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Dual SA, Cowger J, Roche E, Nayak A. The Future of Durable Mechanical Circulatory Support: Emerging Technological Innovations and Considerations to Enable Evolution of the Field. J Card Fail 2024; 30:596-609. [PMID: 38431185 DOI: 10.1016/j.cardfail.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/05/2024]
Abstract
The field of durable mechanical circulatory support (MCS) has undergone an incredible evolution over the past few decades, resulting in significant improvements in longevity and quality of life for patients with advanced heart failure. Despite these successes, substantial opportunities for further improvements remain, including in pump design and ancillary technology, perioperative and postoperative management, and the overall patient experience. Ideally, durable MCS devices would be fully implantable, automatically controlled, and minimize the need for anticoagulation. Reliable and long-term total artificial hearts for biventricular support would be available; and surgical, perioperative, and postoperative management would be informed by the individual patient phenotype along with computational simulations. In this review, we summarize emerging technological innovations in these areas, focusing primarily on innovations in late preclinical or early clinical phases of study. We highlight important considerations that the MCS community of clinicians, engineers, industry partners, and venture capital investors should consider to sustain the evolution of the field.
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Affiliation(s)
- Seraina A Dual
- KTH Royal Institute of Technology, Department of Biomedical Engineering and Health Systems, Stockholm, Sweden
| | | | - Ellen Roche
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Aditi Nayak
- Baylor University Medical Center, Dallas, Texas.
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2
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Miller T, Lang FM, Rahbari A, Theodoropoulos K, Topkara VK. Right heart failure after durable left ventricular assist device implantation. Expert Rev Med Devices 2024; 21:197-206. [PMID: 38214584 DOI: 10.1080/17434440.2024.2305362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Right heart failure (RHF) is a well-known complication after left ventricular assist device (LVAD) implantation and portends increased morbidity and mortality. Understanding the mechanisms and predictors of RHF in this clinical setting may offer ideas for early identification and aggressive management to minimize poor outcomes. A variety of medical therapies and mechanical circulatory support options are currently available for the management of post-LVAD RHF. AREAS COVERED We reviewed the existing definitions of RHF including its potential mechanisms in the context of durable LVAD implantation and currently available medical and device therapies. We performed a literature search using PubMed (from 2010 to 2023). EXPERT OPINION RHF remains a common complication after LVAD implantation. However, existing knowledge gaps limit clinicians' ability to adequately address its consequences. Early identification and management are crucial to reducing the risk of poor outcomes, but existing risk stratification tools perform poorly and have limited clinical applicability. This is an area ripe for investigation with the potential for major improvements in identification and targeted therapy in an effort to improve outcomes.
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Affiliation(s)
- Tamari Miller
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Frederick M Lang
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ashkon Rahbari
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Kleanthis Theodoropoulos
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Themistokles C, Koliopoulou A, Leontiadis E, Gkouziouta A, Bonios MJ. Durable Right Ventricular Assist Device HeartMate 3 Implant to the Right Atrium for Right Ventricular Failure After LVAD Implant. ASAIO J 2024:00002480-990000000-00419. [PMID: 38373165 DOI: 10.1097/mat.0000000000002159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
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Loardi CM, Zanobini M, Ricciardi G, Vermes E. Current and future options for adult biventricular assistance: a review of literature. Front Cardiovasc Med 2023; 10:1234516. [PMID: 38028456 PMCID: PMC10657899 DOI: 10.3389/fcvm.2023.1234516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
In cardiogenic shock various short-term mechanical assistances may be employed, including an Extra Corporeal Membrane Oxygenator and other non-dischargeable devices. Once hemodynamic stabilization is achieved and the patient evolves towards a persisting biventricular dysfunction or an underlying long-standing end-stage disease is present, aside from Orthotopic Heart Transplantation, a limited number of long-term therapeutic options may be offered. So far, only the Syncardia Total Artificial Heart and the Berlin Heart EXCOR (which is not approved for adult use in the United States unlike in Europe) are available for extensive implantation. In addition to this, the strategy providing two continuous-flow Left Ventricular Assist Devices is still off-label despite its widespread use. Nevertheless, every solution ensures at best a 70% survival rate (reflecting both the severity of the condition and the limits of mechanical support) with patients suffering from heavy complications and a poor quality of life. The aim of the present paper is to summarize the features, implantation techniques, and results of current devices used for adult Biventricular Mechanical Circulatory Support, as well as a glance to future options.
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Affiliation(s)
| | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
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Adcox M, Dimarakis I. HM6: greater than the sum of its parts? INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad139. [PMID: 37651447 PMCID: PMC10493184 DOI: 10.1093/icvts/ivad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Mackenzie Adcox
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Ioannis Dimarakis
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
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Arabía FA, Murray CF, Cantor R, Deng L, Gopalan R, Amabile O, Kalya A, Tasset MR, Colón MJ, Smith R, Kirklin JK. Heart Transplant Outcomes After Total Artificial Heart. Transplant Proc 2023; 55:1664-1673. [PMID: 37453855 DOI: 10.1016/j.transproceed.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We sought to compare heart transplant (HTX) outcomes from patients with a total artificial heart (TAH), biventricular assist device (BiVAD), or left ventricular assist device (LVAD) as a bridge to transplant (BTT). Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)-Scientific Registry of Transplant Recipients (SRTR) created a dataset with TAH or durable mechanical circulatory support (MCS) who reached HTX between 2006 and 2015. METHODS The retrospective analysis compared TAH outcomes with those with a BiVAD or LVAD before HTX. The primary outcome was posttransplant survival at 1, 36, and 60 months. Secondary outcomes included simultaneous heart-kidney transplants, donor characteristics, and mortality risk factors. INTERMACS-SRTR cohort had, at the time of HTX, 2762 patients with LVAD; 205 BiVAD (139 durable and 66 temporary RVAD); 176 TAH (6 prior HeartMate II). RESULTS Sixty months after HTX, mortality rates were 16.5% in the total group: LVAD 15.2%, BiVAD 22.4%, and TAH 29%. Survival differed between the LVAD, the TAH, and BiVAD but not between the BiVAD and TAH groups. One-year survival and complication rates were similar across groups-there was no difference in survival by donor age in the overall cohort. There was a difference in TTD based on recipient age in the LVAD group but not in BiVAD or TAH groups. Occurrence of HTX-kidney and post-transplant dialysis were higher in the TAH versus LVAD and BiVAD groups. CONCLUSIONS The TAH is an efficacious BTT. Refinements in technology and patient selection may improve outcomes.
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Affiliation(s)
- Francisco A Arabía
- Advanced Heart Program-University Medical Group and University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
| | | | - Ryan Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama
| | - Luqin Deng
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama
| | - Radha Gopalan
- University of Arizona College of Medicine and Center for Advanced Heart Failure/Mechanical Circulatory Support and Transplant, Banner-University Medical Center Phoenix, Phoenix, Arizona
| | - Orazio Amabile
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Anantharam Kalya
- University of Arizona College of Medicine and Center for Advanced Heart Failure/Mechanical Circulatory Support and Transplant, Banner-University Medical Center Phoenix, Phoenix, Arizona
| | - Mark R Tasset
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Modesto J Colón
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Richard Smith
- Banner-University Medical Center Tucson and South Tucson, Tucson, Arizona
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama
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Dogan G, Hanke JS, Alhumood K, Tarazi R, Riebandt J, Wiedemann D, Kneževič I, Haverich A, Zimpfer D, Schmitto JD. Three-month outcomes after the implantation of two HeartMate 3 devices in total artificial heart configuration. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:121-129. [PMID: 36763071 DOI: 10.23736/s0021-9509.22.12445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Total artificial heart (TAH) implantation is a rarely performed procedure. Contrarily, left ventricular assist device (VAD) implantation is rather common in many centers. As transplantation is quantitatively limited cardiac replacement with artificial hearts is a viable alternative in the treatment of severe biventricular heart failure. An alternative to TAH is the implantation of two VADs in a TAH configuration. We hereby present the first multi-center study on 3-months outcomes of patients treated by cardiectomy and placement of two HeartMate 3s in a TAH configuration. METHODS We retrospectively investigated a cohort of 15 patients that underwent HM3-TAH-implantation at three international institutions. Follow-up was 3 months after implantation. Baseline, intra- and postoperative parameters as well as survival data and adverse events were collected. RESULTS A total of 1089 days on HM3-TAH were observed. Thirty-day survival after HM3-TAH implantation was 53% (8/15) and three month survival was 40% (6/15). The longest duration on device was 274 days. Causes of death were multi-organ failure, sepsis, and neurological adverse events. No technical complications were documented. Two patients remained on the device. Four patients (26%) were successfully bridged to transplantation. CONCLUSIONS The implantation of two HeartMate 3s in a TAH configuration is a last resort and off-label concept in cases of extreme biventricular heart failure. In a diligently selected patient cohort, HM3-TAH implantation is a feasible method to increase the chance of survival in a severely ill patient cohort and successfully bridge patients to heart transplantation that would otherwise have died.
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Affiliation(s)
- Günes Dogan
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany -
| | - Khaldoon Alhumood
- Department of Cardiac Surgery, Salman Al Dabbous Cardiac Center, Kuwait City, Kuwait
| | - Riyad Tarazi
- Department of Cardiac Surgery, Salman Al Dabbous Cardiac Center, Kuwait City, Kuwait
| | - Julia Riebandt
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Ivan Kneževič
- Department of Cardiovascular Surgery, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Axel Haverich
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Daniel Zimpfer
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jan D Schmitto
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Vis A, Arfaee M, Khambati H, Slaughter MS, Gummert JF, Overvelde JTB, Kluin J. The ongoing quest for the first total artificial heart as destination therapy. Nat Rev Cardiol 2022; 19:813-828. [PMID: 35668176 DOI: 10.1038/s41569-022-00723-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 12/18/2022]
Abstract
Many patients with end-stage heart disease die because of the scarcity of donor hearts. A total artificial heart (TAH), an implantable machine that replaces the heart, has so far been successfully used in over 1,700 patients as a temporary life-saving technology for bridging to heart transplantation. However, after more than six decades of research on TAHs, a TAH that is suitable for destination therapy is not yet available. High complication rates, bulky devices, poor durability, poor biocompatibility and low patient quality of life are some of the major drawbacks of current TAH devices that must be addressed before TAHs can be used as a destination therapy. Quickly emerging innovations in battery technology, wireless energy transmission, biocompatible materials and soft robotics are providing a promising opportunity for TAH development and might help to solve the drawbacks of current TAHs. In this Review, we describe the milestones in the history of TAH research and reflect on lessons learned during TAH development. We summarize the differences in the working mechanisms of these devices, discuss the next generation of TAHs and highlight emerging technologies that will promote TAH development in the coming decade. Finally, we present current challenges and future perspectives for the field.
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Affiliation(s)
- Annemijn Vis
- Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maziar Arfaee
- Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Husain Khambati
- Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Johannes T B Overvelde
- Autonomous Matter Department, AMOLF, Amsterdam, The Netherlands.,Institute for Complex Molecular Systems and Department of Mechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jolanda Kluin
- Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands. .,Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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Rodenas-Alesina E, Brahmbhatt DH, Rao V, Salvatori M, Billia F. Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review. Front Cardiovasc Med 2022; 9:1040251. [PMID: 36407460 PMCID: PMC9671519 DOI: 10.3389/fcvm.2022.1040251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/18/2022] [Indexed: 08/26/2023] Open
Abstract
Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Cardiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Darshan H. Brahmbhatt
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Vivek Rao
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Marcus Salvatori
- Department of Anesthesia, University Health Network, Toronto, ON, Canada
| | - Filio Billia
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
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Bonios MJ, Armenis I, Kogerakis N, Thodou A, Gkouziouta A, Koliopoulou A, Kaklamanis L, Chamogeorgakis T, Drakos SG, Adamopoulos SN. Phenotype Characterization and Course of Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Biventricular Advanced Heart Failure: A Report of 3 Cases. Transplant Proc 2022; 54:2347-2351. [PMID: 36195497 DOI: 10.1016/j.transproceed.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) may be complicated by heart failure. Management of advanced heart failure in this context is challenging. METHODS We reviewed our center's experience with advanced heart failure therapies in patients with ARVC. Three rapidly deteriorating patients with ARVC with biventricular heart failure were found. Their management and outcomes are presented. Data on ventricular fibrosis were available in 2 of them and are also included. RESULTS The first patient underwent initially successful paracorporeal pulsatile biventricular assist device (BiVAD) implantation. However, a large ischemic stroke occurred 2 weeks later, and the patient died after 2 months. The second patient underwent urgent BiVAD implantation after extracorporeal membrane oxygenation support because of cardiogenic shock, but his course was complicated by multiorgan failure due to systemic infection and the patient died. The last patient, being at Interagency Registry for Mechanically Assisted Circulatory Support 3-4 profile, underwent heart transplant with uneventful recovery. Extensive fibrosis was present in both ventricles of 2 patients undergoing pathology examination. CONCLUSIONS Patients with ARVC and advanced biventricular heart failure are characterized by extensive ventricular fibrosis and considerable risk, but data on their management are limited. Biventricular circulatory support is associated with suboptimal outcomes, and prioritization for heart transplant seems preferable.
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Affiliation(s)
- Michael J Bonios
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece.
| | - Iakovos Armenis
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nektarios Kogerakis
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Aspasia Thodou
- Division of Cardiovascular Medicine, University of Utah Health and School of Medicine, Salt Lake City, Utah
| | - Angeliki Gkouziouta
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Antigoni Koliopoulou
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Loukas Kaklamanis
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah Health and School of Medicine, Salt Lake City, Utah
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Hanke JS, Dogan G, Shrestha M, Haverich A, Schmitto JD. Innovations in implantation techniques of ventricular assist devices. JTCVS OPEN 2021; 8:28-32. [PMID: 36004096 PMCID: PMC9390346 DOI: 10.1016/j.xjon.2021.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jasmin S. Hanke
- Address for reprints: Jasmin S. Hanke, MD, Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany.
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12
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The HeartMate 6 and CardioMEMS for Fixed Pulmonary Hypertension. ASAIO J 2021; 68:e80-e83. [PMID: 33989210 DOI: 10.1097/mat.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Fixed pulmonary hypertension (FPH) is a contraindication for heart transplantation (HTX). However, this condition might be reversed by continuous left-ventricular unloading with a left-ventricular assist device. We present a case of apical hypertrophic cardiomyopathy with extensive left-ventricular endocardial calcification and severe FPH (systolic pulmonary artery pressure, 102 mm Hg). To bridge the patient to candidacy for HTX, two Abbott HeartMate 3 ventricular assist devices were implanted in a total artificial heart (TAH) configuration ("HeartMate 6"). Before TAH implantation, an Abbott CardioMEMS pressure sensor was implanted to assess reversal of FPH before listing for HTX.
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McGiffin D, Kure C, McLean J, Marasco S, Bergin P, Hare JL, Leet A, Patel H, Zimmet A, Rix J, Taylor A, Kaye D. The results of a single-center experience with HeartMate 3 in a biventricular configuration. J Heart Lung Transplant 2020; 40:193-200. [PMID: 33423854 DOI: 10.1016/j.healun.2020.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Right ventricular (RV) failure after left ventricular assist device (VAD) implantation is a difficult problem. One solution is the implantation of continuous-flow VADs in a biventricular configuration. Disappointing survival and a concerning incidence of right-sided pump thrombosis have been previously reported. METHODS From May 2017 to April 2020, a total of 12 patients underwent implantation of HeartMate 3 (HM3) biventricular VADs (BiVADs) as a bridge to cardiac transplantation. The right-sided pump was implanted in the right atrium in all cases. Adverse events and patient outcomes were determined. RESULTS Patients were male, and the mean age was 44 years. The etiology was dilated cardiomyopathy (6 patients), sarcoid heart disease (2 patients), ischemic cardiomyopathy (1 patient), anthracycline cardiomyopathy (1 patient), non-compaction cardiomyopathy (1 patient), and arrhythmogenic RV cardiomyopathy with biventricular involvement (1 patient). There was 1 death from multisystem failure. There were 3 episodes of right VAD thrombus (thrombosis or clot ingestion); 1 managed medically, 1 recognized intraoperatively treated with clot retrieval, and 1 requiring pump exchange. There were 3 driveline infections. At 18 months after the procedure, 5 patients (41.7%) had undergone cardiac transplantation, 5 patients (41.7%) were alive and on biventricular support, 1 patient had died (8.3%), and 1 patient had VAD explantation for myocardial recovery (8.3%). Actuarial survival at 18 months was 91.7%. CONCLUSIONS In this small study, HM3 BiVAD in these critically ill patients was used with low mortality. This suggests that the timely deployment of biventricular support with HM3 can be associated with favorable outcomes.
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Affiliation(s)
- David McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital and Monash University, Melbourne, Australia.
| | - Christina Kure
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Janelle McLean
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Silvana Marasco
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Peter Bergin
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - James L Hare
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Angeline Leet
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Hitesh Patel
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Adam Zimmet
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Julia Rix
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Andrew Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - David Kaye
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
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Riebandt J, Hanke JS. Der Herzinsuffizienzchirurg – Hausarzt und Herzchirurg. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-019-00350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungBei der Therapie der terminalen Herzinsuffizienz handelt es sich um einen Wachstumsmarkt – sowohl für Kardiologen als auch für Herzchirurgen. Der besondere Reiz der Arbeit eines Herzinsuffizienzchirurgen besteht in der notwendigen Multidisziplinarität und der Tatsache, dass es nicht nur um den rein mechanistischen Zugang im Sinne der chirurgischen Therapie geht. Vielmehr macht ein Großteil der Arbeit die Vor- und Nachbehandlung aus, die meist durch den Chirurgen selbst ausgeführt wird. Umfassende herzchirurgische Kenntnisse sind ebenso unumgänglich wie das Verständnis kardiologischer und intensivmedizinischer Therapiekonzepte, um dem Patienten eine individuelle und sinnvolle Therapie anbieten zu können. Der vorliegende Beitrag bietet interessierten Kollegen einen Überblick über die Möglichkeiten und Anforderungen in diesem Teilgebiet der Herzchirurgie.
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