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Roesel MJ, Nersesian G, Neuber S, Thau H, Wolff von Gudenberg R, Lanmueller P, Hennig F, Falk V, Potapov E, Knosalla C, Iske J. LVAD as a Bridge to Transplantation-Current Status and Future Perspectives. Rev Cardiovasc Med 2024; 25:176. [PMID: 39076481 PMCID: PMC11267215 DOI: 10.31083/j.rcm2505176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 07/31/2024] Open
Abstract
Heart failure (HF) is a common disease associated with high morbidity and mortality rates despite advanced pharmacological therapies. Heart transplantation remains the gold standard therapy for end-stage heart failure; however, its application is curtailed by the persistent shortage of donor organs. Over the past two decades, mechanical circulatory support, notably Left Ventricular Assist Devices (LVADs), have been established as an option for patients waiting for a donor organ. This comprehensive review focuses on elucidating the benefits and barriers associated with this application. We provide an overview of landmark clinical trials that have evaluated the use of LVADs as a bridge to transplantation therapy, with a particular focus on post-transplant outcomes. We discuss the benefits of stabilizing patients with these systems, weighing associated complications and limitations. Further technical advancements and research on optimal implantation timing are critical to ultimately improve outcomes and securing quality of life. In a world where the availability of donor organs remains constrained, LVADs are an increasingly important piece of patient care, bridging the critical gap to transplantation in advanced heart failure management.
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Affiliation(s)
- Maximilian J. Roesel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Sebastian Neuber
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Henriette Thau
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Rosalie Wolff von Gudenberg
- Department of Cardio-, Thoracic-, Transplantation-, and Vascular Surgery, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Pia Lanmueller
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Felix Hennig
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Berlin Institutes of Health at Charité - Universitätsmedizin Berlin, 10178 Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Jasper Iske
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Berlin Institutes of Health at Charité - Universitätsmedizin Berlin, 10178 Berlin, Germany
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Pavía-López AA, Magaña-Serrano JA, Cigarroa-López JA, Chávez-Mendoza A, Mayorga-Butrón JL, Araiza-Garaygordobil D, Ivey-Miranda JB, Méndez-Machado GF, González-Godínez H, Aguilera-Mora LF, Jordán-Ríos A, Olmos-Domínguez L, Olalde-Román MJ, Miranda-Malpica EM, Vázquez-Ortiz Z, Rayo-Chávez J, Mendoza AA, Márquez-Murillo MF, Chávez-Leal SA, Gabriel AÁS, Silva-García MA, Pacheco-Bouthiller AD, Aldrete-Velazco JA, Guizar-Sánchez CA, Gaxiola-López E, Guerra-López A, Figueiras-Graillet L, Sánchez-Miranda G, Mendoza-Zavala GH, Aceves-García M, Chávez-Negrete A, Arroyo-Hernández M, Montaño-Velázquez BB, Romero-Moreno LF, Baquero-Hoyos MM, Velasco-Hidalgo L, Rodríguez-Lozano AL, Aguilar-Gómez NE, Rodríguez-Vega M, Cossío-Aranda JE. Clinical practice guidelines for diagnostic and treatment of the chronic heart failure. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:1-74. [PMID: 38648647 PMCID: PMC11160508 DOI: 10.24875/acm.m24000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 04/25/2024] Open
Abstract
Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.
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Affiliation(s)
- Abel A. Pavía-López
- Coordinador de las Guías Mexicanas de Práctica Clínica de la Sociedad Mexicana de Cardiología, Centro Médico ABC, Ciudad de México, México
| | - José A. Magaña-Serrano
- Jefe de la División de Insuficiencia Cardiaca y Trasplante, Hospital Asociación Mexicana de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
- Presidente de la Asociación Mexicana de Insuficiencia Cardiaca, Ciudad de México, México
| | - José A. Cigarroa-López
- Jefe de la Clínica de Insuficiencia Cardiaca y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Adolfo Chávez-Mendoza
- Jefe de la Clínica de Insuficiencia Cardiaca Hospital de Día, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - José L. Mayorga-Butrón
- Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Ibero American Agency for Development & Assessment of Health Technologies
| | - Diego Araiza-Garaygordobil
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Juan B. Ivey-Miranda
- Adscrito a la Clínica de Insuficiencia Cardiaca Avanzada y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Gustavo F. Méndez-Machado
- Cardiólogo Especialista en Insuficiencia Cardiaca, Imperial College, Londres, Reino Unido
- Unidad de Investigación Clínica Hospital Ángeles Xalapa, Veracruz, México
| | | | - Luisa F. Aguilera-Mora
- Directora de la Clínica de Insuficiencia Cardiaca, Instituto Cardiovascular de Mínima Invasión, Hospital Puerta de Hierro, Zapopan, Jalisco, México
| | - Antonio Jordán-Ríos
- Coordinador Digital, Sociedad Mexicana de Cardiología A.C., México
- Cardiólogo Clínico, Ecocardiografía Adultos, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Luis Olmos-Domínguez
- Cardiólogo Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Marcos J. Olalde-Román
- Cardiólogo Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | | | - Jorge Rayo-Chávez
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Alexandra A. Mendoza
- Cardióloga Especialista en Medicina Crítica, Centro Médico ABC Observatorio, Ciudad de México, México
- Jefa de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Manlio F. Márquez-Murillo
- Cardiólogo Especialista en Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Sergio A. Chávez-Leal
- Clínica de Insuficiencia Cardiaca, SIMNSA Health Care, Tijuana, Baja California, México
| | - Amada Álvarez-San Gabriel
- Coordinadora del Programa de Insuficiencia Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | | | - Alex D. Pacheco-Bouthiller
- Director de la Clínica de Arritmias y Estimulación Cardiaca, Instituto Cardiovascular de Mínima Invasión, Hospital Puerta de Hierro, Zapopan, Jalisco, México
| | | | - Carlos A. Guizar-Sánchez
- Coordinador del Programa de Insuficiencia Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Hospital Central Sur, PEMEX, Ciudad de México, México
| | | | | | | | | | - Genaro H. Mendoza-Zavala
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Moisés Aceves-García
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Marisol Arroyo-Hernández
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Servicio de Neumología, Instituto Nacional de Cancerología, Tlapan, México
| | - Bertha B. Montaño-Velázquez
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Hospital de Especialidades, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Luis F. Romero-Moreno
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Médico Adscrito a la Fundación Hospital de la Misericordia, Bogotá, Colombia
| | - María M. Baquero-Hoyos
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Liliana Velasco-Hidalgo
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Ana L. Rodríguez-Lozano
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Nancy E. Aguilar-Gómez
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Mario Rodríguez-Vega
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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3
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Hullin R, Abdurashidova T, Pitta-Gros B, Schukraft S, Rancati V, Lu H, Zurbuchen A, Marcucci C, Ltaief Z, Lefol K, Huber C, Pascual M, Tozzi P, Meyer P, Kirsch M. Post-transplant survival with pre-transplant durable continuous-flow mechanical circulatory support in a Swiss cohort of heart transplant recipients. Swiss Med Wkly 2023; 153:3500. [PMID: 38579299 DOI: 10.57187/s.3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Worldwide, almost half of all heart transplantation candidates arrive today at their transplant operation with durable continuous-flow mechanical circulatory support (CF-MCS). This evolution is due to a progressive increase of waiting list time and hence an increased risk of haemodynamic worsening. Longer duration of CF-MCS is associated with a higher risk of device-related complications with potential adverse impact on post-transplant outcome as suggested by recent results from the United Network of Organ Sharing of the United States. METHODS A 2-centre Swiss heart transplantation programme conducted a retrospective observational study of consecutive patients of theirs who underwent a transplant in the period 2008-2020. The primary aim was to determine whether post-transplant all-cause mortality is different between heart transplant recipients without or with pre-transplant CF-MCS. The secondary outcome was the acute cellular rejection score within the first year post-transplant. RESULTS The study participants had a median age of 54 years; 38/158 (24%) were females. 53/158 study participants (34%) had pre-transplant CF-MCS with a median treatment duration of 280 days. In heart transplant recipients with pre-transplant CF-MCS, the prevalence of ischaemic cardiomyopathy was higher (51 vs 32%; p = 0.013), the left ventricular ejection fraction was lower (20 vs 25; p = 0.047) and pulmonary vascular resistance was higher (2.3 vs 2.1 Wood Units; p = 0.047). Over the study period, the proportion of heart transplant recipients with pre-transplant CF-MCS and the duration of pre-transplant CF-MCS treatment increased (2008-2014 vs 2015-2020: 22% vs 45%, p = 0.009; increase of treatment days per year: 34.4 ± 11.2 days, p = 0.003; respectively). The primary and secondary outcomes were not different between heart transplant recipients with pre-transplant CF-MCS or direct heart transplantation (log-rank p = 0.515; 0.16 vs 0.14, respectively; p = 0.81). CONCLUSION This data indicates that the strategy of pre-transplant CF-MCS with subsequent orthotopic heart transplantation provides post-transplant outcomes not different to direct heart transplantation despite the fact that the duration of pre-transplant assist device treatment has progressively increased.
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Affiliation(s)
- Roger Hullin
- Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Tamila Abdurashidova
- Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Barbara Pitta-Gros
- Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Sara Schukraft
- Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Valentina Rancati
- Anesthesiology, Surgical Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Henri Lu
- Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Anouck Zurbuchen
- Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Carlo Marcucci
- Anesthesiology, Surgical Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Zied Ltaief
- Intensive Care Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Karl Lefol
- Solid Organ Transplantation Center, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Christoph Huber
- Cardiac Surgery, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Manuel Pascual
- Solid Organ Transplantation Center, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Cardiology, Department of Medical Specialties and Cardiovascular Surgery, Department of Surgery, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Philippe Meyer
- Cardiac Surgery, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Cardiology, Department of Medical Specialties and Cardiovascular Surgery, Department of Surgery, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Zijderhand CF, Yalcin YC, Sjatskig J, Bos D, Constantinescu AA, Manintveld OC, Birim O, Bekkers JA, Bogers AJJC, Caliskan K. Pectus Excavatum and Risk of Right Ventricular Failure in Left Ventricular Assist Device Patients. Rev Cardiovasc Med 2023; 24:313. [PMID: 39076441 PMCID: PMC11272874 DOI: 10.31083/j.rcm2411313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 07/31/2024] Open
Abstract
Background Right ventricular failure (RVF) is a significant cause of morbidity and mortality in patients with a left ventricular assist device (LVAD). This study is aimed to investigate the influence of a pectus excavatum on early and late outcomes, specifically RVF, following LVAD implantation. Methods A retrospective study was performed, that included patients with a HeartMate 3 LVAD at our tertiary referral center. The Haller index (HI) was calculated using computed tomography (CT) scan to evaluate the chest-wall dimensions. Results In total, 80 patients (median age 57 years) were included. Two cohorts were identified: 28 patients (35%) with a normal chest wall (HI < 2.0) and 52 patients (65%) with pectus excavatum (HI 2.0-3.2), with a mean follow-up time of 28 months. Early ( ≤ 30 days) RVF and early acute kidney injury events did not differ between cohorts. Overall survival did not differ between cohorts with a hazard ratio (HR) of 0.47 (95% confidence interval (CI): 0.19-1.19, p = 0.113). Late ( > 30 days) recurrent readmission for RVF occurred more often in patients with pectus excavatum (p = 0.008). The onset of late RVF started around 18 months after implantation and increased thereafter in the overall study cohort. Conclusions Pectus excavatum is observed frequently in patients with a LVAD implantation. These patients have an increased rate of readmissions and late RVF. Further investigation is required to explore the extent and severity of chest-wall abnormalities on the risk of RVF.
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Affiliation(s)
- Casper F. Zijderhand
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical
Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam,
3015 GD Rotterdam, The Netherlands
| | - Yunus C. Yalcin
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical
Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam,
3015 GD Rotterdam, The Netherlands
| | - Jelena Sjatskig
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical
Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC, University
Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center
Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Alina A. Constantinescu
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam,
3015 GD Rotterdam, The Netherlands
| | - Olivier C. Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam,
3015 GD Rotterdam, The Netherlands
| | - Ozcan Birim
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical
Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Jos A. Bekkers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical
Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Ad J. J. C. Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical
Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam,
3015 GD Rotterdam, The Netherlands
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Aludaat C, Dovonou E, Besnier E, Fauvel C, Nardone N, Le Guillou V, D’Agostino A, Nafeh-Bizet C, Gay A, Bouchart F, Bauer F. Upgrading extra corporeal life support to ECMELLA using Impella 5.0 in rescued INTERMACS 1 patients, lactate level matters! J Thorac Dis 2023; 15:3079-3088. [PMID: 37426165 PMCID: PMC10323555 DOI: 10.21037/jtd-22-1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/15/2023] [Indexed: 07/11/2023]
Abstract
Background Venoarterial extra corporeal life support (ECLS) is the treatment of choice of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 1 patients, but left ventricle (LV) overload is a complication of ECLS. Unloading the LV by adding Impella 5.0 to ECLS in Impella used in combination with venoarterial extracorporeal membrane oxygenation (ECMELLA) configuration is recommended only in patients with acceptable prognosis. We investigated whether serum lactate level, a simple biological parameter, could be used as a marker to select candidates for bridging from ECLS to ECMELLA. Methods Forty-one consecutive INTERMACS 1 patients under ECLS were upgraded to ECMELLA using Impella 5.0 pump implantation to unload the LV and were followed-up for 30 days. Demographic, clinical, imaging, and biological parameters were collected. Results The time between ECLS and Impella 5.0 pump implantation was 9 [0-30] hours. Among these 41 patients, 25 died 6±6 days after implantation. They were older (53±12 vs. 43±12 years, P=0.01) with acute coronary syndrome as the primary etiology (64% vs. 13%, P=0.0007). In univariate analysis, patients who died exhibited a lower mean arterial pressure (74±17 vs. 89±9 mmHg, P=0.01), a higher level of troponin (24,000±38,000 vs. 3,500±5,000 mg/dL, P=0.048), a higher level of serum lactate (8.3±7.4 vs. 4.2±3.8 mmol/L, P=0.05) and more frequent cardiac arrest at admission (80% vs. 25%, P=0.03). In multivariate Cox regression analysis, a serum lactate level of >7.9 mmol/L (P=0.008) was found to be an independent predictor of mortality. Conclusions In INTERMACS 1 patients who require urgent ECLS for restoring hemodynamics and organ perfusion, an upgrade from ECLS to ECMELLA is relevant if the serum lactate level is ≤7.9 mmol/L.
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Affiliation(s)
- Chadi Aludaat
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
- Advanced Heart Failure Clinic and Pulmonary Hypertension, Rouen University Hospital, Rouen, France
| | - Estelle Dovonou
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Emmanuel Besnier
- INSERM EnVI U1096, Rouen University Medical School, Rouen, France
- Anesthesiology Department, Rouen University Hospital, Rouen, France
| | - Charles Fauvel
- Advanced Heart Failure Clinic and Pulmonary Hypertension, Rouen University Hospital, Rouen, France
- Internal Medicine Division, Cardiovascular Department, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Nathalie Nardone
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Vincent Le Guillou
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Alessandra D’Agostino
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Catherine Nafeh-Bizet
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Arnaud Gay
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - François Bouchart
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
| | - Fabrice Bauer
- Department of Cardiac Surgery and Transplantation, Rouen University Hospital, Rouen, France
- Advanced Heart Failure Clinic and Pulmonary Hypertension, Rouen University Hospital, Rouen, France
- INSERM EnVI U1096, Rouen University Medical School, Rouen, France
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Impact of Left Ventricular Assist Devices on Days Alive and Out of Hospital in Hemodynamically Stable Patients with End-Stage Heart Failure: A Propensity Score Matched Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12121966. [PMID: 36556331 PMCID: PMC9782187 DOI: 10.3390/life12121966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
The two main surgical options to treat end-stage heart failure are heart transplantation (HTx) or left ventricular assist device (LVAD) implantation. In hemodynamically stable patients, the decision for HTx listing with or without LVADs is challenging. We analyzed the impact of both options on days alive and out of hospital (DAOH) and survival. This retrospective study screened all patients with HTx or LVAD implantation between 2010 and 2020. The main inclusion criterion was hemodynamic stability defined as independence of intravenous inotropic/vasoactive support at decision. Propensity score matching (PSM) was performed. The primary endpoint was DAOH within one year after the decision. Secondary endpoints included survival, duration until HTx, and hospitalizations. In total, 187 patients received HTx and 227 patients underwent LVAD implantation. There were 21 bridge-to-transplant (BTT)-LVAD patients (implantation less than a month after HTx listing or listing after implantation) and 44 HTx-waiting patients included. PSM identified 17 matched pairs. Median DAOH at one year was not significantly different between the groups (BTT-LVAD: median 281, IQR 89; HTx waiting: median 329, IQR 74; p = 0.448). Secondary endpoints did not differ significantly. Our data suggest that BTT-LVAD implantation may not be favorable in terms of DAOH within one year for hemodynamically stable patients compared to waiting for HTx. Further investigations on quality of life and long-term outcomes are warranted.
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George TJ, Schaffer JM, Harrington KB, Meidan TG, Michael DiMaio J, Kabra N, Rawitscher DA, Afzal A. Impact of preoperative Impella support on destination left ventricular assist device outcomes. J Card Surg 2022; 37:3576-3583. [PMID: 36124428 DOI: 10.1111/jocs.16942] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/06/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although left ventricular assist device (LVAD) implantation is associated with improved heart failure survival, the impact of pre-implantation Impella support on outcomes is unknown. We undertook this study to evaluate the impact of preoperative Impella support on LVAD outcomes. METHODS We conducted a retrospective review of all Heartmate 3 LVAD implants. Primary stratification was by the need for preoperative Impella support with the 5.0/5.5 device. Longitudinal survival was assessed by the Kaplan-Meier method. Multivariable Cox proportional hazards regression models were developed to evaluate mortality. Secondary outcomes included changes in laboratory values during Impella support. RESULTS From 2017 to 2021, 87 patients underwent LVAD implantation. Sixteen were supported with a single inotrope, 36 with dual inotropes, 27 with Impella, and 3 with extracorporeal membrane oxygenation (ECMO). When stratified by the need for Impella, there was no difference in survival at 30-days (98.3 [88.2-99.8]% vs. 96.3 [76.5-99.5]%, p = .59), 1-year (91.0 [79.8-96.2] vs. 74.9 [51.7-88.2], p = .10), or at 2 years (87.9 [74.3-94.5] vs. 74.9 [51.7-88.2], p = .15). On multivariable modeling, the need for preoperative Impella was not associated with an increased hazard of 1-year (1.24 [0.23-6.73], p = .81) or 2-year mortality (1.05 [0.21-5.19], p = .95). After 7 (5-10) days of Impella support, recipient creatinine (p < .01), creatinine clearance (p = .02), and total bilirubin (p = .053) improved and lactic acidosis resolved (p < .01). CONCLUSIONS Preoperative Impella support is not associated with increased short or long-term mortality but is associated with improved renal and hepatic function as well as total body perfusion before LVAD implantation.
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Affiliation(s)
- Timothy J George
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Justin M Schaffer
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Katherine B Harrington
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Talia G Meidan
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - John Michael DiMaio
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Nitin Kabra
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - David A Rawitscher
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Aasim Afzal
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
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Doenst T, Schneider U, Can T, Caldonazo T, Diab M, Siemeni T, Färber G, Kirov H. Cardiac Surgery 2021 Reviewed. Thorac Cardiovasc Surg 2022; 70:278-288. [PMID: 35537447 DOI: 10.1055/s-0042-1744264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PubMed displayed more than 35,000 hits for the search term "cardiac surgery AND 2021." We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term "myocardial revascularization" is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tolga Can
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
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