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Chrysakis N, Xanthopoulos A, Magouliotis D, Starling RC, Drakos SG, Triposkiadis F, Skoularigis J. Myocardial Recovery. Diagnostics (Basel) 2023; 13:diagnostics13081504. [PMID: 37189604 DOI: 10.3390/diagnostics13081504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
In this paper, the feasibility of myocardial recovery is analyzed through a literature review. First, the phenomena of remodeling and reverse remodeling are analyzed, approached through the physics of elastic bodies, and the terms myocardial depression and myocardial recovery are defined. Continuing, potential biochemical, molecular, and imaging markers of myocardial recovery are reviewed. Then, the work focuses on therapeutic techniques that can facilitate the reverse remodeling of the myocardium. Left ventricular assist device (LVAD) systems are one of the main ways to promote cardiac recovery. The changes that take place in cardiac hypertrophy, extracellular matrix, cell populations and their structural elements, β-receptors, energetics, and several biological processes, are reviewed. The attempt to wean the patients who experienced cardiac recovery from cardiac assist device systems is also discussed. The characteristics of the patients who will benefit from LVAD are presented and the heterogeneity of the studies performed in terms of patient populations included, diagnostic tests performed, and their results are addressed. The experience with cardiac resynchronization therapy (CRT) as another way to promote reverse remodeling is also reviewed. Myocardial recovery is a phenomenon that presents with a continuous spectrum of phenotypes. There is a need for algorithms to screen suitable patients who may benefit and identify specific ways to enhance this phenomenon in order to help combat the heart failure epidemic.
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Affiliation(s)
- Nikolaos Chrysakis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Dimitrios Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah Health, Salt Lake City, UT 84132, USA
| | - Filippos Triposkiadis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
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Trivella MG, Capobianco E, L’Abbate A. Editorial: Physiology in extreme conditions: Adaptations and unexpected reactions, Volume II. Front Physiol 2023; 14:1181010. [PMID: 36998988 PMCID: PMC10043470 DOI: 10.3389/fphys.2023.1181010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Affiliation(s)
- Maria G. Trivella
- Consiglio Nazionale delle Ricerche, Institute of Clinical Physiology, Pisa, Italy
- *Correspondence: Maria G. Trivella,
| | - Enrico Capobianco
- The Jackson Laboratory, Computational Science, Farmington, CT, United States
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Khan MS, Kyriakopoulos CP, Taleb I, Dranow E, Scott M, Ranjan R, Yin M, Tseliou E, Alharethi R, Caine W, Shaw RM, Selzman CH, Drakos SG, Dosdall DJ. Baseline QRS duration associates with cardiac recovery in patients with continuous-flow left ventricular assist device implantation. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 22:100211. [PMID: 38558900 PMCID: PMC10978410 DOI: 10.1016/j.ahjo.2022.100211] [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: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 04/04/2024]
Abstract
Objective In chronic heart failure (HF) patients supported with continuous-flow left ventricular assist device (CF-LVAD), we aimed to assess the clinical association of pre-LVAD QRS duration (QRSd) with post-LVAD cardiac recovery, and its correlation with pre- to post-LVAD change in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD). Methods Chronic HF patients (n = 402) undergoing CF-LVAD implantation were prospectively enrolled, at one of the centers comprising the U.T.A.H. (Utah Transplant Affiliated Hospitals) consortium. After excluding patients with acute HF etiologies, hypertrophic or infiltrative cardiomyopathy, and/or inadequate post-LVAD follow up (<3 months), 315 patients were included in the study. Cardiac recovery was defined as LVEF ≥ 40 % and LVEDD < 6 cm within 12 months post-LVAD implantation. Patients fulfilling this condition were termed as responders (R) and results were compared with non-responders (NR). Results Thirty-five patients (11 %) achieved 'R' criteria, and exhibited a 15 % shorter QRSd compared to 'NR' (123 ± 37 ms vs 145 ± 36 ms; p < 0.001). A univariate analysis identified association of baseline QRSd with post-LVAD cardiac recovery (OR: 0.986, 95 % CI: 0.976-0.996, p < 0.001). In a multivariate logistic regression model, after adjusting for duration of HF (OR: 0.990, 95 % CI: 0.983-0.997, p = 0.006) and gender (OR: 0.388, 95 % CI: 0.160-0.943, p = 0.037), pre-LVAD QRSd exhibited a significant association with post-LVAD cardiac structural and functional improvement (OR: 0.987, 95 % CI: 0.977-0.998, p = 0.027) and the predictive model showed a c-statistic of 0.73 with p < 0.001. The correlations for baseline QRSd with pre- to post-LVAD change in LVEF and LVEDD were also investigated in 'R' and 'NR' groups. Conclusion Chronic advanced HF patients with a shorter baseline QRSd exhibit an increased potential for cardiac recovery after LVAD support.
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Affiliation(s)
- Muhammad S. Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
| | - Christos P. Kyriakopoulos
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Iosif Taleb
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Elizabeth Dranow
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Monte Scott
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States of America
| | - Michael Yin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Eleni Tseliou
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Rami Alharethi
- Cardiovascular Department, Intermountain Medical Center, Salt Lake City, UT, United States of America
| | - William Caine
- Cardiovascular Department, Intermountain Medical Center, Salt Lake City, UT, United States of America
| | - Robin M. Shaw
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Craig H. Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
| | - Stavros G. Drakos
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States of America
| | - Derek J. Dosdall
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, UT, United States of America
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT, United States of America
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LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement. J Clin Med 2022; 11:jcm11123542. [PMID: 35743611 PMCID: PMC9225013 DOI: 10.3390/jcm11123542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of patients. In the first part of this review, we discuss the historical background, current evidence on the incidence and assessment of LVAD-mediated cardiac recovery, and out-comes including quality of life after LVAD support withdrawal. In the second part, we discuss current and future opportunities to promote LVAD-mediated reverse remodeling and improve our pathophysiological understanding of HF and recovery for the benefit of the greater HF population.
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Mariani S, Li T, Hegermann J, Bounader K, Hanke J, Meyer T, Jannsen-Peters H, Haverich A, Schmitto JD, Dogan G. Biocompatibility of an apical ring plug for left ventricular assist device explantation: Results of a feasibility pre-clinical study. Artif Organs 2021; 46:827-837. [PMID: 34904254 DOI: 10.1111/aor.14149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients receiving left ventricle assist devices (LVADs) as bridge to recovery remain a minority with 1%-5% of LVADs explanted after improvement of myocardial function. Nevertheless, considering the growing population of patients supported with LVADs, an increasing demand of new explantation strategies is expected in the near future. A novel plug for LVAD explantation has been developed and its biocompatibility profile needs to be proved. This study tested the biocompatibility of this novel plug in an in vivo ovine model. METHODS Six adult Blackhead Persian female sheep received plug implantation on the cardiac apex via minimally invasive approach and were clinically observed up to 90 days. Echocardiography was performed to detect thrombus formation or further plug-related complications. After the observation period, euthanasia was performed and samples including the plug and the surrounding tissues were obtained to be analyzed with correlative light and electron microscopy. Organ necrosis, ischemia and peripheral embolism were investigated. RESULTS Three animals survived surgery and completed the follow-up time without experiencing clinical complications. Echocardiographic controls excluded the presence of an intracavitary thrombus in the left ventricle (LV). Autopsy confirmed no signs of local infection, LV thrombus or peripheral embolism. Light and electron microscopy revealed an intact epithelium covering a layer of connective tissue on the plug surface facing the heart lumen. CONCLUSIONS This novel apical plug for LVAD explantation allows for endothelial and connective tissue growth on its ventricular side within 90 days from surgery. Further studies are required to fully demonstrate the biocompatibility of this apical plug and investigate the optimal anticoagulation regimen to be applied after implantation.
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Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Hegermann
- Institute of Functional and Applied Anatomy, Research Core Unit Electron Microscopy, Hannover Medical School, Hannover, Germany
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jasmin Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | | | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Bonnemain J, Zeller M, Pegolotti L, Deparis S, Liaudet L. Deep Neural Network to Accurately Predict Left Ventricular Systolic Function Under Mechanical Assistance. Front Cardiovasc Med 2021; 8:752088. [PMID: 34765658 PMCID: PMC8576185 DOI: 10.3389/fcvm.2021.752088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022] Open
Abstract
Characterizing left ventricle (LV) systolic function in the presence of an LV assist device (LVAD) is extremely challenging. We developed a framework comprising a deep neural network (DNN) and a 0D model of the cardiovascular system to predict parameters of LV systolic function. DNN input data were systemic and pulmonary arterial pressure signals, and rotation speeds of the device. Output data were parameters of LV systolic function, including end-systolic maximal elastance (Emax,lv), a variable essential for adequate hemodynamic assessment of the LV. A 0D model of the cardiovascular system, including a wide range of LVAD settings and incorporating the whole spectrum of heart failure, was used to generate data for the training procedure of the DNN. The DNN predicted Emax,lv with a mean relative error of 10.1%, and all other parameters of LV function with a mean relative error of <13%. The framework was then able to retrieve a number of LV physiological variables (i.e., pressures, volumes, and ejection fraction) with a mean relative error of <5%. Our method provides an innovative tool to assess LV hemodynamics under device assistance, which could be helpful for a better understanding of LV-LVAD interactions, and for therapeutic optimization.
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Affiliation(s)
- Jean Bonnemain
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,SCI-SB-SD, Institute of Mathematics, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, Ecublens, Switzerland
| | - Matthias Zeller
- SCI-SB-SD, Institute of Mathematics, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, Ecublens, Switzerland
| | - Luca Pegolotti
- SCI-SB-SD, Institute of Mathematics, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, Ecublens, Switzerland
| | - Simone Deparis
- SCI-SB-SD, Institute of Mathematics, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, Ecublens, Switzerland
| | - Lucas Liaudet
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Kiriyama Y, Kinishi Y, Hiramatu D, Uchiyama A, Fujino Y, Toda K, Ootaki C. Outcomes of severe peripartum cardiomyopathy and mechanical circulatory support: a case series. JA Clin Rep 2021; 7:80. [PMID: 34725740 PMCID: PMC8560865 DOI: 10.1186/s40981-021-00484-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background We present three cases of severe peripartum cardiomyopathy (PPCM) that required mechanical circulatory supports. Case presentation Case 1: A 33-year-old woman developed acute heart failure (AHF) after normal spontaneous delivery. Intra-aortic balloon pump (IABP) was inserted on postpartum day (PD) 10 with a peripartum cardiomyopathy (PPCM), which was withdrawn on PD 30 after medical treatment including anti-prolactin drugs. Case 2: A 44-year-old woman developed AHF 1 month after vaginal delivery. IABP or extra-corporeal membrane oxygenation (ECMO) was not effective and a biventricular assist device was inserted. It was withdrawn on PD 85 after improvement of left ventricular ejection fraction (LVEF). Case3: A 37-year-old woman was transferred with a diagnosis of PPCM. Cardiac function unimproved by IABP or ECMO, and a left ventricular assist device was implanted. It was withdrawn on PD 386 after recovery of LVEF. Conclusion All the cases with PPCM recovered after mechanical circulatory supports and resumed social lives.
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Affiliation(s)
- Yuki Kiriyama
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuki Kinishi
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Daisuke Hiramatu
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Chiyo Ootaki
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
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Briasoulis A, Ruiz Duque E, Mouselimis D, Tsarouchas A, Bakogiannis C, Alvarez P. The role of renin-angiotensin system in patients with left ventricular assist devices. J Renin Angiotensin Aldosterone Syst 2021; 21:1470320320966445. [PMID: 33084480 PMCID: PMC7871286 DOI: 10.1177/1470320320966445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
End-stage heart failure is a condition in which the up-regulation of the systemic and local renin-angiotensin-aldosterone system (RAAS) leads to end-organ damage and is largely irreversible despite optimal medication. Left ventricular assist devices (LVADs) can downregulate RAAS activation by unloading the left ventricle and increasing the cardiac output translating into a better end-organ perfusion improving survival. However, the absence of pulsatility brought about by continuous-flow devices may variably trigger RAAS activation depending on left ventricular (LV) intrinsic contractility, the design and speed of the pump device. Moreover, the concept of myocardial recovery is being tested in clinical trials and in this setting LVAD support combined with intense RAAS inhibition can promote recovery and ensure maintenance of LV function after explantation. Blood pressure control on LVAD recipients is key to avoiding complications as gastrointestinal bleeding, pump thrombosis and stroke. Furthermore, emerging data highlight the role of RAAS antagonists as prevention of arteriovenous malformations that lead to gastrointestinal bleeds. Future studies should focus on the role of angiotensin receptor inhibitors in preventing myocardial fibrosis in patients with LVADs and examine in greater details the target blood pressure for these patients.
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Affiliation(s)
- Alexandros Briasoulis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ernesto Ruiz Duque
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Dimitrios Mouselimis
- 3rd Department of Cardiology Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- 3rd Department of Cardiology Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Constantinos Bakogiannis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Paulino Alvarez
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Ventricular assist device-promoted recovery and technical aspects of explant. JTCVS Tech 2021; 7:182-188. [PMID: 34318239 PMCID: PMC8311694 DOI: 10.1016/j.xjtc.2021.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 01/09/2023] Open
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Dandel M, Javier MFDM, Javier Delmo EM, Loebe M, Hetzer R. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure. Cardiovasc Diagn Ther 2021; 11:226-242. [PMID: 33708495 DOI: 10.21037/cdt-20-288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although complete myocardial recovery after ventricular assist device (VAD) implantation is rather seldom, systematic search for recovery is worthwhile because for recovered patients weaning from VADs is feasible and can provide survival benefits with long-term freedom from heart failure (HF) recurrence, even if a chronic cardiomyopathy was the primary cause for the drug-refractory HF necessitating left ventricular (LVAD) or biventricular support (as bridge-to-transplantation or definitive therapy) and even if recovery remains incomplete. LVAD patients explanted for myoacardial recovery compared to those transplanted from LVAD support showed similar survival rates and a significant proportion of explanted patients can achieve cardiac and physical functional capacities that are within the normal range of healthy controls. In apparently sufficiently recovered patients, a major challenge remains still the pre-explant prediction of the weaning success which is meanwhile reliably possible for experienced clinicians. In weaning candidates, the combined use of certain echocardiography and right heart catheterization parameters recorded before VAD explantation can predict post-weaning cardiac stability with good accuracy. However, in the absence of standardization or binding recommendations, the protocols for assessment of native cardiac improvement and also the weaning criteria differ widely among centers. Currently there are still only few larger studies on myocardial recovery assessment after VAD implantation. Therefore, the weaning practice relies mostly on small case series, local practice patterns, and case reports, and the existing knowledge, as well as the partially differing recommendations which are based mainly on expert opinions, need to be periodically systematised. Addressing these shortcomings, our review aims to summarize the evidence and expert opinion on the evaluation of cardiac recovery during mechanical ventricular support by paying special attention to the reliability of the methods and parameters used for assessment of myocardial recovery and the challenges met in both evaluation of recovery and weaning decision making.
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Affiliation(s)
- Michael Dandel
- Department of Cardiology, Cardio Centrum Berlin, Berlin, Germany
| | | | | | - Matthias Loebe
- Thoracic Transplant and Mechanical Support, Miami Transplant Institute, Memorial Jackson Health System, University of Miami, Miami, Florida, USA
| | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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11
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Kapuria D, Khumri T, Shamim S, Surana P, Khan S, Al-Khalisi N, Aggarwal S, Koh C, Chhabra R. Characterization and timing of gastrointestinal bleeding in continuous flow left ventricular assist device recipients. Heliyon 2020; 6:e04695. [PMID: 32939410 PMCID: PMC7479277 DOI: 10.1016/j.heliyon.2020.e04695] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/11/2018] [Accepted: 08/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIMS Heart failure is one of the leading causes of morbidity and mortality in the United States. The advent of left ventricular assist devices (LVAD) has improved the survival and quality of life in patients with end stage heart failure. Gastrointestinal bleeding (GIb) remains one of the limitations of LVADs. METHODS A single center, retrospective review of records was performed for patients who underwent LVAD implantation between 2010 and 2015. All patients who survived more than 30 days were followed till March 2016 and are described below. RESULTS A total of 79 patients were included in the study. The rate of GIb was 34.1% (27 patients) with a mean time to bleed of 267 days. Older patients were more likely to bleed. Upper GI bleeding was the source of bleeding in 54% patients. Arteriovenous malformations (AVM) were the source of bleeding in 74% bleeders and 80% of these patients had de novo AVM formation. 14/27 (51%) patients had a re-bleeding event. Thrombotic events were 4.5 times more likely to occur in patients who also had a GI bleed. CONCLUSIONS GI bleeding in LVAD patients is common with the source of bleeding more commonly being in the upper GI tract. GI bleeding may occur as early as 10 days post procedure, despite previous negative screening endoscopies. There is an increased risk of thrombotic events in patients who have experienced a GI bleed.
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Affiliation(s)
- Devika Kapuria
- Department of Internal Medicine, University of Missouri, Kansas City-School of Medicine, USA
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, USA
| | - Taiyeb Khumri
- Department of Cardiology, University of Missouri, Kansas City- School of Medicine, USA
| | - Shariq Shamim
- Department of Cardiology, University of Missouri, Kansas City- School of Medicine, USA
| | - Pallavi Surana
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, USA
| | - Salman Khan
- Department of Internal Medicine, University of Missouri, Kansas City-School of Medicine, USA
| | - Nabil Al-Khalisi
- Department of Radiology, University of Missouri, Kansas City-School of Medicine, USA
| | | | - Christopher Koh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, USA
| | - Rajiv Chhabra
- Department of Gastroenterology, University of Missouri, Kansas-School of Medicine, USA
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12
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Unno K, Oikonomopoulos A, Fujikawa Y, Okuno Y, Narita S, Kato T, Hayashida R, Kondo K, Shibata R, Murohara T, Yang Y, Dangwal S, Sereti KI, Yiling Q, Johnson K, Jha A, Sosnovik DE, Fann Y, Liao R. Alteration in ventricular pressure stimulates cardiac repair and remodeling. J Mol Cell Cardiol 2019; 133:174-187. [PMID: 31220468 DOI: 10.1016/j.yjmcc.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 12/29/2022]
Abstract
The mammalian heart undergoes complex structural and functional remodeling to compensate for stresses such as pressure overload. While studies suggest that, at best, the adult mammalian heart is capable of very limited regeneration arising from the proliferation of existing cardiomyocytes, how myocardial stress affects endogenous cardiac regeneration or repair is unknown. To define the relationship between left ventricular afterload and cardiac repair, we induced left ventricle pressure overload in adult mice by constriction of the ascending aorta (AAC). One week following AAC, we normalized ventricular afterload in a subset of animals through removal of the aortic constriction (de-AAC). Subsequent monitoring of cardiomyocyte cell cycle activity via thymidine analog labeling revealed that an acute increase in ventricular afterload induced cardiomyocyte proliferation. Intriguingly, a release in ventricular overload (de-AAC) further increases cardiomyocyte proliferation. Following both AAC and de-AAC, thymidine analog-positive cardiomyocytes exhibited characteristics of newly generated cardiomyocytes, including single diploid nuclei and reduced cell size as compared to age-matched, sham-operated adult mouse myocytes. Notably, those smaller cardiomyocytes frequently resided alongside one another, consistent with local stimulation of cellular proliferation. Collectively, our data demonstrate that adult cardiomyocyte proliferation can be locally stimulated by an acute increase or decrease of ventricular pressure, and this mode of stimulation can be harnessed to promote cardiac repair.
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Affiliation(s)
- Kazumasa Unno
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Angelos Oikonomopoulos
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Yusuke Fujikawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Okuno
- Deparment of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Singo Narita
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiro Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Hayashida
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhisa Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yanfei Yang
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Seema Dangwal
- Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Konstantina-Ioanna Sereti
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Department of Molecular Biology, Genentech, CA, United States of America
| | - Qiu Yiling
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Kory Johnson
- Bioinformatics Section, DIR, ITP, NINDS, NIH, Bethesda, MD, United States of America
| | - Alokkumar Jha
- Insight Center for Data Analytics, National University of Ireland, Galway, Ireland
| | - David E Sosnovik
- Harvard Medical School, Program in Cardiovascular Imaging, MGH-Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Yang Fann
- Bioinformatics Section, DIR, ITP, NINDS, NIH, Bethesda, MD, United States of America
| | - Ronglih Liao
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, CA, United States of America.
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13
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Beyrouti HE, Kornberger A, Halloum N, Beiras-Fernandez A, Vahl CF. Early LVAD Implantation in a Patient with Left Ventricular Failure after Aortic Dissection with Left Main Stem Involvement. Ann Thorac Cardiovasc Surg 2018; 26:47-50. [PMID: 29780073 PMCID: PMC7046931 DOI: 10.5761/atcs.cr.17-00236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Coronary involvement in aortic dissection heralds a poor outcome. Involvement of the left main stem may lead to left ventricular (LV) failure requiring mechanical circulatory support. Case Report: A staged approach was applied in a 24-year-old female who suffered extensive infarction due to aortic dissection with left main stem involvement. After replacement of the ascending aorta and grafting of the left internal thoracic artery to the left anterior descending artery following a failed attempt at reconstruction of the left coronary ostium, she failed to wean from cardiopulmonary bypass (CPB) and underwent implantation of an extracorporeal life support (ECLS) system as a bridge to decision. Subsequent implantation of a left ventricular assist device (LVAD) as a bridge to recovery/transplantation was followed by an uneventful further course. Conclusions: Our experience suggests that early implantation of a ventricular assist device (VAD) as bridge to recovery/transplantation is an alternative to prolonged ECLS in patients who suffered extensive myocardial infarction in the course of aortic dissection.
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Affiliation(s)
- Hazem El Beyrouti
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany
| | - Angela Kornberger
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany
| | - Nancy Halloum
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany
| | - Andres Beiras-Fernandez
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany
| | - Christian-Friedrich Vahl
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany
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14
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Bonios MJ, Koliopoulou A, Wever-Pinzon O, Taleb I, Stehlik J, Xu W, Wever-Pinzon J, Catino A, Kfoury AG, Horne BD, Nativi-Nicolau J, Adamopoulos SN, Fang JC, Selzman CH, Bax JJ, Drakos SG. Cardiac Rotational Mechanics As a Predictor of Myocardial Recovery in Heart Failure Patients Undergoing Chronic Mechanical Circulatory Support: A Pilot Study. Circ Cardiovasc Imaging 2018; 11:e007117. [PMID: 29653930 PMCID: PMC5901885 DOI: 10.1161/circimaging.117.007117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/22/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. METHODS AND RESULTS Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P=0.014). CONCLUSIONS LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device.
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Affiliation(s)
- Michael J Bonios
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Antigone Koliopoulou
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Omar Wever-Pinzon
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Iosif Taleb
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Josef Stehlik
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Weining Xu
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - James Wever-Pinzon
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Anna Catino
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Abdallah G Kfoury
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Benjamin D Horne
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Jose Nativi-Nicolau
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Stamatis N Adamopoulos
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - James C Fang
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Craig H Selzman
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Jeroen J Bax
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Stavros G Drakos
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.).
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15
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Bouabdallaoui N, Demondion P, Maréchaux S, Varnous S, Lebreton G, Mouquet F, Leprince P. Heart Transplantation for Peripartum Cardiomyopathy: A Single-Center Experience. Arq Bras Cardiol 2018; 110:181-187. [PMID: 29466490 PMCID: PMC5855912 DOI: 10.5935/abc.20180014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 08/29/2017] [Indexed: 12/28/2022] Open
Abstract
Background Peripartum cardiomyopathy is an idiopathic disorder defined by the occurrence
of acute heart failure during late pregnancy or post-partum period in the
absence of any other definable cause. Its clinical course is variable and
severe cases might require heart transplantation. Objective To investigate long-term outcomes after heart transplantation (HT) for
peripartum cardiomyopathy (PPCM). Methods Out of a single-center series of 1938 HT, 14 HT were performed for PPCM. We
evaluated clinical characteristics, transplant-related complications, and
long-term outcomes, in comparison with 28 sex-matched controls. Primary
endpoint was death from any cause; secondary endpoints were
transplant-related complications (rejection, infection, cardiac allograft
vasculopathy). A value of p < 0.05 was considered of statistical
significance. Results PPCM patients and matched controls were comparable for most variables (all p
values > 0.05), except for a higher use of inotropes at the time of HT in
PPCM group (p = 0.03). During a median follow-up of 7.7 years, 16 patients
died, 3 (21.5%) in PPCM group and 13 (46.5%) in control group. Mortality was
significantly lower in PPCM group (p = 0.03). No significant difference was
found in terms of transplant-related complications (p > 0.05). Conclusions Long-term outcomes following HT for PPCM are favorable. Heart transplantation
is a valuable option for PPCM patients who did not recover significantly
under medical treatment.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
| | - Pierre Demondion
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
| | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Cardiology Department and Heart Valve Center, Faculté Libre de Médecine/Université Catholique de Lille, France
| | - Shaida Varnous
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
| | - Guillaume Lebreton
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
| | - Frédéric Mouquet
- Service de Cardiologie, Pôle Cardio-vasculaire et Pulmonaire, Hôpital Cardiologique, CHRU Lille, Lille Cedex, France
| | - Pascal Leprince
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
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16
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Martinez HR, Wittekind S, Bryant R, Tweddell JS, Chin C. Identifiable Risk Factors and Miscalculations During Listing for Pediatric Heart Transplantation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2018; 21:2-8. [PMID: 29425521 DOI: 10.1053/j.pcsu.2017.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/15/2017] [Indexed: 11/11/2022]
Abstract
The objective of this study is to describe identifiable risk factors, complications, and pitfalls while listing pediatric patients for heart transplantation, which is the standard of care for end-stage heart disease in children. Since the introduction of cyclosporine in the 1980s, the management in pediatric heart transplantation has shown consistent improvement, mainly because of technological advances and the integration of multidisciplinary teams in the field. However, the complexity of this patient population makes medical providers vulnerable to complications as a result of undesirable mistakes. Transplant survival is impacted negatively when mistakes from health-care providers compound the high-risk status of the patient. The identification of multiple risk factors and undesirable miscalculations may help transplant teams make decisions before allocating organs, intervene or minimize morbidity, and provide the best quality of life to recipients.
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Affiliation(s)
- Hugo R Martinez
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Samuel Wittekind
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Roosevelt Bryant
- Pediatric Heart Transplant Program, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - James S Tweddell
- Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Clifford Chin
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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17
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Yamauchi T, Masai T, Fujii K, Sawa Y, Shirai S, Kamigaki M, Itou N. Long-term clinical results of acute myocardial infarction at the left main trunk requiring percutaneous cardiopulmonary support. J Artif Organs 2017; 20:303-310. [PMID: 28887708 DOI: 10.1007/s10047-017-0972-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Abstract
The clinical results of patients with acute myocardial infarction (AMI) at the left main trunk (LMT) remain unclear, especially in cases requiring percutaneous cardiopulmonary support (PCPS). Twenty seven cases of AMI at the LMT requiring emergent PCPS were retrospectively investigated. These 27 patients were aged 44-83 years (65.6 ± 8.6 years) and 20 (81.5%) were men. Peak creatine kinase (CK) leakage ranged from 538 to 34,010 IU/l (13,553 ± 7656 IU/l). Eight (29.6%) patients were discharged without mechanical support. Ten (37.0%) patients underwent left ventricular assist device (LVAD) implantation, five of whom with preoperative organ failure could not survive more than 6 months after implantation. The other nine (33.3%) patients died of low output syndrome or brain damage. The overall survival rates were 53.7, 41.3, 33.0, and 28.3% at 3 months, 6 months, 1 year, and 2 years, respectively. Multivariate analysis showed that Killip class 3/4 at hospital arrival was an independent risk factor for hospital mortality (odds ratio 20.4). Patients with more than 5 days of PCPS support period (n = 6), ≥ 4 h to revascularization (n = 6) or maximum CK leakage ≥20,000 IU/dl (n = 3) were not associated with successful PCPS or IABP weaning. The long-term clinical outcomes of patients with LMT disease requiring PCPS is devastating. Rapid cardiopulmonary resuscitation and coronary revascularization and timely insertion of LVAD before the onset of complications might lead to better survival.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan.
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, Osaka, 530-0001, Japan
| | - Kenji Fujii
- Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, Osaka, 530-0001, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shinya Shirai
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
| | - Mitsunori Kamigaki
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
| | - Naofumi Itou
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
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Farris SD, Don C, Helterline D, Costa C, Plummer T, Steffes S, Mahr C, Mokadam NA, Stempien-Otero A. Cell-Specific Pathways Supporting Persistent Fibrosis in Heart Failure. J Am Coll Cardiol 2017; 70:344-354. [PMID: 28705316 DOI: 10.1016/j.jacc.2017.05.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Only limited data exist describing the histologic and noncardiomyocyte function of human myocardium in end-stage heart failure (HF). OBJECTIVES The authors sought to determine changes in noncardiomyocyte cellular activity in patients with end-stage HF after left ventricular assist device (LVAD)-induced remodeling to identify mechanisms impeding recovery. METHODS Myocardium was obtained from subjects undergoing LVAD placement and/or heart transplantation. Detailed histological analyses were performed, and, when feasible, mononuclear cells were isolated from fresh, dissociated myocardium for quantitative reverse transcription polymerase chain reaction studies. Echocardiographic and catheterization data were obtained during routine care. RESULTS Sixty-six subjects were enrolled; 54 underwent 8.0 ± 1.2 months of LVAD unloading. Despite effective hemodynamic unloading and remodeling, there were no differences after LVAD use in capillary density (0.78 ± 0.1% vs. 0.9 ± 0.1% capillary area; n = 42 and 28, respectively; p = 0.40), cardiac fibrosis (25.7 ± 2.4% vs. 27.9 ± 2.4% fibrosis area; n = 44 and 31, respectively; p = 0.50), or macrophage density (80.7 ± 10.4 macrophages/mm2 vs. 108.6 ± 15 macrophages/mm2; n = 33 and 28, respectively; p = 0.1). Despite no change in fibrosis or myofibroblast density (p = 0.40), there was a 16.7-fold decrease (p < 0.01) in fibroblast-specific collagen expression. Furthermore, there was a shift away from pro-fibrotic/alternative pro-fibrotic macrophage signaling after LVAD use. CONCLUSIONS Despite robust cardiac unloading, capillary density and fibrosis are unchanged compared with loaded hearts. Fibroblast-specific collagen expression was decreased and might be due to decreased stretch and/or altered macrophage polarization. Dysfunctional myocardium may persist, in part, from ongoing inflammation and poor extracellular matrix remodeling. Understanding these changes could lead to improved therapies for HF.
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Affiliation(s)
- Stephen D Farris
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Creighton Don
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Deri Helterline
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Christopher Costa
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Tabitha Plummer
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Susanne Steffes
- University of Washington, School of Nursing, Seattle, Washington
| | - Claudius Mahr
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Nahush A Mokadam
- University of Washington, Department of Cardiothoracic Surgery, Seattle, Washington
| | - April Stempien-Otero
- University of Washington, Department of Medicine, Division of Cardiology, Seattle, Washington.
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19
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Topkara VK, Garan AR, Fine B, Godier-Furnémont AF, Breskin A, Cagliostro B, Yuzefpolskaya M, Takeda K, Takayama H, Mancini DM, Naka Y, Colombo PC. Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices: Results From the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.116.003157. [PMID: 27402861 DOI: 10.1161/circheartfailure.116.003157] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Time course and predictors of myocardial recovery on contemporary left ventricular assist device support are poorly defined because of limited number of recovery patients at any implanting center. This study sought to investigate myocardial recovery using multicenter data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). METHODS AND RESULTS Thirteen thousand four hundred fifty-four adult patients were studied. Device explant rates for myocardial recovery were 0.9% at 1-year, 1.9% at 2-year, and 3.1% at 3-year follow-up. Independent predictors of device explantation for recovery were age <50 years (odds ratio [OR] 2.5), nonischemic etiology (OR 5.4), time since initial diagnosis <2 years (OR 3.4), suboptimal heart failure therapy before implant (OR 2.2), left ventricular end-diastolic diameter <6.5 cm (OR 1.7), pulmonary systolic artery pressure <50 mm Hg (OR 2.0), blood urea nitrogen <30 mg/dL (OR 3.3), and axial-flow device (OR 7.6). Patients with myocarditis (7.7%), postpartum cardiomyopathy (4.4%), and adriamycin-induced cardiomyopathy (4.1%) had highest rates of device explantation for recovery. Use of neurohormonal blockers on left ventricular assist device support was significantly higher in patients who were explanted for recovery. Importantly, 9% of all left ventricular assist device patients who were not explanted for recovery have demonstrated substantial improvement in left ventricular ejection fraction (partial recovery) and had remarkable overlap in clinical characteristic profile compared with patients who were explanted for recovery (complete recovery). Complete and partial recovery rates have declined in parallel with recent changes observed in device indications and technology. CONCLUSIONS Myocardial recovery is a spectrum of improvement rather than a binary clinical end point. One in every 10 left ventricular assist device patients demonstrates partial or complete myocardial recovery and should be targeted for functional assessment and optimization.
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Affiliation(s)
- Veli K Topkara
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York.
| | - A Reshad Garan
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Barry Fine
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Amandine F Godier-Furnémont
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Alexander Breskin
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Barbara Cagliostro
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Melana Yuzefpolskaya
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Koji Takeda
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Hiroo Takayama
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Donna M Mancini
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Yoshifumi Naka
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York
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20
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Jakovljevic DG, Yacoub MH, Schueler S, MacGowan GA, Velicki L, Seferovic PM, Hothi S, Tzeng BH, Brodie DA, Birks E, Tan LB. Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure. J Am Coll Cardiol 2017; 69:1924-1933. [PMID: 28408022 PMCID: PMC5388890 DOI: 10.1016/j.jacc.2017.02.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy, or in some patients, as a bridge to recovery. OBJECTIVES This study evaluated whether patients undergoing an LVAD bridge-to-recovery protocol can achieve cardiac and physical functional capacities equivalent to those of healthy controls. METHODS Fifty-eight male patients-18 implanted with a continuous-flow LVAD, 16 patients with LVAD explanted (recovered patients), and 24 heart transplant candidates (HTx)-and 97 healthy controls performed a maximal graded cardiopulmonary exercise test with continuous measurements of respiratory gas exchange and noninvasive (rebreathing) hemodynamic data. Cardiac function was represented by peak exercise cardiac power output (mean arterial blood pressure × cardiac output) and functional capacity by peak exercise O2 consumption. RESULTS All patients demonstrated a significant exertional effort as demonstrated with the mean peak exercise respiratory exchange ratio >1.10. Peak exercise cardiac power output was significantly higher in healthy controls and explanted LVAD patients compared with other patients (healthy 5.35 ± 0.95 W; explanted 3.45 ± 0.72 W; LVAD implanted 2.37 ± 0.68 W; and HTx 1.31 ± 0.31 W; p < 0.05), as was peak O2 consumption (healthy 36.4 ± 10.3 ml/kg/min; explanted 29.8 ± 5.9 ml/kg/min; implanted 20.5 ± 4.3 ml/kg/min; and HTx 12.0 ± 2.2 ml/kg/min; p < 0.05). In the LVAD explanted group, 38% of the patients achieved peak cardiac power output and 69% achieved peak O2 consumption within the ranges of healthy controls. CONCLUSIONS The authors have shown that a substantial number of patients who recovered sufficiently to allow explantation of their LVAD can even achieve cardiac and physical functional capacities nearly equivalent to those of healthy controls.
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Affiliation(s)
- Djordje G Jakovljevic
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Clinical Research Facility, Newcastle Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
| | | | - Stephan Schueler
- Cardiothoracic Centre, Freeman Hospital, and Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Guy A MacGowan
- Cardiothoracic Centre, Freeman Hospital, and Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, and Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Novi Sad, Serbia
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School, Belgrade, Serbia
| | - Sandeep Hothi
- Physiological Laboratory and Murray Edwards College, University of Cambridge, Cambridge, and Department of Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - Bing-Hsiean Tzeng
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital and Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - David A Brodie
- Cardiovascular Research Centre, Buckinghamshire New University, Bucks, London, United Kingdom
| | - Emma Birks
- Department of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Lip-Bun Tan
- Leeds General Infirmary, Cardiology and Institute of Medical Sciences, Leeds University, Leeds, United Kingdom
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21
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Gautier SV, Itkin GP, Shevchenko AO, Khalilulin TA, Kozlov VA. DURABLE MECHANICAL CIRCULATION SUPPORT AS AN ALTERNATIVE TO HEART TRANSPLANTATION. ACTA ACUST UNITED AC 2016. [DOI: 10.15825/1995-1191-2016-3-128-136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the review a comparative analysis of the treatment of end-stage chronic heart failure using heart transplantation and durable mechanical circulatory is conducted. It shows the main advantages and limitations of heart transplantation and the prospects of application of durable mechanical circulatory support technology. The main directions of this technology, including two-stage heart transplant (bridge to transplant – BTT), assisted circulation for myocardial recovery (bridge to recovery – BTR) and implantation of an auxiliary pump on a regular basis (destination therapy, DT).
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Affiliation(s)
- S. V. Gautier
- V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation, Moscow
| | - G. P. Itkin
- V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation, Moscow; Moscow Institute of Physics and Technology (State University), Department of physics of living systems, Moscow
| | - A. O. Shevchenko
- V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation, Moscow; N.I. Pirogov First Moscow State Medical University, Moscow
| | - T. A. Khalilulin
- V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation, Moscow; N.I. Pirogov First Moscow State Medical University, Moscow
| | - V. A. Kozlov
- Moscow Institute of Physics and Technology (State University), Department of physics of living systems, Moscow
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22
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Xiang MSW, Kikuchi K. Endogenous Mechanisms of Cardiac Regeneration. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2016; 326:67-131. [PMID: 27572127 DOI: 10.1016/bs.ircmb.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Zebrafish possess a remarkable capacity for cardiac regeneration throughout their lifetime, providing a model for investigating endogenous cellular and molecular mechanisms regulating myocardial regeneration. By contrast, adult mammals have an extremely limited capacity for cardiac regeneration, contributing to mortality and morbidity from cardiac diseases such as myocardial infarction and heart failure. However, the viewpoint of the mammalian heart as a postmitotic organ was recently revised based on findings that the mammalian heart contains multiple undifferentiated cell types with cardiogenic potential as well as a robust regenerative capacity during a short period early in life. Although it occurs at an extremely low level, continuous cardiomyocyte turnover has been detected in adult mouse and human hearts, which could potentially be enhanced to restore lost myocardium in damaged human hearts. This review summarizes and discusses recent advances in the understanding of endogenous mechanisms of cardiac regeneration.
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Affiliation(s)
- M S W Xiang
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst NSW, Australia
| | - K Kikuchi
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst NSW, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington NSW, Australia.
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23
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Chaggar PS, Williams SG, Yonan N, Fildes J, Venkateswaran R, Shaw SM. Myocardial recovery with mechanical circulatory support. Eur J Heart Fail 2016; 18:1220-1227. [DOI: 10.1002/ejhf.575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/24/2016] [Accepted: 04/28/2016] [Indexed: 01/18/2023] Open
Affiliation(s)
- Parminder S. Chaggar
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
- The Manchester Collaborative Centre for Inflammation Research; University of Manchester; Manchester UK
| | - Simon G. Williams
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
| | - Nizar Yonan
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
| | - James Fildes
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
- The Manchester Collaborative Centre for Inflammation Research; University of Manchester; Manchester UK
| | - Rajamiyer Venkateswaran
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
| | - Steven M. Shaw
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
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24
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Fischer TH, Kleinwächter A, Herting J, Eiringhaus J, Hartmann N, Renner A, Gummert J, Haverich A, Schmitto JD, Sossalla S. Inhibition of CaMKII Attenuates Progressing Disruption of Ca2+Homeostasis Upon Left Ventricular Assist Device Implantation in Human Heart Failure. Artif Organs 2016; 40:719-26. [DOI: 10.1111/aor.12677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas H. Fischer
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - Astrid Kleinwächter
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
| | - Jonas Herting
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - Jörg Eiringhaus
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
| | - Nico Hartmann
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - André Renner
- Department for Heart and Transplantation Surgery; Heart Center; Bad Oeynhausen Germany
| | - Jan Gummert
- Department for Heart and Transplantation Surgery; Heart Center; Bad Oeynhausen Germany
| | - Axel Haverich
- Department for Thoracic and Heart Surgery; Medical University of Hannover; Hannover Germany
| | - Jan D. Schmitto
- Department for Thoracic and Heart Surgery; Medical University of Hannover; Hannover Germany
| | - Samuel Sossalla
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
- Department for Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine; University Medical Center; Kiel Germany
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25
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Imamura T, Kinugawa K. Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment. Int Heart J 2016; 57:3-10. [DOI: 10.1536/ihj.15-250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
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26
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Left Ventricular Assist Devices: A Rapidly Evolving Alternative to Transplant. J Am Coll Cardiol 2015; 65:2542-55. [PMID: 26065994 DOI: 10.1016/j.jacc.2015.04.039] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 01/17/2023]
Abstract
Left ventricular assist devices are becoming an increasingly prevalent therapy for patients with Stage D heart failure with reduced ejection fraction. Technological advances have improved the durability of these devices and have significantly lengthened survival in these patients. Quality of life is also improved, although adverse events related to device therapy remain common. Nevertheless, with the continuing organ donor shortage for cardiac transplantation, left ventricular assist devices are frequently serving as a substitute for transplant, particularly in the elderly patient.
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27
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Improved clinical course of autologous skeletal myoblast sheet (TCD-51073) transplantation when compared to a propensity score-matched cardiac resynchronization therapy population. J Artif Organs 2015; 19:80-6. [PMID: 26267666 DOI: 10.1007/s10047-015-0862-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
We recently reported a multi-center, single-arm, phase II study that evaluated the efficacy and safety of autologous skeletal myoblast sheet (TCD-51073) transplantation. The advantage of this procedure over a control group has not yet been analyzed. Seven patients with advanced heart failure due to ischemic etiology (TCD-51073 group, New York Heart Association (NYHA) class III; left ventricular ejection fraction (LVEF) <35 %) refractory to optimal medical and coronary revascularization therapy, received TCD-51073 at 3 study centers between 2012 and 2013 with a 2-year follow-up period. As previously reported, 112 patients received cardiac resynchronization therapy (CRT) with follow-up at the University of Tokyo Hospital between 2007 and 2014. Of them, 21 patients were selected for the control group by propensity score matching. No significant difference in baseline variables between the groups was observed. LVEF and NYHA class improved significantly in the TCD-51073 group during the 6-month study period (p < 0.05). During the 2-year follow-up, 7 patients (33 %) in the CRT group and no patient in the TCD-51073 group died due to cardiac disease or received VAD implantation (p = 0.128 by the log-rank test). In conclusion, transplantation of TCD-51073 is clinically advantageous in facilitating LV reverse remodeling, improving HF symptoms, and preventing cardiac death in patients with ischemic etiology when compared to background-matched patients receiving CRT.
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28
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Preoperative iodine-123 meta-iodobenzylguanidine imaging is a novel predictor of left ventricular reverse remodeling during treatment with a left ventricular assist device. J Artif Organs 2015. [PMID: 26219410 DOI: 10.1007/s10047-015-0857-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although left ventricular reverse remodeling (LVRR) is accompanied with an improved clinical course during LV assist device (LVAD) treatment, its preoperative prediction remains uncertain. Twenty-seven heart failure patients with dilated cardiomyopathy were enrolled in this study. Patients underwent (123)I-meta-iodobenzylguanidine (MIBG) scintigraphy before LVAD implantation, and were monitored at our institute from 2010 to 2014. This study investigated the prognostic value of preoperative (123)I-MIBG parameters for predicting postoperative LVRR. Of the preoperative variables studied, including (123)I-MIBG data, washout rate (WR) ≤ 39 % was the only significant, independent predictor of LVRR (defined as LV ejection fraction ≥35 % at 6 months post-LVAD implant using univariate and multivariate logistic regression analyses) (p = 0.036, odds ratio [OR]:14.45). Improved exercise capacity and more frequent opening of the native aortic valve, as well as lower B-type natriuretic peptide plasma levels, were observed in LVRR patients (p < 0.05 for all), although β-blocker doses were comparable with those of non-LVRR patients throughout the 6-month LVAD support period. In conclusion, preoperative (123)I-MIBG is a novel predictive tool of LVRR during LVAD support.
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29
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Abstract
Continuous-flow left ventricular assist devices (LVAD) have become standard therapy option for patients with advanced heart failure. They offer several advantages over previously used pulsatile-flow LVADs, including improved durability, less surgical trauma, higher energy efficiency, and lower thrombogenicity. These benefits translate into better survival, lower frequency of adverse events, improved quality of life, and higher functional capacity of patients. However, mounting evidence shows unanticipated consequences of continuous-flow support, such as acquired aortic valve insufficiency and acquired von Willebrand syndrome. In this review article we discuss current evidence on differences between continuous and pulsatile mechanical circulatory support, with a focus on clinical implications and potential benefits of pulsatile flow.
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Affiliation(s)
- Davor Barić
- Davor Barić, Department of Cardiac Surgery and Transplantation, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia,
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30
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Tseng CCS, Ramjankhan FZ, de Jonge N, Chamuleau SAJ. Advanced Strategies for End-Stage Heart Failure: Combining Regenerative Approaches with LVAD, a New Horizon? Front Surg 2015; 2:10. [PMID: 25905105 PMCID: PMC4387859 DOI: 10.3389/fsurg.2015.00010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/07/2015] [Indexed: 12/15/2022] Open
Abstract
Despite the improved treatment of cardiovascular diseases, the population with end-stage heart failure (HF) is progressively growing. The scarcity of the gold standard therapy, heart transplantation, demands novel therapeutic approaches. For patients awaiting transplantation, ventricular-assist devices have been of great benefit on survival. To allow explantation of the assist device and obviate heart transplantation, sufficient and durable myocardial recovery is necessary. However, explant rates so far are low. Combining mechanical circulatory support with regenerative therapies such as cell (-based) therapy and biomaterials might give rise to improved long-term results. Although synergistic effects are suggested with mechanical support and stem cell therapy, evidence in both preclinical and clinical setting is lacking. This review focuses on advanced and innovative strategies for the treatment of end-stage HF and furthermore appraises clinical experience with combined strategies.
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Affiliation(s)
- Cheyenne C S Tseng
- Department of Cardiology, Division Heart and Lungs, University Medical Center , Utrecht , Netherlands ; Interuniversity Cardiology Institute of the Netherlands , Utrecht , Netherlands
| | - Faiz Z Ramjankhan
- Department of Cardio-thoracic Surgery, Division Heart and Lungs, University Medical Center , Utrecht , Netherlands
| | - Nicolaas de Jonge
- Department of Cardiology, Division Heart and Lungs, University Medical Center , Utrecht , Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Division Heart and Lungs, University Medical Center , Utrecht , Netherlands
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Ding J, Chen Z, Niu S, Zhang J, Mondal NK, Griffith BP, Wu ZJ. Quantification of Shear-Induced Platelet Activation: High Shear Stresses for Short Exposure Time. Artif Organs 2015; 39:576-83. [PMID: 25808300 DOI: 10.1111/aor.12438] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Thrombosis and thromboembolism are the life-threatening clinical complications for patients supported or treated with prosthetic cardiovascular devices. The high mechanical shear stress within these devices is believed to be the major contributing factor to cause platelet activation (PA) and function alteration, leading to thrombotic events. There have been limited quantitative data on how the high mechanical shear stress causes platelet activation. In this study, shear-induced PA in the ranges of well-defined shear stress and exposure time relevant to cardiovascular devices was quantitatively characterized for human blood using two novel flow-through Couette-type blood shearing devices. Four markers of platelet activation-surface P-selectin (CD62p), platelet-derived microparticles (PMPs), platelet-monocyte aggregation (PMA), and soluble P-selectin-were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA), respectively. The results indicated that PA induced by high shear stresses with short exposure time could be reliably detected with surface P-selectin, and, to a lesser extent, PMPs rather than soluble P-selectin. It was also verified that PMA can be a highly sensitive indirect marker of platelet activation. The quantitative relationship between percentage of activated platelets indicated by surface P-selectin expression and shear stress/exposure time follows well the power law functional form. The coefficients of the power law models of PA based on surface P-selectin expression were derived.
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Affiliation(s)
- Jun Ding
- Artificial Organs Laboratory, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Mechanical Engineering, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Zengsheng Chen
- Artificial Organs Laboratory, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shuqiong Niu
- Artificial Organs Laboratory, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jiafeng Zhang
- Artificial Organs Laboratory, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nandan K Mondal
- Artificial Organs Laboratory, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bartley P Griffith
- Artificial Organs Laboratory, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zhongjun J Wu
- Artificial Organs Laboratory, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Imamura T, Kinugawa K, Nitta D, Fujino T, Inaba T, Maki H, Hatano M, Kinoshita O, Nawata K, Kyo S, Ono M. Novel Scoring System Using Postoperative Cardiopulmonary Exercise Testing Predicts Future Explantation of Left Ventricular Assist Device. Circ J 2015; 79:560-6. [DOI: 10.1253/circj.cj-14-1058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Daisuke Nitta
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo
| | - Kan Nawata
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo
| | - Shunei Kyo
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo
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33
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Imamura T, Kinugawa K, Nitta D, Hatano M, Kinoshita O, Nawata K, Ono M. Advantage of Pulsatility in Left Ventricular Reverse Remodeling and Aortic Insufficiency Prevention During Left Ventricular Assist Device Treatment. Circ J 2015; 79:1994-9. [DOI: 10.1253/circj.cj-15-0419] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Daisuke Nitta
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo
| | - Kan Nawata
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo
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34
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Bridge to removal: a paradigm shift for left ventricular assist device therapy. Ann Thorac Surg 2014; 99:360-7. [PMID: 25442985 DOI: 10.1016/j.athoracsur.2014.07.061] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/30/2022]
Abstract
Ventricular assist devices have become standard therapy for patients with advanced heart failure either as a bridge to transplantation or destination therapy. Despite the functional and biologic evidence of reverse cardiac remodeling, few patients actually proceed to myocardial recovery, and even fewer to the point of having their device explanted. An enhanced understanding of the biology and care of the mechanically supported patient has redirected focus on the possibility of using ventricular assist devices as a bridge to myocardial recovery and removal. Herein, we review the current issues and approaches to transforming myocardial recovery to a practical reality.
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Imamura T, Kinugawa K, Fujino T, Inaba T, Maki H, Hatano M, Kinoshita O, Nawata K, Kyo S, Ono M. Aortic insufficiency in patients with sustained left ventricular systolic dysfunction after axial flow assist device implantation. Circ J 2014; 79:104-11. [PMID: 25381791 DOI: 10.1253/circj.cj-14-0944] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved. METHODS AND RESULTS We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for ≥6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35%) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65%) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55% vs. 8%; P<0.001). CONCLUSIONS Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome.
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Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
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Caceres M, Esmailian F, Moriguchi JD, Arabia FA, Czer LS. Mechanical Circulatory Support in Cardiogenic Shock Following an Acute Myocardial Infarction:
A Systematic Review. J Card Surg 2014; 29:743-51. [DOI: 10.1111/jocs.12405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Manuel Caceres
- Division of Cardiothoracic Surgery; Veterans Affairs Medical Center; Memphis Tennessee
| | - Fardad Esmailian
- Division of Cardiothoracic Surgery and Cardiology; Cedars-Sinai Heart Institute, Cedars Sinai Medical Center; Los Angeles California
| | - Jaime D. Moriguchi
- Division of Cardiothoracic Surgery and Cardiology; Cedars-Sinai Heart Institute, Cedars Sinai Medical Center; Los Angeles California
| | - Francisco A. Arabia
- Division of Cardiothoracic Surgery and Cardiology; Cedars-Sinai Heart Institute, Cedars Sinai Medical Center; Los Angeles California
| | - Lawrence S. Czer
- Division of Cardiothoracic Surgery and Cardiology; Cedars-Sinai Heart Institute, Cedars Sinai Medical Center; Los Angeles California
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Abstract
Mechanical circulatory support of the failing heart has become an important means of treating end-stage heart disease. This rapidly growing therapeutic field has produced impressive clinical outcomes and has great potential to help thousands of otherwise terminal patients worldwide. In this review, we examine the state of the art of mechanical circulatory support: current practice, totally implantable systems of the future, evolving biventricular support mechanisms, the potential for myocardial recovery and adjunctive treatment methods, and miniaturized devices with expanded indications for therapy.
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Affiliation(s)
- Hari R Mallidi
- Department of Surgery, Baylor College of Medicine; and Center for Cardiac Support, Texas Heart Institute; Houston, Texas 77030
| | - Jatin Anand
- Department of Surgery, Baylor College of Medicine; and Center for Cardiac Support, Texas Heart Institute; Houston, Texas 77030
| | - William E Cohn
- Department of Surgery, Baylor College of Medicine; and Center for Cardiac Support, Texas Heart Institute; Houston, Texas 77030
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Bortnik M, Verdoia M, Schaffer A, Degiovanni A, Marino P. WITHDRAWN: Cardiogenic shock after fulminant myocarditis: a pluricomplicated case report. Am J Emerg Med 2014. [DOI: 10.1016/j.ajem.2014.03.009] [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] Open
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Goldfinger JZ, Nair AP. Myocardial recovery and the failing heart: medical, device and mechanical methods. Ann Glob Health 2013; 80:55-60. [PMID: 24751565 DOI: 10.1016/j.aogh.2013.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/05/2013] [Accepted: 12/19/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cardiac remodeling describes the molecular, cellular, and interstitial changes that cause the ventricle to develop pathologic geometry as heart failure progresses. Reverse remodeling, or the healing of a failing heart, leads to improved mortality and quality of life. FINDINGS Therapies that lead to reverse remodeling include medications such as β-blockers and angiotensin-converting enzyme inhibitors; cardiac resynchronization therapy with biventricular pacing; and mechanical support with left ventricular assist devices. CONCLUSIONS Further study is needed to better predict which patients will benefit most from these therapies and will then go on to experience reverse remodeling and myocardial recovery.
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Affiliation(s)
- Judith Z Goldfinger
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Ajith P Nair
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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40
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Dandel M, Knosalla C, Hetzer R. Contribution of ventricular assist devices to the recovery of failing hearts: a review and the Berlin Heart Center Experience. Eur J Heart Fail 2013; 16:248-63. [DOI: 10.1002/ejhf.18] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/25/2013] [Accepted: 09/27/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michael Dandel
- Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum Berlin; Berlin D-13353 Germany
- DZHK (German Centre for Cardiovascular Research); Berlin Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum Berlin; Berlin D-13353 Germany
- DZHK (German Centre for Cardiovascular Research); Berlin Germany
| | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum Berlin; Berlin D-13353 Germany
- DZHK (German Centre for Cardiovascular Research); Berlin Germany
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41
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Imamura T, Kinugawa K, Hatano M, Fujino T, Muraoka H, Inaba T, Maki H, Kagami Y, Endo M, Kinoshita O, Nawata K, Kyo S, Ono M. Preoperative beta-blocker treatment is a key for deciding left ventricular assist device implantation strategy as a bridge to recovery. J Artif Organs 2013; 17:23-32. [PMID: 24337665 DOI: 10.1007/s10047-013-0748-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/24/2013] [Indexed: 11/29/2022]
Abstract
To date, there have been few reports demonstrating preoperative predictors for left ventricular reverse remodeling (LVRR) after LV assist device (LVAD) implantation, especially among patients with dilated cardiomyopathy (DCM). We retrospectively analyzed 60 patients with stage D heart failure due to DCM who had received LVAD treatment [pulsatile flow (PF) type, 26; continuous flow type, 34]. Data were evaluated at 6 months or just before explantation of the LVAD. We defined "LV reverse remodeling" (LVRR) by the achievement of an LV ejection fraction (LVEF) of ≥ 35 % after 6 months of LVAD support or explantation of LVAD within 6 months. LVRR occurred in 16 of our patients (26.7 %). Uni/multivariate logistic regression analyses for LVRR demonstrated that of the preoperative variables evaluated, PF LVAD usage and insufficient preoperative β-blocker treatment were independent predictors for LVRR. Patients who accomplished LVRR had a better clinical course, including lower levels of aortic valve insufficiency and lower levels of plasma B-type natriuretic peptide. Of the six patients (10.0 %) in whom LVADs were eventually explanted, all had an LVEF of ≥ 35 % before explantation or at 6 months. Based on these results, we conclude that DCM patients with insufficient preoperative β-blocker treatment have a chance to achieve LVRR under LVAD support as a bridge to recovery.
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Affiliation(s)
- Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
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IL-33/ST2 pathway and classical cytokines in end-stage heart failure patients submitted to left ventricular assist device support: a paradoxic role for inflammatory mediators? Mediators Inflamm 2013; 2013:498703. [PMID: 24385685 PMCID: PMC3872445 DOI: 10.1155/2013/498703] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/13/2013] [Indexed: 01/07/2023] Open
Abstract
Background. Inflammation is a critical process contributing to heart failure (HF). We hypothesized that IL-33/ST2 pathway, a new mechanism regulated during cardiac stress, may be involved in the functional worsening of end-stage HF patients, candidates for left ventricular assist device (LVAD) implantation, and potentially responsible for their outcome. Methods. IL-33, ST2, and conventional cytokines (IL-6, IL-8, and TNF-α) were determined in cardiac biopsies and plasma of 22 patients submitted to LVAD implantation (pre-LVAD) and compared with (1) control stable chronic HF patients on medical therapy at the moment of heart transplantation without prior circulatory support (HT); (2) patients supported by LVAD at the moment of LVAD weaning (post-LVAD). Results. Cardiac expression of ST2/IL-33 and cytokines was lower in the pre-LVAD than in the HT group. LVAD determined an increase of inflammatory mediators comparable to levels of the HT group. Only ST2 correlated with outcome indices after LVAD implantation. Conclusions. IL-33/ST2 and traditional cytokines were involved in decline of cardiac function of ESHF patients as well as in hemodynamic recovery induced by LVAD. IL-33/ST2 pathway was also associated to severity of clinical course. Thus, a better understanding of inflammation is the key to achieving more favorable outcome by new specific therapies.
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Abstract
Heart failure is associated with remodeling that consists of adverse cellular, structural, and functional changes in the myocardium. Until recently, this was thought to be unidirectional, progressive, and irreversible. However, irreversibility has been shown to be incorrect because complete or partial reversal can occur that can be marked after myocardial unloading with a left ventricular assist device (LVAD). Patients with chronic advanced heart failure can show near-normalization of nearly all structural abnormalities of the myocardium or reverse remodeling after LVAD support. However, reverse remodeling does not always equate with clinical recovery. The molecular changes occurring after LVAD support are reviewed, both those demonstrated with LVAD unloading alone in patients bridged to transplantation and those occurring in the myocardium of patients who have recovered enough myocardial function to have the device removed. Reverse remodeling may be attributable to a reversal of the pathological mechanisms that occur in remodeling or the generation of new pathways. A reduction in cell size occurs after LVAD unloading, which does not necessarily correlate with improved cardiac function. However, some of the changes in both the cardiac myocyte and the matrix after LVAD support are specific to myocardial recovery. In the myocyte, increases in the cytoskeletal proteins and improvements in the Ca²⁺ handling pathway seem to be specifically associated with myocardial recovery. Changes in the matrix are complex, but excessive scarring appears to limit the ability for recovery, and the degree of fibrosis in the myocardium at the time of implantation may predict the ability to recover.
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Affiliation(s)
- Emma J Birks
- Department of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA.
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Abstract
Although cardiac transplant remains the gold standard for the treatment of end-stage heart failure, limited donor organ availability and growing numbers of eligible recipients have increased the demand for alternative therapies. Limitations of first-generation left ventricular assist devices for long-term support of patients with end-stage disease have led to the development of newer second-generation and third-generation pumps, which are smaller, have fewer moving parts, and have shown improved durability, allowing for extended support. The HeartMate II (second generation) and HeartWare (third generation) are 2 devices that have shown great promise as potential alternatives to transplantation in select patients.
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Affiliation(s)
- Michelle Capdeville
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, 9500 Euclid Avenue, J4-331, Cleveland, OH 44195, USA.
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45
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Tsipouras MG, Karvounis EC, Tzallas AT, Goletsis Y, Fotiadis DI, Adamopoulos S, Trivella MG. Automated knowledge-based fuzzy models generation for weaning of patients receiving ventricular assist device (VAD) therapy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:2206-9. [PMID: 23366361 DOI: 10.1109/embc.2012.6346400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The SensorART project focus on the management of heart failure (HF) patients which are treated with implantable ventricular assist devices (VADs). This work presents the way that crisp models are transformed into fuzzy in the weaning module, which is one of the core modules of the specialist's decision support system (DSS) in SensorART. The weaning module is a DSS that supports the medical expert on the weaning and remove VAD from the patient decision. Weaning module has been developed following a "mixture of experts" philosophy, with the experts being fuzzy knowledge-based models, automatically generated from initial crisp knowledge-based set of rules and criteria for weaning.
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46
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Simon MA, Borovetz HS, Wagner WR. Implantable Cardiac Assist Devices and IABPs. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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Khvilivitzky K, Mountis MM, Gonzalez-Stawinski GV. Heartmate II outflow graft ligation and driveline excision without pump removal for left ventricular recovery. Proc (Bayl Univ Med Cent) 2012; 25:344-5. [PMID: 23077383 DOI: 10.1080/08998280.2012.11928872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We report interruption of left ventricular assist device (VAD) support by way of outflow graft ligation and driveline excision while leaving the pump in situ. In this case, the indication for mechanical assist device separation was myocardial recovery, which occurred following 9 months of support. This case report demonstrates the feasibility of separating a patient from a VAD without the need for a major reoperative intervention.
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Affiliation(s)
- Katherine Khvilivitzky
- Department of Cardiothoracic Surgery, Baylor University Medical Center at Dallas (Khvilivitzky, Gonzalez-Stawinski); and the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio (Mountis)
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48
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Navaratnarajah M, Ibrahim M, Siedlecka U, van Doorn C, Shah A, Gandhi A, Dias P, Sarathchandra P, Yacoub MH, Terracciano CM. Influence of ivabradine on reverse remodelling during mechanical unloading. Cardiovasc Res 2012; 97:230-9. [DOI: 10.1093/cvr/cvs318] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Chronic heart failure is a major healthcare problem associated with high morbidity and mortality. Despite significant progress in treatment strategies, the prognosis of heart failure patients remains poor. The golden standard treatment for heart failure is heart transplantation after failure of medical therapy, surgery and/or cardiac resynchronisation therapy. In order to improve patients’ outcome and quality of life, new emerging treatment modalities are currently being investigated, including mechanical cardiac support devices, of which the left ventricular assist device is the most promising treatment option. Structured care for heart failure patients according to the most recent international heart failure guidelines may further contribute to optimal decision-making. This article will review the conventional and novel treatment modalities of heart failure.
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50
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Abstract
OPINION STATEMENT Advanced heart failure (HF) is a condition that is rarely thought of in terms of cure. Left ventricular assist devices (LVADs), like no therapy before them, provide complete decongestion of the left ventricle, with resulting favorable changes at all levels, from reversal of hypertrophy of cardiomyocytes to recovery of normal geometry and function of the ventricles. Although not a frequent phenomenon at most institutions, LV recovery is achieved in 20-25 % of LVAD recipients in some programs. Patients with good chances for recovery are usually young, with nonischemic cardiomyopathy and short duration of HF symptoms. After LVAD removal, patients with recovered function remain asymptomatic for years. To reach this level of sustainable restoration of cardiac function, several steps need to be taken: 1) myocardial recovery has to be recognized as a therapeutic goal, especially in patients with nonischemic cardiomyopathy; 2) HF medications have to be restarted and aggressively uptitrated after LVAD implantation; 3) regular monitoring for signs of myocardial recovery (eg, echocardiography or hemodynamics) should become a standard practice in LVAD centers; and 4) weaning protocols should be discussed and accepted at each LVAD program. While some protocols involve extensive several-day testing both at rest and with exercise, others are mostly guided by echocardiographic evaluation.
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