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Park Y, Kim D, Yang JH, Cho YH, Choi JO, Jeon ES. Clinical outcome in patients with end-stage heart failure who underwent continuous-flow left ventricular assist devices in a single center. Korean J Intern Med 2022; 37:340-349. [PMID: 34871480 PMCID: PMC8925944 DOI: 10.3904/kjim.2021.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/19/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The continuous flow left ventricular assist device (cf-LVAD) has improved the survival of chronic end-stage heart failure (HF) patients. Here we describe our clinical experience of the initial 50 LVAD patients from a single center. METHODS A total of 50 patients underwent LVAD implantation as bridge to transplantation (BTT; n = 28, 56%), bridge to candidacy (BTC; n = 2, 4%), or as destination therapy (DT; n = 20, 40%) from 2012 to 2019. Pre-implant characteristics and clinical outcomes were compared between BTT/BTC and DT. RESULTS The median age of patients was 67 years (range, 59 to 73). Men were more likely to receive LVAD (76% vs. 24%) than women. DT patients were older, had smaller body surface area, and worse laboratory profiles than BTT/BTC patients. There was no in-hospital mortality. During an average of 14 months (range, 8 to 23), the all-cause mortality was 22%. The first-year survival was 86 and 90% in BTT/BTC and DT groups, respectively. Hemorrhagic stroke was the most common cause (27%) of death. In the BTT/BTC group, 22 patients successfully underwent heart transplantation during median duration of 10 months (range, 7 to 14). The most common post-LVAD complication during the first year of LVAD implantation was major bleeding (44%). A significant proportion (76%) of patients experienced rehospitalization with gastrointestinal bleeding as the most common cause. CONCLUSION We describe short-term clinical outcome of LVAD patients from a single center for the first time in Korea. With the newer generation LVAD and a dedicated team approach, improved clinical outcomes of LVAD for end-stage HF are expected.
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Affiliation(s)
- Yoonjee Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul,
Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul,
Korea
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Lee JH, Park I, Lee H, Sung K, Lee YT, Kim D, Yang JH, Choi JO, Jeon ES, Cho YH. Use of durable left ventricular assist devices for high-risk patients: Korean experience before insurance coverage. J Thorac Dis 2020; 12:7236-7244. [PMID: 33447412 PMCID: PMC7797861 DOI: 10.21037/jtd-20-1429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Left ventricular assist devices (LVADs) were not covered by the Korean national insurance until September 2018, and they were implanted at the patient’s own or a third party’s expense. However, there have been no reports on using an LVAD without insurance coverage or manufacturer support. Methods We reviewed 23 patients who underwent durable LVAD implantation at our institution from August 2012 to September 2018. Patients with temporary LVADs using extracorporeal or paracorporeal circulation were excluded. The available devices were the HeartMate IITM (HMII) and HeartWareTM Ventricular Assist Device (HVAD). The primary outcome was 30-day mortality. The secondary outcomes were postoperative complications and late mortality. Results The mean age of the patients was 68.7±9.9 years. The study sample comprised six female (26.1%) and 17 male (73.9%) patients. All patients had modifiable (bridge to candidacy) or unmodifiable absolute (destination therapy) contraindications for heart transplantation (HT). Among the patients in this study, 12 (52.2%) had ischemic cardiomyopathy and 11 (47.8%) had non-ischemic cardiomyopathy. Nine patients (39.1%) had temporary mechanical circulatory support such as extracorporeal membrane oxygenation or a temporary LVAD in place preoperatively. The average duration of LVAD support was 618.6±563.2 days (range, 59–2,285 days). There was no 30-day mortality. Four patients (17.4%) underwent HT. Six patients (26.1%) underwent re-exploration for postoperative bleeding, and one patient (4.3%) had a disabling stroke after discharge. The estimated survival rates at 12 and 24 months were 89.2% and 68.8%, respectively. Conclusions All patients who received LVADs before insurance coverage had contraindications for HT. The overall outcomes were comparable with those reported in the international registry.
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Affiliation(s)
- Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea
| | - Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi-do, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Darae Kim
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Seok Jeon
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Stenberg R, Shenvi C. Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Ann Emerg Med 2020; 76:34-41. [PMID: 32111507 DOI: 10.1016/j.annemergmed.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Robert Stenberg
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC.
| | - Christina Shenvi
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
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Seo YG, Park WH, Oh S, Sung J, Jeon ES, Choi JO, Oh JK, Kim YH, Kim HY, Jang MJ, Choi NG, Cho YH. Clinical outcomes of inpatient cardiac rehabilitation for patients with treated left ventricular assist device in Korea: 1-year follow-up. J Exerc Rehabil 2019; 15:481-487. [PMID: 31316945 PMCID: PMC6614778 DOI: 10.12965/jer.1938124.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/07/2019] [Indexed: 11/22/2022] Open
Abstract
In Korea, the first patient with a left ventricular assist device (LVAD) for destination therapy had successful implantation of a continuous-flow model in 2012. We investigated the safety and efficacy of exercise therapy with LVAD implantation 15 Korean patients. We retrospectively reviewed 15 patients (mean age, 67.4±11.6 years; 10 males, 5 female, left ventricular ejection fraction 23.6%±7.1%), including 4 with implanted continuous-flow and 11 an axial-flow LVAD. The New York Heart Association functional classification, ejection fraction, and quality of life were obtained. Survival rate, adverse events, admission rates, and enrollment rates in cardiac rehabilitation were investigated. Survival at 6 and 12 months was 100% and 89%, respectively. The New York Heart Association functional classification improved from 3.4±0.5 to 2.3±0.05 at 12 months postoperatively (P<0.0001). The ejection fraction significantly increased from 23.6%±7.2% on the preoperative day to 35.4%±14.2% at 1 year (P<0.0018). The quality of life was also improved at 1 year (P<0.0001). The most common adverse events were bleeding (56%) and dyspnea (44%). The number of admissions was 3.2 per patient-year. LVAD therapy is a safe and effective treatment option with exercise intervention for Korean patients waiting for heart transplantation or those who were ineligible for heart transplantation. A larger study with longer follow-up is needed to determine details clinical outcomes after LVAD.
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Affiliation(s)
- Yong Gon Seo
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul, Korea
| | - Won Hah Park
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul, Korea
| | - SuKi Oh
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Jin Oh Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Jae K Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Yun Hee Kim
- Cardiac Rehabilitation and Prevention Center, Samsung Medical Center, Seoul, Korea
| | - Ho Young Kim
- Cardiac Rehabilitation and Prevention Center, Samsung Medical Center, Seoul, Korea
| | - Mi Ja Jang
- Department of Nursing, Cardiac Rehabilitation and Prevention Center, Samsung Medical Center, Seoul, Korea
| | - Nam Gyung Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea
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Cestari VRF, Pessoa VLMDP, Moreira TMM, Florêncio RS, Barbosa IV, Ribeiro SB. DISPOSITIVOS DE ASSISTÊNCIA VENTRICULAR E CUIDADOS DE ENFERMAGEM. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017000980016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: descrever o funcionamento, os benefícios e as complicações associadas ao uso de dispositivos de assistência ventricular e identificar as intervenções realizadas por enfermeiros no cuidado ao paciente com este dispositivo, de acordo com as evidências. Método: revisão integrativa, com artigos coletados em bases de dados da saúde, em fevereiro de 2015. Os descritores utilizados foram heart diseases, heart-assist devices e nursing. Identificaram-se 34 artigos, os quais foram submetidos à análise temática. Resultados: os dispositivos de assistência ventricular funcionam como bombas mecânicas promotoras de débito cardíaco adequado. Seu principal benefício é a estabilização hemodinâmica. A complicação mais comum é a infecção. Educação em saúde, suporte emocional, cuidados com sítio de saída e realização de curativo são os principais cuidados realizados por enfermeiros. Conclusão: as evidências comprovam a melhoria da sobrevida de pacientes com insuficiência cardíaca grave com o uso dos dispositivos de assistência ventricular, reiterando a importância da ampliação dessa tecnologia no Brasil como possibilidade de tratamento.
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