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Korn L, Dual S, Rixen J, Meboldt M, Leonhardt S, Schmid Daners M, Walter M. Dual-modality Volume Measurement integrated on a Ventricular Assist Device. IEEE Trans Biomed Eng 2021; 69:1151-1161. [PMID: 34559630 DOI: 10.1109/tbme.2021.3115019] [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: 11/08/2022]
Abstract
OBJECTIVE Ventricular assist devices (VADs) are implanted in patients suffering from end-stage heart failure to sustain the blood circulation. Real-time volume measurement could be a valuable tool to monitor patients and enable physiological control strategies to provide individualized therapy. However, volume measurement using one sensor modality requires re-calibration in the critical time post VAD implantation. METHODS To overcome this limitation, we have integrated ultrasound and impedance volume measurement techniques into a cannula of an apical VAD. We tested both modalities across a volume range from 140-420 mL using two differently sized and shaped biventricular silicon heart phantoms, which were subjected to physiological pressures in an in-vitro test bench. We compared results from standard calibrated measurements with calculations found by a quadratic optimization for the single modality and their combination (dual-modality) and validated the results using twofold cross-validation. RESULTS The dual-modality approach resulted in most favorable limits of agreement (LOA) of -0.83 ± 1.54% compared to -13.88 ± 5.90% for ultrasound and -43.45 ± 10.28% for electric impedance, separately. CONCLUSION The results of the dual-modality approach were as accurate as the standard calibrated measurement and valid over a large range of volumes (140-420 mL). In this in-vitro study, we show how a dual-modality ventricular volume measurement of ultrasound and electric impedance increases the robustness and renders calibration obsolete. SIGNIFICANCE Ventricular volumes could be measured accurately in the critical period post VAD implantation despite ventricular remodeling.
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Chan JL, Patel DC, Megna D, Dimbil SJ, Levine R, Moriguchi J, Czer LS, Kobashigawa JA, Arabia F, Esmailian F. Use of durable mechanical circulatory support on outcomes of heart-kidney transplantation. Interact Cardiovasc Thorac Surg 2019; 27:773-777. [PMID: 29846594 DOI: 10.1093/icvts/ivy156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/10/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Previous studies have demonstrated that preheart transplant mechanical circulatory support (MCS) can lead to a small but significant increase in mortality. However, data on outcomes of patients with MCS who require simultaneous heart-kidney transplant are limited. METHODS A retrospective review of simultaneous heart-kidney transplantations (HKTxs) performed at a single institution over a 5-year period was performed. Patients were divided based on the preoperative use of durable MCS. Renal graft-related end points were evaluated, including glomerular filtration rate following transplantation, prevalence of delayed renal graft function and freedom from antibody and cellular-mediated graft rejection. Patient-specific outcomes, including survival and frequency of non-fatal major adverse cardiac events at 1 year, were additionally assessed. RESULTS During the study period, 50 HKTxs were performed, 14 of which had preoperative MCS. HKTx patients with and without MCS implantations had a similar prevalence of delayed graft function (57.1% vs 50.0%; P = 0.757). A numerical trend was observed towards a reduced glomerular filtration rate 1-month post-transplant in patients without an MCS device (81.2 ± 32.8 vs 64.4 ± 27.5; P = 0.072), but no significant difference was observed at 6 and 12 months. No significant difference was observed on the need for post-transplant renal replacement therapy, non-fatal major adverse cardiac events, freedom from graft rejection and overall survival at 1 year. CONCLUSIONS The use of preoperative MCS in patients undergoing combined HKTx was not found to affect renal graft function post-transplantation and does not seem to be associated with increase in morbidity or mortality.
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Affiliation(s)
- Joshua L Chan
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Deven C Patel
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dominick Megna
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Ryan Levine
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | | | | | - Francisco Arabia
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Fardad Esmailian
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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El-Sayed Ahmed MM, Thomas M, Jacob S, Makey IA, Landolfo KP, Pham SM, Belli EV. Triple bridge of mechanical circulatory support to heart transplantation listing: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19834816. [PMID: 30858974 PMCID: PMC6404238 DOI: 10.1177/2050313x19834816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
A 60-year-old male patient presented to an outside hospital with severe
cardiogenic shock. A triple bridge of mechanical circulatory support was
utilized to transition him to heart transplantation listing. Initially, coronary
artery disease was percutaneously treated and Impella 2.5 was used as mechanical
circulatory support for 5 days followed by the second Impella 2.5 for 4 days.
Veno-arterial extracorporeal membrane oxygenation support was deployed for
16 days. This was exchanged for HeartWare ventricular assist device support as
the third stage of mechanical circulatory support to heart transplantation
listing. The patient experienced acute renal failure which was managed by
continuous renal replacement therapy then intermittent hemodialysis with
eventual complete recovery of the renal function. He was discharged home 56 days
after HeartWare ventricular assist device implantation with stable hemodynamic,
intact neurologic status and fully recovered renal function. Currently, the
patient is listed for heart transplantation.
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Affiliation(s)
- Magdy Mohamed El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Erol V Belli
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
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Loosli C, Moy L, Kress G, Mazza E, Ermanni P. Corrugated diaphragm shape design study for hemocompatible pulsatile ventricular assist devices. Comput Methods Biomech Biomed Engin 2018; 21:399-407. [PMID: 29996696 DOI: 10.1080/10255842.2018.1434623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We aim to maximize the pumping volume of a pulsatile ventricular assist device, where the diaphragm is covered with an endothelial cell layer. These cells are estimated to survive a cyclic strain up to fifteen percent. To increase the pumping volume under this strain constraint we use an approach based on corrugation of the diaphragm in its reference configuration. The paper explains the parametrization scheme for finding corrugation shapes, addresses modeling and evaluation schemes and reports on the results of a parameter study. The results show that corrugated diaphragm shapes are effective for increasing pumping volumes under a strain constraint.
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Affiliation(s)
- C Loosli
- a Laboratory of Composite Materials and Adaptive Structures, Department of Mechanical and Process Engineering , ETH Zürich , Tannenstr. 3 , CH-8092 Zürich , Switzerland
| | - L Moy
- a Laboratory of Composite Materials and Adaptive Structures, Department of Mechanical and Process Engineering , ETH Zürich , Tannenstr. 3 , CH-8092 Zürich , Switzerland
| | - G Kress
- a Laboratory of Composite Materials and Adaptive Structures, Department of Mechanical and Process Engineering , ETH Zürich , Tannenstr. 3 , CH-8092 Zürich , Switzerland
| | - E Mazza
- b Experimental Continuum Mechanics, Department of Mechanical and Process Engineering , ETH Zürich , Leonhardstr. 21 , CH-8092 Zürich , Switzerland
| | - P Ermanni
- a Laboratory of Composite Materials and Adaptive Structures, Department of Mechanical and Process Engineering , ETH Zürich , Tannenstr. 3 , CH-8092 Zürich , Switzerland
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Ezekowitz JA, O'Meara E, McDonald MA, Abrams H, Chan M, Ducharme A, Giannetti N, Grzeslo A, Hamilton PG, Heckman GA, Howlett JG, Koshman SL, Lepage S, McKelvie RS, Moe GW, Rajda M, Swiggum E, Virani SA, Zieroth S, Al-Hesayen A, Cohen-Solal A, D'Astous M, De S, Estrella-Holder E, Fremes S, Green L, Haddad H, Harkness K, Hernandez AF, Kouz S, LeBlanc MH, Masoudi FA, Ross HJ, Roussin A, Sussex B. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol 2017; 33:1342-1433. [PMID: 29111106 DOI: 10.1016/j.cjca.2017.08.022] [Citation(s) in RCA: 435] [Impact Index Per Article: 62.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 02/06/2023] Open
Abstract
Since the inception of the Canadian Cardiovascular Society heart failure (HF) guidelines in 2006, much has changed in the care for patients with HF. Over the past decade, the HF Guidelines Committee has published regular updates. However, because of the major changes that have occurred, the Guidelines Committee believes that a comprehensive reassessment of the HF management recommendations is presently needed, with a view to producing a full and complete set of updated guidelines. The primary and secondary Canadian Cardiovascular Society HF panel members as well as external experts have reviewed clinically relevant literature to provide guidance for the practicing clinician. The 2017 HF guidelines provide updated guidance on the diagnosis and management (self-care, pharmacologic, nonpharmacologic, device, and referral) that should aid in day-to-day decisions for caring for patients with HF. Among specific issues covered are risk scores, the differences in management for HF with preserved vs reduced ejection fraction, exercise and rehabilitation, implantable devices, revascularization, right ventricular dysfunction, anemia, and iron deficiency, cardiorenal syndrome, sleep apnea, cardiomyopathies, HF in pregnancy, cardio-oncology, and myocarditis. We devoted attention to strategies and treatments to prevent HF, to the organization of HF care, comorbidity management, as well as practical issues around the timing of referral and follow-up care. Recognition and treatment of advanced HF is another important aspect of this update, including how to select advanced therapies as well as end of life considerations. Finally, we acknowledge the remaining gaps in evidence that need to be filled by future research.
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Affiliation(s)
| | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Michael Chan
- Edmonton Cardiology Consultants, Edmonton, Alberta, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Adam Grzeslo
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Serge Lepage
- Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | | | - Miroslaw Rajda
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Sabe De
- London Health Sciences, Western University, London, Ontario, Canada
| | | | - Stephen Fremes
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lee Green
- University of Alberta, Edmonton, Alberta, Canada
| | - Haissam Haddad
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karen Harkness
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Québec, Canada
| | | | | | | | - Andre Roussin
- Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Bruce Sussex
- Memorial University, St John's, Newfoundland, Canada
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Left Ventricular Assist Devices: Challenges Toward Sustaining Long-Term Patient Care. Ann Biomed Eng 2017; 45:1836-1851. [DOI: 10.1007/s10439-017-1858-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022]
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Liu T, Ma X, Liu W, Ling S, Zhao L, Xu L, Song D, Liu J, Sun Z, Fan Z, Luo T, Kang J, Liu X, Dong J. Late Gadolinium Enhancement Amount As an Independent Risk Factor for the Incidence of Adverse Cardiovascular Events in Patients with Stage C or D Heart Failure. Front Physiol 2016; 7:484. [PMID: 27840608 PMCID: PMC5083842 DOI: 10.3389/fphys.2016.00484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background: Myocardial fibrosis (MF) is a risk factor for poor prognosis in dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE) of the myocardium on cardiac magnetic resonance (CMR) represents MF. We examined whether the LGE amount increases the incidence of adverse cardiovascular events in patients with stage C or D heart failure (HF). Methods: Eighty-four consecutive patients with stage C or D HF, either ischemic or non-ischemic, were enrolled. Comprehensive clinical and CMR evaluations were performed. All patients were followed up for a composite endpoint of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D). Results: LGE was present in 79.7% of the end-stage HF patients. LGE distribution patterns were mid-wall, epi-myocardial, endo-myocardial, and the morphological patterns were patchy, transmural, and diffuse. During the average follow-up of 544 days, 13 (15.5%) patients had endpoint events: 7 patients cardiac death, 2 patients heart transplantation, and 4 patients underwent CRT-D implantation. On univariate analysis, LGE quantification on cardiac magnetic resonance, blood urine nitrogen, QRS duration on electrocardiogram, left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) on CMR had the strongest associations with the composite endpoint events. However, on multivariate analysis for both Model I (after adjusting for age, sex, and body mass index) and Model II (after adjusting for age, sex, BMI, renal function, QRS duration, and atrial fibrillation on electrocardiogram, the etiology of HF, LVEF, CMR-LVEDD, and CMR-LVEDV), LGE amount was a significant risk factor for composite endpoint events (Model I 6SD HR 1.037, 95%CI 1.005–1.071, p = 0.022; Model II 6SD HR 1.045, 95%CI 1.001–1.084, p = 0.022). Conclusion: LGE amount from high-scale threshold on CMR increased the incidence of adverse cardiovascular events for patients in either stage C or D HF.
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Affiliation(s)
- Tong Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Xiaohai Ma
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Wei Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Shukuan Ling
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center Beijing, China
| | - Lei Zhao
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Lei Xu
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Deli Song
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Jie Liu
- Department of Vascular Surgery, Chinese PLA General Hospital Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, School of Science, Curtin University Perth, WA, Australia
| | - Zhanming Fan
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Taiyang Luo
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Junping Kang
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Xiaohui Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
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