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Schueler S, Bowles CT, Hinkel R, Wohlfarth R, Schmid MR, Wildhirt S, Stock U, Fischer J, Reiser J, Kamla C, Tzekos K, Smail H, de Vaal MH. A novel intrapericardial pulsatile device for individualized, biventricular circulatory support without direct blood contact. J Thorac Cardiovasc Surg 2023; 166:1119-1129.e1. [PMID: 35379474 DOI: 10.1016/j.jtcvs.2021.11.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Due to severely limited donor heart availability, durable mechanical circulatory support remains the only treatment option for many patients with end-stage heart failure. However, treatment complexity persists due to its univentricular support modality and continuous contact with blood. We investigated the function and safety of reBEAT (AdjuCor GmbH), a novel, minimal invasive mechanical circulatory support device that completely avoids blood contact and provides pulsatile, biventricular support. METHODS For each animal tested, an accurately sized cardiac implant was manufactured from computed tomography scan analyses. The implant consists of a cardiac sleeve with three inflatable cushions, 6 epicardial electrodes and driveline connecting to an electro-pneumatic, extracorporeal portable driver. Continuous epicardial electrocardiogram signal analysis allows for systolic and diastolic synchronization of biventricular mechanical support. In 7 pigs (weight, 50-80 kg), data were analyzed acutely (under beta-blockade, n = 5) and in a 30-day long-term survival model (n = 2). Acquisition of intracardiac pressures and aortic and pulmonary flow data were used to determine left ventricle and right ventricle stroke work and stroke volume, respectively. RESULTS Each implant was successfully positioned around the ventricles. Automatic algorithm electrocardiogram signal annotations resulted in precise, real-time mechanical support synchronization with each cardiac cycle. Consequently, progressive improvements in cardiac hemodynamic parameters in acute animals were achieved. Long-term survival demonstrated safe device integration, and clear and stable electrocardiogram signal detection over time. CONCLUSIONS The present study demonstrates biventricular cardiac support with reBEAT. Various demonstrated features are essential for realistic translation into the clinical setting, including safe implantation, anatomical fit, safe device-tissue integration, and real-time electrocardiogram synchronized mechanical support, result in effective device function and long-term safety.
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Affiliation(s)
- Stephan Schueler
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom.
| | - Christopher T Bowles
- Department of Cardiothoracic Surgery, Transplantation, and MCS Programme, Harefield Hospital, Harefield, United Kingdom
| | - Rabea Hinkel
- Laboratory Animal Science Unit, German Primate Center, Leibniz Institute for Primate Research, Göttingen, Germany; German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany; Stiftung Tieraerztliche Hochschule Hannover, University of Veterinary Medicine, Hannover, Germany
| | - Robert Wohlfarth
- Mechanics and High Performance Computing Group, Technical University of Munich, Munich, Germany
| | | | | | - Ulrich Stock
- Department of Cardiothoracic Surgery, Transplantation, and MCS Programme, Harefield Hospital, Harefield, United Kingdom; Imperial College London, London, United Kingdom
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Judith Reiser
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Christine Kamla
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Konstantin Tzekos
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Hassiba Smail
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - M Hamman de Vaal
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Khoshbin E, Khushnood A, Reinhardt Z, Parry G, Schueler S, Hasan A. Heart transplantation in children and adults with Down syndrome: A single centre experience. Pediatr Transplant 2022; 26:e14383. [PMID: 36036956 DOI: 10.1111/petr.14383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/25/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In recent years, rapid advances in cardiac surgery and changes in attitude towards patients with cognitive disability have led to these patients receiving cardiac transplantation. METHOD This is a retrospective report describing the experience of four patients with Down Syndrome who received heart transplantation in a single institution. RESULTS Anthracycline-induced cardiomyopathy was the most common cause of heart failure in this group (3/4). Two patients were bridged to transplantation, one by using a combination of extra-corporeal membrane oxygenation and biventricular assist device and the other by using a durable implantable left ventricular assist device. All the four patients are alive with the longest surviving patient 17 years after transplantation. Against strong hypothetical predictions, we observed no propensity for the development of post-transplant infections or lymphoproliferative disorders. CONCLUSION Down Syndrome should not be the sole contraindication to heart transplantation. The decision for transplantation should be on a case-by-case basis provided adequate social support is in place.
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Affiliation(s)
- Espeed Khoshbin
- The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Abbas Khushnood
- The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Zdenka Reinhardt
- The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Gareth Parry
- The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Stephan Schueler
- The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Asif Hasan
- The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
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MacGowan GA, McDiarmid A, Jansen K, Coats L, Crossland D, Woods A, Kunadian V, Shah A, Schueler S, Parry G. Gender differences in the assessment, decision making and outcomes for ventricular assist devices and heart transplantation: An analysis from a UK transplant centre. Clin Transplant 2022; 36:e14666. [PMID: 35385147 DOI: 10.1111/ctr.14666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/15/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE There are marked gender differences in all aetiologies of advanced heart failure. We sought to determine whether there is evidence of gender-specific decision making for transplant assessments, and how gender effects outcomes. METHODS Retrospective analysis of adult heart transplant assessments at a single UK centre between April 2015 and March 2020. RESULTS Females were 32% of referrals (N = 137 females, 285 males), with marked differences between diagnoses - 11% ischaemics and 43% of adult congenital. Females were younger, shorter, weighed less, and had lower pulmonary pressures. Females were much less likely to receive a ventricular assist device (13%). Blood type 'O' females were relatively more likely compared to males to receive a transplant (45%). Comparing males and females who received a ventricular assist device, both had similar levels of high pulmonary pressures, indicating consistent decision making based on haemodynamics to implant a device. Overall survival was better for females (in non congenital patients), and this was due to female patients who were not accepted for transplant or a ventricular assist device being more often 'too well for transplant', rather than in males when they were more often 'unsuitable'. CONCLUSIONS Marked gender differences exist at all stages of the heart transplant assessment pathway. Appropriate decision making based on clinical grounds is shown with less transplants in male blood type 'O's and haemodynamic criteria for ventricular assist device implantation in both genders. Further studies are need to determine if there is a wider community bias in advanced heart failure treatments for females. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Guy A MacGowan
- Department of Cardiology, Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Adam McDiarmid
- Department of Cardiology, Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.,Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katrijn Jansen
- Department of Cardiology, Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Coats
- Department of Cardiology, Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Crossland
- Department of Cardiology, Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Woods
- Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vijay Kunadian
- Department of Cardiology, Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.,Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Asif Shah
- Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gareth Parry
- Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
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Gonzalez-Fernandez O, De Rita F, Coats L, Crossland D, Nassar MS, Hermuzi A, Santos Lopes B, Woods A, Robinson-Smith N, Petit T, Seller N, O'Sullivan J, McDiarmid A, Schueler S, Hasan A, MacGowan G, Jansen K. Ventricular assist devices in transposition and failing systemic right ventricle: role of tricuspid valve replacement. Eur J Cardiothorac Surg 2022; 62:6542520. [PMID: 35244691 DOI: 10.1093/ejcts/ezac130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/31/2022] [Accepted: 02/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Ventricular assist device (VAD) for systemic right ventricular (RV) failure patients post-atrial switch, for transposition of the great arteries (TGA), and those with congenitally corrected TGA has proven useful to reduce transpulmonary gradient and bridge-to-transplantation. The purpose of this study is to describe our experience of VAD in systemic RV failure and our move towards concomitant tricuspid valve replacement (TVR). METHODS This is a single-centre retrospective study of consecutive adult patients receiving HeartWare VAD for systemic RV failure between 2010 and 2019. From 2017, concomitant TVR was performed routinely. Demographic, clinical variables and echocardiographic and haemodynamic measurements pre- and post-VAD implantation were recorded. Complications on support, heart transplantation and survival rates were described. RESULTS Eighteen patients underwent VAD implantation. Moderate or severe systemic tricuspid regurgitation was present in 83.3% of patients, and subpulmonic left ventricular impairment in 88.9%. One-year survival was 72.2%. VAD implantation was technically feasible and successful in all but one. Post-VAD, transpulmonary gradient fell from 16 (15-22) to 10 (7-13) mmHg (P = 0.01). Patients with TVR (n = 6) also demonstrated a reduction in mean pulmonary and wedge pressures. Furthermore, subpulmonic left ventricular end-diastolic dimension (44.3 vs 39.6 mm; P = 0.03) and function improved in this group. After 1 year of support, 72.2% of patients were suitable for transplantation. CONCLUSIONS VAD is an effective strategy as bridge-to-candidacy and bridge-to-transplantation in patients with end-stage systemic RV failure. Concomitant TVR at the time of implant is associated with better early haemodynamic and echocardiographic results post-VAD.
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Affiliation(s)
- Oscar Gonzalez-Fernandez
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Universidad Autonoma de Madrid, Madrid, Spain
| | - Fabrizio De Rita
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Coats
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Crossland
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mohamed S Nassar
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antony Hermuzi
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Bruno Santos Lopes
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Woods
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Robinson-Smith
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thibault Petit
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,University Hospitals Leuven, Leuven, Belgium
| | - Neil Seller
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John O'Sullivan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Adam McDiarmid
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Asif Hasan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy MacGowan
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Bouzas-Cruz N, Castrodeza J, Gonzalez-Fernandez O, Ferrera C, Woods A, Tovey S, Robinson-Smith N, McDiarmid AK, Parry G, Samuel J, Schueler S, MacGowan GA. Does infection predispose to thrombosis during long term ventricular assist device support? Artif Organs 2022; 46:1399-1408. [PMID: 35167124 DOI: 10.1111/aor.14209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infections and thrombotic events remain life-threatening complications in patients with ventricular assist devices (VAD). METHODS We describe the relationship between both events in our cohort of patients (n=220) supported with the HeartWare VAD (HVAD). This is a retrospective analysis of patients undergoing HVAD implantation between July 2009 and March 2019 at the Freeman Hospital, Newcastle upon Tyne, United Kingdom. RESULTS Infection was the most common adverse event in HVAD patients, with 125 patients (56.8%) experiencing ≥ one infection (n=168, 0.33 event-per-person-year-EPPY), followed by pump thrombosis (PT) in 61 patients (27.7%, 0.16 EPPY). VAD-specific infections were the largest group of infections. Of the 125 patients who had an infection, 66 (53%) had a thrombotic event. Both thrombotic events and infections were related to the duration of support, though there was only limited evidence that infections predispose to thrombosis. Those with higher than median levels of CRP during the infection were more likely to have an ischaemic stroke (IS) (34.5% vs 16.7%, p=0.03), though not PT or a combined thrombotic event (CTE: first PT or IS). However, in multivariate analysis there was no significant effect of infection predisposing to CTE. CONCLUSIONS Infection and thrombotic events are significant adverse events related to the duration of support in patients receiving HVADs. Infections do not clearly predispose to thrombotic events.
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Affiliation(s)
- Noelia Bouzas-Cruz
- Dept of Cardiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Javier Castrodeza
- Dept of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Carlos Ferrera
- Dept of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Andrew Woods
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Sian Tovey
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Nicola Robinson-Smith
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Adam K McDiarmid
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Gareth Parry
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Julie Samuel
- Depts of Microbiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Stephan Schueler
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Guy A MacGowan
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom.,Newcastle University Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
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Al-Kindi SG, Xie R, Kirklin JK, Cowger J, Oliveira GH, Krabatsch T, Nakatani T, Schueler S, Leet A, Golstein D, Elamm CA. Outcomes of Durable Mechanical Circulatory Support in Myocarditis: Analysis of the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support Registry. ASAIO J 2022; 68:190-196. [PMID: 33769352 DOI: 10.1097/mat.0000000000001430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Myocarditis can be refractory to medical therapy and require durable mechanical circulatory support (MCS). The characteristics and outcomes of these patients are not known. We identified all patients with clinically-diagnosed or pathology-proven myocarditis who underwent mechanical circulatory support in the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support registry (2013-2016). The characteristics and outcomes of these patients were compared to those of patients with nonischemic cardiomyopathy (NICM). Out of 14,062 patients in the registry, 180 (1.2%) had myocarditis and 6,602 (46.9%) had NICM. Among patients with myocarditis, duration of heart failure was <1 month in 22%, 1-12 months in 22.6%, and >1 year in 55.4%. Compared with NICM, patients with myocarditis were younger (45 vs. 52 years, P < 0.001) and were more often implanted with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30% vs. 15%, P < 0.001). Biventricular mechanical support (biventricular ventricular assist device [BIVAD] or total artificial heart) was implanted more frequently in myocarditis (18% vs. 6.7%, P < 0.001). Overall postimplant survival was not different between myocarditis and NICM (left ventricular assist device: P = 0.27, BIVAD: P = 0.50). The proportion of myocarditis patients that have recovered by 12 months postimplant was significantly higher in myocarditis compared to that of NICM (5% vs. 1.7%, P = 0.0003). Adverse events (bleeding, infection, and neurologic dysfunction) were all lower in the myocarditis than NICM. In conclusion, although myocarditis patients who receive durable MCS are sicker preoperatively with higher needs for biventricular MCS, their overall MCS survival is noninferior to NICM. Patients who received MCS for myocarditis are more likely than NICM to have MCS explanted due to recovery, however, the absolute rates of recovery were low.
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Affiliation(s)
- Sadeer G Al-Kindi
- From the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rongbing Xie
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - James K Kirklin
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer Cowger
- Department of Cardiology, Advanced Heart Failure and Transplant Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Guilherme H Oliveira
- Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida
| | | | - Takeshi Nakatani
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Stephan Schueler
- Department of Cardiothoracic & Vascular Surgery, Newcastle/Freeman Hospital, UK, Newcastle, United Kingdom
| | | | - Daniel Golstein
- Department of Cardiovascular Surgery, Montefiore Medical Center, Bronx, New York
| | - Chantal A Elamm
- From the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Gerhard EF, Wang L, Singh R, Schueler S, Genovese LD, Woods A, Tang D, Smith NR, Psotka MA, Tovey S, Desai SS, Jakovljevic DG, MacGowan GA, Shah P. LVAD decommissioning for myocardial recovery: Long-term ventricular remodeling and adverse events. J Heart Lung Transplant 2021; 40:1560-1570. [PMID: 34479776 PMCID: PMC8627486 DOI: 10.1016/j.healun.2021.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Left ventricular assist devices (LVADs) mechanically unload the heart and coupled with neurohormonal therapy can promote reverse cardiac remodeling and myocardial recovery. Minimally invasive LVAD decommissioning with the device left in place has been reported to be safe over short-term follow-up. Whether device retention reduces long-term safety, or sustainability of recovery is unknown. METHODS This is a dual-center retrospective analysis of patients who had achieved responder status (left ventricular ejection fraction, LVEF ≥40% and left ventricular internal diastolic diameter, LVIDd ≤6.0 cm) and underwent elective LVAD decommissioning for myocardial recovery from May 2010 to January 2020. All patients had outflow graft closure and driveline resection with the LVAD left in place. Emergent LVAD decommissioning for an infection or device thrombosis was excluded. Patients were followed with serial echocardiography for up to 3-years. The primary clinical outcome was survival free of heart failure hospitalization, LVAD reimplantation, or transplant. RESULTS During the study period 515 patients received an LVAD and 29 (5.6%) achieved myocardial recovery, 12 patients underwent total device explantation or urgent device decommissioning, 17 patients underwent elective LVAD decommissioning, and were included in the analysis. Median age of patients at LVAD implantation was 42 years (interquartile range, IQR: 25-54 years), all had a nonischemic cardiomyopathy, and 5 (29%) were female. At LVAD implantation, median LVEF was 10% (IQR: 5%-15%), and LVIDd 6.6 cm (IQR: 5.8-7.1 cm). There were 11 hydrodynamically levitated centrifugal-flow (65%), and 6 axial-flow LVADs (35%). The median duration of LVAD support before decommissioning was 28.7 months (range 13.5-36.2 months). As compared to the turndown study parameters, 1-month post-decommissioning, median LVEF decreased from 55% to 48% (p = 0.03), and LVIDd increased from 4.8 cm to 5.2 cm (p = 0.10). There was gradual remodeling until 6 months, after which there was no statistical difference on follow-up through 3-years (LVEF 42%, LVIDd 5.6 cm). Recurrent infections affected 41% of patients leading to 3 deaths and 1 complete device explant. Recurrent HF occurred in 1 patient who required a transplant. Probability of survival free of HF, LVAD, or transplant was 94% at 1-year, and 78% at 3-years. CONCLUSIONS LVAD decommissioning for myocardial recovery was associated with excellent long-term survival free from recurrent heart failure and preservation of ventricular size and function up to 3-years. Reducing the risk of recurrent infections, remains an important therapeutic goal for this management strategy.
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Affiliation(s)
- Eleanor F Gerhard
- Heart Failure, Mechanical Circulatory Support and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia; George Washington University School of Medicine, Washington DC, Washington DC
| | - Lu Wang
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ramesh Singh
- Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Stephan Schueler
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Leonard D Genovese
- Heart Failure, Mechanical Circulatory Support and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Andrew Woods
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Daniel Tang
- Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Mitchell A Psotka
- Heart Failure, Mechanical Circulatory Support and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Sian Tovey
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Shashank S Desai
- Heart Failure, Mechanical Circulatory Support and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Guy A MacGowan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Palak Shah
- Heart Failure, Mechanical Circulatory Support and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia.
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8
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Schueler S, Silvestry SC, Cotts WG, Slaughter MS, Levy WC, Cheng RK, Beckman JA, Villinger J, Ismyrloglou E, Tsintzos SI, Mahr C. Cost-effectiveness of left ventricular assist devices as destination therapy in the United Kingdom. ESC Heart Fail 2021; 8:3049-3057. [PMID: 34047072 PMCID: PMC8318455 DOI: 10.1002/ehf2.13401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 01/12/2023] Open
Abstract
Aims Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality‐of‐life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost‐effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost‐effectiveness of DT LVADs compared with medical management (MM) in the NHS England. Methods and results We developed a Markov multiple‐state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost‐effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality‐adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. Conclusions The implantation of the HeartWare™ HVAD™ System in patients ineligible for cardiac transplantation as DT is a cost‐effective therapy in the NHS England healthcare system under the end‐of‐life willingness‐to‐pay threshold of £50 000/QALY, which applies for VAD patients.
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Affiliation(s)
| | - Scott C Silvestry
- Cardiothoracic Surgery, Advent Health Transplant Institute, Orlando, FL, USA
| | - William G Cotts
- Heart Transplantation and Mechanical Assistance, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Mark S Slaughter
- Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Wayne C Levy
- Cardiology, University of Washington, Seattle, WA, USA
| | | | | | - Jonas Villinger
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | | | - Claudius Mahr
- Cardiology, University of Washington, Seattle, WA, USA
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Bouzas-Cruz N, Koshy A, Gonzalez-Fernandez O, Ferrera C, Green T, Okwose N, Woods A, Tovey S, Robinson-Smith N, McDiarmid A, Parry G, Gonzalez-Juanatey J, Schueler S, MacGowan G. Markers of Right Ventricle Dysfunction Predict Exercise Capacity on Left Ventricular Assist Device (LVAD) Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Gonzalez Fernandez O, De Rita F, Coats L, Crossland D, Nassar M, Hermuzi A, Santos Lopez B, Woods A, Robinson-Smith N, Petit T, Seller N, O´Sullivan J, McDiarmid A, Schueler S, Hasan A, MacGowan G, Jansen K. Ventricular Assist Devices in Adults with Failing Systemic Right Ventricle: The Importance of Concomitant Tricuspid Valve Replacement. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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11
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Pingle V, Woods A, Izanee M, Shah A, Robinson N, Tovey S, Jungschleger J, Butt T, MacGowan G, McDiarmid A, Schueler S. Left Ventricular Assist Device Decommissioning, the Journey so Far - Single Centre Experience. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Mydin MM, Woods A, Pingle V, Robinson-Smith N, Tovey S, Jungschleger J, Butt T, Shah A, McDiarmid A, McGowan G, Schueler S. A Simplified Temporary Right Ventricular Assist Device (RVAD) during LVAD Implantation - Low Risk, Easy to Do and Ideal for Patient Rehabilitation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Tovey S, Robinson-Smith N, Woods A, McDiarmid A, MacGowan G, Schueler S. A Review of Ventricular Assist Device Patients’ Compliance in INR Reporting Using a New App-Based Programme Compared with Telephone Surveillance. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Fernandez OG, De Rita F, Hasan A, Schueler S, MacGowan G, Jansen K. HVAD Decommission in a Failing Mustard: Making Virtue out of Necessity. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Stock U, Bowles C, Hinkel R, Fischer J, Smail H, Wildhirt S, Schueler S. The BEAT Device for Intrathoracic, Extracardiac Biventricular Mechanical Circulatory Support for Advanced Heart Failure. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Bouzas-Cruz N, Koshy A, Gonzalez-Fernandez O, Ferrera C, Green T, Okwose NC, Woods A, Tovey S, Robinson-Smith N, Mcdiarmid AK, Parry G, Gonzalez-Juanatey JR, Schueler S, Jakovljevic DG, Macgowan G. Markers of Right Ventricular Dysfunction Predict Maximal Exercise Capacity After Left Ventricular Assist Device Implantation. ASAIO J 2021; 67:284-289. [PMID: 33627602 DOI: 10.1097/mat.0000000000001245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although left ventricular assist device (LVAD) improves functional capacity, on average LVAD patients are unable to achieve the aerobic capacity of normal healthy subjects or mild heart failure patients. The aim of this study was to examine if markers of right ventricular (RV) function influence maximal exercise capacity. This was a single-center prospective study that enrolled 20 consecutive HeartWare ventricular assist device patients who were admitted at the Freeman Hospital (Newcastle upon Tyne, United Kingdom) for a heart transplant assessment from August 2017 to October 2018. Mean peak oxygen consumption (Peak VO2) was 14.0 ± 5.0 ml/kg/min, and mean peak age and gender-adjusted percent predicted oxygen consumption (%VO2) was 40.0% ± 11.5%. Patients were subdivided into two groups based on the median peak VO2, so each group consisted of 10 patients (50%). Right-sided and pulmonary pressures were consistently higher in the group with poorer exercise tolerance. Patients with poor exercise tolerance (peak VO2 below the median) had higher right atrial pressures at rest (10.6 ± 6.4 vs. 4.3 mmHg ± 3.2; p = 0.02) and the increase with passive leg raising was significantly greater than those with preserved exercise tolerance (peak VO2 above the median). Patients with poor functional capacity also had greater RV dimensions (4.4 cm ± 0.5 vs. 3.7 cm ± 0.5; p = 0.02) and a higher incidence of significant tricuspid regurgitation (moderate or severe tricuspid regurgitation in five patients in the poor exercise capacity group vs. none in the preserved exercise capacity group; p = 0.03). In conclusion, echocardiographic and hemodynamic markers of RV dysfunction discriminate between preserved and nonpreserved exercise capacity in HeartWare ventricular assist device patients.
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Affiliation(s)
- Noelia Bouzas-Cruz
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Cardiology Department, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Aaron Koshy
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Oscar Gonzalez-Fernandez
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Carlos Ferrera
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Thomas Green
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Nduka C Okwose
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Cardiology Department, University of Santiago de Compostela, Santiago de Compostela, Spain
- Newcastle University, Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
| | - Andrew Woods
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Sian Tovey
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Nicola Robinson-Smith
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Adam K Mcdiarmid
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Gareth Parry
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Jose R Gonzalez-Juanatey
- Newcastle University, Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
| | - Stephan Schueler
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Newcastle University, Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
| | - Guy Macgowan
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Newcastle University, Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
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17
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McPherson I, Generali T, Reinhardt Z, Chilvers N, Nassar M, De Rita F, Viganò G, Schueler S, Hasan A. HeartWare Explant After Recovery 6 Years After Implant in a 3-Year-Old Child: Has the Game Changed? Ann Thorac Surg 2021; 112:e37-e39. [PMID: 33412138 DOI: 10.1016/j.athoracsur.2020.10.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
The use of continuous-flow mechanical circulatory support in preschool children remains anecdotal. This case report describes the sequel to the implantation with a HeartWare HVAD system (Medtronic, Minneapolis, MN) in a 3-year old child. A 3-year-old boy with myocarditis-related cardiomyopathy underwent implantation with a HeartWare device. After an uncomplicated postoperative course, the patient was discharged home. Serial echocardiography showed progressive left ventricular recovery. After 6 months, the device was decommissioned, and the outflow graft was tied off. Six years after insertion, the device was explanted uneventfully. The HeartWare ventricular assist device offers viable long-term mechanical circulatory support in selected children that results in sustainable care and good quality of life.
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Affiliation(s)
- Iain McPherson
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Tommaso Generali
- Department of Congenital Cardiac Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
| | - Zdenka Reinhardt
- Department of Pediatric Cardiology and Transplantation, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Nicholas Chilvers
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Mohamed Nassar
- Department of Congenital Cardiac Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Fabrizio De Rita
- Department of Congenital Cardiac Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Gaia Viganò
- Department of Congenital Cardiac Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Asif Hasan
- Department of Congenital Cardiac Surgery and Cardiopulmonary Transplantation, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
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18
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Okwose NC, Bouzas-Cruz N, Fernandez OG, Koshy A, Green T, Woods A, Robinson-Smith N, Tovey S, Mcdiarmid A, Parry G, Schueler S, Macgowan GA, Jakovljevic DG. Validity of Hemodynamic Monitoring Using Inert Gas Rebreathing Method in Patients With Chronic Heart Failure and Those Implanted With a Left Ventricular Assist Device. J Card Fail 2020; 27:414-418. [PMID: 33035686 DOI: 10.1016/j.cardfail.2020.09.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The present study assessed agreement between resting cardiac output estimated by inert gas rebreathing (IGR) and thermodilution methods in patients with heart failure and those implanted with a left ventricular assist device (LVAD). METHODS AND RESULTS Hemodynamic measurements were obtained in 42 patients, 22 with chronic heart failure and 20 with implanted continuous flow LVAD (34 males, aged 50 ± 11 years). Measurements were performed at rest using thermodilution and IGR methods. Cardiac output derived by thermodilution and IGR were not significantly different in LVAD (4.4 ± 0.9 L/min vs 4.7 ± 0.8 L/min, P = .27) or patients with heart failure (4.4 ± 1.4 L/min vs 4.5 ± 1.3 L/min, P = .75). There was a strong relationship between thermodilution and IGR cardiac index (r = 0.81, P = .001) and stroke volume index (r = 0.75, P = .001). Bland-Altman analysis showed acceptable limits of agreement for cardiac index derived by thermodilution and IGR, namely, the mean difference (lower and upper limits of agreement) for patients with heart failure -0.002 L/min/m2 (-0.65 to 0.66 L/min/m2), and -0.14 L/min/m2 (-0.78 to 0.49 L/min/m2) for patients with LVAD. CONCLUSIONS IGR is a valid method for estimating cardiac output and should be used in clinical practice to complement the evaluation and management of chronic heart failure and patients with an LVAD.
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Affiliation(s)
- Nduka C Okwose
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Noelia Bouzas-Cruz
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Oscar Gonzalez Fernandez
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aaron Koshy
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Green
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Woods
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Robinson-Smith
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sian Tovey
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Adam Mcdiarmid
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gareth Parry
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy A Macgowan
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Djordje G Jakovljevic
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Cardiovascular Research Division, Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
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19
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Gerhard EF, Wang L, Singh R, Schueler S, Genovese L, MacGowan G, Shah P. Long-term Cardiac Remodeling and Outcomes after LVAD Discontinuation for Myocardial Recovery with Device Left In-Situ. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Bouzas-Cruz N, Gonzalez-Fernandez O, Koshy A, Okwose N, Woods A, Robinson-Smith N, Tovey S, McDiarmid A, Parry G, Schueler S, Jakovljevic D, MacGowan G. Elevation of Right-Sided Pressures and Right Ventricular Echocardiographic Parameters: Predictors of Exercise Limitation in Patients with Implanted Continuous Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Schueler S, Silvestry S, Cotts W, Levy W, Cheng R, Villinger J, Ismyrloglou E, Tsintzos S, Mahr C. Cost-Effectiveness of a Small Intrapericardial Centrifugal LVAD versus Medical Management in Destination Therapy Patients in the UK. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Zimpfer D, Fiane AE, Larbalestier R, Tsui S, Jansz P, Simon A, Schueler S, Strueber M, Schmitto JD. Long-Term Survival of Patients With Advanced Heart Failure Receiving an Left Ventricular Assist Device Intended as a Bridge to Transplantation: The Registry to Evaluate the HeartWare Left Ventricular Assist System. Circ Heart Fail 2020; 13:e006252. [PMID: 32164438 DOI: 10.1161/circheartfailure.119.006252] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The paucity of available hearts for transplantation means that more patients remain on durable left ventricular support for longer periods of time. The Registry to Evaluate the HeartWare Left Ventricular Assist System was an investigator-initiated multicenter, prospective, single-arm database established to collect post-Conformité Européene mark clinical information on patients receiving the HeartWare ventricular assist device system as a bridge to transplantation. This registry represents the longest multicenter follow-up of primary left ventricular assist device outcomes. METHODS Data were collected on 254 commercial implants performed between February 2009 and March 2012 from 9 centers in Europe (7) and Australia (2). Patients were followed to device explant, heart transplantation, or death. The outcomes of patients through July/August 2018 were analyzed. Summary statistics were used to describe patient demographics, adverse events, length of support, and outcomes for this extended-term cohort. RESULTS A total of 122 patients were on support for >2 years, and 34 patients were on support for >5 years. Twenty nine patients are still alive on support (support ranging from 1213 to 3396 days), and 23 of those are on their original HeartWare ventricular assist device system. Kaplan-Meier survival through 7 years was 51%. Through 6 years, freedom from any stroke was 82%, while freedom from severely disabling stroke was 89%. CONCLUSIONS Low rates of heart transplant now require longer periods of left ventricular assist device support in patients. This analysis demonstrates that long-term support using a HeartWare ventricular assist device system offers survival of 51% through 7 years.
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Affiliation(s)
| | | | | | - Steven Tsui
- Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (S.T.)
| | - Paul Jansz
- St Vincent's Clinic, Sydney, Australia (P.J.)
| | - Andre Simon
- Royal Brompton and Harefield Hospital, London, United Kingdom (A.S.)
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23
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Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D'Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Thorac Cardiovasc Surg 2020; 159:865-896. [DOI: 10.1016/j.jtcvs.2019.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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24
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Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D'Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Heart Lung Transplant 2020; 39:187-219. [PMID: 31983666 DOI: 10.1016/j.healun.2020.01.1329] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
| | | | - Daniel J Goldstein
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | | | | - Anson Cheung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - William Holman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Charles Hoopes
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | | | - Ulrich P Jorde
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | - Nader Moazami
- Langone Medical Center, New York University, New York, NY
| | - Yoshifumi Naka
- Columbia University College of Physicians & Surgeons, New York, NY
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Salpy V Pamboukian
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | | | | | | | | | - John Stulak
- Mayo Clinic College of Medicine and Science, Rochester, Minn
| | | | | | | | - Stephan Schueler
- Department for Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - David A D'Alessandro
- Department of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Mass
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25
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Bouzas-Cruz N, Gonzalez-Fernandez O, Ferrera-Durán C, Woods A, Robinson-Smith N, Tovey S, Jungschleger J, Booth K, Shah A, Parry G, MacGowan GA, Schueler S. Initial conservative management strategy of HeartWare left ventricular assist device thrombosis with intravenous heparin or bivalirudin. Int J Artif Organs 2019; 43:444-451. [DOI: 10.1177/0391398819896585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction and objectives: Pump thrombosis is a serious left ventricular assist device complication, though there are no guidelines regarding its treatment. The main aim of this study was to describe a strategy of intravenous anticoagulation as the initial treatment in these patients and then to compare intravenous heparin with bivalirudin. Methods: All consecutive patients who received a HeartWare left ventricular assist device from July 2009 to March 2019 were retrospectively analysed. Patients developing a pump thrombosis were selected, and treatment, outcomes and complications were recorded. Results: During this period of time (116 months), 220 patients underwent HeartWare left ventricular assist device implantation and 57 developed pump thrombosis, with an incidence rate of first pump thrombosis of 0.17 events per patient-year of support (incidence rate of all episodes of pump thrombosis: 0.30 events per patient-year of support). All the patients were initially treated medically, predominantly with either intravenous heparin (n = 26) or bivalirudin (n = 16). Patients treated with bivalirudin during the first pump thrombosis episode had less subsequent re-thrombosis episodes (18.7% vs 57.7%, p < 0.05). In addition, percentage time in therapeutic range was greater for bivalirudin compared with heparin (68.5% ± 16.9% vs 37.4% ± 31.0%, p < 0.01). During the first pump thrombosis episode, 26.3% of the patients needed surgery (left ventricular assist device exchange (n = 8), transplant (n = 6) or decommissioning (n = 1)). The overall survival at 1 year was 61.4%, and there was no significant difference in survival. Conclusion: Left ventricular assist device thrombosis is a serious life-threatening complication; hence, we propose an initial conservative management of pump thrombosis with enhanced intravenous anticoagulation with either intravenous heparin or bivalirudin, with surgery reserved for refractory cases.
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Affiliation(s)
- Noelia Bouzas-Cruz
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
- University of Santiago de Compostela, Santiago, Spain
| | | | - Carlos Ferrera-Durán
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Andrew Woods
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
| | | | - Sian Tovey
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jérôme Jungschleger
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Karen Booth
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Asif Shah
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Gareth Parry
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Guy A MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
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26
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Shaw SM, Venkateswaran R, Hogg R, Rushton S, Al-Attar N, Schueler S, Lim S, Parameshwar J, Banner NR. Durable left ventricular assist device support as a bridge to heart transplant candidacy†. Interact Cardiovasc Thorac Surg 2019; 28:594-601. [PMID: 30351360 DOI: 10.1093/icvts/ivy288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/16/2018] [Accepted: 08/28/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Left ventricular assist devices are funded in the UK exclusively as a bridge to transplant (BTT). However, patients who potentially could receive a transplant may develop reversible contraindications to transplant. Bridge to candidacy (BTC) has sometimes been controversial, given the uncertain clinical efficacy of BTC and the risk that reimbursement could be denied. We analysed the UK ventricular assist device database to understand how common BTC was and to assess patient survival rates and incidences of transplants. METHODS We identified BTC implants in patients with pulmonary hypertension, chronic kidney disease and obesity using the UK guidelines for heart transplants. RESULTS A total of 306 of 540 patients had complete data and 157 were identified as BTC (51%). Overall, there was no difference in survival rates between patients designated as BTC and those designated at BTT (71.9 vs 72.9% at 1 year, respectively; P = 0.82). However, the survival rate was lower at all time points in those with an estimated glomerular filtration rate (eGFR) <40 and in patients with a body mass index (BMI) >32 up to 1-year postimplant. There were no significant differences in the incidence of transplant between patients who were BTC and BTT or for any subgroup up to 5 years. However, we noted a diverging trend towards a lower cumulative incidence of transplant for patients with a BMI >32. CONCLUSIONS BTC is common in the UK and appears clinically effective, given that the survival rates and the incidence of transplants were comparable with those for BTT. Patients with a high BMI have a worse survival rate through to 1 year and a trend for a lower incidence of a transplant. Patients with a low eGFR also have a worse survival rate, but a similar proportion received transplants.
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Affiliation(s)
- Steven M Shaw
- Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Rajamiyer Venkateswaran
- Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Rachel Hogg
- Statistics and Clinical Studies, NHSBT, Bristol, UK
| | | | | | - Stephan Schueler
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sern Lim
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Koshy A, Green T, Toms A, Cassidy S, Schueler S, Jakovljevic D, MacGowan GA. The role of exercise hemodynamics in assessing patients with chronic heart failure and left ventricular assist devices. Expert Rev Med Devices 2019; 16:891-898. [PMID: 31584302 DOI: 10.1080/17434440.2019.1675506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Chronic heart failure is characterized by reduced exercise capacity. Invasive exercise hemodynamics are not routinely performed unless patients undergo transplant or left ventricular assist devices (LVAD) assessment, though now with readily available noninvasive devices, exercise hemodynamics are easily obtained. Our contention is that this is a valuable opportunity to acquire a more accurate measure of cardiac status in heart failure. Exercise hemodynamic measures such as cardiac power output can be carried out cheaply and effectively. Recent studies have highlighted the added value of exercise hemodynamics in prognostication of heart failure, and their role in assessing myocardial recovery in LVADs. Areas covered: In this review, we explore the literature available on Medline until 2019 focusing on resting and exercise hemodynamics alongside the methods of assessment (invasive and noninvasive) in heart failure with reduced ejection fraction and patients with implanted LVADs. Expert opinion: Hemodynamics measured both at rest and exercise are expected to play a significant role in the work up of transplant and LVAD patients. Furthermore, there is the potential to utilize noninvasive assessment in a complimentary fashion to support patient selection and improve the monitoring of response to treatment across the full cohort of heart failure patients.
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Affiliation(s)
- Aaron Koshy
- Institute of Cellular and Genetic Medicine, Cardiovascular Research Centre, Faculty of Medical Sciences, Newcastle University, and Newcastle upon Tyne Hospitals , Newcastle upon Tyne , UK
| | - Thomas Green
- Cardiothoracic Centre, Freeman Hospital , Newcastle upon Tyne , UK
| | - Anet Toms
- Institute of Cellular and Genetic Medicine, Cardiovascular Research Centre, Faculty of Medical Sciences, Newcastle University, and Newcastle upon Tyne Hospitals , Newcastle upon Tyne , UK
| | - Sophie Cassidy
- Institute of Cellular and Genetic Medicine, Cardiovascular Research Centre, Faculty of Medical Sciences, Newcastle University, and Newcastle upon Tyne Hospitals , Newcastle upon Tyne , UK
| | - Stephan Schueler
- Cardiothoracic Centre, Freeman Hospital , Newcastle upon Tyne , UK
| | | | - Guy A MacGowan
- Institute of Cellular and Genetic Medicine, Cardiovascular Research Centre, Faculty of Medical Sciences, Newcastle University, and Newcastle upon Tyne Hospitals , Newcastle upon Tyne , UK.,Cardiothoracic Centre, Freeman Hospital , Newcastle upon Tyne , UK
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Gonzalez Fernandez O, Bouzas Cruz N, Ferrera Duran C, Woods A, Robinson-Smith N, Tovey S, MacGowan G, Schueler S. P1672Late right heart failure predictors after left ventricular assist device implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is a significant cause of morbidity and mortality. While multiple predictors of early RHF have been described, information on late RHF is scarce. The aim of this study was to identify predictors of late RHF in LVAD patients.
Methods
A retrospective analysis of all adult patients who underwent HeartWare-VAD implantation for ischemic heart disease or non-ischemic dilated cardiomyopathy in a single centre was performed. Late RHF was defined as RHF requiring hospitalization and medical treatment after 30 days of LVAD implantation.
Results
A total of 16 (10.3%) patients from 156 implantations developed late RHF. Patients developing late RHF were older at time of surgery, 56.7±6.9 vs 49.5±12.5 years; p<0.01. A significantly higher rate of moderate or severe tricuspid regurgitation before implantation was found in patients presenting with late RHF, 81.2% vs 33.5%; p<0.001. Several echocardiographic parameters at discharge post-implant, such as mitral regurgitation, demonstrated a strong association with late RHF. A multivariate Cox proportional-hazards regression analysis (table 1) revealed that significant pre-operative tricuspid regurgitation (moderate or severe) was the strongest predictor of late RHF development after LVAD surgery (HR 5.50, 95% CI [1.34–22.58]; p=0.02). Significant mitral regurgitation post-implantation and older age also predicted late RHF development.
Multivariate Cox proportional-hazards analysis for late right heart failure Variable Hazard ratio 95% confidence interval P-value Tricuspid regurgitation- moderate or severe 5.50 1.34–22.58 0.02 Mitral regurgitation (discharge)- moderate or severe 3.54 1.14–11.02 0.03 Age 1.07 1.01–1.14 0.03 Right ventricular basal diameter 1.14 0.43–3.03 0.79 Right ventricular fractional area change 0.98 0.87–1.10 0.79 Multivariate analysis showing predictors of late right heart failure according to a multivariate model.
Late RHF according to TR severity
Conclusions
Pre-operative significant tricuspid regurgitation and mitral regurgitation after implantation predict the occurrence of late RHF. Prospective studies are needed to determine whether tricuspid valve interventions may reduce late RHF.
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Affiliation(s)
| | - N Bouzas Cruz
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | | | - A Woods
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - N Robinson-Smith
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - S Tovey
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - G MacGowan
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - S Schueler
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
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Bouzas Cruz N, Gonzalez-Fernandez O, Ferrera-Duran C, Woods A, Robinson-Smith N, Tovey S, Jungschleger J, Booth K, Shah A, Parry G, MacGowan G, Schueler S. P5418Anticoagulation management of heartware left ventricular assist device thrombosis: comparison of heparin and bivalirudin. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction and purpose
Pump thrombosis (PT) is a serious left ventricular assist device (LVAD) complication, though there are no guidelines regarding its treatment. We have adopted a strategy of intravenous anticoagulation as the initial treatment strategy in these patients.
Methods
All consecutive patients who received a HeartWare LVAD from July-2009 to January-2018 were retrospectively analyzed. Patients developing a PT were selected, and treatment, outcomes and complications were recorded.
Results
197 patients underwent HVAD, and 49 developed PT. All the patients were initially treated medically, though during the first PT 26.5% of the patients needed surgery [VAD exchange (n=6), transplant (n=6), or decommissioning (n=1)]. The overall survival at 1 year was 63.3%. Patients were treated predominantly with either intravenous heparin or bivalirudin. There were no significant differences neither in complications nor in survival between the 2 treatments (Figure 1); however, patients treated with bivalirudin during the first PT episode had less subsequent re-thrombosis episodes (18.2% vs 57.7%, p<0.05), and percentage time in therapeutic range was greater for bivalirudin compared with heparin (59.7±4.2 vs 36.3±7.1, p<0.01). Nevertheless, time to normalisation of LDH levels with bivalirudin was longer than with heparin (17.2±2.6 vs 10.2±4.5 days, p<0.01) (Table 1).
Table 1. Comparison of baseline characteristics and outcomes between Heparin and Bivalirudin Heparin (n=26) Bivalirudin (n=11) p-value Male, gender n (%) 20 (76.9) 9 (81.8) 1.00 Age when implant (years) 48±11.8 49.8±11.4 0.67 AF n (%) 9 (34.6) 6 (54.5) 0.50 Diagnosis: Dilated cardiomyopathy n (%) 13 (50) 7 (63.6) Ischemic heart disease n (%) 12 (46.2) 3 (27.3) Congenital heart disease n (%) 1 (3.8) 1 (9) 0.50 Thrombolysis (+ alteplase) n (%) 19 (73.1) 4 (36.4) 0.08 Treatment duration (days) 11.5±7.2 15.3±6.5 0.15 % Time in range 36.3±7.1 59.7±4.2 0.009 Hospitalisation (days) 19.1±16.4 31.9±18.2 0.06 Complications: Ischemic Stroke n (%) 2 (7.7) 4 (36.4) 0.09 Intracraneal bleeding n (%) 2 (7.7) 0 (0) 0.88 Gastrointestinal bleeding n (%) 1 (3.8) 0 (0) 1.00 Serious bleeding n (%) 5 (19.2) 0 (0) 0.29 Any bleeding n (%) 7 (26.9) 2 (18.2) 0.88 LDH Baseline 271.7±79.3 221.6±41.3 0.10 Admision 727.8±448.2 517.5±171.3 0.21 Maximum 827.1±424.7 1217.6±1004 0.03 Discharge 334.9±135.9 308.6±111.8 0.70 Time to normalisation (days) 10.2±4.5 17.2±2.6 0.004 Outcomes: Transplant (total) n (%) 7 (26.9) 2 (18.2) 0.88 VAD Exchange (total) n (%) 8 (30.8) 4 (36.4) 1.00 Mortality at 2 years n (%) 15 (57.7) 5 (45.4) 0.831 Rethrombosis: Rethrombosis n (%) 15 (57.7) 2 (18.2) 0.03 Number of episodes of rethrombosis 0.15 +1 n=6 n=1 +2 n=4 n=1 +3 n=4 n=0 +4 n=1 n=0
Figure 1
Conclusion
VAD thrombosis is a serious life threatening complication, though an initial strategy with enhanced intravenous anticoagulation is an acceptable strategy with either intravenous heparin or bivalirudin.
Acknowledgement/Funding
N. Bouzas-Cruz would like to thank the Spanish Society of Cardiology (Sociedad Española de Cardiología), for her research grant and fellowship.
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Affiliation(s)
- N Bouzas Cruz
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | | | | | - A Woods
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | | | - S Tovey
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | | | - K Booth
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - A Shah
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - G Parry
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - G MacGowan
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - S Schueler
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Bouzas Cruz N, Gonzalez-Fernandez O, Koshy A, Okwose N, Green T, Woods A, Robinson-Smith N, Tovey S, McDiarmid A, Parry G, Schueler S, Jakovljevic DG, MacGowan GA. P1677Elevation of right-sided pressures and right ventricular echocardiographic parameters: predictors of Exercise Limitation in Patients with Implanted Continuous Flow Left Ventricular Assist Devices. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left Ventricular Assist Devices (LVAD) improve survival and functional capacity in patients with advanced heart failure (HF). However, there are potential complications.
Purpose
We sought to determine parameters of exercise intolerance in a group of patients with the HeartWare LVAD (HVAD) compared to a group of HF patients.
Methods
This was a single-centre parallel prospective group-study. Briefly, echocardiograms, right heart catheterisation (RHC) and cardiopulmonary exercise tests were performed in forty-two patients admitted for a heart transplant assessment between August2017 and October2018.Of them 20 belonged to the HVAD group and 22 to the HF group.
Results
In our study, HVAD patients had a better exercise capacity than HF patients, although no significant differences were noted (14.0±5.0 ml/kg/min vs 11.3±3.9 ml/kg/min, p=0.06). To determine exercise tolerance, both HVAD and HF groups were subdivided into 2 groups based on the median peak exercise oxygen consumption (peakVO2) for that group. The table shows the comparison between preserved and non-preserved exercise tolerance in HF and HVADpatients. First of all, in the HVADgroup, all resting RHC pressures were significantly lower in the preserved exercise capacity group. However, in HFpatients there were no statistically significant differences between both subgroups in right-sided pressures, but Thermodilution exercise-induced change in cardiac output (ΔCO) and cardiac index (ΔCI) was significantly higher in the patients with preserved exercise tolerance. Secondly, in the HVADgroup the right ventricle was significantly larger in the reduced exercise tolerance subgroup. Moreover, patients with lower peak VO2 had more significant tricuspid regurgitation. Nevertheless, in HFpatients none of the echocardiographic parameters were related to the exercise capacity.
HF HVAD > Median Peak V02 < Median Peak V02 p > Median Peak V02 < Median Peak V02 p Thermodilution CO, l/min: • Rest 4.3±1.0 4.4±1.8 0.82 4.8±0.8 4.2±1.2 0.21 • Exercise 5.6±1.7 4.8±1.8 0.36 7.1±3.2 4.8±0.8 0.05 • ΔCO 1.26±1.0 0.26±0.7 0.02 2.2±2.5 0.4±0.7 0.05 Right Atrium pressure, mmHg 7.0±4.5 6.8±4.10 0.92 4.3±3.2 10.6±6.40 0.02 Mean Pulmonary Artery pressure, mmHg 26.4±12.6 26.5±10.9 0.97 16.8±5.4 30.5±12.5 0.01 Tricuspid Regurgitation, n (%): • None 1 (9) 1 (9) 1 (12) 0 (0) • Mild 7 (64) 8 (73) 7 (88) 4 (44) • Moderate 2 (18) 0 (0) 0 (0) 4 (44) • Severe 1 (9) 2 (18) 0.36 0 (0) 1 (12) 0.03 Right Ventricle Basal Diastolic Diameter, cm 4.0±1.0 4.1±1.0 0.83 3.7±0.5 4.4±0.5 0.02
Conclusion
Right-sided parameters in the echocardiogram and RHC pressures discriminate between preserved and non-preserved exercise capacity in HVADpatients, but not in HFpatients. In these last patients only ΔCO and ΔCI were statistically correlated with peak exercise oxygen consumption
Acknowledgement/Funding
N. Bouzas-Cruz would like to thank the Spanish Society of Cardiology (Sociedad Española de Cardiología), for her research grant and fellowship
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Affiliation(s)
- N Bouzas Cruz
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | | | - A Koshy
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - N Okwose
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - T Green
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - A Woods
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | | | - S Tovey
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - A McDiarmid
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - G Parry
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - S Schueler
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | | | - G A MacGowan
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
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31
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Madassery S, O'Leary D, Schueler S, Macgowan G, Robinson N, Woods A, Samuel A. A New Less Invasive Technique of RVAD Insertion - Time to Lower the Threshold around LVAD Insertion. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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32
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Smith NR, Woods A, Brown S, MacGowan G, Schueler S, Samuel J. MSSA Bacteraemia Can Be Eliminated in LVAD Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Smith NR, Sowerby E, Meadows J, Brown ST, Woods A, MacGowan G, Schueler S. Lack of Social Support is Not a Contraindication to VAD Therapy. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Gonzalez Fernandez O, Bouzas Cruz N, Ferrera Duran C, Woods A, Robinson-Smith N, Tovey S, Parry G, Booth K, MacGowan G, Schueler S. Tricuspid Regurgitation Predicts Late Onset Right Heart Failure after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hannan MM, Xie R, Cowger J, Schueler S, de By T, Dipchand AI, Chu VH, Cantor RS, Koval CE, Krabatsch T, Hayward CS, Nakatani T, Kirklin JK. Epidemiology of infection in mechanical circulatory support: A global analysis from the ISHLT Mechanically Assisted Circulatory Support Registry. J Heart Lung Transplant 2019; 38:364-373. [PMID: 30733158 DOI: 10.1016/j.healun.2019.01.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite advances in device technology and treatment strategies, infection remains a major cause of adverse events (AEs) in mechanical circulatory support (MCS) patients. To characterize the epidemiology of MCS infection, we examined the type, location, and timing of infection in the International Society for Heart and Lung Transplantation Registry (ISHLT) for Mechanically Assisted Circulatory Support (IMACS) over 3 years, 2013 to 2015. METHODS Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definitions were used to categorize AE infections occurring in MCS patients within IMACS. The IMACS infection variables were mapped to ISHLT definitions for infection where feasible. Three categories of MCS infection were defined as ventricular assist device (VAD) specific, VAD related, and non-VAD. RESULTS There were 10,171 patients enrolled from January 2013 through December 2015. Infection was the most common AE, with 3,788 patients (37%) experiencing ≥ 1 infection, and 6,758 AE infections reported overall. Non-VAD infection was the largest category, 4,501: 34.0% pneumonias, 30.6% non-VAD-related bloodstream infections (BSIs), 24.15% urinary tract infections (UTIs), and 10.2% gastrointestinal infections. VAD-specific infection was the second largest category, 1,756: 82.9% driveline, 12.8% pocket, and 4.3% pump/or cannula infections. VAD-related infection was the smallest category, 501: 47.5% BSIs, 47.5% mediastinitis, and 5.0% mediastinitis/pocket infections. All 3 categories were more frequently reported ≤ 3 months after implant. CONCLUSIONS Non-VAD infection, including pneumonia, BSI, UTI, and gastrointestinal infection, was the leading category of infection in MCS patients and the most frequently reported ≤ 3 months after implant. These results provide evidence to support resourcing and strengthening infection prevention strategy early after implantation in MCS.
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Affiliation(s)
- Margaret M Hannan
- Department of Clinical Microbiology, Mater Misercordiae University Hospital, University College Dublin, Dublin, Ireland.
| | - Rongbing Xie
- James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), University of Alabama, Birmingham, Alabama
| | - Jennifer Cowger
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Theo de By
- EUROMACS, EACTS, Windsor, United Kingdom
| | - Anne I Dipchand
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Ryan S Cantor
- James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), University of Alabama, Birmingham, Alabama
| | - Christine E Koval
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
| | - Christopher S Hayward
- Heart Failure and Transplant Unit, Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - James K Kirklin
- James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), University of Alabama, Birmingham, Alabama
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Mujtaba SS, Ledingham S, Shah AR, Schueler S, Clark S, Pillay T. Thrombocytopenia After Aortic Valve Replacement: Comparison Between Sutureless Perceval S Valve and Perimount Magna Ease Bioprosthesis. Braz J Cardiovasc Surg 2019; 33:169-175. [PMID: 29898147 PMCID: PMC5985844 DOI: 10.21470/1678-9741-2017-0157] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/06/2017] [Indexed: 12/31/2022] Open
Abstract
Introduction The incidence of postoperative thrombocytopenia after aortic valve
replacement (AVR) with the Perceval S Sutureless bioprosthesis remains
unclear. The aim of this study was to report thrombocytopenia associated
with the use of sutureless AVR. Methods The data was collected retrospectively for patients who had isolated AVR with
sutureless Perceval S valve (Group A: 72 patients) and was compared with
patients who underwent isolated sutured AVR with Perimount Magna Ease
Bioprosthesis (Group B: 101 patients) in our institution between June 2014
and January 2017. Results Cardiopulmonary bypass and cross-clamp time were significantly shorter in
group A. Maximum drop in platelet count was 58% mean (day 2.3) in group A
versus 44% mean (day 1.7) in group B
(P=0.0001). Absolute platelet count on postoperative
day 1-6 in group A was significantly less than in group B
(P≤0.05). Platelet count recovered to
preoperative value in 44% patients in group B versus only
in 26% patients in group A at discharge (P=0.018). Moderate
thrombocytopenia occurs more often in group A (41% vs. 26%)
(P=0.008) while severe thrombocytopenia (<50 x
109) was observed in 6% in group A but never in group B.
Platelets (P=0.007) and packed red blood cells
(P=0.009) transfusion was significantly higher in the
group A. Conclusion The implantation of sutureless Perceval aortic valves was associated with a
significant drop in platelet count postoperatively with slow recovery and
higher platelets and packed red blood cells transfusion requirements. A
prospective randomised trial is needed to confirm our findings.
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Affiliation(s)
- Syed Saleem Mujtaba
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Simon Ledingham
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Asif Raza Shah
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Clark
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Thasee Pillay
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
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Mujtaba SS, Ledingham SM, Shah AR, Pillay T, Schueler S, Clark S. Aortic Valve Replacement with a Conventional Stented Bioprosthesis versus Sutureless Bioprosthesis: a Study of 763 Patients. Braz J Cardiovasc Surg 2019; 33:122-128. [PMID: 29898140 PMCID: PMC5985837 DOI: 10.21470/1678-9741-2017-0088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/22/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this retrospective study was to compare early postoperative outcomes after aortic valve replacement (AVR) with sutureless bioprostheses and conventional stented bioprostheses implanted through median sternotomy. METHODS From January 2011 to December 2016, 763 patients underwent aortic valve replacement with bioprostheses; of these, 139 received a Perceval S sutureless valve (Group A) and 624 received a Perimount Magna Ease valve (Group B). These groups were further divided into A1 (isolated Perceval AVR), A2 (Perceval AVR with coronary artery bypass grafting [CABG]), B1 (isolated conventional stented bioprosthesis), and B2 (conventional stented bioprosthesis + CABG). RESULTS Patients in Group A were older (mean 74 years vs. 71 years; P<0.0001), predominantly women (53% vs. 32%; P<0.0001), had a higher logistic EuroSCORE (3.26 vs. 2.43; P<0.001), more preoperative atrial fibrillation (20% vs. 13%; P=0.03), and had a lower reopening rate for bleeding (2.1% vs. 6.7%; P=0.04). Compared to Group B1, Group A1 had shorter cross-clamp (mean 40 min vs. 57 min; P≤0.0001) and bypass times (mean 63 min vs. mean 80 min; P=0.02), and they bled less postoperatively (mean 295 ml vs. mean 393 ml; P=0.002). The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2. CONCLUSION In our retrospective study of 763 patients, sutureless valve group patients are older, mostly women, more symptomatic preoperatively, and have higher logistic EuroSCORE. They have shorter cross-clamp and bypass times, less postoperative bleeding, and reduced incidence of reopening. Further studies are needed to evaluate the clinical benefits in short, mid, and long-terms.
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Affiliation(s)
- Syed Saleem Mujtaba
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Simon M Ledingham
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Asif Raza Shah
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Thasee Pillay
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Clark
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
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Riebandt J, Zimpfer D, Fiane A, Labalestier R, Tsui S, Jansz P, Simon A, Schueler S, Hanke J, Strueber M, Dogan G, Schmitto J. Long-Term Support of Patients Receiving a Left Ventricular Assist System for Advanced Heart Failure. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1679021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. Riebandt
- Medical University of Vienna, Cardiac Surgery, Wien, Austria
| | - D. Zimpfer
- Medical University of Vienna, Cardiac Surgery, Wien, Austria
| | - A. Fiane
- Oslo University Hospital, Cardiothoracic Surgery, Oslo, Norway
| | - R. Labalestier
- Royal Perth Hospital, Advanced Heart Failure and Cardiac Transplant Service, Perth, Australia
| | - S. Tsui
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - P. Jansz
- St. Vincent’s Hospital, Heart Lung Transplant Unit, Sydney, Australia
| | - A.E. Simon
- Royal Brompton and Harefield Hospital, Department of Cardiothoracic Transplantation and Mechanical Support, Harefield Hospital, Harefield, United Kingdom
| | - S. Schueler
- Department for Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - J. Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - M. Strueber
- Beth Israel Medical Center, Cardiothoracic Surgery, Newark, United States
| | - G. Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J. Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Urban M, Booth K, Jungschleger J, Netuka I, Schueler S, MacGowan G. Impact of donor variables on heart transplantation outcomes in mechanically bridged versus standard recipients†. Interact Cardiovasc Thorac Surg 2018; 28:455-464. [DOI: 10.1093/icvts/ivy262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/06/2018] [Accepted: 07/28/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Marian Urban
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Karen Booth
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jerome Jungschleger
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ivan Netuka
- Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Guy MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Department of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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Urban M, Booth K, Schueler S, Netuka I, MacGowan G. Donor and recipient risk factor analysis of inferior postheart transplantation outcome in the era of durable mechanical assist devices. Clin Transplant 2018; 32:e13390. [PMID: 30144327 DOI: 10.1111/ctr.13390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
Abstract
The study objective is to quantify the impact of donor and recipient variables on heart transplant survival in recipients with a significant proportion of implanted continuous-flow left ventricular assist devices (LVADs). This is a prospective cohort study of International Society for Heart and Lung Transplantation (ISHLT) Registry that includes all primary heart-alone transplants in adult recipients (January 2005 and June 2013, N = 15 532, 27% LVADs). Donor and recipient characteristics were assessed for association with death or graft failure within 90 days and between 90 days and 5 years after transplantation. On Cox proportional hazard model donor cause of death other than head trauma (hazard ratio [HR] 1.985, P < 0.0001), recipient congenital (HR 2.7555, P < 0.0001) and ischemic (HR 1.165, P = 0.0383) vs dilated etiology and female donor heart transplanted into male recipient (HR 1.207, P = 0.0354) were predictors of death or graft failure within 90 days. Between 90 days and 5 years, donor cigarette use (HR 1.232, P = 0.0001), recipient cigarette use (HR 1.193, P = 0.0003), diabetes (HR 1.159, P = 0.0050), arterial hypertension (HR 1.129, P = 0.0115), and ischemic vs dilative cardiomyopathy had an increased probability of death or graft failure.
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Affiliation(s)
- Marian Urban
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Karen Booth
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ivan Netuka
- Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Guy MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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Parameshwar J, Hogg R, Rushton S, Taylor R, Shaw S, Mehew J, Simon A, MacGowan GA, Dalzell JR, Al Attar N, Venkateswaran R, Lim HS, Schueler S, Tsui S, Banner NR. Patient survival and therapeutic outcome in the UK bridge to transplant left ventricular assist device population. Heart 2018; 105:291-296. [DOI: 10.1136/heartjnl-2018-313355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 11/12/2022] Open
Abstract
ObjectiveTo study the survival and patient outcome in a population of UK patients supported by an implantable left ventricular assist device (LVAD) as a bridge to heart transplantation.MethodsData on all adult patients (n=342) who received a HeartMate II or HVAD as a first long-term LVAD between January 2007 and 31 December 2013 were extracted from the UK Ventricular Assist Device (VAD) Database in November 2015. Outcomes analysed include survival on a LVAD, time to urgent listing, heart transplantation and complications including those needing a pump exchange.Results112 patients were supported with the Thoratec HeartMate II and 230 were supported with the HeartWare HVAD. Median duration of support was 534 days. During the study period, 81 patients required moving to the UK urgent waiting list for heart transplantation. Of the 342 patients, 85 (24.8%) received a heart transplant, this included 63 on the urgent list. Thirty-day survival was 88.9%, while overall patient survival at 3 years from LVAD implant was 49.6%. 156 patients (46%) died during LVAD support; the most common cause of death on a VAD was a cerebrovascular accident. There was no significant difference between the two devices used in any outcome.ConclusionsIn a population of patients with advanced heart failure, who have a very poor prognosis, support with an implantable LVAD allowed a quarter to receive a heart transplant in a 3-year period. Overall survival of the cohort was about 50%. With improvement in technology and in post-LVAD management, it is likely that outcomes will improve further.
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Koshy A, Green T, Fernandez OG, Schueler S, Jakovljevic D, MacGowan G. P5121Invasive exercise haemodynamics predict functional capacity in patients with advanced heart failure implanted with a left ventricular assist device. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Koshy
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - T Green
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - O G Fernandez
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - S Schueler
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - D Jakovljevic
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - G MacGowan
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Gonzalez-Fernandez O, Jansen K, MacGowan G, Woods A, Robinson-Smith N, Tovey S, Hasan A, Coats L, Crossland D, O'Sullivan J, Schueler S. P711Ventricular assist devices for failing systemic right ventricle in adults with prior atrial switch procedure and congenitally corrected transposition of the great arteries:responders vs non responders. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - K Jansen
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - G MacGowan
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - A Woods
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - N Robinson-Smith
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - S Tovey
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - A Hasan
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - L Coats
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - D Crossland
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - J O'Sullivan
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
| | - S Schueler
- Freeman Hospital, Cardiothoracic, Newcastle upon Tyne, United Kingdom
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44
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Urban M, Woods A, Robinson-Smith N, MacGowan G, Roysam C, Schueler S. First-in-man use of the MVAD axial-flow pump: Long-term outcome. J Heart Lung Transplant 2018; 37:933-936. [DOI: 10.1016/j.healun.2018.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022] Open
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Aslam S, Xie R, Cowger J, Kirklin JK, Chu VH, Schueler S, de By T, Gould K, Morrissey O, Lund LH, Martin S, Goldstein D, Hannan M. Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry: Epidemiology, risk factors, and mortality. J Heart Lung Transplant 2018; 37:1013-1020. [PMID: 29936085 DOI: 10.1016/j.healun.2018.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. METHODS Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non-MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality. RESULTS We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12%), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8%) were non- MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non-MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9% at 24 months vs 77.4% in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95% confidence interval, 2.09-3.15; p < 0.001). CONCLUSIONS Early-onset BSI was associated with significantly increased 24-month mortality. More than 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.
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Affiliation(s)
- Saima Aslam
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, California.
| | - Rongbing Xie
- James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Alabama
| | - Jennifer Cowger
- Division of Cardiovascular Medicine, Henry Ford Hospitals, Detroit, Michigan
| | - James K Kirklin
- Division of Cardiothoracic Surgery. Director, Kirklin Institute for Research in Surgical Outcomes (KIRSO), Department of Surgery, University of Alabama at Birmingham, Alabama
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Theo de By
- QUIP Project Manager, EUROMACS Managing Director, EUROMACS, Berlin, Germany
| | - Kate Gould
- Department of Microbiology, Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Orla Morrissey
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stanley Martin
- Division of Infectious Diseases. Geisinger Health System, Danville, Pennsylvania
| | - Daniel Goldstein
- Department of Cardiothoracic Surgery, Montefiore Medical Center, New York, New York
| | - Margaret Hannan
- Division of Infectious Diseases, Mater Miscordiae University Hospital, Dublin, Ireland
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Mujtaba SS, Ledingham S, Shah AR, Clark S, Pillay T, Schueler S. Early Clinical Results of Perceval Sutureless Aortic Valve in 139 Patients: Freeman Experience. Braz J Cardiovasc Surg 2018; 33:8-14. [PMID: 29617495 PMCID: PMC5873786 DOI: 10.21470/1678-9741-2017-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/28/2017] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this retrospective study is to evaluate the safety and performance
of the Perceval sutureless valve in patients undergoing aortic valve
replacement. We report the 30-day clinical outcomes of 139 patients. Methods From January 2014 to December 2016, 139 patients underwent sutureless aortic
valve replacement. Their operation notes, National Adult Cardiac Surgery
Database and perioperative transoesophageal echocardiography findings were
studied retrospectively. Results Ninety-two patients underwent isolated aortic valve replacement (group A)
with Perceval valve and 47 patients had combined procedures of aortic valve
replacement and coronary artery bypass grafting (group B). The patients
received a size S (n=23), M (n=39), L (n=42) or XL (n=35) prosthesis.
Perceval valve was successfully implanted in 135 (97.1%) patients. Mean
cross-clamping time and bypass time were 40 and 63 minutes for isolated
cases, while 68 and 107 minutes for combined cases. Three (2.1%) patients
died within 30 days. Four patients suffered stroke and 5 patients went into
acute renal failure. Median intensive care unit and hospital stay was 2 and
8.5, respectively. Four valves were explanted due to significant
paravalvular leak after surgery. Five patients had permanent pacemaker as a
result of complete heart block and mean postoperative drainage was 295 mL
for isolated case and 457 mL for combined cases. The mean gradient across
Perceval valve was 12.5 mmHg while its effective orifice area was 1.5
cm2. Conclusion Early postoperative results showed that Perceval valve is safe. Further
follow up is needed to evaluate the long-term outcome with this
bioprosthesis.
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Affiliation(s)
- Syed Saleem Mujtaba
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Simon Ledingham
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Asif Raza Shah
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Clark
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Thasee Pillay
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
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Castrodeza J, Gonzalez O, Woods A, Dobarro D, Urban M, Robinson-Smith N, Tovey S, Koshy A, Jakovljevic D, Samuel J, Jungschleger J, Carrasco-Moraleja M, Parry G, Schueler S, MacGowan G. Infection Predisposes to Thrombosis During Long Term VAD Support. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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48
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Shaw S, Venkateswaran R, Rushton S, Hogg R, Al-Attar N, Lim S, Schueler S, Parameshwar J, Banner N. LVADs as Bridge to Candidacy in the UK. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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49
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Laible M, Schueler S, Veltkamp R. Response to the letter by Safiri et al. Acta Neurol Scand 2018; 137:371. [PMID: 29392721 DOI: 10.1111/ane.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Schueler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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Abstract
Explantation of a left ventricular assist device (LVAD) may be challenging even in the most experienced hands. We aim to describe the technique for explantation of an LVAD together with the heart as applicable to all contemporary implantable mechanical assist devices. In order to ensure safe explantation, particular care must be taken at three distinct stages: at the time of LVAD implantation, at pre-transplant assessment and at the time of heart transplantation. The preparation for a safe explantation at LVAD implantation includes positioning the driveline and the outflow graft away from the back of the sternum to ensure protection from injury during re-entry into the chest. At transplant assessment, essential investigations include computed tomography (CT) of the chest and ultrasound imaging of femoral vessels. At the time of heart transplantation, the site of peripheral access should be prepared and vessels exposed in case of a need for emergency bypass. We advise careful dissection starting from the lower aspect of the under surface of the sternum, moving as proximally as possible before attempting to use the oscillating saw. Much of the dissection of the heart is done off-pump. Cardiopulmonary bypass may be established either through peripheral vessels or the outflow graft in an emergency. Central direct cannulation is then established. After the heart and major vessels are isolated, explantation of the heart may begin either en-bloc or after splitting the ventricles in a sagittal plane. The basal regions of both ventricles and both atria are removed, leaving generous cuffs for anastomosis of the left atrium, pulmonary artery, aorta, inferior and superior vena cava (SVC). The apex of the heart is then removed with the device taking care not to injure the phrenic nerve.
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Affiliation(s)
- Espeed Khoshbin
- The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Stephan Schueler
- The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
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