chest x-ray films. Patients demonstrating PT were compared with patients having normal function. RESULTS Of the 49 patients reviewed, 11 (22.4%) displayed evidence of PT at a median of 42 days after HM2 implantation. Patient with PT had greater acute angulation of the HM2 inflow cannula immediately postoperatively (48.2 ± 6.8 versus 65.4 ± 9.2 degrees, p < 0.001) and after 30 days (50.1 ± 8.0 versus 65.1 ± 9.9 degrees, p < 0.001). Pump pocket depth was lower in the PT group immediately after HM2 implantation (107.0 ± 41.9 versus 144.3 ± 20.3 cm, p < 0.001) and after 30 days (86.0 ± 39.1 versus 113.1 ± 25.4 cm, p = 0.02). Patients with evidence of PT did not have a decrease in end-diastolic diameter (76 ± 9 versus 70 ± 15 mm, p = 0.24) whereas patients in the normal function group had effective remodeling of the left ventricle (70 ± 10 versus 56 ± 12 mm, p = 0.01). CONCLUSIONS Meticulous surgical technique, which necessitates creating an adequately sized pump pocket and appropriately directing the inflow cannula at the time of operation, may reduce the risk of PT.
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Affiliation(s)
- Sharven Taghavi
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Charisse Ward
- Yale University School of Medicine, New Haven, Connecticut
| | - Senthil N Jayarajan
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - John Gaughan
- Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Lynn M Wilson
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Abeel A Mangi
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut.
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27
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Abstract
Although cardiac transplant remains the gold standard for the treatment of end-stage heart failure, limited donor organ availability and growing numbers of eligible recipients have increased the demand for alternative therapies. Limitations of first-generation left ventricular assist devices for long-term support of patients with end-stage disease have led to the development of newer second-generation and third-generation pumps, which are smaller, have fewer moving parts, and have shown improved durability, allowing for extended support. The HeartMate II (second generation) and HeartWare (third generation) are 2 devices that have shown great promise as potential alternatives to transplantation in select patients.
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Affiliation(s)
- Michelle Capdeville
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, 9500 Euclid Avenue, J4-331, Cleveland, OH 44195, USA.
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28
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Osorio AF, Osorio R, Ceballos A, Tran R, Clark W, Divo EA, Argueta-Morales IR, Kassab AJ, DeCampli WM. Computational fluid dynamics analysis of surgical adjustment of left ventricular assist device implantation to minimise stroke risk. Comput Methods Biomech Biomed Engin 2013; 16:622-38. [DOI: 10.1080/10255842.2011.629616] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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29
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Islam S, Cevik C, Madonna R, Frandah W, Islam E, Islam S, Nugent K. Left ventricular assist devices and gastrointestinal bleeding: a narrative review of case reports and case series. Clin Cardiol 2013; 36:190-200. [PMID: 23378047 DOI: 10.1002/clc.22096] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/02/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of left ventricular assist devices (LVADs) has become a state-of-the-art therapy for advanced cardiac heart failure; however, multiple reports in the literature describe an increased risk for gastrointestinal (GI) bleeding in these patients. We characterized this association by reviewing recent studies on this topic. HYPOTHESIS GI bleeding occurs frequently in patients with LVADs, especially with devices with nonpulsatile flow patterns. METHODS We performed a comprehensive literature review to identify articles that reported GI bleeding in patients with LVADs. Databases used included PubMed, EMBASE, Scopus, Web of Knowledge, and Ovid. Baseline and outcome data were then ed from these reports. RESULTS We identified 10 case reports and 22 case series with 1543 patients. The mean age was 54.2 years. Most patients had nonpulsatile LVADs (1316, 85.3%). Three hundred and seventeen patients (20.5%) developed GI bleeding; this occurred more frequently in patients with nonpulsatile LVADs. Multiple procedures were performed without complications but often did not identify a definite bleeding site. Suspect lesions occurred throughout the GI tract but were more frequent in the upper GI tract. Many patients had arteriovenous malformations. All patients received medical therapy. None of the patients had their LVAD replaced. The use of anticoagulation did not appear to predispose these patients to more GI bleeding episodes. CONCLUSIONS Patients with LVADs have frequent GI bleeds, especially from arteriovenous malformations, which can occur throughout the GI tract. Most diagnostic and therapeutic interventions can be used safely in these patients. The pathogenesis of the GI bleeding in these patients may involve the use of anticoagulant medications, the formation of arteriovenous malformations, loss of von Willebrand factor activity, and mucosal ischemia.
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Affiliation(s)
- Sameer Islam
- Department of Gastroenterology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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30
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Islam S, Cevik C, Madonna R, Frandah W, Islam E, Islam S, Nugent K. Left ventricular assist devices and gastrointestinal bleeding: a narrative review of case reports and case series. Clin Cardiol 2013; 31:1171-6. [PMID: 23378047 DOI: 10.1016/j.healun.2012.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 06/07/2012] [Accepted: 08/04/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The use of left ventricular assist devices (LVADs) has become a state-of-the-art therapy for advanced cardiac heart failure; however, multiple reports in the literature describe an increased risk for gastrointestinal (GI) bleeding in these patients. We characterized this association by reviewing recent studies on this topic. HYPOTHESIS GI bleeding occurs frequently in patients with LVADs, especially with devices with nonpulsatile flow patterns. METHODS We performed a comprehensive literature review to identify articles that reported GI bleeding in patients with LVADs. Databases used included PubMed, EMBASE, Scopus, Web of Knowledge, and Ovid. Baseline and outcome data were then ed from these reports. RESULTS We identified 10 case reports and 22 case series with 1543 patients. The mean age was 54.2 years. Most patients had nonpulsatile LVADs (1316, 85.3%). Three hundred and seventeen patients (20.5%) developed GI bleeding; this occurred more frequently in patients with nonpulsatile LVADs. Multiple procedures were performed without complications but often did not identify a definite bleeding site. Suspect lesions occurred throughout the GI tract but were more frequent in the upper GI tract. Many patients had arteriovenous malformations. All patients received medical therapy. None of the patients had their LVAD replaced. The use of anticoagulation did not appear to predispose these patients to more GI bleeding episodes. CONCLUSIONS Patients with LVADs have frequent GI bleeds, especially from arteriovenous malformations, which can occur throughout the GI tract. Most diagnostic and therapeutic interventions can be used safely in these patients. The pathogenesis of the GI bleeding in these patients may involve the use of anticoagulant medications, the formation of arteriovenous malformations, loss of von Willebrand factor activity, and mucosal ischemia.
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Affiliation(s)
- Sameer Islam
- Department of Gastroenterology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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Gallen TB, Lau WT, Mehta AR. Complete Aortic Valve Fusion After HeartMate II Left Ventricular Assist Device Support. J Cardiothorac Vasc Anesth 2012; 26:1060-2. [DOI: 10.1053/j.jvca.2012.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Indexed: 11/11/2022]
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Third-generation continuous flow left ventricular assist devices. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 5:250-8. [PMID: 22437454 DOI: 10.1097/imi.0b013e3181ee77a1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tremendous advances have been made in the treatment of end-stage heart failure patients with left ventricular assist devices (LVADs). An important factor playing a role in the improved clinical outcomes is the development of continuous flow, rotary LVADs. New technology using magnetic levitation and hydrodynamic suspension to eliminate contact bearings offers the potential of more durable and efficacious mechanical circulatory blood pumps. Clinical trials evaluating these novel "third-generation" LVADs are in progress.
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Gregory SD, Pearcy MJ, Timms D. Passive Control of a Biventricular Assist Device With Compliant Inflow Cannulae. Artif Organs 2012; 36:683-90. [DOI: 10.1111/j.1525-1594.2012.01504.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Han Q, Zou J, Ruan X, Fu X, Yang H. A novel design of spiral groove bearing in a hydrodynamically levitated centrifugal rotary blood pump. Artif Organs 2012; 36:739-46. [PMID: 22747897 DOI: 10.1111/j.1525-1594.2012.01467.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Good washout is very important in spiral groove bearing (SGB) designs when applied to blood pumps due to the micrometer scales of lubrication films and groove depths. To improve washout, flow rate or leakage through SGBs should be as large as possible. However, this special goal violates conventional SGB designs in which no leakage is desired as the leakage would decrease load-carrying capacity significantly. So, a design concept is formed fulfilling the two goals of high load-carrying capacity and large flow rate: let groove width decrease along flow path and the mating surface of the rotor rotate with a direction facilitating the flow through the grooves. Under this concept, a novel SGB is designed, contrary to conventional ones, with groove width decreasing with increasing spiral radius. This SGB is mounted on the motionless upper plate of our designed centrifugal blood pump, with the mating surface of rotor rotating with a direction facilitating the outward flow. To assess SGB designs, a characteristic plane is originally presented relating to pressure-normalized load-carrying capacity and flow rate. Comparisons between various kinds of SGB designs are made, and computational fluid dynamics (CFD) results are plotted in this characteristic plane from which load/flow performances can be directly read out. CFD and comparison results show that the new designs have superior load/flow characteristics. However, the impact of SGB designs upon hemolysis/thrombus formation is still to be verified according to the concept presented.
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Affiliation(s)
- Qing Han
- State Key Laboratory of Fluid Power Transmission and Control, Zhejiang University, Zheda Road 38, Hangzhou, China
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Zhou MD, Yang C, Liu Z, Cysyk JP, Zheng SY. An implantable Fabry-Pérot pressure sensor fabricated on left ventricular assist device for heart failure. Biomed Microdevices 2012; 14:235-45. [PMID: 21997499 DOI: 10.1007/s10544-011-9601-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Continuous flow left ventricular assist devices (LVADs) are commonly used as bridge-to-transplantation or destination therapy for heart failure patients. However, non-optimal pumping speeds can reduce the efficacy of circulatory support or cause dangerous ventricular arrhythmias. Optimal flow control for continuous flow LVADs has not been defined and calls for an implantable pressure sensor integrated with the LVAD for real-time feedback control of pump speed based on ventricular pressure. A MEMS pressure sensor prototype is designed, fabricated and seamlessly integrated with LVAD to enable real-time control, optimize its performance and reduce its risks. The pressure sensing mechanism is based on Fabry-Pérot interferometer principle. A biocompatible parylene diaphragm with a silicon mirror at the center is fabricated directly on the inlet shell of the LVAD to sense pressure changes. The sensitivity, range and response time of the pressure sensor are measured and validated to meet the requirements of LVAD pressure sensing.
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Affiliation(s)
- Ming-Da Zhou
- Department of Bioengineering and Material Research Institute, Pennsylvania State University, University Park, PA 16802, USA
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Abstract
As life expectancy continues to increase and biotechnology advances, the use of cardiovascular implantable devices will continue to rise. Unfortunately, despite modern medical advances, the infection and mortality rates remain excessively elevated. This article reviews the pathophysiology and general concepts of cardiac device-related infections, including the physical and chemical characteristics of the medical device, host response to the medical device, and the microbiologic virulence factors. Infections of the most commonly utilized cardiovascular implantable devices, including cardiovascular implantable electronic devices, bioprosthetic and mechanical valves, ventricular assist devices, total artificial hearts, and coronary artery stents, are reviewed in detail.
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Healy AH, Mason NO, Hammond ME, Reid BB, Clayson SE, Drakos SG, Kfoury AG, Patel AN, Bull DA, Budge D, Alharethi RA, Bader FM, Gilbert EM, Stehlik J, Selzman CH. Allograft rejection in patients supported with continuous-flow left ventricular assist devices. Ann Thorac Surg 2011; 92:1601-7; discussion 1607. [PMID: 21944258 DOI: 10.1016/j.athoracsur.2011.05.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 05/23/2011] [Accepted: 05/27/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both pulsatile-flow and continuous-flow left ventricular assist devices (LVADs) successfully provide patients a bridge to transplantation. Some data suggest that continuous-flow pumps increase the risk of allograft rejection, contributing to posttransplantation morbidity and mortality. We sought to analyze the relationship between LVAD flow characteristics and subsequent allograft rejection in bridge to transplant (BTT) patients. METHODS Patients with LVADs from the UTAH Transplant Affiliated Hospitals were retrospectively analyzed. Rejection was determined pathologically according to the International Society for Heart and Lung Transplantation revised cardiac allograft rejection scale. Multimodal statistical analyses were applied. RESULTS Of 1,076 patients who underwent transplantation over a 26-year period, 151 had LVADs. Of these, 111 (77 pulsatile flow, 34 continuous flow) patients had pathologic data available. There was no difference in overall rejection (grades 1R to 3R) between the pulsatile-flow LVAD and continuous-flow LVAD groups (2.00 ± 1.43 versus 1.50 ± 1.16 episodes/year; p = 0.076.) Patients with pulsatile-flow LVADs had more clinically relevant (grades 2R to 3R) rejection than did patients with continuous-flow LVADs (0.49 ± 0.72 versus 0.12 ± 0.33 episodes/year; p < 0.001). There was no survival difference at 1 year (p = 0.920) or 4 years (p = 0.721) after transplantation. CONCLUSIONS Patients with continuous-flow LVADs have similar overall rejection rates and a reduced rate of clinically relevant rejection compared with patients with pulsatile-flow LVADs during the first year after transplantation. Although there is theoretical concern that nonphysiologic, nonpulsatile flow could alter the neurohormonal profile of patients in heart failure, we are encouraged that the type of LVAD circulation does not influence posttransplantation allograft survival.
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Affiliation(s)
- Aaron H Healy
- UTAH (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program, University of Utah, Salt Lake City, Utah 84132, USA
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Gregory SD, Timms D, Gaddum NR, McDonald C, Pearcy MJ, Fraser JF. In Vitro Evaluation of a Compliant Inflow Cannula Reservoir to Reduce Suction Events With Extracorporeal Rotary Ventricular Assist Device Support. Artif Organs 2011; 35:765-72. [DOI: 10.1111/j.1525-1594.2011.01311.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Biventricular Assist Devices: A Technical Review. Ann Biomed Eng 2011; 39:2313-28. [DOI: 10.1007/s10439-011-0348-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/28/2011] [Indexed: 01/16/2023]
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Less invasive off-pump implantation of axial flow pumps in chronic ischemic heart failure: Survival effects. J Heart Lung Transplant 2011; 30:834-7. [DOI: 10.1016/j.healun.2011.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 03/08/2011] [Accepted: 03/08/2011] [Indexed: 11/18/2022] Open
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Sheinberg R, Brady MB, Mitter N. Intraoperative transesophageal echocardiography and ventricular assist device insertion. Semin Cardiothorac Vasc Anesth 2011; 15:14-24. [PMID: 21719549 DOI: 10.1177/1089253211411733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A decade after cardiac surgery was established, transesophageal echocardiography (TEE) was developed and used to evaluate perioperative cardiac performance. It has become an invaluable tool to provide real-time information in the cardiac operating room. TEE provides practical and useful information prior to insertion as well as after placement of the device. Additionally, during episodes of device malfunction or hemodynamic instability, TEE can be extremely useful in defining the etiology of the problem. As ventricular assist devices (VADs) have undergone evolution in design and as more VADs are being implanted, the development of specific indications for TEE use during device placement is a relevant issue. Formal guidelines for use of TEE during VAD insertion are yet to be adopted or implemented, but for now TEE remains an essential tool for managing this patient population.
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Timms D. A review of clinical ventricular assist devices. Med Eng Phys 2011; 33:1041-7. [PMID: 21665512 DOI: 10.1016/j.medengphy.2011.04.010] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 04/18/2011] [Accepted: 04/23/2011] [Indexed: 11/18/2022]
Abstract
Given the limited availability of donor hearts, ventricular assist device (VAD) therapy is fast becoming an accepted alternative treatment strategy to treat end-stage heart failure. The field of mechanical ventricular assistance is littered with novel and unique ideas either based on volume displacement or rotary pump technology, which aim to sufficiently restore cardiac output. However, only a select few have made the transition to the clinical arena. Clinical implants were initially dominated by the FDA approved volume displacement Thoratec HeartMate I, IVAD, and PVAD, whilst Berlin Heart's EXCOR, and Abiomed's BVS5000 and AB5000 offered suitable alternatives. However, limitations associated with an inherently large size and reduced lifetime of these devices stimulated the development and subsequent implantation of rotary blood pump (RBP) technology. Almost all of the reviewed RBPs are clinically available in Europe, whilst many are still undergoing clinical trial in the USA. Thoratec's HeartMate II is currently the only rotary device approved by the FDA, and has supported the highest number of patients to date. This pump is joined by MicroMed Cardiovascular's Heart Assist 5 Adult VAD, Jarvik Heart's Jarvik 2000 FlowMaker and Berlin Heart's InCOR as the axial flow devices under investigation in the USA. More recently developed radial flow devices such as WorldHeart's Levacor, Terumo's DuraHeart, and HeartWare's HVAD are increasing in their clinical trial patient numbers. Finally CircuLite's Synergy and Abiomed's Impella are two mixed flow type devices designed to offer partial cardiac support to less sick patients. This review provides a brief overview of the volume displacement and rotary devices which are either clinically available, or undergoing the advanced stages of human clinical trials.
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Affiliation(s)
- Daniel Timms
- ICET Laboratory, Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.
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Rasalingam R, Johnson SN, Bilhorn KR, Huang PH, Makan M, Moazami N, Pérez JE. Transthoracic Echocardiographic Assessment of Continuous-Flow Left Ventricular Assist Devices. J Am Soc Echocardiogr 2011; 24:135-48. [DOI: 10.1016/j.echo.2010.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Indexed: 10/18/2022]
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Ensor CR, Paciullo CA, Cahoon WD, Nolan PE. Pharmacotherapy for Mechanical Circulatory Support: A Comprehensive Review. Ann Pharmacother 2011; 45:60-77. [DOI: 10.1345/aph.1p459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To provide a comprehensive review of the pharmacotherapy associated with the provision of mechanical circulatory support (MCS) to patients with end-stage heart failure and guidance regarding the selection, assessment, and optimization of drug therapy for this population. Data Sources: The MEDLINE/PubMed, EMBASE, and Cochrane databases were searched from 1960 to July 2010 for articles published in English using the search terms mechanical circulatory support, ventricular assist system, ventricular assist device, left ventricular assist device, right ventricular assist device, biventricular assist device, total artificial heart, pulsatile, positive displacement, axial, centrifugal, hemostasis, bleeding, hemodynamic, blood pressure, thrombosis, antithrombotic therapy, anticoagulant, antiplatelet, right ventricular failure, ventricular arrhythmia, anemia, arteriovenous malformation, stroke, infection, and clinical pharmacist. Study Selection And Data Extraction: All relevant original studies, metaanalyses, systematic reviews, guidelines, and reviews were assessed for inclusion. References from pertinent articles were examined for content not found during the initial search. Data Synthesis: MCS has advanced significantly since the first left ventricular assist device was implanted in 1966. Further advancements in MCS technology that occurred in the tatter decade are changing the overall management of end-stage heart failure care and cardiac transplantation. These pumps allow for improved bridge-to-transplant rates, enhanced survival, and quality of life. Pharmacotherapy associated with MCS devices may optimize the performance of the pumps and improve patient outcomes, as well as minimize morbidity related to their adverse effects. This review highlights the knowledge needed to provide appropriate clinical pharmacy services for patients supported by MCS devices. Conclusions: The HeartMate II clinical investigators called for the involvement of pharmacists in MCS patient assessment and optimization. Pharmacotherapeutic management of patients supported with MCS devices requires individualized care, with pharmacists as part of the team, based on the characteristics of each pump and recipient.
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Affiliation(s)
- Christopher R Ensor
- Cardiothoracic Transplantation and Mechanical Circulatory Support; Clinical Assistant Professor, School of Pharmacy, University of Maryland; Department of Pharmacy, Comprehensive Transplant Center, The Johns Hopkins Hospital, Baltimore, MD
| | - Christopher A Paciullo
- Cardiothoracic Surgery Critical Care, Department of Pharmacy, Emory University Hospital, Atlanta, GA
| | - William D Cahoon
- Cardiology; Clinical Assistant Professor, School of Pharmacy, Virginia Commonwealth University, Virginia Commonwealth University Health System; Department of Pharmacy, Medical College of Virginia Hospitals, Richmond, VA
| | - Paul E Nolan
- College of Pharmacy, University of Arizona; Senior Clinical Scientist, The University Medical Center, Tucson, AZ
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Cysyk J, Jhun CS, Newswanger R, Weiss W, Rosenberg G. Rotary blood pump control using integrated inlet pressure sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2011:373-376. [PMID: 22254326 DOI: 10.1109/iembs.2011.6090121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Due to improved reliability and reduced risk of thromboembolic events, continuous flow left ventricular assist devices are being used more commonly as a long term treatment for end-stage heart failure. As more and more patients with these devices are leaving the hospital, a reliable control system is needed that can adjust pump support in response to changes in physiologic demand. An inlet pressure sensor has been developed that can be integrated with existing assist devices. A control system has been designed to adjust pump speed based on peak-to-peak changes in inlet pressure. The inlet pressure sensor and control system have been tested with the HeartMate II axial flow blood pump using a mock circulatory loop and an active left ventricle model. The closed loop control system increased total systemic flow and reduced ventricular load following a change in preload as compared to fixed speed control. The increase in systemic flow occurred under all operating conditions, and maximum unloading occurred in the case of reduced ventricular contractility.
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Affiliation(s)
- Joshua Cysyk
- Division of Artificial Organs, Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA.
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Maffè S, Perucca A, Signorotti F, Pistono M, Paffoni P, Parravicini U, Dellavesa P, Cucchi L, Paino AM, Zenone F, Pardo NF, Bielli M, Zanetta M. Electrophysiological interactions between implantable cardioverter defibrillators and left ventricular assist device. Int J Cardiol 2010; 145:620-3. [DOI: 10.1016/j.ijcard.2010.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 09/16/2010] [Indexed: 11/17/2022]
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Daliakopoulos SI, Schaedel M, Klimatsidas MN, Spiliopoulos S, Koerfer R, Tenderich G. Intra-abdominal hypertension due to heparin - induced retroperitoneal hematoma in patients with ventricle assist devices: report of four cases and review of the literature. J Cardiothorac Surg 2010; 5:108. [PMID: 21067596 PMCID: PMC2992055 DOI: 10.1186/1749-8090-5-108] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 11/10/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Elevated intra-abdominal pressure (IAP) has been identified as a cascade of pathophysiologic changes leading in end-organ failure due to decreasing compliance of the abdomen and the development of abdomen compartment syndrome (ACS). Spontaneous retroperitoneal hematoma (SRH) is a rare clinical entity seen almost exclusively in association with anticoagulation states, coagulopathies and hemodialysis; that may cause ACS among patients in the intensive care unit (ICU) and if treated inappropriately represents a high mortality rate. CASE PRESENTATION We report four patients (a 36-year-old Caucasian female, a 59-year-old White-Asian male, a 64-year-old Caucasian female and a 61-year-old Caucasian female) that developed an intra-abdominal hypertension due to heparin-induced retroperitoneal hematomas after implantation of ventricular assist devices because of heart failure. Three of the patients presented with dyspnea at rest, fatigue, pleura effusions in chest XR and increased heart rate although b-blocker therapy. A 36-year old female (the forth patient) presented with sudden, severe shortness of breath at rest, 10 days after an "acute bronchitis". At the time of the event in all cases international normalized ratio (INR) was <3.5 and partial thromboplastin time <65 sec. The patients were treated surgically, the large hematomas were evacuated and the systemic manifestations of the syndrome were reversed. CONCLUSION Identifying patients in the ICU at risk for developing ACS with constant surveillance can lead to prevention. ACS is the natural progression of pressure-induced end-organ changes and develops if IAP is not recognized and treated in a timely manner. Failure to recognize and appropriately treat ACS is fatal while timely intervention - if indicated - is associated with improvements in organ function and patient survival. Means for surgical decision making are based on clinical indicators of adverse physiology, rather than on a single measured parameter.
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Nguyen DQ, Thourani VH. Third-Generation Continuous Flow Left Ventricular Assist Devices. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Duc Q. Nguyen
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | - Vinod H. Thourani
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
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Castillo JG, Anyanwu AC, Adams DH, Nyirenda T, Fischer GW. Real-time 3-dimensional echocardiographic assessment of current continuous-flow rotary left ventricular assist devices. J Cardiothorac Vasc Anesth 2010; 23:702-10. [PMID: 19789057 DOI: 10.1053/j.jvca.2009.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Javier G Castillo
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY 10029, USA
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