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Bernhardt AM, Reichenspurner H. Anticoagulation in LVAD recipients and thrombembolic complications: Where do we stand? Where are we going to? J Heart Lung Transplant 2024; 43:876-877. [PMID: 38431240 DOI: 10.1016/j.healun.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Carey MR, Marshall D, Clerkin K, Laracuente R, Sanchez J, Jain SS, Raikhelkar JK, Leb JS, Kaku Y, Yuzefpolskaya M, Naka Y, Colombo PC, Sayer GT, Takeda K, Uriel N, Topkara VK, Fried JA. Aortic Root Thrombosis in patients with HeartMate 3 left ventricular assist device support. J Heart Lung Transplant 2024; 43:866-875. [PMID: 37739242 DOI: 10.1016/j.healun.2023.08.023] [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: 11/02/2022] [Revised: 08/07/2023] [Accepted: 08/26/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Aortic root thrombosis(ART) is a complication of continuous-flow left ventricular assist device therapy. However, the incidence and related complications of ART in HeartMate 3 (HM3) patients remain unknown. METHODS Patients who underwent HM3 implantation from November 2014 to August 2020 at a quaternary academic medical center were included. Demographics and outcomes were abstracted from the medical record. Echocardiograms and contrast-enhanced computed tomography studies were reviewed to identify patients who developed ART and/or moderate or greater aortic insufficiency (AI) on HM3 support. RESULTS The study cohort included 197 HM3 patients with a median postimplant follow-up of 17.5 months. Nineteen patients (9.6%) developed ART during HM3 support, and 15 patients (7.6%) developed moderate or greater AI. Baseline age, gender, race, implantation strategy, and INTERMACS classification were similar between the ART and no-ART groups. ART was associated with an increased risk of death, stroke, or aortic valve (AV) intervention (subhazard ratio [SHR] 3.60 [95% confidence interval (CI) 1.71-7.56]; p = 0.001) and moderate or greater AI (SHR 11.1 [CI 3.60-34.1]; p < 0.001) but was not associated with a statistically significantly increased risk of death or stroke on HM3 support (2.12 [0.86-5.22]; p = 0.10). Of the 19 patients with ART, 6 (31.6%) developed moderate or greater AI, necessitating more frequent AV interventions (ART: 5 AV interventions [3 surgical repairs, 1 surgical replacement, 1 transcatheter replacement; 26.3%]; no-ART: 0). CONCLUSIONS Nearly 10% of HM3 patients developed ART during device support. ART was associated with increased risk of a composite end-point of death, stroke, or AV intervention as well as moderate or greater AI.
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Affiliation(s)
- Matthew R Carey
- Department of Internal Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Dylan Marshall
- Division of Cardiology, NewYork-Presbyterian/Weill Cornell Medical College, New York, New York
| | - Kevin Clerkin
- Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Ronald Laracuente
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Joseph Sanchez
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Sneha S Jain
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Jayant K Raikhelkar
- Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Jay S Leb
- Department of Radiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Yuji Kaku
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Gabriel T Sayer
- Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Koji Takeda
- Department of Radiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Veli K Topkara
- Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Justin A Fried
- Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York.
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Lopez-Santana G, De Rosis A, Grant S, Venkateswaran R, Keshmiri A. Enhancing the implantation of mechanical circulatory support devices using computational simulations. Front Bioeng Biotechnol 2024; 12:1279268. [PMID: 38737533 PMCID: PMC11084291 DOI: 10.3389/fbioe.2024.1279268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction: Patients with end-stage heart failure (HF) may need mechanical circulatory support such as a left ventricular assist device (LVAD). However, there are a range of complications associated with LVAD including aortic regurgitation (AR) and thrombus formation. This study assesses whether the risk of developing aortic conditions can be minimised by optimising LVAD implantation technique. Methods: In this work, we evaluate the aortic flow patterns produced under different geometrical parameters for the anastomosis of the outflow graft (OG) to the aorta using computational fluid dynamics (CFD). A three-dimensional aortic model is created and the HeartMate III OG positioning is simulated by modifying (i) the distance from the anatomic ventriculo-arterial junction (AVJ) to the OG, (ii) the cardinal position around the aorta, and (iii) the angle between the aorta and the OG. The continuous LVAD flow and the remnant native cardiac cycle are used as inlet boundaries and the three-element Windkessel model is applied at the pressure outlets. Results: The analysis quantifies the impact of OG positioning on different haemodynamic parameters, including velocity, wall shear stress (WSS), pressure, vorticity and turbulent kinetic energy (TKE). We find that WSS on the aortic root (AoR) is around two times lower when the OG is attached to the coronal side of the aorta using an angle of 45° ± 10° at a distance of 55 mm. Discussion: The results show that the OG placement may significantly influence the haemodynamic patterns, demonstrating the potential application of CFD for optimising OG positioning to minimise the risk of cardiovascular complications after LVAD implantation.
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Affiliation(s)
- Gabriela Lopez-Santana
- School of Engineering, The University of Manchester, Manchester, United Kingdom
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Wythenshawe Hospital, Manchester, United Kingdom
| | - Alessandro De Rosis
- School of Engineering, The University of Manchester, Manchester, United Kingdom
| | - Stuart Grant
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Rajamiyer Venkateswaran
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Wythenshawe Hospital, Manchester, United Kingdom
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Amir Keshmiri
- School of Engineering, The University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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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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Martinez J, Smegner K, Tomoda M, Motomura T, Chivukula VK. Encouraging Regular Aortic Valve Opening for EVAHEART 2 LVAD Support Using Virtual Patient Hemodynamic Speed Modulation Analysis. ASAIO J 2024; 70:207-216. [PMID: 38029749 DOI: 10.1097/mat.0000000000002093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
This study focuses on investigating the EVAHEART 2 left ventricular assist device (LVAD) toward designing optimal pump speed modulation (PSM) algorithms for encouraging aortic valve (AV) flow. A custom-designed virtual patient hemodynamic model incorporating the EVAHEART 2 pressure-flow curves, cardiac chambers, and the systemic and pulmonary circulations was developed and used in this study. Several PSM waveforms were tested to evaluate their influence on the mean arterial pressure (MAP), cardiac output (CO), and AV flow for representative heart failure patients. Baseline speeds were varied from 1,600 to 2,000 rpm. For each baseline speed, the following parameters were analyzed: 1) PSM ratio (reduced speed/baseline speed), 2) PSM duration (3-7 seconds), 3) native ventricle contractility, and 4) patient MAP of 70 and 80 mm Hg. More than 2,000 rpm virtual patient scenarios were explored. A lower baseline speed (1,600 and 1,700 rpm) produced more opportunities for AV opening and more AV flow. Higher baseline speeds (1,800 and 2,000 rpm) had lower or nonexistent AV flow. When analyzing PSM ratios, a larger reduction in speed (25%) over a longer PSM (5+ seconds) duration produced the most AV flow. Lower patient MAP and increased native ventricle contractility also contributed to improving AV opening frequency and flow. This study of the EVAHEART 2 LVAD is the first to focus on leveraging PSM to enhance pulsatility and encourage AV flow. Increased AV opening frequency can benefit aortic root hemodynamics, thereby improving patient outcomes.
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Affiliation(s)
- Jasmine Martinez
- From the Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
| | | | | | | | - Venkat Keshav Chivukula
- From the Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
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Kanelidis AJ, Siddiqi U, Miller T, Belkin M, Li G, Smith B, Kalantari S, Nguyen A, Chung BB, Sarswat N, Kim G, Salerno C, Jeevanandam V, Pinney S, Grinstein J. The prognostic role of advanced hemodynamic variables in patients with left ventricular assist devices. Artif Organs 2023; 47:574-581. [PMID: 36305735 PMCID: PMC10023393 DOI: 10.1111/aor.14441] [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: 06/29/2022] [Revised: 09/21/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Invasive hemodynamic variables obtained from right heart catheterization have been used for risk-stratifying patients with advanced heart failure (HF). However, there is a paucity of data on the prognostic value of invasive hemodynamic variables in patients with left ventricular assist devices (LVAD). We hypothesized that cardiac power output (CPO), cardiac power efficiency (CPE), and left ventricular stroke work index (LVSWI) can serve as prognostic markers in patients with LVADs. METHODS Baseline hemodynamic data from patients who had LVAD ramp studies at our institution from 4/2014 to 7/2018 were prospectively collected, from which advanced hemodynamic variables (CPO, CPE, and LVSWI) were retrospectively analyzed. Univariate and multivariable analyses were performed for hemocompatibility-related adverse events (HRAE), HF admissions, and mortality. RESULTS Ninety-one participants (age 61 ± 11 years, 34% women, 40% Black or African American, and 38% ischemic cardiomyopathy) were analyzed. Low CPE was significantly associated with mortality (HR 2.42, 95% CI 1.02-5.74, p = 0.045) in univariate analysis and Kaplan-Meier analysis (p = 0.04). Low LVSWI was significantly associated with mortality (HR 2.13, 95% CI 1.09-4.17, p = 0.03) in univariate analysis and Kaplan-Meier analysis (p = 0.02). CPO was not associated with mortality. CPO, CPE, and LVSWI were not associated with HRAE or HF admissions. CONCLUSIONS Advanced hemodynamic variables can serve as prognostic indicators for patients with LVADs. Low CPE and LVSWI are prognostic for higher mortality, but no variables were associated with HF admissions or HRAEs.
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Affiliation(s)
- Anthony J Kanelidis
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Umar Siddiqi
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Tamari Miller
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Mark Belkin
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - George Li
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Bryan Smith
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Sara Kalantari
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Ann Nguyen
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Ben B Chung
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Nitasha Sarswat
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Gene Kim
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Christopher Salerno
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Valluvan Jeevanandam
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Sean Pinney
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jonathan Grinstein
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
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Wu X, Zhang Y, Zheng X, Liu H, Wang H. Numerical simulation for suction detection based on improved model of cardiovascular system. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Function Follows Form: Modeling Ventricular Assist Device-Mediated Blood Flow. ASAIO J 2021; 67:734-736. [PMID: 33470640 DOI: 10.1097/mat.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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