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Dezfouly MA, Jeewa A, Maurich A, Honjo O, Pidborochynski T, Buchholz H, Conway J. Nutritional status and cannula infections in pediatric patients on ventricular assist device support. Artif Organs 2024. [PMID: 38884381 DOI: 10.1111/aor.14810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/14/2024] [Accepted: 06/02/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Ventricular assist devices (VADs) are used to bridge pediatric patients to heart transplantation. Paracorporeal VADs require the placement of cannulas, which can create an environment for infections. We examined cannula infections in pediatric VAD patients and the role of nutritional status. METHODS This retrospective study (2005-2021) included patients <20 years old on VAD support using Berlin Heart EXCOR® cannulas. Cannula infections were defined by a positive culture and need for antibiotic therapy. Malnutrition was defined using the American Society of Parenteral and Enteral Nutrition guidelines as well as the Michigan MTool. RESULTS There were 76 patients with a median age at implant of 0.9 years (IQR 0.4, 3.6), 50% male, with 73.7% having non-congenital heart disease. More than one-quarter (26.3%) of patients developed a cannula infection. Higher pre-implant weight (OR = 1.93, p = 0.05), creatinine (OR = 1.02, p = 0.044), and pre-albumin (OR = 15.79, p = 0.025), as well as duration of VAD support (OR = 1.01; p = 0.003) were associated with increased odds of developing a cannula infection. There was no difference in the malnutrition parameters between those with and without an infection. CONCLUSIONS Further exploration in a larger cohort is needed to see whether these associations remain and if the incorporation of objective measures of nutritional status at the time of infection are predictive.
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Affiliation(s)
| | - Aamir Jeewa
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Maurich
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Department of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Holger Buchholz
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
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Almond CS, Davies R, Adachi I, Richmond M, Law S, Tunuguntla H, Mao C, Shaw F, Lantz J, Wearden PD, Jordan LC, Ichord RN, Burns K, Zak V, Magnavita A, Gonzales S, Conway J, Jeewa A, Freemon D'A, Stylianou M, Sleeper L, Dykes JC, Ma M, Fynn-Thompson F, Lorts A, Morales D, Vanderpluym C, Dasse K, Patricia Massicotte M, Jaquiss R, Mahle WT. A prospective multicenter feasibility study of a miniaturized implantable continuous flow ventricular assist device in smaller children with heart failure. J Heart Lung Transplant 2024; 43:889-900. [PMID: 38713124 DOI: 10.1016/j.healun.2024.02.003] [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: 08/15/2023] [Revised: 01/15/2024] [Accepted: 02/03/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND There is no FDA-approved left ventricular assist device (LVAD) for smaller children permitting routine hospital discharge. Smaller children supported with LVADs typically remain hospitalized for months awaiting heart transplant-a major burden for families and a challenge for hospitals. We describe the initial outcomes of the Jarvik 2015, a miniaturized implantable continuous flow LVAD, in the NHLBI-funded Pumps for Kids, Infants, and Neonates (PumpKIN) study, for bridge-to-heart transplant. METHODS Children weighing 8 to 30 kg with severe systolic heart failure and failing optimal medical therapy were recruited at 7 centers in the United States. Patients with severe right heart failure and single-ventricle congenital heart disease were excluded. The primary feasibility endpoint was survival to 30 days without severe stroke or non-operational device failure. RESULTS Of 7 children implanted, the median age was 2.2 (range 0.7, 7.1) years, median weight 10 (8.2 to 20.7) kilograms; 86% had dilated cardiomyopathy; 29% were INTERMACS profile 1. The median duration of Jarvik 2015 support was 149 (range 5 to 188) days where all 7 children survived including 5 to heart transplant, 1 to recovery, and 1 to conversion to a paracorporeal device. One patient experienced an ischemic stroke on day 53 of device support in the setting of myocardial recovery. One patient required ECMO support for intractable ventricular arrhythmias and was eventually transplanted from paracorporeal biventricular VAD support. The median pump speed was 1600 RPM with power ranging from 1-4 Watts. The median plasma free hemoglobin was 19, 30, 19 and 30 mg/dL at 7, 30, 90 and 180 days or time of explant, respectively. All patients reached the primary feasibility endpoint. Patient-reported outcomes with the device were favorable with respect to participation in a full range of activities. Due to financial issues with the manufacturer, the study was suspended after consent of the eighth patient. CONCLUSION The Jarvik 2015 LVAD appears to hold important promise as an implantable continuous flow device for smaller children that may support hospital discharge. The FDA has approved the device to proceed to a 22-subject pivotal trial. Whether this device will survive to commercialization remains unclear because of the financial challenges faced by industry seeking to develop pediatric medical devices. (Supported by NIH/NHLBI HHS Contract N268201200001I, clinicaltrials.gov 02954497).
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Affiliation(s)
| | - Ryan Davies
- University of Texas Southwestern, Dallas, Texas
| | - Iki Adachi
- Texas Children's Hospital, Houston, Texas
| | | | | | | | - Chad Mao
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Fawwaz Shaw
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jodie Lantz
- University of Texas Southwestern, Dallas, Texas
| | | | - Lori C Jordan
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kristin Burns
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | - Selena Gonzales
- Stanford University School of Medicine, Palo Alto, California
| | | | - Aamir Jeewa
- Toronto Sick Kids Hospital, Toronto, Ontario, Canada
| | | | - Mario Stylianou
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Lynn Sleeper
- Boston Children's Hospital, Boston, Massachusetts
| | - John C Dykes
- Stanford University School of Medicine, Palo Alto, California
| | - Michael Ma
- Stanford University School of Medicine, Palo Alto, California
| | | | - Angela Lorts
- Cinciannati Children's Hospital, Cincinnati, Ohio
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Kremer J, El-Dor A, Rivinius R, Schlegel P, Sommer W, Warnecke G, Karck M, Ruhparwar A, Meyer AL. Wound Infections in Adult Patients after Berlin Heart ® EXCOR Biventricular Assist Device Implantation. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101550. [PMID: 36294985 PMCID: PMC9604684 DOI: 10.3390/life12101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/11/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022]
Abstract
Simple Summary Our study shows that the Berlin Heart® EXCOR as a biventricular assist device in adult patients is an effective strategy in heart failure medicine. Our results may increase the use of the EXCOR with acceptable clinical outcomes despite long support times. With ongoing research to implement the EXCOR as a permanent right ventricular assist device, our results highlight possible arising complications. Abstract The Berlin Heart® EXCOR is a paracorporeal, pulsatile ventricular assist device used in patients of all age groups. However, adolescent and adult patients on EXCOR support are scarcely explored. Herein, we present a detailed description of infectious complications in this patient cohort. From 2006 to 2020, 58 patients received a biventricular assist device (BiVAD) at our institution and were included in this study. Postoperative infections were assessed after BiVAD implantation and subsequent heart transplantation (HTx). A Berlin Heart® EXCOR BiVAD was implanted as a bridge to transplantation in 58 patients (12–64 years). Most patients were INTERMACS I, and their median age was 49 years. Wound infections (WI) specific to the ventricular assist device (VAD) occurred in 31 (53.4%) patients with a mean time of 113 ± 155 days after BiVAD implantation. HTx was performed in 30 (51.7%) patients and thereof 10 (33.3%) patients developed at least one WI post-HTx. The mean time of WI after HTx was 17 ± 14 days. In four cases, WIs were caused by the same pathogen as before HTx. According to our institutional BiVAD wound classification, the mean wound score was 3. The VAD-specific wound infections were manageable and did not increase mortality nor precluded HTx in Berlin Heart® EXCOR patients. No specific risk factors for VAD-specific wound infections could be identified.
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Affiliation(s)
- Jamila Kremer
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-566272
| | - Abbas El-Dor
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Philipp Schlegel
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Arjang Ruhparwar
- Clinic of Thoracic and Cardiovascular Surgery, Essen University Hospital, 45147 Essen, Germany
| | - Anna L. Meyer
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
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Kremer J, El-Dor A, Sommer W, Tochtermann U, Warnecke G, Karck M, Ruhparwar A, Meyer AL. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6582577. [PMID: 35532167 PMCID: PMC9419688 DOI: 10.1093/icvts/ivac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/09/2022] [Accepted: 04/08/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jamila Kremer
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Corresponding author. Department of Cardiothoracic Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany. Tel: +49-6221-5634944; e-mail: (J. Kremer)
| | - Abbas El-Dor
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Tochtermann
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Clinic of Thoracic and Cardiovascular Surgery, Essen University Hospital, Essen, Germany
| | - Anna Lassia Meyer
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
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von Cube M, Timsit JF, Schumacher M, Motschall E, Schumacher M. Quantification and interpretation of attributable mortality in core clinical infectious disease journals. THE LANCET. INFECTIOUS DISEASES 2020; 20:e299-e306. [PMID: 32916101 DOI: 10.1016/s1473-3099(20)30485-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/06/2023]
Abstract
Attributable mortality is an important metric that mirrors the public health effect of a potentially harmful infection by accounting not only for the effect of infection on mortality, but also for its prevalence within the target population. We did a systematic literature review to identify how attributable deaths were quantified and interpreted in core clinical infectious diseases journals between Jan 1, 2013, and April 6, 2020. Of the 1591 abstracts screened, 234 entered the primary analysis. Our summary of the epidemiological measures used in these articles reveals fundamental shortcomings in the conception of attributable mortality. Because of its importance as a basis for decision making on public health matters, it is essential to correctly quantify and report on attributable mortality. Our recommendation for quantification and reporting of attributable deaths aids clinical researchers in the correct statistical assessment of the burden of infections. Fictional as well as real data is used to illustrate these issues.
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Affiliation(s)
- Maja von Cube
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
| | - Jean-Francois Timsit
- Unités Mixtes de Recherche 1137 Infection Antimicrobials Modelling Evolution, INSERM, Université Paris Diderot, Paris, France; Assistance Publique Hôpitaux de Paris, Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, Paris, France
| | - Marc Schumacher
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Edith Motschall
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Schumacher
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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