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Crespo-Diaz R, Mudy K, Khan N, Samara M, Eckman PM, Sun B, Hryniewicz K. Right Ventricular Assist Device Placement During Left Ventricular Assist Device Implantation Is Associated With Improved Survival. ASAIO J 2024; 70:570-577. [PMID: 38373178 DOI: 10.1097/mat.0000000000002160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
Right ventricular failure (RVF) is a significant cause of mortality in patients undergoing left ventricular assist device (LVAD) implantation. Although right ventricular assist devices (RVADs) can treat RVF in the perioperative LVAD period, liberal employment before RVF is not well established. We therefore compared the survival outcomes between proactive RVAD placement at the time of LVAD implantation with a bailout strategy in patients with RVF. Retrospectively, 75 adult patients who underwent durable LVAD implantation at our institution and had an RVAD placed proactively before LVAD implantation or as a bailout strategy postoperatively due to hemodynamically unstable RVF were evaluated. Patients treated with a proactive RVAD strategy had lower Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and a higher proportion of these required temporary mechanical circulatory support (MCS) preoperatively. Preoperative hemodynamic profiling showed a low pulmonary artery pulsatility index (PAPi) score of 1.8 ± 1.4 and 1.6 ± 0.94 ( p = 0.42) in the bailout RVAD and proactive RVAD groups, respectively. Survival at 3, 6, and 12 months post-LVAD implantation was statistically significantly higher in patients who received a proactive RVAD. Thus, proactive RVAD implantation is associated with short- and medium-term survival benefits compared to a bailout strategy in RVF patients undergoing LVAD placement.
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Affiliation(s)
- Ruben Crespo-Diaz
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Karol Mudy
- Department of Cardiothoracic Surgery, Baptist Health, Little Rock, Arkansas
| | - Nadeem Khan
- Department of Cardiovascular Diseases, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Michael Samara
- Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Peter M Eckman
- Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Benjamin Sun
- Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Katarzyna Hryniewicz
- Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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2
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Karimov JH, Fukamachi K, Masuzawa T. Editorial: Mechanical circulatory support therapy for biventricular failure. Front Cardiovasc Med 2024; 11:1421550. [PMID: 38841259 PMCID: PMC11150802 DOI: 10.3389/fcvm.2024.1421550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Affiliation(s)
- Jamshid H. Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
- Kaufman Center for Heart Failure, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
- Kaufman Center for Heart Failure, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
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3
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Brewer JM, Lorusso R, Broman LM, Conrad SA, Swol J, Maybauer MO. Central Venopulmonary Extracorporeal Membrane Oxygenation: Background and Standardized Nomenclature. ASAIO J 2024:00002480-990000000-00486. [PMID: 38768563 DOI: 10.1097/mat.0000000000002239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
This review highlights advancements in extracorporeal life support (ECLS), emphasizing the critical role of standardized terminology, particularly for extracorporeal membrane oxygenation (ECMO) in treating right ventricular and respiratory failure. Advocating for the adoption of the Extracorporeal Life Support Organization (ELSO) Maastricht Treaty for ECLS Nomenclature guidelines, it aims to resolve communication barriers in the ECMO field. Focusing on venopulmonary (VP) ECMO utilizing central pulmonary artery (PA) access, this review details surgical approaches and introduces a terminology guide to support effective knowledge exchange and advancements in patient care.
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Affiliation(s)
- J Michael Brewer
- From the Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
- Queen's University Health Quality Programs, Kingston, ON, Canada
| | - Roberto Lorusso
- Extracorporeal Life Support (ECLS) Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - L Mikael Broman
- Extracorporeal Membrane Oxygenation (ECMO) Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Marc O Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, Florida
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4
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Sciaccaluga C, Procopio MC, Potena L, Masetti M, Bernazzali S, Maccherini M, Landra F, Righini FM, Cameli M, Valente S. Right ventricular dysfunction in left ventricular assist device candidates: is it time to change our prospective? Heart Fail Rev 2024; 29:559-569. [PMID: 38329583 PMCID: PMC10942886 DOI: 10.1007/s10741-024-10387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
The use of left ventricular assist devices (LVAD) has significantly increased in the last years, trying to offer a therapeutic alternative to heart transplantation, in light also to the significant heart donor shortage compared to the growing advanced heart failure population. Despite technological improvements in the devices, LVAD-related mortality is still fairly high, with right heart failure being one of the predominant predictors. Therefore, many efforts have been made toward a thorough right ventricular (RV) evaluation prior to LVAD implant, considering clinical, laboratory, echocardiographic, and invasive hemodynamic parameters. However, there is high heterogeneity regarding both which predictor is the strongest as well as the relative cut-off values, and a consensus has not been reached yet, increasing the risk of facing patients in which the distinction between good or poor RV function cannot be surely reached. In parallel, due to technological development and availability of mechanical circulatory support of the RV, LVADs are being considered even in patients with suboptimal RV function. The aim of our review is to analyze the current evidence regarding the role of RV function prior to LVAD and its evaluation, pointing out the extreme variability in parameters that are currently assessed and future prospective regarding new diagnostic tools. Finally, we attempt to gather the available information on the therapeutic strategies to use in the peri-operative phase, in order to reduce the incidence of RV failure, especially in patients in which the preoperative evaluation highlighted some conflicting results with regard to ventricular function.
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Affiliation(s)
- Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | | | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Masetti
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, Siena, Italy
| | | | - Federico Landra
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Maria Righini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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5
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Goodin MS, Showalter M, Horvath DJ, Kuban BD, Flick CR, Polakowski AR, Fukamachi K, Karimov JH. Characterization and Development of Universal Ventricular Assist Device: Computational Fluid Dynamics Analysis of Advanced Design. ASAIO J 2022; 68:1024-1035. [PMID: 34772847 PMCID: PMC9085974 DOI: 10.1097/mat.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We are developing a universal, advanced ventricular assist device (AVAD) with automatic pressure regulation suitable for both left and right ventricular support. The primary goal of this computational fluid dynamics (CFD) study was to analyze the biventricular performance of the AVAD across its wide range of operating conditions. An AVAD CFD model was created and validated using in vitro hydraulic performance measurements taken over conditions spanning both left ventricular assist device (LVAD) and right ventricular assist device (RVAD) operation. Static pressure taps, placed throughout the pump, were used to validate the CFD results. The CFD model was then used to assess the change in hydraulic performance with varying rotor axial positions and identify potential design improvements. The hydraulic performance was simulated and measured at rotor speeds from 2,300 to 3,600 revolutions/min and flow rates from 2.0 to 8.0 L/min. The CFD-predicted hydraulic pressure rise agreed well with the in vitro measured data, within 6.5% at 2300 rpm and within 3.5% for the higher rotor speeds. The CFD successfully predicted wall static pressures, matching experimental values within 7%. High degree of similarity and circumferential uniformity in the pump's flow fields were observed over the pump operation as an LVAD and an RVAD. A secondary impeller axial clearance reduction resulted in a 10% decrease in peak flow residence time and lower static pressures on the secondary impeller. These lower static pressures suggest a reduction in the upwards rotor forces from the secondary impeller and a desired increase in the pressure sensitivity of the pump. The CFD analyses supported the feasibility of the proposed AVAD's use as an LVAD or an RVAD, over a wide range of operating conditions. The CFD results demonstrated the operability of the pump in providing the desired circumferential flow similarity over the intended range of flow/speed conditions and the intended functionality of the AVAD's automated pressure regulation.
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Affiliation(s)
| | | | | | - Barry D. Kuban
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Christine R. Flick
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Anthony R. Polakowski
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Jamshid H. Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Abstract
PURPOSE OF REVIEW Since the first implantation of a total artificial heart (TAH) 50 years ago the devices and technique have evolved to provide reliable support for patients with biventricular failure as a bridge to heart transplant. The purpose of this review is to discuss the history and evolution of devices, current devices, critical aspects of patient selection, tips and pitfalls of implantation, and future directions. RECENT FINDINGS The most studied device on the market is the SynCardia TAH, which has been implanted in over 2000 patients worldwide and is the only device that is currently Food and Drug Administration approved as a bridge to transplant. The overall survival in patients supported by the device at 1 year is 42% while those that make it to transplant have a 1 year post transplant survival of 83%. A newer device the Aeson TAH (Carmat, Velizy-Villacoublay, France) was first implanted in France in 2013 and is currently under clinical trial in the United States. SUMMARY Significant progress has been made in both the technology and technique of TAH implantation and these devices remain both a reliable and sometimes only option for patients with severe biventricular heart failure.
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7
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Lanmüller P, Eulert‐Grehn J, Starck C, Falk V, Potapov E. Right atriotomy closure with modified ventricular assist device ring. J Card Surg 2022; 37:1114-1117. [DOI: 10.1111/jocs.16276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/20/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Pia Lanmüller
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin Germany
| | - Jaime‐Jürgen Eulert‐Grehn
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin Germany
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of Health Berlin Germany
- Department of Health Sciences and Technology ETH Zürich Zürich Switzerland
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin Germany
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8
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Abdelshafy M, Caliskan K, Guven G, Elkoumy A, Elsherbini H, Elzomor H, Tenekecioglu E, Akin S, Soliman O. Temporary Right-Ventricular Assist Devices: A Systematic Review. J Clin Med 2022; 11:jcm11030613. [PMID: 35160064 PMCID: PMC8837135 DOI: 10.3390/jcm11030613] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 12/04/2022] Open
Abstract
Acute right-sided heart failure (RHF) is a complex clinical syndrome, with a wide range of clinical presentations, associated with increased mortality and morbidity, but about which there is a scarcity of evidence-based literature. A temporary right-ventricular assist device (t-RVAD) is a potential treatment option for selected patients with severe right-ventricular dysfunction as a bridge-to-recovery or as a permanent solution. We sought to conduct a systematic review to determine the safety and efficacy of t-RVAD implantation. Thirty-one studies met the inclusion criteria, from which data were extracted. Successful t-RVAD weaning ranged between 23% and 100%. Moreover, 30-day survival post-temporary RAVD implantation ranged from 46% to 100%. Bleeding, acute kidney injury, stroke, and device malfunction were the most commonly reported complications. Notwithstanding this, t-RVAD is a lifesaving option for patients with severe RHF, but the evidence stems from small non-randomized heterogeneous studies utilizing a variety of devices. Both the etiology of RHF and time of intervention might play a major role in determining the t-RVAD outcome. Standardized endpoints definitions, design and methodology for t-RVAD trials is needed. Furthermore, efforts should continue in improving the technology as well as improving the timely provision of a t-RVAD.
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Affiliation(s)
- Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (M.A.); (A.E.); (H.E.)
- Department of Cardiology, Al-Azhar University, Al-Hussein University Hospital, Cairo 11311, Egypt
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (K.C.); (H.E.); (E.T.); (S.A.)
| | - Goksel Guven
- Department of Intensive Care Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands;
- Division of Internal Medicine Intensive Care, Hacettepe University Faculty of Medicine, 06230 Ankara, Turkey
| | - Ahmed Elkoumy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (M.A.); (A.E.); (H.E.)
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Nasr City, Cairo 11651, Egypt
| | - Hagar Elsherbini
- Department of Cardiology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (K.C.); (H.E.); (E.T.); (S.A.)
| | - Hesham Elzomor
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (M.A.); (A.E.); (H.E.)
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Nasr City, Cairo 11651, Egypt
| | - Erhan Tenekecioglu
- Department of Cardiology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (K.C.); (H.E.); (E.T.); (S.A.)
- Department of Cardiology, Bursa Education and Research Hospital, Bursa Medicine School, University of Health Sciences, 16059 Bursa, Turkey
| | - Sakir Akin
- Department of Cardiology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (K.C.); (H.E.); (E.T.); (S.A.)
- Department of Intensive Care Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands;
- Department of Intensive Care, Haga Teaching Hospital, 2545 AA The Hague, The Netherlands
| | - Osama Soliman
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), H91 V4AY Galway, Ireland; (M.A.); (A.E.); (H.E.)
- CÚRAM, The SFI Research Centre for Medical Devices, H91TK 33 Galway, Ireland
- Correspondence: ; Tel.: +353-91-493-781
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9
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Loforte A. Tricuspid valve repair and mechanical right ventricular support in rescue left ventricular assist device implantations: Still a relevant issue. J Card Surg 2022; 37:1118-1120. [DOI: 10.1111/jocs.16275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna Bologna Italy
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10
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Henn MC, Mokadam NA. Right ventricular dysfunction is best managed with a total artificial heart. JTCVS OPEN 2021; 8:42-46. [PMID: 36004155 PMCID: PMC9390209 DOI: 10.1016/j.xjon.2021.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/25/2021] [Indexed: 06/15/2023]
Affiliation(s)
| | - Nahush A. Mokadam
- Address for reprints: Nahush A. Mokadam, MD, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, N-825 Doan Hall, Columbus, OH 43210.
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11
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Guidetti F, Arrigo M, Frank M, Mikulicic F, Sokolski M, Aser R, Wilhelm MJ, Flammer AJ, Ruschitzka F, Winnik S. Treatment of Advanced Heart Failure-Focus on Transplantation and Durable Mechanical Circulatory Support: What Does the Future Hold? Heart Fail Clin 2021; 17:697-708. [PMID: 34511216 DOI: 10.1016/j.hfc.2021.05.013] [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] [Indexed: 11/15/2022]
Abstract
Heart transplantation (HTx) is the treatment of choice in patients with late-stage advanced heart failure (Advanced HF). Survival rates 1, 5, and 10 years after transplantation are 87%, 77%, and 57%, respectively, and the average life expectancy is 9.16 years. However, because of the donor organ shortage, waiting times often exceed life expectancy, resulting in a waiting list mortality of around 20%. This review aims to provide an overview of current standard, recent advances, and future developments in the treatment of Advanced HF with a focus on long-term mechanical circulatory support and HTx.
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Affiliation(s)
- Federica Guidetti
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland.
| | - Mattia Arrigo
- Department of Internal Medicine, Triemli Hospital Zürich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Fran Mikulicic
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Mateusz Sokolski
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Raed Aser
- Department of Cardiac Surgery, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Markus J Wilhelm
- Department of Cardiac Surgery, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
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12
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Joshi Y, Bories MC, Aissaoui N, Grinda JM, Bel A, Latremouille C, Jouan J. Percutaneous venopulmonary artery extracorporeal membrane oxygenation for right heart failure after left ventricular assist device insertion. Interact Cardiovasc Thorac Surg 2021; 33:978-985. [PMID: 34313320 DOI: 10.1093/icvts/ivab197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/24/2021] [Accepted: 06/13/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Right ventricular failure after left ventricular assist device (LVAD) insertion is associated with significant mortality and morbidity. Mechanical support options include right ventricular assist devices, venoarterial extracorporeal membrane oxygenation (ECMO) and venopulmonary artery ECMO, the latter often involving central cannulation. We sought to evaluate the feasibility and early outcomes of a truly percutaneous venopulmonary artery (pVPA) ECMO strategy, with the potential advantage of bedside removal once weaned. METHODS Data from a single tertiary centre were reviewed retrospectively from January 2014 to January 2019. During this time, 54 patients underwent LVAD insertion, with 19 requiring mechanical support for right ventricular failure. Among them, 10 patients received pVPA ECMO. Implantation of the pVPA ECMO was performed under transoesophageal echocardiography and fluoroscopy guidance, with an inflow cannula placed in the right atrium via the right femoral vein and an outflow cannula placed in the left pulmonary artery (PA) via the right internal jugular vein. RESULTS Cannula insertion was 100% successful with no need for repositioning. Eight patients (80%) were able to be successfully weaned (at the bedside); 6 were discharged from the hospital and there were no cases of early sepsis, mediastinitis or thromboembolism. At follow-up, 5 patients had received transplants (50%), with 1 on LVAD support as destination therapy (10%). Survival was 60 ± 15% and 50 ± 16% at 6 and 12 months, respectively. CONCLUSIONS pVPA ECMO is 100% technically feasible and is an efficient method for temporary right ventricular support after LVAD insertion with the advantage of simple bedside removal and avoidance of a PA graft remnant in the chest cavity.
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Affiliation(s)
- Yashutosh Joshi
- St Vincent's Hospital, Sydney, NSW, Australia.,Western Sydney University, Blacktown Clinical School, Sydney, NSW, Australia.,St Vincent's Clinical School UNSW, Sydney, NSW, Australia
| | - Marie-Cecile Bories
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nadia Aissaoui
- Hôpital Européen Georges Pompidou, Service de Réanimation médicale, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Descartes, Paris, France
| | - Jean-Michel Grinda
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alain Bel
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christian Latremouille
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Descartes, Paris, France
| | - Jérôme Jouan
- Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Descartes, Paris, France
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13
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Tchantchaleishvili V. Antonio Loforte to serve as an Associate Editor of Artificial Organs. Artif Organs 2021; 45:330-331. [PMID: 33704795 DOI: 10.1111/aor.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Benedetto M, Nardozi L, Baca GL, Loforte A, Baiocchi M. Heart failure: role and point of view of cardiac intensivist. Cardiovasc Diagn Ther 2021; 11:301-308. [PMID: 33708501 DOI: 10.21037/cdt-20-339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Heart failure is an acute or chronic syndrome where the heart is unable to provide adequate amount of oxygen to body tissues. The treatment of heart failure aims to give an immediate answer in terms of regression of volume overload and restoration of hemodynamic stability and then to ensure management of clinical exacerbation, reduction in hospital stay, and increasing of survival. The pharmacological treatment of heart failure includes drugs with different strength of evidence. When the patient is no more responsive to medical therapy a non-pharmacological approach may be required. The first step is cardiac resynchronization therapy and implantable cardiac defibrillator. Then hospitalization and inotropic support may be needed. When cardiac disease reaches the end stage, the severe decrease in multi organ perfusion requires a quick therapeutic response. This is a time dependent scenario, when mechanical circulatory support (MCS) plays a crucial role. MCS may be used as temporary hemodynamic support on situations where myocardial recovery is likely, such as after revascularization and in cases of fulminant acute myocarditis. Conversion to ventricular assist devices or transplantation should be considered if longer duration of MCS is required. Advances in the treatment of cardiogenic shock patients in terms of pharmacological therapies, short term and long term MCS could provide opportunities to improve survival, but they also increase the complexity of clinical care. For this reason a multidisciplinary shock team approach is paramount for early symptom detection, to guide initial haemodynamic therapy and for the right choice of MCS device at the right time.
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Affiliation(s)
- Maria Benedetto
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Sant' Orsola Malpighi University Hospital, Bologna, Italy
| | - Ludovica Nardozi
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Sant' Orsola Malpighi University Hospital, Bologna, Italy
| | | | - Antonio Loforte
- Cardiothoracic Department, Sant' Orsola Malpighi University Hospital, Bologna, Italy
| | - Massimo Baiocchi
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Sant' Orsola Malpighi University Hospital, Bologna, Italy
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15
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Hanff TC, Birati EY. Left Ventricular Assist Device as Destination Therapy: a State of the Science and Art of Long-Term Mechanical Circulatory Support. Curr Heart Fail Rep 2020; 16:168-179. [PMID: 31631240 DOI: 10.1007/s11897-019-00438-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to synthesize and summarize recent developments in the care of patients with end-stage heart failure being managed with a left ventricular assist device (LVAD) as destination therapy. RECENT FINDINGS Although the survival of patients treated with LVAD continues to improve, the rates of LVAD-associated complication, such as right ventricular failure, bleeding complications, and major infection, remain high, and management of these patients remains challenging. The durability and hemocompatibility of LVAD support have greatly increased in recent years as a result of new technologies and novel management strategies. Challenges remain in the comprehensive care of patients with destination therapy LVADs, including management of comorbidities and optimizing patient function and quality of life.
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Affiliation(s)
- Thomas C Hanff
- Department of Medicine Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edo Y Birati
- Department of Medicine Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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16
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Abstract
The total artificial heart (TAH) is a device that replaces the failing ventricles. There have been numerous TAHs designed over the last few decades, but the one with the largest patient experience is the SynCardia temporary TAH. The 50-mL and 70-mL sizes have been approved in the United States, Europe, and Canada as a bridge to transplantation. It is indicated in patients with severe biventricular failure or structural heart issues that preclude the use of a left ventricular assist device. The majority of the patients implanted are Interagency Registry for Mechanically Assisted Circulatory Support profile 1 or 2. The 1-year survival in experienced centers that have implanted over 10 TAHs is 73%. The risk factors for death include older age, need for preimplantation dialysis, and malnutrition. The most common causes of death are multiple organ failure, usually the result of physiologic deterioration before implantation, and neurologic dysfunction. The device allows the patient to be discharged home and managed as an outpatient. Proper patient selection, the timing of intervention, patient care, and device management are essential for a suitable outcome. In addition, the CARMAT TAH is another device that will soon be studied in a clinical trial in the United States. The BiVACOR TAH is a revolutionary design utilizing electromagnetic levitation that is expected to enter a clinical trial in the next few years.
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Noly PE, Ben Ali W, Lamarche Y, Carrier M. Status, Indications, and Use of Cardiac Replacement Therapy in the Era of Multimodal Mechanical Approaches to Circulatory Support: A Scoping Review. Can J Cardiol 2020; 36:261-269. [DOI: 10.1016/j.cjca.2019.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022] Open
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18
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Calculation of the ALMA Risk of Right Ventricular Failure After Left Ventricular Assist Device Implantation. ASAIO J 2019; 64:e140-e147. [PMID: 29746312 DOI: 10.1097/mat.0000000000000800] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Right ventricular failure after continuous-flow left ventricular assist device (LVAD) implantation is still an unsolved issue and remains a life-threatening event for patients. We undertook this study to determine predictors of the patients who are candidates for isolated LVAD therapy as opposed to biventricular support (BVAD). We reviewed demographic, echocardiographic, hemodynamic, and laboratory variables for 258 patients who underwent both isolated LVAD implantation and unplanned BVAD because of early right ventricular failure after LVAD insertion, between 2006 and 2017 (LVAD = 170 and BVAD = 88). The final study patients were randomly divided into derivation (79.8%, n = 206) and validation (20.1%, n = 52) cohorts. Fifty-seven preoperative risk factors were compared between patients who were successfully managed with an LVAD and those who required a BVAD. Nineteen variables demonstrated statistical significance on univariable analysis. Multivariable logistic regression analysis identified destination therapy (odds ratio [OR] 2.0 [1.7-3.9], p = 0.003), a pulmonary artery pulsatility index <2 (OR 3.3 [1.7-6.1], p = 0.001), a right ventricle/left ventricle end-diastolic diameter ratio >0.75 (OR 2.7 [1.5-5.5], p = 0.001), an right ventricle stroke work index <300 mm Hg/ml/m (OR 4.3 [2.5-7.3], p < 0.001), and a United Network for Organ Sharing modified Model for End-Stage Liver Disease Excluding INR score >17 (OR 3.5 [1.9-6.9], p < 0.001) as the major predictors of the need for BVAD. Using these data, we propose a simple risk calculator to determine the suitability of patients for isolated LVAD support in the era of continuous-flow mechanical circulatory support devices.
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Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Färber G, Hannan MM, Kukucka M, de Jonge N, Loforte A, Lund LH, Mohacsi P, Morshuis M, Netuka I, Özbaran M, Pappalardo F, Scandroglio AM, Schweiger M, Tsui S, Zimpfer D, Gustafsson F. 2019 EACTS Expert Consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg 2019; 56:230-270. [PMID: 31100109 PMCID: PMC6640909 DOI: 10.1093/ejcts/ezz098] [Citation(s) in RCA: 231] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.
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Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Christiaan Antonides
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain
| | - Alain Combes
- Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de médecine intensive-réanimation, Institut de Cardiologie, APHP, Hôpital Pitié–Salpêtrière, Paris, France
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Margaret M Hannan
- Department of Medical Microbiology, University College of Dublin, Dublin, Ireland
| | - Marian Kukucka
- Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antonio Loforte
- Department of Cardiothoracic, S. Orsola Hospital, Transplantation and Vascular Surgery, University of Bologna, Bologna, Italy
| | - Lars H Lund
- Department of Medicine Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Solna, Sweden
| | - Paul Mohacsi
- Department of Cardiovascular Surgery Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege University, Izmir, Turkey
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Cardiac Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Zurich Children's Hospital, Zurich, Switzerland
| | - Steven Tsui
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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20
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Dandel M, Hetzer R. Temporary assist device support for the right ventricle: pre-implant and post-implant challenges. Heart Fail Rev 2019; 23:157-171. [PMID: 29453695 DOI: 10.1007/s10741-018-9678-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Severe right ventricular (RV) failure is more likely reversible than similar magnitudes of left ventricular (LV) failure and, because reversal of both adaptive remodeling and impaired contractility require most often only short periods of support, the use of temporary RV assist devices (t-RVADs) can be a life-saving therapy option for many patients. Although increased experience with t-RVADs and progresses made in the development of safer devices with lower risk for complications has improved both recovery rate of RV function and patient survival, the mortality of t-RVAD recipients can still be high but it depends mainly on the primary cause of RV failure (RVF), the severity of end-organ dysfunction, and the timing of RVAD implantation, and much less on adverse events and complications related to RVAD implantation, support, or removal. Reduced survival of RVAD recipients should therefore not discourage appropriate application of RVADs because their underuse further reduces the chances for RV recovery and patient survival. The article reviews and discusses the challenges related to the pre-implant and post-implant decision-making processes aiming to get best possible therapeutic results. Special attention is focused on pre-implant RV assessment and prediction of RV improvement during mechanical unloading, patient selection for t-RVAD therapy, assessment of unloading-promoted RV recovery, and prediction of its stability after RVAD removal. Particular consideration is also given to prediction of RVF after LVAD implantation which is usually hampered by the complex interactions between the different risk factors related indirectly or directly to the RV potential for reverse remodeling and functional recovery.
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Affiliation(s)
- Michael Dandel
- DZHK (German Centre for Heart and Circulatory Research), Partner site Berlin, Berlin, Germany. .,Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Roland Hetzer
- Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Cardio Centrum Berlin, Berlin, Germany
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Khorsandi M, Schroder J, Daneshmand M, Bishawi M, Bouamra O, Winterton P, Choi AY, Patel C, Rogers J, Del Rio JM, Milano C. Outcomes After Extracorporeal Right Ventricular Assist Device Combined With Durable Left Ventricular Assist Device Support. Ann Thorac Surg 2018; 107:1768-1774. [PMID: 30582926 DOI: 10.1016/j.athoracsur.2018.11.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/13/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Right heart failure occurs in 9% to 44% of left ventricular assist device (LVAD) implants, of which less than 10% require right ventricular assist device (RVAD) support either concurrently with the LVAD or staged, as a delayed procedure. We have reported our outcomes based on whether the RVAD was placed concurrently or staged. METHODS Clinical data were obtained from the Duke University Medical Center database. The study focused on all consecutive adult patients who received continuous flow LVAD with either concurrent or staged (within 7 days) extracorporeal, temporary RVAD, between October 2007 and October 2017. Adverse event profiles and ability to wean from RVAD were compared between these two groups. RESULTS Overall, 43 patients required an extracorporeal RVAD; 67% (n = 29) were implanted concurrently and 33% (n = 14) were implanted as staged after the LVAD. In all, 67% of patients (n = 29) could be weaned to an isolated LVAD. The 30-day, inhospital, and total mortality rates for our cohort were 14%, 28%, and 51% respectively. The mortality rate in the study period for the staged implants was 71% versus 45% for the concurrent implants (p = 0.101). In addition, staged RVAD implantation carried a significantly higher rate of postoperative renal failure (64% versus 28%, p = 0.044). CONCLUSIONS There was a low incidence of need for RVAD in our cohort. The majority could be weaned to an isolated LVAD. Morbidity and mortality rates of this mode of biventricular support remain high. Early institution of RVAD support was associated with reduced rates of post-LVAD renal failure rates.
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Affiliation(s)
- Maziar Khorsandi
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Jacob Schroder
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mani Daneshmand
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Muath Bishawi
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Omar Bouamra
- Department of Medical Statistics, Trauma Audit and Research Network, University of Manchester, Manchester, United Kingdom
| | - Patrick Winterton
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ashley Y Choi
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chetan Patel
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph Rogers
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - J Mauricio Del Rio
- Division of Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Carmelo Milano
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
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22
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Ayub-Ferreira SM. Executive Summary - Guidelines for Mechanical Circulatory Support of the Brazilian Society of Cardiology. Arq Bras Cardiol 2018; 111:4-12. [PMID: 30110040 PMCID: PMC6078376 DOI: 10.5935/abc.20180126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 06/13/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Silvia Moreira Ayub-Ferreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil. Hospital Sírio-Libanês, São Paulo, SP - Brazil
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23
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Loforte A, Grigioni F, Marinelli G. The risk of right ventricular failure with current continuous-flow left ventricular assist devices. Expert Rev Med Devices 2017; 14:969-983. [DOI: 10.1080/17434440.2017.1409111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Francesco Grigioni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Giuseppe Marinelli
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
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24
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Right Ventricular Failure Post LVAD Implantation Corrected with Biventricular Support: An In Vitro Model. ASAIO J 2017; 63:41-47. [PMID: 28033201 DOI: 10.1097/mat.0000000000000455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Right ventricular failure after left ventricular assist device (LVAD) implantation is associated with high mortality. Management remains limited to pharmacologic therapy and temporary mechanical support. Delayed right ventricular assist device (RVAD) support after LVAD implantation is associated with poorer outcomes. With the advent of miniaturized, durable, continuous flow ventricular assist device systems, chronic RVAD and biventricular assist device (BiVAD) support has been used with some success. The purpose of this study was to assess combined BiVAD and LVAD with delayed RVAD support within a four-elemental mock circulatory loop (MCL) simulating the human cardiovascular system. Our hypothesis was that delayed continuous flow RVAD (RVAD) would produce similar hemodynamic and flow parameters to those of initial BiVAD support. Using the MCL, baseline biventricular heart failure with elevated right and left filling pressures with low cardiac output was simulated. The addition of LVAD within a biventricular configuration improved cardiac output somewhat, but was associated with persistent right heart failure with elevated right-sided filling pressures. The addition of an RVAD significantly improved LVAD outputs and returned filling pressures to normal throughout the circulation. In conclusion, RVAD support successfully restored hemodynamics and flow parameters of biventricular failure supported with isolated LVAD with persistent elevated right atrial pressure.
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25
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Yoshioka D, Takayama H, Garan RA, Topkara VK, Han J, Kurlansky P, Yuzefpolskaya M, Colombo PC, Naka Y, Takeda K. Contemporary outcome of unplanned right ventricular assist device for severe right heart failure after continuous-flow left ventricular assist device insertion. Interact Cardiovasc Thorac Surg 2017; 24:828-834. [DOI: 10.1093/icvts/ivw409] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/01/2016] [Indexed: 11/14/2022] Open
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26
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Karimov JH, Sunagawa G, Horvath D, Fukamachi K, Starling RC, Moazami N. Limitations to Chronic Right Ventricular Assist Device Support. Ann Thorac Surg 2016; 102:651-8. [DOI: 10.1016/j.athoracsur.2016.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/20/2016] [Accepted: 02/01/2016] [Indexed: 12/16/2022]
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27
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Potapov EV, Kukucka M, Falk V, Krabatsch T. Biventricular support using 2 HeartMate 3 pumps. J Heart Lung Transplant 2016; 35:1268-1270. [PMID: 27569985 DOI: 10.1016/j.healun.2016.07.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/13/2016] [Accepted: 07/17/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Marian Kukucka
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Department of Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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28
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Deschka H, Holthaus AJ, Sindermann JR, Welp H, Schlarb D, Monsefi N, Martens S, Scherer M. Can Perioperative Right Ventricular Support Prevent Postoperative Right Heart Failure in Patients With Biventricular Dysfunction Undergoing Left Ventricular Assist Device Implantation? J Cardiothorac Vasc Anesth 2016; 30:619-26. [DOI: 10.1053/j.jvca.2016.02.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Indexed: 01/16/2023]
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Schmack B, Weymann A, Popov AF, Patil NP, Sabashnikov A, Kremer J, Farag M, Brcic A, Lichtenstern C, Karck M, Ruhparwar A. Concurrent Left Ventricular Assist Device (LVAD) Implantation and Percutaneous Temporary RVAD Support via CardiacAssist Protek-Duo TandemHeart to Preempt Right Heart Failure. Med Sci Monit Basic Res 2016; 22:53-7. [PMID: 27145697 PMCID: PMC4913730 DOI: 10.12659/msmbr.898897] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Right ventricular failure (RVF) is an unfortunate complication that continues to limit outcomes following durable left ventricular assist device (LVAD) implantation. Despite several ‘RVF risk scores’ having been proposed, preoperative prediction of post-LVAD RVF remains a guesstimate at best. Current strategies for institution of temporary RVAD support are invasive, necessitate additional re-thoracotomy, restrict postoperative mobilization, and/or entail prolonged retention of prosthetic material in-situ. The authors propose a novel surgical strategy comprising simultaneous implantation of a permanent LVAD and percutaneous TandemHeart® plus ProtekDuo® to provide temporary RVAD support and preempt RVF in patients with impaired RV function.
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Affiliation(s)
- Bastian Schmack
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Nikhil Prakash Patil
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Jamila Kremer
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Brcic
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Matthias Karck
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany
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30
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Long-term biventricular HeartWare ventricular assist device support—Case series of right atrial and right ventricular implantation outcomes. J Heart Lung Transplant 2016; 35:466-73. [DOI: 10.1016/j.healun.2015.12.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 10/06/2015] [Accepted: 12/04/2015] [Indexed: 01/16/2023] Open
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31
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Shehab S, Newton PJ, Allida SM, Jansz PC, Hayward CS. Biventricular mechanical support devices--clinical perspectives. Expert Rev Med Devices 2016; 13:353-65. [PMID: 26894825 DOI: 10.1586/17434440.2016.1154454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac transplantation remains the optimal treatment for end stage heart failure in selected patients. However, the shortage of donor hearts, rigorous eligibility criteria and long waiting lists have increased the demand for alternative treatment strategies such as mechanical circulatory support. While many patients are adequately supported with left ventricular assist devices, frequently there is right heart failure or involvement of the right ventricle, requiring biventricular support. Pulsatile flow biventricular devices and total artificial hearts approved for temporary biventricular support have limitations including size, high rates of adverse events and restricted mobility which makes them unsuitable for long term support. A number of centres have reported dual continuous flow left ventricular assist devices as a means of supporting the left and right heart. This review will summarise the literature on the outcomes and complications from current biventricular support devices and assess the role of dual continuous flow VAD therapy, and the new continuous flow total heart replacement devices.
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Affiliation(s)
- Sajad Shehab
- a Centre for Cardiovascular & Chronic Care, Faculty of Health , University of Technology , Sydney , Australia.,b Cardiology Department , St. Vincent's Hospital , Darlinghurst , Australia
| | - Phillip J Newton
- a Centre for Cardiovascular & Chronic Care, Faculty of Health , University of Technology , Sydney , Australia
| | - Sabine M Allida
- a Centre for Cardiovascular & Chronic Care, Faculty of Health , University of Technology , Sydney , Australia
| | - Paul C Jansz
- b Cardiology Department , St. Vincent's Hospital , Darlinghurst , Australia
| | - Christopher S Hayward
- b Cardiology Department , St. Vincent's Hospital , Darlinghurst , Australia.,c Victor Chang Cardiac Research Institute , Darlinghurst , Australia.,d Faculty of Medicine , University of New South Wales , Kensington , Australia
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32
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Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation. Int J Cardiol 2015; 198:241-50. [DOI: 10.1016/j.ijcard.2015.06.103] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 11/16/2022]
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33
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Oezpeker C, Zittermann A, Paluszkiewicz L, Piran M, Puehler T, Sayin AO, Ensminger S, Milting H, Morshuis M, Gummert JF. Tricuspid valve repair in patients with left-ventricular assist device implants and tricuspid valve regurgitation: propensity score-adjusted analysis of clinical outcome. Interact Cardiovasc Thorac Surg 2015; 21:741-7. [DOI: 10.1093/icvts/ivv260] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/19/2015] [Indexed: 11/14/2022] Open
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Kiernan MS, French AL, DeNofrio D, Parmar YJ, Pham DT, Kapur NK, Pandian NG, Patel AR. Preoperative Three-Dimensional Echocardiography to Assess Risk of Right Ventricular Failure After Left Ventricular Assist Device Surgery. J Card Fail 2015; 21:189-97. [DOI: 10.1016/j.cardfail.2014.12.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 11/21/2014] [Accepted: 12/16/2014] [Indexed: 12/31/2022]
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Abstract
PURPOSE OF REVIEW Every year, thousands of heart and lung transplants are performed worldwide. As experience and clinical acumen advance, both fields are continually evolving. This review elucidates and describes many of the recent changes in practice and future directions of heart and lung transplantation. Preoperative, intraoperative and postoperative developments are presented with supporting evidence in these continually evolving fields. RECENT FINDINGS The field of heart transplantation is continually adapting to the growing use of mechanical circulatory support devices as bridge to transplant and for postoperative support. Recent modifications in surgical technique have contributed to improved outcomes.Lung transplantation advancements include the increasing use of extracorporeal membrane oxygenation during the perioperative period. Lobar transplantation and ex-vivo lung perfusion techniques may aid in providing successful lung grafts to those with potentially long wait list times.Rates of rejection continue to decline in both fields as immunosuppression regimens are improved and modified. SUMMARY This review investigates and summarizes the recent changes and advancements in heart and lung transplantation. Mechanical circulatory support and extracorporeal membrane oxygenation are increasingly used in the perioperative setting, and continuing research will evaluate their safety profiles. Optimizing and tailoring immunosuppression regimens for transplant recipients continue to be the subject of ongoing investigation.
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Boulate D, Marques MA, Ha R, Banerjee D, Haddad F. Biventricular VAD versus LVAD for right heart failure. Ann Cardiothorac Surg 2014; 3:585-8. [PMID: 25512899 DOI: 10.3978/j.issn.2225-319x.2014.08.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/04/2014] [Indexed: 11/14/2022]
Affiliation(s)
- David Boulate
- Division of Cardiovascular Medicine, Department of Anesthesiology and Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michael A Marques
- Division of Cardiovascular Medicine, Department of Anesthesiology and Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Richard Ha
- Division of Cardiovascular Medicine, Department of Anesthesiology and Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Dipanjan Banerjee
- Division of Cardiovascular Medicine, Department of Anesthesiology and Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Department of Anesthesiology and Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA
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Arabia FA, Moriguchi JD. Machines versus medication for biventricular heart failure: focus on the total artificial heart. Future Cardiol 2014; 10:593-609. [DOI: 10.2217/fca.14.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
ABSTRACT The medical/surgical management of advanced heart failure has evolved rapidly over the last few decades. With better understanding of heart failure pathophysiology, new pharmacological agents have been introduced that have resulted in improvements in survival. For those patients that fail to improve, mechanical circulatory support with left ventricular assist devices and total artificial hearts (TAHs) have served as a beneficial bridge to transplantation. The TAH has continued to play a significant role as a bridge to transplantation in patients with biventricular failure and more selected indications that could not be completely helped with left ventricular assist devices. Improved survival with the TAH has resulted in more patients benefiting from this technology. Improvements will eventually lead to a totally implantable device that will permanently replace the failing human heart.
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Affiliation(s)
- Francisco A Arabia
- Mechanical Circulatory Support Program, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A3600, Los Angeles, CA 90048, USA
| | - Jaime D Moriguchi
- Mechanical Circulatory Support Program, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A3600, Los Angeles, CA 90048, USA
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Loforte A, Musumeci F, Montalto A, Pilato E, Lilla Della Monica P, Grigioni F, Di Bartolomeo R, Marinelli G. Use of Mechanical Circulatory Support Devices in End-Stage Heart Failure Patients. J Card Surg 2014; 29:717-22. [DOI: 10.1111/jocs.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Loforte
- Department of Cardiovascular Surgery and Transplantation; S. Orsola-Malpighi Hospital, Bologna University; Bologna Italy
| | - Francesco Musumeci
- Department of Cardiac Surgery and Transplantation; S. Camillo Hospital; Rome Italy
| | - Andrea Montalto
- Department of Cardiac Surgery and Transplantation; S. Camillo Hospital; Rome Italy
| | - Emanuele Pilato
- Department of Cardiovascular Surgery and Transplantation; S. Orsola-Malpighi Hospital, Bologna University; Bologna Italy
| | | | - Francesco Grigioni
- Department of Cardiovascular Surgery and Transplantation; S. Orsola-Malpighi Hospital, Bologna University; Bologna Italy
| | - Roberto Di Bartolomeo
- Department of Cardiovascular Surgery and Transplantation; S. Orsola-Malpighi Hospital, Bologna University; Bologna Italy
| | - Giuseppe Marinelli
- Department of Cardiovascular Surgery and Transplantation; S. Orsola-Malpighi Hospital, Bologna University; Bologna Italy
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Steffen RJ, Halbreiner MS, Zhang L, Fukamachi K, Soltesz EG, Starling RC, Moazami N. Mechanical circulatory support for the right ventricle in the setting of a left ventricular assist device. Expert Rev Med Devices 2014; 11:587-93. [DOI: 10.1586/17434440.2014.940316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nishimura T. Current status of extracorporeal ventricular assist devices in Japan. J Artif Organs 2014; 17:211-9. [PMID: 24952465 DOI: 10.1007/s10047-014-0779-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/04/2014] [Indexed: 11/30/2022]
Abstract
Extracorporeal VADs are less expensive, their prices reimbursable by the health insurance being about one-sixth of those of implantable VADs in Japan. However, a disadvantage is that, in Japan, their use is restricted to hospitals, necessitating prolonged hospitalization, reducing the patients' quality of life. According to the Japanese registry for Mechanically Assisted Circulatory Support, the survival rate does not differ significantly between patients with extracorporeal and implantable VADs. As in Europe and North America, extracorporeal VADs in Japan are commonly used as Bridge to Decision or Bridge to Recovery. Extracorporeal VADs are switched to implantable VADs as a Bridge-to-Bridge strategy after stabilization or when cardiac function recovery fails. They are also used as right ventricular assist devices (RVADs) in patients with right heart failure. A special characteristic of extracorporeal VADs in Japan is their frequent use as a Bridge to Candidacy. In Japan, indications for implantable VADs are restricted to patients registered for heart transplantation. Therefore, in patients who cannot be registered for transplantation because of transient renal dysfunction, etc., due to heart failure, extracorporeal VADs are used first, and then replaced by implantable VADs after transplant registry is done. Here, we describe the current status of extracorporeal VADs in Japan, focusing on the environmental backgrounds, along with a review of the relevant literature.
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Affiliation(s)
- Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan,
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Loforte A, Montalto A, Lilla della Monica P, Lappa A, Contento C, Menichetti A, Musumeci F. Mechanical circulatory support in advanced heart failure: single-center experience. Transplant Proc 2014; 46:1476-80. [PMID: 24935316 DOI: 10.1016/j.transproceed.2014.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 01/08/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Currently, ventricular assist device (VAD) or total artificial heart (TAH) mechanical support provides an effective treatment of unstable patients with advanced heart failure. We report our single-center experience with mechanical circulatory support therapy. METHODS From March 2002 to December 2012, 107 adult patients (mean age, 56.8 ± 9.9 y; range, 31-76 y) were primarly supported on temporary or long-term VAD or TAH support as treatment for refractory heart failure at our institution. Temporary extracorporeal radial VAD support (group A) was established in 49 patients (45.7%), and long-term paracorporeal and intracorporeal VAD or TAH (group B) in 58 patients (54.2%). Left ventricular (LVAD) support was established in 55 patients (51.4%; n = 33, Heartmate II; n = 6, Heartmate I XVE; n = 4, Heartware HVAD; and n = 12, Centrimag) and biventricular (BVAD/TAH) support (group B) in 28 patients (26.1%; n = 10, Thoratec paracorporeal; n = 2, Heartware HVAD, n = 1, Thoratec implantable; n = 1, Syncardia TAH; and n = 14, Centrimag). The temporary Centrimag was the only device adopted as isolated right ventricular (RVAD) support, and it was inserted in 24 patients (22.4%). RESULTS In group A, overall mean support time was 10.2 ± 6.6 days (range, 3-43 d). In group B, LVAD mean support time was 357 ± 352.3 days (range, 1-902 d) and BVAD/TAH support time was 98 ± 82.6 days (range, 8-832 d). In group A, the overall success rate was 55.1% (27 patients). In group B, LVAD overall success rate was 74.4% (32 patients) and BVAD/TAH success rate was 50% (7 patients). Overall heart transplantation rate for both groups was 27.1% (n = 2, group A; n = 27, group B). Overall 1-year and 5-year survivals after heart transplantation were 72.4% (n = 21) and 58.6% (n = 17), respectively. CONCLUSIONS Mechanical circulatory support is an effective strategy even in cases of end-stage heart failure according to our experience. Further improvement of VAD and TAH technologies may support their adoption as an encouraging alternative to heart transplantation in the near future.
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Affiliation(s)
- A Loforte
- Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
| | - A Montalto
- Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy
| | - P Lilla della Monica
- Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy
| | - A Lappa
- Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy
| | - C Contento
- Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy
| | - A Menichetti
- Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy
| | - F Musumeci
- Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy
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Rechtsventrikuläre Funktion bei Implantation eines linksventrikulären Unterstützungssystems. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-013-1057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stevens MC, Wilson S, Bradley A, Fraser J, Timms D. Physiological control of dual rotary pumps as a biventricular assist device using a master/slave approach. Artif Organs 2014; 38:766-74. [PMID: 24749848 DOI: 10.1111/aor.12303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dual rotary left ventricular assist devices (LVADs) can provide biventricular mechanical support during heart failure. Coordination of left and right pump speeds is critical not only to avoid ventricular suction and to match cardiac output with demand, but also to ensure balanced systemic and pulmonary circulatory volumes. Physiological control systems for dual LVADs must meet these objectives across a variety of clinical scenarios by automatically adjusting left and right pump speeds to avoid catastrophic physiological consequences. In this study we evaluate a novel master/slave physiological control system for dual LVADs. The master controller is a Starling-like controller, which sets flow rate as a function of end-diastolic ventricular pressure (EDP). The slave controller then maintains a linear relationship between right and left EDPs. Both left/right and right/left master/slave combinations were evaluated by subjecting them to four clinical scenarios (rest, postural change, Valsalva maneuver, and exercise) simulated in a mock circulation loop. The controller's performance was compared to constant-rotational-speed control and two other dual LVAD control systems: dual constant inlet pressure and dual Frank-Starling control. The results showed that the master/slave physiological control system produced fewer suction events than constant-speed control (6 vs. 62 over a 7-min period). Left/right master/slave control had lower risk of pulmonary congestion than the other control systems, as indicated by lower maximum EDPs (15.1 vs. 25.2-28.4 mm Hg). During exercise, master/slave control increased total flow from 5.2 to 10.1 L/min, primarily due to an increase of left and right pump speed. Use of the left pump as the master resulted in fewer suction events and lower EDPs than when the right pump was master. Based on these results, master/slave control using the left pump as the master automatically adjusts pump speed to avoid suction and increases pump flow during exercise without causing pulmonary venous congestion.
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Affiliation(s)
- Michael C Stevens
- Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Brisbane, Queensland, Australia; Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia; School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Queensland, Australia
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Stevens MC, Gregory SD, Nestler F, Thomson B, Choudhary J, Garlick B, Pauls JP, Fraser JF, Timms D. In vitro and in vivo characterization of three different modes of pump operation when using a left ventricular assist device as a right ventricular assist device. Artif Organs 2014; 38:931-9. [PMID: 24660783 DOI: 10.1111/aor.12289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Dual rotary left ventricular assist devices (LVADs) have been used clinically to support patients with biventricular failure. However, due to the lower vascular resistance in the pulmonary circulation compared with its systemic counterpart, excessively high pulmonary flow rates are expected if the right ventricular assist device (RVAD) is operated at its design LVAD speed. Three possible approaches are available to match the LVAD to the pulmonary circulation: operating the RVAD at a lower speed than the LVAD (mode 1), operating both pumps at their design speeds (mode 2) while relying on the cardiovascular system to adapt, and operating both pumps at their design speeds while restricting the diameter of the RVAD outflow graft (mode 3). In this study, each mode was characterized using in vitro and in vivo models of biventricular heart failure supported with two VentrAssist LVADs. The effect of each mode on arterial and atrial pressures and flow rates for low, medium, and high vascular resistances and three different contractility levels were evaluated. The amount of speed/diameter adjustment required to accommodate elevated pulmonary vascular resistance (PVR) during support with mode 3 was then investigated. Mode 1 required relatively low systemic vascular resistance to achieve arterial pressures less than 100 mm Hg in vitro, resulting in flow rates greater than 6 L/min. Mode 2 resulted in left atrial pressures above 25 mm Hg, unless left heart contractility was near-normal. In vitro, mode 3 resulted in expected arterial pressures and flow rates with an RVAD outflow diameter of 6.5 mm. In contrast, all modes were achievable in vivo, primarily due to higher RVAD outflow graft resistance (more than 500 dyn·s/cm(5)), caused by longer cannula. Flow rates could be maintained during instances of elevated PVR by increasing the RVAD speed or expanding the outflow graft diameter using an externally applied variable graft occlusion device. In conclusion, suitable hemodynamics could be produced by either restricting or not restricting the right outflow graft diameter; however, the latter required an operation of the RVAD at lower than design speed. Adjustments in outflow restriction and/or RVAD speed are recommended to accommodate varying PVR.
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Affiliation(s)
- Michael C Stevens
- Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Brisbane, Queensland, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Queensland, Australia
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Abstract
In this Editor's Review, articles published in 2013 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level". Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide so meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley Periodicals, for their expert attention and support in the production and marketing of Artificial Organs. We look forward to recording further advances in the coming years.
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Timing of Temporary Right Ventricular Assist Device Insertion for Severe Right Heart Failure After Left Ventricular Assist Device Implantation. ASAIO J 2013; 59:564-9. [DOI: 10.1097/mat.0b013e3182a816d1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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