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Schaffer AJ, El-Harasis MA, Tinianow A, Azose A, Zalawadiya S, Dee K, Balsara K, Montgomery JA. Clinical Outcomes in Patients With Bacteremia and Concomitant Left Ventricular Assist Devices and Cardiac Implantable Electronic Devices. ASAIO J 2023; 69:782-788. [PMID: 37084328 DOI: 10.1097/mat.0000000000001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
Infection remains a common cause of morbidity and mortality in patients with both left ventricular assist devices (LVADs) and cardiac implanted electronic devices (CIEDs) with limited data describing outcomes in patients who have both devices implanted. We performed a single-center, retrospective, observational cohort study of patients with both a transvenous CIED and LVAD who developed bacteremia. Ninety-one patients were evaluated. Eighty-one patients (89.0%) were treated medically and nine patients (9.9%) underwent surgical management. A multivariable logistic regression showed that blood culture positivity for >72 hours was associated with inpatient death, when controlled for age and management strategy (odds ratio [OR] = 3.73 [95% confidence interval {CI} = 1.34-10.4], p = 0.012). In patients who survived the initial hospitalization, the use of long-term suppressive antibiotics was not associated with the composite outcome of death or infection recurrence within 1 year, when controlled for age and management strategy (OR = 2.31 [95% CI = 0.88-2.62], p = 0.09). A Cox proportional hazards model showed that blood culture positivity for >72 hours was associated with a trend toward increased mortality in the first year, when controlled for age, management strategy, and staphylococcal infection (hazard ratio = 1.72 [95% CI = 0.88-3.37], p = 0.11). Surgical management was associated with a trend toward decreased mortality (hazard ratio = 0.23 [95% CI = 0.05-1.00], p = 0.05).
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Affiliation(s)
- Andrew J Schaffer
- From the Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Majd A El-Harasis
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alex Tinianow
- Department of Internal Medicine, Washington University, St. Louis, Missouri
| | - Aaron Azose
- Department of Internal Medicine, Olive View UCLA Medical Center, Los Angeles, California
| | - Sandip Zalawadiya
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin Dee
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Keki Balsara
- Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jay A Montgomery
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Lucertini G, Rogers MP, Italiano EG, Tarzia V, Pradegan N, Gallo M, Gerosa G. Left ventricular assist device exchange: a review of indications, operative procedure, and outcomes. Indian J Thorac Cardiovasc Surg 2023; 39:143-153. [PMID: 37525708 PMCID: PMC10386995 DOI: 10.1007/s12055-022-01450-y] [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: 07/22/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 01/18/2023] Open
Abstract
The use of left ventricular assist devices (LVADs) is intended to treat patients with end-stage heart failure. Owing to technological advances, these devices are becoming more durable. However, LVADs may need to be exchanged when complications arise and heart transplantation is not possible. Indications for LVAD exchange (LVADE) include device thrombosis, device infections, and pump component failure. LVADE has historically been associated with a high risk of morbidity and mortality. In this review, we discuss the indications of LVADE, the decisional and technical aspects during surgery, and outcomes.
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Affiliation(s)
- Giovanni Lucertini
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Michael Paul Rogers
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Enrico Giuseppe Italiano
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Vincenzo Tarzia
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Nicola Pradegan
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Michele Gallo
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
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Zheng X, Pan Y, Zhang Y, Meng K, Zhou J, Wang X, Cui Y, Li J, Li Y, Chen H. Interventional Microbubble Enhanced Sonothrombolysis on Left Ventricular Assist Devices. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2201291. [PMID: 35615977 PMCID: PMC9313509 DOI: 10.1002/advs.202201291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/27/2022] [Indexed: 06/15/2023]
Abstract
The left ventricular assist device (LVAD) is often used in the treatment of heart failure. However, 4% to 9% implanted LVAD will have thrombosis problem in one year, which is fatal to the patient's life. In this work, an interventional sonothrombolysis (IST) method is developed to realize the thrombolysis on LVAD. A pair of ultrasound transducer rings is installed on the shell of LVAD, and drug-loaded microbubbles are injected into the LVAD through the interventional method. The microbubbles are adhere on the thrombus with the coated thrombus-targeted drugs, and the thrombolytic drugs carried by the bubbles are brought into the thrombus by the cavitation of bubbles under the ultrasound. In a proof-of-concept experiment in a live sheep model, the thrombus on LVAD is dissolved in 30 min, without damages on LVADs and organs. This IST exhibits to be more efficient and safer compared with other thrombolysis methods on LVAD.
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Affiliation(s)
- Xiaobing Zheng
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Yunfan Pan
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Yuan Zhang
- School of Mechanical Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Kuilin Meng
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Jianye Zhou
- Animal Experiment Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Xin Wang
- Animal Experiment Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Yongchun Cui
- Animal Experiment Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Jiang Li
- School of Mechanical Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yongjian Li
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Haosheng Chen
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
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Osho AA, D'Alessandro DA. Approaches to ventricular assist device exchange: Resternotomy vs. limited incisions. JTCVS Tech 2022; 12:94-99. [PMID: 35403042 PMCID: PMC8987313 DOI: 10.1016/j.xjtc.2021.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - David A. D'Alessandro
- Address for reprints: David A. D'Alessandro, MD, 55 Fruit St, Cox 630, Boston, MA 20114.
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Expanding Use of New Technology Creates New Challenges in Preventing and Managing Infections: a Review of Diagnostic and Management Considerations for Infections Among Patients with Long-Term Invasive Devices for Advanced Heart Failure. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ayers B, Cheyne C, Wood K, Quinlan A, Dick S, Vidula H, Alexis J, Barrus B, Prasad S, Gosev I. Long-term ungrounded cable support for short-to-shield syndrome. Clin Case Rep 2020; 8:512-515. [PMID: 32185047 PMCID: PMC7069869 DOI: 10.1002/ccr3.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 11/11/2022] Open
Abstract
Short-to-shield (STS) is a potential complication for left ventricular assist device (LVAD) patients supported by the HeartMate II (HMII) pump. This phenomenon occurs when a damaged internal wire within the driveline makes contact with the surrounding sheath, resulting in insufficient power delivery to the motor when connected to a grounded power base unit (PBU). An ungrounded cable can be used to negate these effects, but the long-term safety of this treatment strategy is unknown. In this case series, we present our institutional experience treating 17 STS patients with an ungrounded cable. In total, we present 4922 patient-days (13.4 patient-years) of ungrounded cable support after primary STS treatment. There were no deaths or complications related to STS. These data suggest that the long-term use of an ungrounded cable is a reasonable treatment option for patients who cannot or do not wish to undergo pump exchange or splice repair.
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Affiliation(s)
- Brian Ayers
- University of Rochester Medical CenterRochesterNYUSA
| | | | | | - Amy Quinlan
- University of Rochester Medical CenterRochesterNYUSA
| | - Sara Dick
- University of Rochester Medical CenterRochesterNYUSA
| | | | | | - Bryan Barrus
- University of Rochester Medical CenterRochesterNYUSA
| | - Sunil Prasad
- University of Rochester Medical CenterRochesterNYUSA
| | - Igor Gosev
- University of Rochester Medical CenterRochesterNYUSA
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Imamura T, Narang N, Rodgers D, Nguyen A, Ota T, Song T, Kim G, Raikhelkar J, Jeevanandam V, Sayer G, Uriel N. Outcomes following left ventricular assist device exchange. J Card Surg 2020; 35:591-597. [PMID: 31945223 DOI: 10.1111/jocs.14423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Left ventricular assist device (LVAD) exchange has been historically associated with a significant risk of morbidity and mortality. It is unknown, however, whether these outcomes have improved. We aimed to compare clinical outcomes following LVAD exchange to those following initial LVAD implant in a contemporary patient cohort. METHODS A total of 115 LVAD patients were enrolled between 2014 and 2017 and followed for 1 year. Of these, 15 patients (54.5 ± 13.3 years old, 87% male) underwent LVAD exchange at 277 (IQR 191-597) days following LVAD implantation and 100 patients (57.5 ± 12.3 years old, 76% male) did not undergo an LVAD exchange (non-exchange group). RESULTS One-year survival rate following LVAD exchange tended to be higher than the non-exchange patients (93% vs 76%, P = .15). Readmission rates for each comorbidity did not significantly differ between the two groups (P > .05 for all) except for the higher rate of pump thrombosis in the LVAD exchange group (P < .05). DISCUSSION LVAD exchange cohorts seem to have comparable clinical outcome with the non-exchange cohorts. CONCLUSION LVAD exchange might be an increasingly appropriate therapeutic option for the management of pump thrombosis, although careful monitoring for recurrent pump thrombosis is required.
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Affiliation(s)
- Teruhiko Imamura
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.,Second Department of Medicine, University of Toyama, Toyama, Japan
| | - Nikhil Narang
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Daniel Rodgers
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Ann Nguyen
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Tae Song
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Gene Kim
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Jayant Raikhelkar
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | | | - Gabriel Sayer
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Nir Uriel
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
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Urban M, Um J, Moulton M, Stoller D, Zolty R, Lowes B, Macdonald C, McCain N, Siddique A. Recurrent pump thrombosis is common after axial continuous-flow left ventricular assist device exchange. Int J Artif Organs 2019; 43:109-118. [PMID: 31530254 DOI: 10.1177/0391398819876293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In selected patients with left ventricular assist device-associated infection or malfunction, pump exchange may become necessary after conservative treatment options fail and heart transplantation is not readily available. We examined the survival and complication rate in patients (⩾19 years of age) who underwent HeartMate II to HeartMate II exchange at our institution from 1 January 2010 to 28 February 2018. Clinical outcomes were analyzed and compared for patients who underwent exchange for pump thrombosis (14 patients), breach of driveline integrity (5 patients), and device-associated infection (2 patients). There were no differences in 30-day mortality (p = 0.58), need for temporary renal replacement therapy (p = 0.58), right ventricular mechanical support (p = 0.11), and postoperative stroke (p = 0.80) among groups. Survival at 1 year was 90% ± 7% for the whole cohort and 85% ± 10% for those who underwent exchange for pump thrombosis. In patients exchanged for device thrombosis, freedom from re-thrombosis and survival free from pump re-thrombosis at 1 year were 49% ± 16% and 42% ± 15%, respectively. No association of demographic and clinical variables with the risk of recurrent pump thrombosis after the first exchange was identified. Survival after left ventricular assist device exchange compares well with published results after primary left ventricular assist device implantation. However, recurrence of thrombosis was common among patients who required a left ventricular assist device exchange due to pump thrombosis. In this sub-group, consideration should be given to alternative strategies to improve the outcomes.
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Affiliation(s)
- Marian Urban
- University of Nebraska Medical Center, Omaha, NE, USA
| | - John Um
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Ronald Zolty
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE, USA
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