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Worku B, Vinogradsky A, Ibrahim A, Rossi CS, Mack C, Gambardella I, Srivastava A, Takeda K, Naka Y. Outcomes After Heartmate 3 Left Ventricular Assist Device Implantation Using a 10 mm Outflow Graft. ASAIO J 2024:00002480-990000000-00503. [PMID: 38875452 DOI: 10.1097/mat.0000000000002249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
The presence of adhesions and patent bypass grafts may create challenges for standard 14 mm outflow graft placement during left ventricular assist device implantation. We retrospectively describe our experience using a 10 mm Bioline Fusion graft (Getinge, Goteborg, Sweden) as the outflow graft in patients undergoing primary Heartmate 3 (Abbott, Abbott Park, IL) implantation. One hundred one patients underwent Heartmate 3 left ventricular assist device implantation, 80% via a thoracotomy approach, with the standard 14 mm outflow graft (78) or a 10 mm Bioline Fusion outflow graft (23). Initial postoperative rotor speed-to-flow ratio (the revolutions per minutes (RPMs) required to achieve a given flow) was significantly higher in 10 mm graft patients (1,472 vs. 1,283 RPM/L/min; p = 0.03), suggesting elevated resistance in the smaller graft. Furthermore, the initial postoperative vasoactive-inotrope score was higher in the 10 mm graft patients (24.1 vs. 17.6; p = 0.022). Postoperative outcomes were similar between groups. In conclusion, the use of a 10 mm graft was associated with higher RPMs needed to generate a given flow and a higher vasoactive-inotrope score, but these differences were not associated with increased right ventricular failure or mortality.
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Affiliation(s)
- Berhane Worku
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital
| | - Alice Vinogradsky
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center
| | - Aminat Ibrahim
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital
| | - Camilla Sofia Rossi
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
| | - Charles Mack
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
- Department of Cardiothoracic Surgery, New York Presbyterian Queens Hospital
| | - Ivancarmine Gambardella
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center
| | - Ankur Srivastava
- Department of Anesthesia Surgery, New York Presbyterian Weill Cornell Medical Center
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center
| | - Yoshifumi Naka
- From the Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, New York
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2
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Sun YT, Wu W, Yao YT. The association of vasoactive-inotropic score and surgical patients' outcomes: a systematic review and meta-analysis. Syst Rev 2024; 13:20. [PMID: 38184601 PMCID: PMC10770946 DOI: 10.1186/s13643-023-02403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The objective of this study is to conduct a systematic review and meta-analysis examining the relationship between the vasoactive-inotropic score (VIS) and patient outcomes in surgical settings. METHODS Two independent reviewers searched PubMed, Web of Science, EMBASE, Scopus, Cochrane Library, Google Scholar, and CNKI databases from November 2010, when the VIS was first published, to December 2022. Additional studies were identified through hand-searching the reference lists of included studies. Eligible studies were those published in English that evaluated the association between the VIS and short- or long-term patient outcomes in both pediatric and adult surgical patients. Meta-analysis was performed using RevMan Manager version 5.3, and quality assessment followed the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. RESULTS A total of 58 studies comprising 29,920 patients were included in the systematic review, 34 of which were eligible for meta-analysis. Early postoperative VIS was found to be associated with prolonged mechanical ventilation (OR 5.20, 95% CI 3.78-7.16), mortality (OR 1.08, 95% CI 1.05-1.12), acute kidney injury (AKI) (OR 1.26, 95% CI 1.13-1.41), poor outcomes (OR 1.02, 95% CI 1.01-1.04), and length of stay (LOS) in the ICU (OR 3.50, 95% CI 2.25-5.44). The optimal cutoff value for the VIS as an outcome predictor varied between studies, ranging from 10 to 30. CONCLUSION Elevated early postoperative VIS is associated with various adverse outcomes, including acute kidney injury (AKI), mechanical ventilation duration, mortality, poor outcomes, and length of stay (LOS) in the ICU. Monitoring the VIS upon return to the Intensive Care Unit (ICU) could assist medical teams in risk stratification, targeted interventions, and parent counseling. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022359100.
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Affiliation(s)
- Yan-Ting Sun
- Department of Anesthesiology, Baoji High-Tech Hospital, Shaanxi, 721000, China
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Wei Wu
- Department of Anesthesiology, Baoji High-Tech Hospital, Shaanxi, 721000, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, China.
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3
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Hack M, Wood KL, Bjelic M, Paic F, Vidula H, Cheyne C, Chase K, Tallman M, Bernstein W, Wyrobek JA, Alexis JD, Gosev I. Less Invasive Left Ventricular Assist Device Implantation Is Safe and Feasible in Patients With Smaller Body Surface Area. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:445-451. [PMID: 37794726 DOI: 10.1177/15569845231198088] [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] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Smaller body surface area (BSA) frequently precludes patients from left ventricular assist device (LVAD) therapy. We sought to investigate the clinical outcomes in patients with small BSA undergoing less invasive LVAD implantation. METHODS We conducted a retrospective review of 216 patients implanted with HeartMate 3 LVAD (Abbott, Chicago, IL) via less invasive surgery at our institution. Patients were dichotomized based on their preimplant BSA for comparison between small BSA (≤1.8 m2) and normal/large BSA (>1.8 m2). We analyzed patient perioperative characteristics and outcomes. RESULTS In our study, small BSA was found in 32 patients (14.8%), while 184 patients (85.2%) had normal/large BSA. Women were more prevalent in the small BSA group (50.0% vs 13.0%, P < 0.001). Preoperative and intraoperative data showed comparable results. Major complications and hospital length of stay did not differ by BSA group. Patients with smaller BSA had significantly decreased pump parameters at discharge, including LVAD flow (4.11 ± 0.49 vs 4.60 ± 0.54 L/min, P < 0.001) and pump speed (5,200 vs 5,400 rpm, P < 0.001). Survival to discharge and within 6 months after implantation were similar between the groups. CONCLUSIONS Our study results suggest that less invasive HeartMate 3 implantation can be safely performed and demonstrates equivalent outcomes in patients with smaller body habitus. Randomized trials are required to confirm our data.
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Affiliation(s)
- Madelaine Hack
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | - Milica Bjelic
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Frane Paic
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | | | - Karin Chase
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Mark Tallman
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Wendy Bernstein
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Julie A Wyrobek
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | - Igor Gosev
- Division of Cardiac Surgery, University of Rochester, NY, USA
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Alkhunaizi FA, Azih NI, Read JM, Goldberg RL, Gulati AA, Scheel PJ, Muslem R, Gilotra NA, Sharma K, Kilic A, Houston BA, Tedford RJ, Hsu S. Characteristics and Predictors of Late Right Heart Failure After Left Ventricular Assist Device Implantation. ASAIO J 2023; 69:315-323. [PMID: 36191552 PMCID: PMC10901567 DOI: 10.1097/mat.0000000000001804] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Late right heart failure (LRHF) following left ventricular assist device (LVAD) implantation remains poorly characterized and challenging to predict. We performed a multicenter retrospective study of LRHF in 237 consecutive adult LVAD patients, in which LRHF was defined according to the 2020 Mechanical Circulatory Support Academic Research Consortium guidelines. Clinical and hemodynamic variables were assessed pre- and post-implant. Competing-risk regression and Kaplan-Meier survival analysis were used to assess outcomes. LRHF prediction was assessed using multivariable logistic and Cox proportional hazards regression. Among 237 LVAD patients, 45 (19%) developed LRHF at a median of 133 days post-LVAD. LRHF patients had more frequent heart failure hospitalizations ( p < 0.001) alongside other complications. LRHF patients did not experience reduced bridge-to-transplant rates but did suffer increased mortality (hazard ratio 1.95, 95% confidence interval [CI] 1.11-3.42; p = 0.02). Hemodynamically, LRHF patients demonstrated higher right atrial pressure, mean pulmonary arterial pressure, and pulmonary vascular resistance (PVR), but no difference in pulmonary arterial wedge pressure. History of early right heart failure, blood urea nitrogen (BUN) > 35 mg/dl at 1 month post-LVAD, and diuretic requirements at 1 month post-LVAD were each significant, independent predictors of LRHF in multivariable analysis. An LRHF prediction risk score incorporating these variables predicted LRHF with excellent discrimination (log-rank p < 0.0001). Overall, LRHF post-LVAD is more common than generally appreciated, with significant morbidity and mortality. Elevated PVR and precapillary pulmonary pressures may play a role. A risk score using early right heart failure, elevated BUN, and diuretic requirements 1 month post implant predicted the development of LRHF.
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Affiliation(s)
- Fatimah A Alkhunaizi
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nnamdi I Azih
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jacob M Read
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rachel L Goldberg
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Arune A Gulati
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Paul J Scheel
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Rahatullah Muslem
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nisha A Gilotra
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kavita Sharma
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ahmet Kilic
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Steven Hsu
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
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5
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Rodenas-Alesina E, Brahmbhatt DH, Rao V, Salvatori M, Billia F. Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review. Front Cardiovasc Med 2022; 9:1040251. [PMID: 36407460 PMCID: PMC9671519 DOI: 10.3389/fcvm.2022.1040251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/18/2022] [Indexed: 08/26/2023] Open
Abstract
Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Cardiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Darshan H. Brahmbhatt
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Vivek Rao
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Marcus Salvatori
- Department of Anesthesia, University Health Network, Toronto, ON, Canada
| | - Filio Billia
- Mechanical Circulatory Support Program, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
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6
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Trasplante cardíaco en pacientes portadores de asistencia ventricular izquierda de larga duración: «trucos y consejos». CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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7
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Bjelic M, Vidula H, Wu IY, McNitt S, Barrus B, Cheyne C, Chase K, Zottola Z, Alexis JD, Goldenberg I, Gosev I. Impact of surgical approach for left ventricular assist device implantation on postoperative invasive hemodynamics and right ventricular failure. J Card Surg 2022; 37:3072-3081. [PMID: 35842802 DOI: 10.1111/jocs.16766] [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: 01/10/2022] [Revised: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right ventricular failure (RVF) remains one of the major causes of morbidity and mortality after left ventricular assist device (LVAD) implantation. We sought to compare immediate postoperative invasive hemodynamics and the risk of RVF following two different surgical approaches: less invasive surgery (LIS) versus full sternotomy (FS). METHODS The study population comprised all 231 patients who underwent implantation of a HeartMate 3 (Abbott) LVAD at our institution from 2015 to 2020, utilizing an LIS (n = 161; 70%) versus FS (n = 70; 30%) surgical approach. Outcomes included postoperative invasive hemodynamic parameters, vasoactive-inotropic score (VIS), RVF during index hospitalization, and 6-month mortality. RESULTS Baseline clinical characteristics of the two groups were similar. Multivariate analysis showed that LIS, compared with FS, was associated with the improved cardiac index (CI) at the sixth postoperative hour (p = .036) and similar CI at 24 h, maintained by lower VIS at both timepoints (p = .002). The LIS versus FS approach was also associated with a three-fold lower incidence of in-hospital severe RVF (8.7% vs. 28.6%, p < .001) and need for RVAD support (5.0% vs. 17.1%, p = .003), and with 68% reduction in the risk of 6-month mortality after LVAD implantation (Hazard ratio, 0.32; CI, 0.13-0.78; p = .012). CONCLUSION Our findings suggest that LIS, compared with FS, is associated with a more favorable hemodynamic profile, as indicated by similar hemodynamic parameters maintained by lower vasoactive-inotropic support during the acute postoperative period. These findings were followed by a reduction in the risk of severe RVF and 6-month mortality in the LIS group.
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Affiliation(s)
- Milica Bjelic
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Isaac Y Wu
- Department of Anesthesiology, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Bryan Barrus
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Christina Cheyne
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Karin Chase
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Zachary Zottola
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Jeffrey D Alexis
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Igor Gosev
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
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8
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Tie H, Shi R, Welp H, Martens S, Li Z, Sindermann JR, Martens S. Tricuspid Valve Surgery in Patients Receiving Left Ventricular Assist Devices. Thorac Cardiovasc Surg 2022; 70:475-481. [PMID: 35785810 DOI: 10.1055/s-0042-1743594] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is common and related to poor prognosis in patients after left ventricular assist device (LVAD) implantation. The concomitant tricuspid valve surgery (TVS) at the time of LVAD implantation on short and long-term outcomes are controversial in current evidence. METHODS This is a single-center, observational, retrospective study. We enrolled patients with moderate-to-severe TR who received LVAD implantations from 2009 to 2020. Postoperative right ventricular failure (RVF), right ventricular assist device (RVAD) use, hospital mortality, new-onset renal replacement therapy (RRT), and acute kidney injury (AKI) were evaluated retrospectively. RESULTS Sixty-eight patients were included, 36 with and 32 without concomitant TVS. Baseline characteristics did not differ between the two groups. Patients receiving TVS had significantly increased incidences of postoperative RVF (52.8 vs. 25.0%, p = 0.019), RVAD implantation (41.7 vs. 18.8%, p = 0.041), and new-onset RRT (22.2 vs. 0%, p = 0.004). No difference in the incidence of AKI and hospital mortality was detected. Besides, these associations remained consistent in patients who underwent LVAD implantation via median sternotomy. During a median follow-up of 2.76 years, Kaplan-Meier analysis and competing-risk analysis showed that TVS was not associated with better overall survival in patients after LVAD implantation compared with the no-TVS group. CONCLUSION Our study suggests that concomitant TVS failed to show benefits in patients receiving LVAD implantation. Even worse, concomitant TVS is associated with significantly increased incidences of RVF, RVAD use, and new-onset of RRT. Considering the small sample size and short follow-up, these findings warrant further study.
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Affiliation(s)
- Hongtao Tie
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.,Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Shi
- Service de médecine intensive-réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Henryk Welp
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Sven Martens
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Zhenhan Li
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Jürgen R Sindermann
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Sabrina Martens
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
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9
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Left Ventricular Assist Device Implantation via Lateral Thoracotomy: A Systematic Review and Meta-Analysis. J Heart Lung Transplant 2022; 41:1440-1458. [DOI: 10.1016/j.healun.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 12/29/2022] Open
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10
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Grinstein J, Torii R, Salerno C, Blanco PJ, Garcia-Garcia H, Bourantas CV. Flow Dynamics During the HeartWare HVAD to HeartMate 3 Exchange: A Computational Study Assessing Differential Graft Lengths and Surgical Techniques. JTCVS Tech 2022; 14:125-126. [PMID: 35967208 PMCID: PMC9366874 DOI: 10.1016/j.xjtc.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jonathan Grinstein
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Ill
| | - Ryo Torii
- Department of Engineering, University College of London, London, United Kingdom
| | - Christopher Salerno
- Department of Surgery, Section of Cardiothoracic Surgery, University of Chicago, Chicago, Ill
| | - Pablo J Blanco
- Department of Mathematical and Computational Methods, National Laboratory for Scientific Computing, Petrópolis, Brazil
| | - Hector Garcia-Garcia
- Department of Medicine, Section of Cardiology, MedStar Cardiovascular Research Network, Washington, DC
| | - Christos V Bourantas
- Department of Medicine, Section of Cardiology, Barts Heart Centre, London, United Kingdom
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11
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Rivas-Lasarte M, Kumar S, Derbala MH, Ferrall J, Cefalu M, Rashid SMI, Joseph DT, Goldstein DJ, Jorde UP, Guha A, Bhimaraj A, Suarez EE, Smith SA, Sims DB. Prediction of right heart failure after left ventricular assist implantation: external validation of the EUROMACS right-sided heart failure risk score. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:723-732. [PMID: 34050652 DOI: 10.1093/ehjacc/zuab029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/21/2021] [Indexed: 11/13/2022]
Abstract
AIMS Prediction of right heart failure (RHF) after left ventricular assist device (LVAD) implant remains a challenge. The EUROMACS right-sided heart failure (EUROMACS-RHF) risk score was proposed as a prediction tool for post-LVAD RHF but lacks from large external validation. The aim of our study was to externally validate the score. METHODS AND RESULTS From January 2007 to December 2017, 878 continuous-flow LVADs were implanted at three tertiary centres. We calculated the EUROMACS-RHF score in 662 patients with complete data. We evaluated its predictive performance for early RHF defined as either (i) need for short- or long-term right-sided circulatory support, (ii) continuous inotropic support for ≥14 days, or (iii) nitric oxide for ≥48 h post-operatively. Right heart failure occurred in 211 patients (32%). When compared with non-RHF patients, pre-operatively they had higher creatinine, bilirubin, right atrial pressure, and lower INTERMACS class (P < 0.05); length of stay and in-hospital mortality were higher. Area under the ROC curve for RHF prediction of the EUROMACS-RHF score was 0.64 [95% confidence interval (CI) 0.60-0.68]. Reclassification of patients with RHF was significantly better when applying the EUROMACS-RHF risk score on top of previous published scores. Patients in the high-risk category had significantly higher in-hospital and 2-year mortality [hazard ratio: 1.64 (95% CI 1.16-2.32) P = 0.005]. CONCLUSION In an external cohort, the EUROMACS-RHF had limited discrimination predicting RHF. The clinical utility of this score remains to be determined.
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Affiliation(s)
- Mercedes Rivas-Lasarte
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.,Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Majadahonda, Madrid, Spain
| | - Salil Kumar
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.,Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamed H Derbala
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joel Ferrall
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew Cefalu
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Syed Muhammad Ibrahim Rashid
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Denny T Joseph
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Ashrith Guha
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Arvind Bhimaraj
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Erik E Suarez
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Sakima A Smith
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel B Sims
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA
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12
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Worku B, Gambardella I, Rahouma M, Demetres M, Gaudino M, Girardi L. Thoracotomy versus sternotomy? The effect of surgical approach on outcomes after left ventricular assist device implantation: A review of the literature and meta-analysis. J Card Surg 2021; 36:2314-2328. [PMID: 33908092 DOI: 10.1111/jocs.15552] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Thoracotomy approaches to left ventricular assist device (LVAD) implantation may reduce surgical morbidity and, through preservation of the pericardial restraint over the right heart, may reduce the incidence of right ventricular failure (RVF). METHODS A meta-analysis of all original studies describing the effect of the surgical approach on postoperative outcomes after LVAD implantation was performed. Postoperative outcomes analyzed. RESULTS Thirteen studies were included with 692 patients undergoing a sternotomy and 373 a thoracotomy approach. Patients undergoing a thoracotomy approach had a higher comorbid status (INTERMACS 1-2: 56% vs. 44%; p = .0004), but were less likely to undergo a concomitant procedure (4% vs. 15%; p = .0002) than patients undergoing a sternotomy approach. Patients undergoing a thoracotomy approach demonstrated a reduced incidence of RVF (OR, .47; CI, .23-.97; p = .04), reexploration for bleeding (OR, .55; CI, .32-.94; p = .03), perioperative blood transfusion (SMD, -.30; CI, -.49 to -.11; p = .002), LOS (-5.57; -10.56 to -.59; p = .03), and mortality (OR, .57; CI, .33-.98; p = .04), but no difference in RVAD requirement or stroke were noted. Metaregression demonstrated that the performance of a concomitant procedure did not modify the effect of the surgical approach on the primary endpoints of RVF or RVAD requirement. CONCLUSIONS In the current meta-analysis including over 1000 patients undergoing LVAD implantation, a thoracotomy approach was associated with a reduced incidence of RVF (but not RVAD requirement), bleeding, LOS, and mortality. No difference in stroke rates was noted. These findings not only offer additional support as to the feasibility of a thoracotomy approach for LVAD implantation but also suggest a potential superiority over a sternotomy approach.
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Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York, USA
| | - Ivan Gambardella
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York, USA
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York, USA
| | - Michelle Demetres
- Samuel J. Wood Library and CV Starr Biomedical Information Centre Weill Cornell Medicine, New York, New York, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York, USA
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York, USA
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Mehaffey JH, Hawkins RB. Commentary: Less May Be More: Once You Get to Transplant. Semin Thorac Cardiovasc Surg 2021; 34:157. [PMID: 33878437 DOI: 10.1053/j.semtcvs.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022]
Affiliation(s)
- J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
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14
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Lateral Thoracotomy for Ventricular Assist Device Implantation: A Meta-Analysis of Literature. ASAIO J 2021; 67:845-855. [PMID: 33620165 DOI: 10.1097/mat.0000000000001359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The use of lateral thoracotomy (LT) for implanting left ventricular assist devices (LVADs) is worldwide increasing, although the available evidence for its positive effects compared with conventional sternotomy (CS) is limited. This systematic review and meta-analysis analyzes the outcomes of LT compared with CS in patients undergoing implantation of a centrifugal continuous-flow LVAD. Four databases and 1,053 publications were screened until December 2019. Articles including patients undergoing implantation of a centrifugal continuous-flow LVAD through LT were included. A meta-analysis to compare LT and CS was performed to summarize evidences from studies including both LT and CS patients extracted from the same population. Primary outcome measure was in-hospital or 30-day mortality. Eight studies reporting on 730 patients undergoing LVAD implantation through LT (n = 242) or CS (n = 488) were included in the meta-analysis. Left thoracotomy showed lower in-hospital/30-day mortality (odds ratio [OR]: 0.520, 95% confidence interval [CI]: 0.27-0.99, p = 0.050), shorter intensive care unit (ICU) stay (mean difference [MD]: 3.29, CI: 1.76-4.82, p < 0.001), lower incidence of severe right heart failure (OR: 0.41; CI: 0.19-0.87, p = 0.020) and postoperative right ventricular assist device (RVAD) implantation (OR: 0.27, CI: 0.10-0.76, p = 0.010), fewer perioperative transfusions (MD: 0.75, CI: 0.36-1.14, p < 0.001), and lower incidence of renal failure (OR: 0.45, CI: 0.20-1.01, p = 0.050) and device-related infections (OR: 0.45, CI: 0.20-1.01, p = 0.050), respectively. This meta-analysis demonstrates that implantation of a centrifugal continuous-flow LVAD system via LT benefits from higher short-term survival, less right heart failure, lower postoperative RVAD need, shorter ICU stay, less transfusions, lower risk of device-related infections and kidney failure. Prospective studies are needed for further proof.
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15
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Zhigalov K, Van den Eynde J, Chrosch T, Goerdt L, Sá MPBO, Zubarevich A, Papathanasiou M, Wendt D, Luedike P, Pizanis N, Koch A, Schmack B, Rassaf T, Kamler M, Ruhparwar A, Weymann A. Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): A retrospective study. Artif Organs 2021; 45:706-716. [PMID: 33350481 DOI: 10.1111/aor.13897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
The use of left ventricular assist devices (LVADs) for advanced heart failure is becoming increasingly common. However, optimal timing and patient selection remain controversial. The aim of this study was to investigate outcomes of LVAD implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2). Between August 2010 and January 2020, 207 consecutive patients underwent LVAD implantation. Overall survival, major adverse events, and laboratory parameters were compared between patients in INTERMACS 1-2 (n = 107) and INTERMACS 3-5 (n = 100). Preoperative white blood cells, C-reactive protein, procalcitonin, bilirubin, alanine transaminase, and lactate dehydrogenase were all significantly higher in INTERMACS 1-2 when compared to INTERMACS 3-5 (P < .05). During hospitalization following LVAD implantation, patients in INTERMACS 1-2 were more likely to develop major infections (41.1% vs. 23.0%, P = .005), respiratory failure (57.9% vs. 25.0%, P < .001), mild (20.6% vs. 8.0%, P = .010), and moderate (31.8% vs. 7.0%, P < .001) right heart failure, and acute renal dysfunction (56.1% vs. 6.0%, P < .001). During a median follow-up of 2.00 years (interquartile range (IQR) 0.24-3.39 years), they had a higher incidence of thoracic (15.9% vs. 4.0%, P = .005) and gastrointestinal bleeding (21.5% vs. 11.0%, P = .042), as well as right heart failure (18.7% vs. 1%, P < .001). Risk of death was significantly higher in the INTERMACS 1-2 group (hazards ratio (HR) 1.64, 95% CI 1.12-2.40, P = .011). LVAD implantation in critically ill patients is associated with increased morbidity and mortality. Our results suggest that decision for LVAD should be not be delayed until INTERMACS 1 and 2 levels whenever possible.
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Affiliation(s)
- Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR)
| | - Jef Van den Eynde
- International Thoracic and Cardiovascular Research Association (ITCVR).,Department of Cardiovascular Sciences, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Chrosch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Lukas Goerdt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Michel Pompeu Barros Oliveira Sá
- International Thoracic and Cardiovascular Research Association (ITCVR).,Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiothoracic Surgery, Heart Center Essen Huttrop, University Hospital Essen, Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Achim Koch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR)
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Cardiothoracic Surgery, Heart Center Essen Huttrop, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR)
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR)
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16
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Nguyen SN, Nguyen TC. Commentary: Less-invasive approaches to big complex problems in patients with end-stage heart disease. JTCVS Tech 2020; 4:200-201. [PMID: 34318012 PMCID: PMC8306215 DOI: 10.1016/j.xjtc.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 08/29/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Stephanie N Nguyen
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Tex
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