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Baldasseroni S, Orso F, Herbst A, Bo M, Boccanelli A, Desideri GB, Rozzini R, Terrosu P, Alboni P, Marchionni N, Ungar A. Role of new drug therapies and innovative procedures in older patients with heart failure: from trials to clinical practice. Minerva Med 2022; 113:647-666. [PMID: 35332760 DOI: 10.23736/s0026-4806.22.08082-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samuele Baldasseroni
- Unit of Geriatric Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy - .,Department of Clinical and Experimental medicine, University of Florence, Florence, Italy - .,Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy -
| | - Francesco Orso
- Unit of Geriatric Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.,Department of Clinical and Experimental medicine, University of Florence, Florence, Italy
| | - Andrea Herbst
- Unit of Geriatric Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.,Department of Clinical and Experimental medicine, University of Florence, Florence, Italy
| | - Mario Bo
- Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy
| | | | | | - Renzo Rozzini
- Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy
| | | | - Paolo Alboni
- Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy
| | - Niccolò Marchionni
- Department of Clinical and Experimental medicine, University of Florence, Florence, Italy.,Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy.,Division of Cardiology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Andrea Ungar
- Unit of Geriatric Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.,Department of Clinical and Experimental medicine, University of Florence, Florence, Italy.,Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy
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A Novel Control Method for Rotary Blood Pumps as Left Ventricular Assist Device Utilizing Aortic Valve State Detection. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1732160. [PMID: 31886175 PMCID: PMC6927030 DOI: 10.1155/2019/1732160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/29/2019] [Accepted: 08/08/2019] [Indexed: 12/28/2022]
Abstract
A novel control method for rotary blood pumps is proposed relying on two different objectives: regulation of pump flow in accordance with desired value and the maintenance of partial support with an open aortic valve by the variation of pump speed. The estimation of pump flow and detection of aortic valve state was performed with mathematical models describing the first- and second generation of Sputnik rotary blood pumps. The control method was validated using a cardiovascular system model. The state of the aortic valve was detected with a mean accuracy of 91% for Sputnik 1 and 96.2% for Sputnik 2 when contractility, heart rate, and systemic vascular resistance was changed. In silico results for both pumps showed that the proposed control method can achieve the desired pump flow level and maintain the open state of the aortic valve by periodically switching between two objectives under contractility, heart rate, and systemic vascular resistance changes. The proposed method showed its potential for safe operation without adverse events and for the improvement of chances for myocardial recovery.
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Schmidt T, Mewes P, Hoffmann J, Müller‐von Aschwege F, Glitza JI, Schmitto JD, Schulte‐Eistrup S, Sindermann JR, Reiss N. Improved aftercare in LVAD patients: Development and feasibility of a smartphone application as a first step for telemonitoring. Artif Organs 2019; 44:248-256. [DOI: 10.1111/aor.13560] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Thomas Schmidt
- Schüchtermann‐Klinik Bad Rothenfelde Bad Rothenfelde Germany
- Institute for Cardiology and Sports Medicine, German Sports University Cologne Cologne Germany
| | - Philipp Mewes
- Schüchtermann‐Klinik Bad Rothenfelde Bad Rothenfelde Germany
- Technical University Dortmund Dortmund Germany
| | | | | | - Jenny I. Glitza
- OFFIS, Institute for Information Technology Oldenburg Germany
| | - Jan D. Schmitto
- Department for Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School Hannover Germany
| | | | | | - Nils Reiss
- Schüchtermann‐Klinik Bad Rothenfelde Bad Rothenfelde Germany
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Tsushima Y, Imamura T, Landeras L, Kitahara H, Gonoi W, Sayer G, Uriel N, Jeevanandam V, Ota T. Novel Formula to Calculate Three-Dimensional Angle Between Inflow Cannula and Device Body of HeartMate II LVAD. Ann Thorac Surg 2019; 109:63-68. [PMID: 31255615 DOI: 10.1016/j.athoracsur.2019.04.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/09/2019] [Accepted: 04/30/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The acute angle between inflow cannula and device body of HeartMate II left ventricular assist device (LVAD) (Abbott, Pleasanton, California) is associated with device thrombosis. However, most studies utilized two-dimensional (2D) angle obtained from chest roentgenogram (CXR), which is unlikely accurate. We aimed to create and validate a formula to estimate actual three-dimensional (3D) angle. METHODS We retrospectively reviewed the cohort undergoing HeartMate II LVAD implantation between 2008 and 2016. A formula for calculating 3D angles of the LVAD inflow cannula relative to the device body was mathematically derived, using simple 2D measurements from CXR. RESULTS The cohort included consecutive 275 patients with HeartMate II (median age: 60 [25% quartile: 51, 75% quartile: 68] years). There was no significant difference between the calculated 3D angles (from formula) and actual 3D angles (from computed tomography) from the subset group with 3D computed tomography (n = 28) (71.7° ± 13.4° vs 71.1° ± 11.5°, P = .858). Among all participants, the calculated 3D angle (from formula) was 74.4° ± 14.2°, which was significantly larger than the 2D projected angle (from CXR) (65.2° ± 11.3°, P < .001). There was no statistical difference in the calculated 3D angles (from formula) between patients with/without device thrombosis, hemorrhagic stroke, ischemic stroke, or mortality (P > .05 for all). CONCLUSIONS We established a novel formula to mathematically calculate actual 3D angles between inflow cannula and device body of HeartMate II. The formula would help investigators to validate their findings of the relationship between 2D projected angle (from CXR) and device thrombosis.
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Affiliation(s)
| | - Teruhiko Imamura
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Luis Landeras
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Hiroto Kitahara
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Gabriel Sayer
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Nir Uriel
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | | | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.
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5
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Arkles JS, Marchlinski F. When Should the Electrophysiologist Be Involved in Managing Patients with Ventricular Assist Devices and Ventricular Arrhythmias? J Innov Card Rhythm Manag 2019; 10:3605-3610. [PMID: 32494416 PMCID: PMC7252896 DOI: 10.19102/icrm.2019.100407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/18/2018] [Indexed: 11/06/2022] Open
Abstract
The successful management of ventricular arrhythmias (VAs) in people with left ventricular assist devices (LVADs) is often complex. The need for and the role of defibrillator therapy is continually evolving in this group. VAs occur frequently and significantly impact the clinical course of patients with LVADs. The management of VAs begins prior to LVAD implantation and typically involves appropriate implantable cardioverter-defibrillator use and programming after the fact. Surgical ablation during LVAD implantation and supplementary catheter ablation performed as needed are attractive options for the management of VAs in this population. The performance of catheter ablation is generally safe and feasible after LVAD implantation with a team approach.
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Affiliation(s)
- Jeffrey S Arkles
- Electrophysiology Section, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Francis Marchlinski
- Electrophysiology Section, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Sex-Specific Outcome Disparities in Patients Receiving Continuous-Flow Left Ventricular Assist Devices: A Systematic Review and Meta-analysis. ASAIO J 2019; 64:440-449. [PMID: 29084066 DOI: 10.1097/mat.0000000000000695] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Continuous-flow left ventricular assist devices (CF-LVADs) decrease mortality and improve quality of life in patients with advanced heart failure (HF). Their widespread utilization has led to concerns regarding increased adverse effects, especially in women. Nevertheless, sex-specific data remain limited. We searched Medline, Embase, Scopus, and the Cochrane Library for publications reporting sex-specific outcomes after CF-LVADs from January 2008 through January 2017. Outcomes were compared under the random-effects model and heterogeneity examined via χ test and I statistics. A total of 10 studies including 4,493 CF-LVAD recipients were included in the analysis (23.5% women). The overall rate of stroke was significantly higher in women (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.32-2.84; p = 0.0007). This was true for ischemic strokes (OR 2.03; 95% CI 1.21-3.42; p = 0.008) and hemorrhagic strokes (OR 2.03; 95% CI 1.21-3.42; p = 0.008). Women were also more likely to develop right HF necessitating right ventricular assist device (RVAD) implantation (OR 2.12; 95% CI 1.08-4.15; p = 0.03). Other adverse events including renal failure, bleeding, and device-related infection were comparable for both genders. The overall mortality while on CF-LVAD was similar in both groups (OR 1.05; 95% CI 0.81-1.36; p = 0.71). Our analysis suggests that women are at greater risk of significant complications such as cerebrovascular events and right HF necessitating RVAD after CF-LVAD implantation. Further research is needed to better understand the mechanisms underlying these sex-specific outcome disparities.
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7
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Hamed S, Schmack B, Mueller F, Ehlermann P, Hittmann D, Ruhparwar A, Katus HA, Raake PW, Kreusser MM. Implementation of an intensified outpatient follow-up protocol improves outcomes in patients with ventricular assist devices. Clin Res Cardiol 2019; 108:1197-1207. [DOI: 10.1007/s00392-019-01451-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
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8
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Sigakis CJG, Mathai SK, Suby-Long TD, Restauri NL, Ocazionez D, Bang TJ, Restrepo CS, Sachs PB, Vargas D. Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest. Radiographics 2018; 38:1027-1045. [PMID: 29906203 DOI: 10.1148/rg.2018170096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chest radiographs are obtained as a standard part of clinical care. Rapid advancements in medical technology have resulted in a myriad of new medical devices, and familiarity with their imaging appearance is a critical yet increasingly difficult endeavor. Many modern thoracic medical devices are new renditions of old designs and are often smaller than older versions. In addition, multiple device designs serving the same purpose may have varying morphologies and positions within the chest. The radiologist must be able to recognize and correctly identify the proper positioning of state-of-the-art medical devices and identify any potential complications that could impact patient care and management. To familiarize radiologists with the arsenal of newer thoracic medical devices, this review describes the indications, radiologic appearance, complications, and magnetic resonance imaging safety of each device. ©RSNA, 2018.
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Affiliation(s)
- Christopher J G Sigakis
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Susan K Mathai
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Thomas D Suby-Long
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Nicole L Restauri
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Daniel Ocazionez
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Tami J Bang
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Carlos S Restrepo
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Peter B Sachs
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Daniel Vargas
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
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Schmidt T, Bjarnason-Wehrens B, Schulte-Eistrup S, Reiss N. Effects of pump speed changes on exercise capacity in patients supported with a left ventricular assist device-an overview. J Thorac Dis 2018; 10:S1802-S1810. [PMID: 30034856 DOI: 10.21037/jtd.2018.01.114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The implantation of left ventricular assist devices (LVAD) has been established as a successful treatment for terminal heart failure (HF) for many years. Patient benefits include significantly improved survival, as well as improved quality of life. However, peak exercise capacity following LVAD implantation remains considerably restricted. This could be due to the predominate use of continuous-flow pumps, which operate at a fixed rotational speed and do not adapt to exercise conditions. Therefore, current research is focused on whether, and to what extent, adaptations in pump speed can influence and improve patient exercise capacity. We performed a systematic PubMed literature search on this topic, and found 11 relevant studies with 161 patients. Exercise time, peak work load, total cardiac output (TCO), peak oxygen consumption (peak VO2) and, if available, values at the anaerobic threshold (AT) were all taken into consideration. Possible complications were documented. This paper aims to compare the results from these studies in order to discuss the effects of pump speed adaptations on exercise capacity.
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Affiliation(s)
- Thomas Schmidt
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany.,Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | | | - Nils Reiss
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
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Ohler L. Courage and Character, Leaders and Legends: An Interview With O. H. "Bud" Frazier, MD, FACS, FACC. Prog Transplant 2017; 27:223-224. [PMID: 29187092 DOI: 10.1177/1526924817717608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marinescu KK, Uriel N, Mann DL, Burkhoff D. Left ventricular assist device-induced reverse remodeling: it's not just about myocardial recovery. Expert Rev Med Devices 2016; 14:15-26. [PMID: 27871197 DOI: 10.1080/17434440.2017.1262762] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The abnormal structure, function and molecular makeup of dilated cardiomyopathic hearts can be partially normalized in patients supported by a left ventricular assist device (LVAD), a process called reverse remodeling. This leads to recovery of function in many patients, though the rate of full recovery is low and in many cases is temporary, leading to the concept of heart failure remission, rather than recovery. Areas covered: We summarize data indicative of ventricular reverse remodeling, recovery and remission during LVAD support. These terms were used in searches performed in Pubmed. Duplication of topics covered in depth in prior review articles were avoided. Expert commentary: Although most patients undergoing mechanical circulatory support (MCS) show a significant degree of reverse remodeling, very few exhibit sufficiently improved function to justify device explantation, and many from whom LVADs have been explanted have relapsed back to the original heart failure phenotype. Future research has the potential to clarify the ideal combination of pharmacological, cell, gene, and mechanical therapies that would maximize recovery of function which has the potential to improve exercise tolerance of patients while on support, and to achieve a higher degree of myocardial recovery that is more likely to persist after device removal.
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Affiliation(s)
- Karolina K Marinescu
- a Department of Medicine, Division of Cardiology, Advanced Heart Failure , Rush University Medical Center , Chicago , IL , USA
| | - Nir Uriel
- b Department of Medicine, Division of Cardiology , University of Chicago , Chicago , IL , USA
| | - Douglas L Mann
- c Department of Medicine, Division of Cardiology , Washington University School of Medicine/Barnes Jewish Hospital , St. Louis , MO , USA
| | - Daniel Burkhoff
- d Department of Medicine, Division of Cardiology , Columbia University Medical Center/New York-Presbyterian Hospital , New York , NY , USA
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