1
|
Abstract
The Jarvik 2000 Flowmaker® is an intraventricular continuous axial flow left ventricular assist device. We describe the anaesthetic management and considerations for five patients with end-stage heart failure who underwent implantation of the Jarvik 2000 Flowmaker® as a bridge to transplantation or as destination therapy.
Collapse
Affiliation(s)
- L H Tan
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | | |
Collapse
|
2
|
Bienia S, Feider A, Griauzde R, Patel KD, Minhaj MM. CASE 13—2016 Minimally Invasive Left Ventricular Assist Device Insertion Without Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2016; 30:1716-1726. [DOI: 10.1053/j.jvca.2015.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Indexed: 11/11/2022]
|
3
|
Abstract
Ventricular assist devices (VADs) have revolutionized longterm care for patients with congestive heart failure. These patients represent about 1% of the adults in the United States, considering that heart failure is a contributing factor in more than 250,000 deaths annually. It has been estimated that about 60,000 patients per year in the United States could benefit from heart transplantation or long-term mechanical support. Because of the short supply of donor hearts for transplant, assist devices have become of great value. At least four assist devices are clinically available, and two other devices are being investigated. Because cardiopulmonary bypass is required for implantation of these devices, anesthetizing these critically compromised patients requires extensive monitoring, skillful anesthetic management, and expert postoperative care.
Collapse
Affiliation(s)
- Ibrahim El-Magharbel
- Department of Anesthesiology, Santa Monica UCLA Medical Center, Los Angeles, CA 90095-1778, USA
| |
Collapse
|
4
|
Scolletta S, Gregoric ID, Muzzi L, Radovancevic B, Frazier OH. Pulse wave analysis to assess systemic blood flow during mechanical biventricular support. Perfusion 2016; 22:63-6. [PMID: 17633137 DOI: 10.1177/0267659106074784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Measurement of systemic blood flow is of crucial importance in patients on mechanical circulatory support (MCS). We reported the case of a 65-year-old female patient in severe cardiogenic shock undergoing left (Jarvik 2000 axial flow pump) and right (Levitronix-Centrimag centrifugal pump) ventricular assist device implant. Evaluation of blood flow was obtained by ultrasonic flowmetry, continuous thermodilution technique, and pressure recording analytical method (PRAM). This pulse contour system allows beat-by-beat systemic blood flow assessment from the analysis of radial artery pressure waveform. At a Jarvik pump speed ≤ 10 000 rotations per minutes (rpm), thermodilution and PRAM showed similar blood flow values. At a Jarvik pump speed ≥11 000 rpm, the aortic valve did not open and PRAM did not provide blood flow values due to nonpulsatile blood flow. The present paper describes the first experience with PRAM in a single patient on MCS. Further studies are required to assess the validity of PRAM as an additional monitoring system in the setting of ventricular assist device support. Perfusion (2007) 22, 63-66.
Collapse
Affiliation(s)
- Sabino Scolletta
- Department of Cardiothoracic Anesthesia, University of Siena, Siena, Italy.
| | | | | | | | | |
Collapse
|
5
|
Iodice F, Testa G, Averardi M, Brancaccio G, Amodeo A, Cogo P. Implantation of a left ventricular assist device as a destination therapy in Duchenne muscular dystrophy patients with end stage cardiac failure: management and lessons learned. Neuromuscul Disord 2014; 25:19-23. [PMID: 25444433 DOI: 10.1016/j.nmd.2014.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/15/2014] [Accepted: 08/28/2014] [Indexed: 01/16/2023]
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder, characterized by progressive skeletal muscle weakness, loss of ambulation, and death secondary to cardiac or respiratory failure. End-stage dilated cardiomyopathy (DCM) is a frequent finding in DMD patients, they are rarely candidates for cardiac transplantation. Recently, the use of ventricular assist devices as a destination therapy (DT) as an alternative to cardiac transplantation in DMD patients has been described. Preoperative planning and patient selection play a significant role in the successful postoperative course of these patients. We describe the preoperative, intraoperative and postoperative management of Jarvik 2000 implantation in 4 DMD pediatric (age range 12-17 years) patients. We also describe the complications that may occur. The most frequent were bleeding and difficulty in weaning from mechanical ventilation. Our standard protocol includes: 1) preoperative multidisciplinary evaluation and selection, 2) preoperative and postoperative non-invasive ventilation and cough machine cycles, 3) intraoperative use of near infrared spectroscopy (NIRS) and transesophageal echocardiography, 4) attention on surgical blood loss, use of tranexamic acid and prothrombin complexes, 5) early extubation and 6) avoiding the use of nasogastric feeding tubes and nasal temperature probes. Our case reports describe the use of Jarvik 2000 as a destination therapy in young patients emphasizing the use of ventricular assist devices as a new therapeutic option in DMD.
Collapse
Affiliation(s)
- Francesca Iodice
- Department of Pediatric Cardiac Anesthesia and Intensive Care, Ospedale Bambino Gesu', Rome, Italy.
| | - Giuseppina Testa
- Department of Pediatric Cardiac Anesthesia and Intensive Care, Ospedale Bambino Gesu', Rome, Italy
| | - Marco Averardi
- Department of Pediatric Cardiac Anesthesia and Intensive Care, Ospedale Bambino Gesu', Rome, Italy
| | | | - Antonio Amodeo
- Department of Cardiothoracic Surgery, Ospedale Bambino Gesu', Rome, Italy
| | - Paola Cogo
- Department of Pediatric Cardiac Anesthesia and Intensive Care, Ospedale Bambino Gesu', Rome, Italy
| |
Collapse
|
6
|
Blum FE. [Noncardiological surgical procedure for patients implanted with a ventricular assist device. Anesthesiological management concepts]. Med Klin Intensivmed Notfmed 2014; 110:197-203. [PMID: 24981063 DOI: 10.1007/s00063-014-0398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 06/03/2014] [Accepted: 06/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The implantation of a ventricular assist device (VAD) is more frequently used as destination therapy of end-stage heart failure compared to the use of the device as bridge-to-transplantation, this results in an increasing number of noncardiac surgical procedures for patients implanted with a VAD. OBJECTIVE For these procedures, the anesthesia provider faces various device-related complications, such as an increased risk for bleeding complications, thromboembolism, hypotension, infections, mechanical device limitations, and right heart failure. Anesthesia care is challenging in this high-risk patient population and has significant implications on patient outcome. CONCLUSION More research is needed to determine specific guidelines for the anesthesiological management of VAD patients undergoing noncardiac surgical procedures. In this manuscript, device-related perioperative complications and concepts of anesthesia care for noncardiac procedures in patients implanted with a VAD are briefly reviewed.
Collapse
Affiliation(s)
- F E Blum
- Department of Internal Medicine, Weiss Memorial Hospital, affiliate of the University of Illinois, 4646 North Marine Drive, 60640, Chicago, IL, USA,
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Michelle Capdeville
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, 9500 Euclid Avenue, J4-331, Cleveland, OH 44195, USA.
| | | |
Collapse
|
8
|
Kocabas S, Askar F, Yagdi T, Engin C, Ozbaran M. Anesthesia for Ventricular Assist Device Placement: Experience From a Single Center. Transplant Proc 2013; 45:1005-8. [DOI: 10.1016/j.transproceed.2013.02.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
9
|
Morgan JA, Paone G, Nemeh HW, Henry SE, Gerlach B, Williams CT, Lanfear DE, Tita C, Brewer RJ. Non-cardiac surgery in patients on long-term left ventricular assist device support. J Heart Lung Transplant 2012; 31:757-63. [DOI: 10.1016/j.healun.2012.02.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 02/03/2012] [Accepted: 02/11/2012] [Indexed: 10/28/2022] Open
|
10
|
Feussner M, Mukherjee C, Garbade J, Ender J. Anaesthesia for patients undergoing ventricular assist-device implantation. Best Pract Res Clin Anaesthesiol 2012; 26:167-77. [DOI: 10.1016/j.bpa.2012.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/04/2012] [Accepted: 06/04/2012] [Indexed: 01/03/2023]
|
11
|
Thunberg CA, Gaitan BD, Arabia FA, Cole DJ, Grigore AM. Ventricular Assist Devices Today and Tomorrow. J Cardiothorac Vasc Anesth 2010; 24:656-80. [DOI: 10.1053/j.jvca.2009.11.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Indexed: 12/22/2022]
|
12
|
Noncardiac surgical procedures in patient supported with long-term implantable left ventricular assist device. Am J Surg 2009; 197:710-4. [DOI: 10.1016/j.amjsurg.2008.05.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 05/08/2008] [Accepted: 05/08/2008] [Indexed: 11/19/2022]
|
13
|
Chumnanvej S, Wood MJ, MacGillivray TE, Melo MFV. Perioperative echocardiographic examination for ventricular assist device implantation. Anesth Analg 2007; 105:583-601. [PMID: 17717209 DOI: 10.1213/01.ane.0000278088.22952.82] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ventricular assist devices (VADs) are systems for mechanical circulatory support of the patient with severe heart failure. Perioperative transesophageal echocardiography is a major component of patient management, and important for surgical and anesthetic decision making. In this review we present the rationale and available data for a comprehensive echocardiographic assessment of patients receiving a VAD. In addition to the standard examination, device-specific pre-, intra-, and postoperative considerations are essential to the echocardiographic evaluation. These include: (a) the pre-VAD insertion examination of the heart and large vessels to exclude significant aortic regurgitation, tricuspid regurgitation, mitral stenosis, patent foramen ovale, or other cardiac abnormality that could lead to right-to-left shunt after left VAD placement, intracardiac thrombi, ventricular scars, pulmonic regurgitation, pulmonary hypertension, pulmonary embolism, and atherosclerotic disease in the ascending aorta; and to assess right ventricular function; and (b) the post-VAD insertion examination of the device and reassessment of the heart and large vessels. The examination of the device aims to confirm completeness of device and heart deairing, cannulas alignment and patency, and competency of device valves using two-dimensional, and color, continuous and pulsed wave Doppler modalities. The goal for the heart examination after implantation should be to exclude aortic regurgitation, or an uncovered right-to-left shunt; and to assess right ventricular function, left ventricular unloading, and the effect of device settings on global heart function. The variety of VAD models with different basic and operation principles requires specific echocardiographic assessment targeted to the characteristics of the implanted device.
Collapse
Affiliation(s)
- Siriluk Chumnanvej
- Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | | | | | | |
Collapse
|
14
|
Marcel R, Meyer DM. An overview of approved and investigational left ventricular assist devices. Proc (Bayl Univ Med Cent) 2005; 17:407-10. [PMID: 16200128 PMCID: PMC1200680 DOI: 10.1080/08998280.2004.11928003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Randy Marcel
- Department of Anesthesiology and Pain Management, Baylor University Medical Center, Dallas, Texas 75246, USA
| | | |
Collapse
|