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Kirschner M, Topkara VK, Sun J, Kurlansky P, Kaku Y, Naka Y, Yuzefpolskaya M, Colombo PC, Sayer G, Uriel N, Takeda K. Comparing 3-year survival and readmissions between HeartMate 3 and heart transplant as primary treatment for advanced heart failure. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01207-2. [PMID: 38154500 DOI: 10.1016/j.jtcvs.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To compare 3-year survival and readmissions of patients who received the HeartMate 3 (HM3) left ventricular assist device (LVAD) or underwent orthotopic heart transplantation (OHT) as primary treatment for advanced heart failure. METHODS We retrospectively analyzed 381 adult patients who received an HM3 LVAD or were listed for OHT between January 2014 and March 2021 at our center. To minimize crossover bias, OHT recipients with a prior LVAD were excluded, and HM3 patients were censored at the time of transplant. Cohorts were propensity score-matched to reduce confounding variables. The primary outcome was 3-year survival, and the secondary outcome was mean cumulative all-cause unplanned readmission. RESULTS The study population comprised 185 HM3 patients (49%) and 196 OHT patients (51%), with 104 propensity score-matched patients in each group. After propensity score matching, there was no statistical difference in 3-year survival (83.7% for HM3 vs 87.0% for OHT; P = .91; relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.20). In the unmatched cohorts, patients age 18 to 49 years had comparable survival with HM3 and OHT (96.9% vs 95.9%; N = 91; P = 1.00; RR, 0.92; 95% CI, 0.09-9.78). Patients age 50+ years had slightly inferior survival with HM3 (75.0% vs 83.9%; N = 290; P = .60; RR, 1.51; 95% CI, 0.85-2.68). The mean number of readmissions at 3 years was higher in the HM3 group (3.89 vs 2.05; P < .001). CONCLUSIONS This exploratory analysis suggests that for similar patients, HM3 may provide comparable 3-year survival to OHT as a primary treatment for heart failure but may result in more readmissions.
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Affiliation(s)
- Michael Kirschner
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jocelyn Sun
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY
| | - Paul Kurlansky
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY; Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY
| | - Yuji Kaku
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.
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Rajapreyar I, Soliman O, Brailovsky Y, Tedford RJ, Gibson G, Mohacsi P, Hajduczok AG, Tchantchaleishvili V, Wieselthaler G, Rame JE, Caliskan K. Late Right Heart Failure After Left Ventricular Assist Device Implantation: Contemporary Insights and Future Perspectives. JACC. HEART FAILURE 2023; 11:865-878. [PMID: 37269258 DOI: 10.1016/j.jchf.2023.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
Late right heart failure (RHF) is increasingly recognized in patients with long-term left ventricular assist device (LVAD) support and is associated with decreased survival and increased incidence of adverse events such as gastrointestinal bleeding and stroke. Progression of right ventricular (RV) dysfunction to clinical syndrome of late RHF in patients supported with LVAD is dependent on the severity of pre-existing RV dysfunction, persistent or worsening left- or right-sided valvular heart disease, pulmonary hypertension, inadequate or excessive left ventricular unloading, and/or progression of the underlying cardiac disease. RHF likely represents a continuum of risk with early presentation and progression to late RHF. However, de novo RHF develops in a subset of patients leading to increased diuretic requirement, arrhythmias, renal and hepatic dysfunction, and heart failure hospitalizations. The distinction between isolated late RHF and RHF due to left-sided contributions is lacking in registry studies and should be the focus of future registry data collection. Potential management strategies include optimization of RV preload and afterload, neurohormonal blockade, LVAD speed optimization, and treatment of concomitant valvular disease. In this review, the authors discuss definition, pathophysiology, prevention, and management of late RHF.
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Affiliation(s)
- Indranee Rajapreyar
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Osama Soliman
- Discipline of Cardiology, University Hospital Galway, School of Medicine, University of Galway, Ireland
| | - Yevgeniy Brailovsky
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gregory Gibson
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul Mohacsi
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander G Hajduczok
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georg Wieselthaler
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco, California, USA
| | - J Eduardo Rame
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kadir Caliskan
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
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Trachtenberg B, Cowger J. HFSA Expert Consensus Statement on the Medical Management of Patients on Durable Mechanical Circulatory Support. J Card Fail 2023; 29:479-502. [PMID: 36828256 DOI: 10.1016/j.cardfail.2023.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/24/2023]
Abstract
The medical management of patients supported with durable continuous flow left ventricular assist device (LVAD) support encompasses pharmacologic therapies administered in the preoperative, intraoperative, postoperative and chronic LVAD support stages. As patients live longer on LVAD support, the risks of LVAD-related complications and progression of cardiovascular and other diseases increase. Using existing data from cohort studies, registries, randomized trials and expert opinion, this Heart Failure Society of America Consensus Document on the Medical Management of Patients on Durable Mechanical Circulatory Support offers best practices on the management of patients on durable MCS, focusing on pharmacological therapies administered to patients on continuous flow LVADs. While quality data in the LVAD population are few, the utilization of guideline directed heart failure medical therapies (GDMT) and the importance of blood pressure management, right ventricular preload and afterload optimization, and antiplatelet and anticoagulation regimens are discussed. Recommended pharmacologic regimens used to mitigate or treat common complications encountered during LVAD support, including arrhythmias, vasoplegia, mucocutaneous bleeding, and infectious complications are addressed. Finally, this document touches on important potential pharmacological interactions from anti-depressants, herbal and nutritional supplements of relevance to providers of patients on LVAD support.
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Affiliation(s)
- Barry Trachtenberg
- Houston Methodist Heart and Vascular Center, Methodist J.C. Walter Transplant Center.
| | - Jennifer Cowger
- Medical Director, Mechanical Circulatory Support Program, Codirector, Cardiac Critical Care, Henry Ford Advanced Heart Failure Program.
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Shi J, Yu X, Liu Z. A review of new-onset ventricular arrhythmia after left ventricular assist device implantation. Cardiology 2022; 147:315-327. [PMID: 35483328 PMCID: PMC9393833 DOI: 10.1159/000524779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/24/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Heart failure (HF) is a severe and terminal stage of various heart diseases. Left ventricular assist devices (LVADs) are relatively mature and have contributed to the treatment of end-stage HF. Ventricular arrhythmia (VA) is a common complication after LVAD implantation, including ventricular tachycardia and ventricular fibrillation, both of which may cause abnormal circulation in the body. METHODS A literature search was conducted in the PubMed database, "Ventricular Arrhythmia" OR "VA" OR "Arrhythmia" OR "Ventricular Tachycardia," OR "Ventricular Fibrillation" AND "LVAD" OR "Left Ventricular Assist Device" OR "Heart Assist Device" as either keywords or MeSH terms, the authors screened the titles and abstracts of the articles. Eventually, 12 original research articles were retrieved. RESULTS The 0.83 [95%CI: 0.77, 0.89] of patients were male. A whole of 53% [95%CI:0.25, 0.81] of VA patients had a history of atrial fibrillation and 61% [95%CI:0.52, 0.69] had a history of VA. 39% [95%CI:0.29, 0.49] of the participants had no prior history of VA and experienced new VA following CF-LVAD implantation. Following CF-LVAD implantation, 59% [95%CI:0.51, 0.67] of patients developed the early VA (VA ≤ 30 days). The 30-day mortality of patients was 4% [95%CI:0.01, 0.07]. And overall mortality was 28% [95%CI:0.15, 0.41] The reported incidence of VA after LVAD implantation is not identical in different medical centers and ranges from 20% to 60%. The mechanism of VA after LVAD implantation is summarized as primary cardiomyopathy-related, device mechanical stimulation, myocardial scarring, ventricular displacement, electrolyte regulation, and other processes. CONCLUSIONS A preoperative VA history is considered a predictor of VA following LVAD implantation in most studies. Multiple mechanisms and factors, such as prevention of "suction events", ablation, and ICD, should be considered for the prevention and treatment of postoperative VA in patients requiring long-term VAD treatment. This study provides a reference for the clinical application of LAVD and the prevention of postoperative VA after LVAD implantation. Future multicenter prospective studies with uniform patient follow-up are needed to screen for additional potential risk factors and predictors. These studies will help to define the incidence rate of VA after LAVD implantation. As a result, we provide guidance for the selection of preventive intervention.
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Bonnemain J, Del Nido PJ, Roche ET. Direct Cardiac Compression Devices to Augment Heart Biomechanics and Function. Annu Rev Biomed Eng 2022; 24:137-156. [PMID: 35395165 DOI: 10.1146/annurev-bioeng-110220-025309] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The treatment of end-stage heart failure has evolved substantially with advances in medical treatment, cardiac transplantation, and mechanical circulatory support (MCS) devices such as left ventricular assist devices and total artificial hearts. However, current MCS devices are inherently blood contacting and can lead to potential complications including pump thrombosis, hemorrhage, stroke, and hemolysis. Attempts to address these issues and avoid blood contact led to the concept of compressing the failing heart from the epicardial surface and the design of direct cardiac compression (DCC) devices. We review the fundamental concepts related to DCC, present the foundational devices and recent devices in the research and commercialization stages, and discuss the milestones required for clinical translation and adoption of this technology. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 24 is June 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Jean Bonnemain
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland;
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA;
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Mechanical Engineering and Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA;
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Doğan Ö, Arslan Ş, Özyıldırım S, Abacı O. A stable patient with a left ventricular assist device was admitted to the outpatient clinic with ventricular fibrillation. Anatol J Cardiol 2021; 25:595-597. [PMID: 34369890 DOI: 10.5152/anatoljcardiol.2021.02009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ömer Doğan
- İstanbul University-Cerrahpaşa, Institute of Cardiology; İstanbul-Turkey
| | - Şükrü Arslan
- İstanbul University-Cerrahpaşa, Institute of Cardiology; İstanbul-Turkey
| | - Serhan Özyıldırım
- İstanbul University-Cerrahpaşa, Institute of Cardiology; İstanbul-Turkey
| | - Okay Abacı
- İstanbul University-Cerrahpaşa, Institute of Cardiology; İstanbul-Turkey
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Troubleshooting Left Ventricular Assist Devices: Modern Technology and Its Limitations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barssoum K, Patel H, Rai D, Kumar A, Hassib M, Othman HF, Thakkar S, El Karyoni A, Idemudia O, Ibrahim F, Salem T, Shariff M, Jabri A, ElBadawi A, Khodjaev S, Bandyopadhyay D, Aronow WS, Parikh V, Rao M, Soon P. Outcomes of Cardiac Arrest and Cardiopulmonary Resuscitation in Patients With Left Ventricular Assist Device; an Insight From a National Inpatient Sample. Heart Lung Circ 2021; 31:246-254. [PMID: 34226105 DOI: 10.1016/j.hlc.2021.05.096] [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] [Received: 12/01/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Outcomes of patients with implanted left ventricular assist device (LVAD) implantation experiencing a cardiac arrest (CA) are not well reported. We aimed at defining the in-hospital outcomes of patients with implanted LVAD experiencing a CA. METHODS The national inpatient sample (NIS) was queried using ICD9/ICD10 codes for patients older than 18 years with implanted LVAD and CA between 2010-2018. We excluded patients with orthotropic heart transplantation, biventricular assist device (BiVAD) implantation and do not resuscitate (DNR) status. RESULTS A total of 93,153 hospitalisations between 2010 and 2018 with implanted LVAD were identified. Only 578 of these hospitalisations had experienced CA and of those, 173 (33%) hospitalisations underwent cardiopulmonary resuscitation (CPR). The mean age of hospitalisations that experienced a CA was 60.61±14.85 for non-survivors and 56.23±17.33 for survivors (p=0.14). The in-hospital mortality was 60.8 % in hospitalisations with CA and 74.33% in hospitalisations in whom CPR was performed. In an analysis comparing survivors with non-survivors, non-survivors had more diabetes mellitus (DM) (p=0.01), and ischaemic heart disease (IHD) (p=0.04). Age, female sex, peripheral vascular disease and history of coronary artery bypass graft (CABG) were independently associated with increased mortality in our cohort. Also, ventricular tachycardia (VT) and CPR were independently associated with in-hospital mortality. During the study period, there was a significantly decreasing trend in performing CPR in LVAD hospitalisations with CA. CONCLUSION In conclusion, age, female sex, peripheral vascular disease, history of CABG, VT and CPR were independently associated with in-hospital mortality in LVAD hospitalisations who experienced CA.
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Affiliation(s)
- Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA; Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA.
| | - Harsh Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | | | - Hasan F Othman
- Michigan State University/Sparrow Health System, Lansing, MI, USA
| | | | - Ahmed El Karyoni
- Cardiovascular Department, Loyola University Medical Center, IL, USA
| | - Osarenren Idemudia
- Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA
| | - Fadi Ibrahim
- American University of Antigua, Antigua and Barbuda
| | - Tala Salem
- Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA
| | - Mariam Shariff
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ahmad Jabri
- Heart and Vascular Center, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH, USA
| | - Ayman ElBadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Soidjon Khodjaev
- Department of Advanced Heart Failure and Transplant, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | | | - Wilbert S Aronow
- Department of Cardiology, New York Medical College at Westchester Medical Center, New York, NY, USA
| | - Vishal Parikh
- Department of Advanced Heart Failure and Transplant, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Mohan Rao
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Park Soon
- Department of Advanced Heart Failure and Transplant, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
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Gao B, Kang Y, Zhang Q, Chang Y. Biomechanical effects of the novel series LVAD on the aortic valve. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105763. [PMID: 32998103 DOI: 10.1016/j.cmpb.2020.105763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The series type of LVAD (i.e., BJUT-II VAD) is a novel left ventricular assist device, whose effects on the aortic valve remain unclear. METHODS The biomechanical effects of BJUT-II VAD on the aortic valve were investigated by using a fluid-structure interaction method. The geometric model of BJUT-II VAD was virtually implanted into the ascending aorta to generate the realistic flow pattern for the aortic valve (i.e., support). In addition, the biomechanical states of the aortic valve without BJUT-II VAD support was computed as control (i.e., control case). RESULTS Results demonstrated that the biomechanical effects of BJUT-II VAD were quite different from that resulting from traditional "bypass LVAD." Compared with those in the control case, BJUT-II VAD support could significantly reduce the stress load of the leaflet (maximum stress, 0.5 MPa in the control case vs. 0.12 MPa in the support case). Similarly, the rapid valve opening time (100 ms in the control case vs. 175 ms in the support case) and rapid valve closing time (50 ms in the control case vs. 150 ms in the support case) in the support case were obviously longer than those in the control case. Moreover, BJUT-II VAD support reduced retrograde blood flow during the diastolic phase and significantly changed the distribution of WSS of the leaflets. CONCLUSIONS In summary, while unloading the left ventricle, BJUT-II VAD could provide beneficial biomechanical states for the aortic leaflets, thereby reducing the risk of aortic valve disease.
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Affiliation(s)
- Bin Gao
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, PR China.
| | - Yizhou Kang
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, PR China
| | - Qi Zhang
- National Energy Conservation Center, Beijing, PR China
| | - Yu Chang
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, PR China
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