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Akhtar W, Baston VR, Berman M, Bhagra S, Chue C, Deakin CD, Dalzell JR, Dunning J, Dunning J, Gardner RS, Kiff K, Kore S, Lim S, MacGowan G, Naldrett I, Ostermann M, Pinto S, Pettit S, Gil FR, Rosenberg A, Rubino A, Sayeed R, Sequeira J, Swanson N, Tsui S, Walker C, Webb S, Woods A, Ventkateswaran R, Bowles CT. British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres. Intensive Care Med 2024; 50:493-501. [PMID: 38526578 PMCID: PMC11018667 DOI: 10.1007/s00134-024-07382-y] [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: 12/26/2023] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation focus but are widely applicable to professionals regularly managing patients with implantable LVADs.
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Affiliation(s)
- Waqas Akhtar
- Harefield Hospital, London, UK.
- Faculty of Intensive Care Medicine, London, UK.
| | | | | | | | - Colin Chue
- University Hospitals Birmingham, Birmingham, UK
| | | | | | - Joel Dunning
- Cardiac Advanced Resuscitation Education, Festus, MO, USA
| | | | - Roy S Gardner
- Golden Jubilee National Hospital, Glasgow, UK
- British Society of Heart Failure, London, UK
| | | | | | - Sern Lim
- University Hospitals Birmingham, Birmingham, UK
| | | | - Ian Naldrett
- British Association of Critical Care Nurses, Newcastle, UK
| | | | | | | | | | | | | | - Rana Sayeed
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
| | | | | | - Steven Tsui
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
| | | | | | | | - Rajamiyer Ventkateswaran
- Wythenshawe Hospital, Manchester, UK
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
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Deconinck SJ, Nix C, Barth S, Bennek-Schöpping E, Rauch A, Schelpe AS, Roose E, Feys HB, Pareyn I, Vandenbulcke A, Muia J, Vandenbriele C, Susen S, Meyns B, Tersteeg C, Jacobs S, De Meyer SF, Vanhoorelbeke K. ADAMTS13 inhibition to treat acquired von Willebrand syndrome during mechanical circulatory support device implantation. J Thromb Haemost 2022; 20:2797-2809. [PMID: 36128768 PMCID: PMC9669188 DOI: 10.1111/jth.15889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/31/2022] [Accepted: 09/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acquired von Willebrand syndrome (aVWS) is common in patients with mechanical circulatory support (MCS) devices. In these patients, the high shear stress in the device leads to increased shear-induced proteolysis of von Willebrand factor (VWF) by A Disintegrin And Metalloprotease with Thrombospondin type 1 repeats, number 13 (ADAMTS13). As a result, the high molecular weight (HMW) VWF multimers are lost, leading to a decreased VWF function and impaired hemostasis that could explain the bleeding complications that are frequently observed in these patients. To counteract this abnormal VWF degradation by ADAMTS13, we developed a novel targeted therapy, using an anti-ADAMTS13 monoclonal antibody (mAb) that inhibits the shear-induced proteolysis of VWF by ADAMTS13. METHODS Human or bovine blood was circulated through in vitro MCS device systems with either inhibitory anti-ADAMTS13 mAb 3H9 or 17C7 (20 μg/ml) or control anti-ADAMTS13 mAb 5C11 or phosphate buffered saline (PBS). VWF multimers and function (collagen binding activity) were determined at different time points. Next, Impella pumps were implanted in calves and the calves were injected with PBS and subsequently treated with mAb 17C7. VWF, ADAMTS13, and blood parameters were determined. RESULTS We demonstrated that blocking ADAMTS13 could prevent the loss of HMW VWF multimers in in vitro MCS device systems. Importantly, our antibody could reverse aVWS in a preclinical Impella-induced aVWS calf model. CONCLUSION Hence, inhibition of ADAMTS13 could become a novel therapeutic strategy to manage aVWS in MCS device patients.
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Affiliation(s)
- Shannen J Deconinck
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Christoph Nix
- Abiomed Europe GmbH, Neuenhofer Weg 3, Aachen, D-52074
| | - Svenja Barth
- Abiomed Europe GmbH, Neuenhofer Weg 3, Aachen, D-52074
| | | | - Antoine Rauch
- University of Lille, INSERM U1011-EGID, Lille, France
- CHU Lille, Hematology Transfusion, Lille, France
| | - An-Sofie Schelpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
- Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Inge Pareyn
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Joshua Muia
- Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | | | - Sophie Susen
- University of Lille, INSERM U1011-EGID, Lille, France
- CHU Lille, Hematology Transfusion, Lille, France
| | - Bart Meyns
- Department of Clinical Cardiac Surgery, University Hospitals Leuven, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Steven Jacobs
- Department of Clinical Cardiac Surgery, University Hospitals Leuven, Belgium
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Asuka E, Pak S, Thiess AK, Torres A. Gastrointestinal Bleeding as a Complication in Continuous Flow Ventricular Assist Devices: A Systematic Review With Meta-Analysis. J Clin Med Res 2020; 12:543-559. [PMID: 32849943 PMCID: PMC7430922 DOI: 10.14740/jocmr4262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background The use of ventricular assist devices (VADs) has become predominant in this era of medicine. It is commonly used as a bridge to transplant, recovery and as a destination therapy for patients with severe heart failure, who are not responsive to maximum optimal management or ineligible for transplant. However, several complications are known to occur with the use of these devices. In this research, we will compare gastrointestinal bleeding in patients who used centrifugal flow versus axial flow VADs. We hope that the result of this meta-analysis and the review presented provide adequate information to future researchers, physicians and other healthcare professionals who are interested in this topic. Methods Published articles evaluated for inclusion were obtained from MEDLINE (PubMed), Cochrane, EBSCO, clinicaltrials.gov, and international clinical trials registry. This research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Procured articles were reviewed by two independent reviewers. Only randomized control trials and observational studies were used. Quality assessment was done with Cochrane Collaboration’s tool (RoB.2 with visualization through robviz) and Newcastle-Ottawa Scale (NOS). Data analysis was carried out with the use of R data analysis tool (version 4.0.0; release date: April 24th, 2020). Results At the end of this meta-analysis, the occurrence of gastrointestinal bleeding was not significantly different between both groups; with odds ratio (OR): 0.81; 95% confidence interval (CI): 0.65 - 1.00; P value = 0.05. Between-study variance (Tau-squared) was zero (0), standard error (SE) = 0.06. The degree of heterogeneity measured with I-squared statistic was 0% (minimal). Egger’s regression test was not statistically significant, P = 0.93. Symmetry of distribution was observed on the funnel plot. Trim and fill analysis showed no missing studies on the left; SE = 1.68. Conclusions The result obtained from this research indicates that the occurrence of gastrointestinal bleeding is not significantly different in both groups of patients, irrespective of the type of continuous flow VAD used. Although, the study sample used in this meta-analysis was limited.
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Affiliation(s)
- Edinen Asuka
- All Saints University School Of Medicine, Hillsborough St, Roseau, Dominica
| | - Stella Pak
- Department of Medicine, Orange Regional Medical Center, 707 East Main Street, Middletown, NY 10940, USA
| | - Armond-Kristopher Thiess
- Department of Medicine, Universidad Autonoma de Guadalajara, Av. Patria 1201, Lomas del Valle 45129, Zapopan, Mexico
| | - Anthony Torres
- Department of Medicine, Universidad Autonoma de Guadalajara, Av. Patria 1201, Lomas del Valle 45129, Zapopan, Mexico
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