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Eckmann C, Sunderkötter C, Becker K, Grabein B, Hagel S, Hanses F, Wichmann D, Thalhammer F. Left ventricular assist device-associated driveline infections as a specific form of complicated skin and soft tissue infection/acute bacterial skin and skin structure infection - issues and therapeutic options. Curr Opin Infect Dis 2024; 37:95-104. [PMID: 38085707 PMCID: PMC10911258 DOI: 10.1097/qco.0000000000000999] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW This review comments on the current guidelines for the treatment of wound infections under definition of acute bacterial skin and skin structure infections (ABSSSI). However, wound infections around a catheter, such as driveline infections of a left ventricular assist device (LVAD) are not specifically listed under this definition in any of the existing guidelines. RECENT FINDINGS Definitions and classification of LVAD infections may vary across countries, and the existing guidelines and recommendations may not be equally interpreted among physicians, making it unclear if these infections can be considered as ABSSSI. Consequently, the use of certain antibiotics that are approved for ABSSSI may be considered as 'off-label' for LVAD infections, leading to rejection of reimbursement applications in some countries, affecting treatment strategies, and hence, patients' outcomes. However, we believe driveline exit site infections related to LVAD can be included within the ABSSSI definition. SUMMARY We argue that driveline infections meet the criteria for ABSSSI which would enlarge the 'on-label' antibiotic armamentarium for treating these severe infections, thereby improving the patients' quality of life.
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Affiliation(s)
- Christian Eckmann
- Academic Hospital of Goettingen University, Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Hannoversch-Muenden
| | - Cord Sunderkötter
- Martin-Luther-University Halle-Wittenberg, University and University Hospital of Halle, Department of Dermatology and Venerology, Halle
| | - Karsten Becker
- University Medicine Greifswald, Friedrich Loeffler-Institute of Medical Microbiology, Greifswald
| | - Béatrice Grabein
- LMU Hospital, Clinical Microbiology and Hospital Hygiene, Munich
| | - Stefan Hagel
- Jena University Hospital-Friedrich Schiller University Jena, Institute for Infectious Diseases and Infection Control, Jena
| | - Frank Hanses
- University Hospital Regensburg, Department of Infection Prevention and Infectious Diseases
- University Hospital Regensburg, Emergency Department, Regensburg
| | - Dominic Wichmann
- University Medical Center Hamburg-Eppendorf, Department of Intensive Care Medicine, Hamburg
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2
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Falland R, Allen S. Perioperative management of patients with a ventricular assist device undergoing non-cardiac surgery. BJA Educ 2023; 23:406-413. [PMID: 37720560 PMCID: PMC10501881 DOI: 10.1016/j.bjae.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- R. Falland
- Royal Adelaide Hospital, Adelaide, Australia
| | - S.J. Allen
- Auckland City Hospital, Auckland, New Zealand
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Munoz Tello C, Jamil D, Tran HHV, Mansoor M, Butt SR, Satnarine T, Ratna P, Sarker A, Ramesh AS, Mohammed L. The Therapeutic Use of Impella Device in Cardiogenic Shock: A Systematic Review. Cureus 2022; 14:e30045. [PMID: 36381689 PMCID: PMC9637443 DOI: 10.7759/cureus.30045] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023] Open
Abstract
Impella (Abiomed, Danvers, MA) devices nowadays have been linked to cardiogenic shock (CS) due to the importance of their use as therapeutic instruments. This study aims to review pathophysiologic mechanisms of cardiogenic shock and the implementation of Impella to overcome this condition. To investigate several different types of studies and analyze the use of Impella device in cardiogenic shock and the outcomes of heart malfunctioning and determine its positive and negative impacts as a therapeutic tool in cardiac ischemia and use as a resource in critical patients, we conducted a systematic review through different databases (PubMed, ScienceDirect, and Google Scholar) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and used the Medical Subjects Heading (MeSH) search strategy to obtain significant articles. We found 883 papers in total, and after removing duplicates, applying inclusion/exclusion criteria, and finding the most significant information, we ended up with 30 articles that were reviewed containing information about the impact of Impella device in cardiogenic shock in different locations. The study strongly concludes that Impella device in the setting of cardiogenic shock has more advantages than disadvantages in terms of outcomes and complications as a non-pharmacologic tool. Improvements in left ventricular ejection fraction and signs and symptoms of cardiogenic shock criteria were determinants. Nevertheless, complications during the implementation and use of the device were established; in this manner, the evaluation and treatment of each patient separately are imperative. Consequently, more studies on this relevant topic are needed.
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Affiliation(s)
- Carlos Munoz Tello
- General Medicine, Universidad Católica de Cuenca, Cuenca, ECU
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Dawood Jamil
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hadrian Hoang-Vu Tran
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Mafaz Mansoor
- General Practice, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Samia Rauf Butt
- General Practice, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Pranuthi Ratna
- Medicine, Kamineni Academy of Medical Sciences and Research Centre (KAMSRC), Hyderabad, IND
| | - Aditi Sarker
- General Practice, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Adarsh Srinivas Ramesh
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Nix C, Ishikawa K, Meyns B, Yasuda S, Adriaenssens T, Barth S, Zayat R, Leprince P, Lebreton G. Comparison of Hemodynamic Support by Impella vs. Peripheral Extra-Corporeal Membrane Oxygenation: A Porcine Model of Acute Myocardial Infarction. Front Cardiovasc Med 2020; 7:99. [PMID: 32587862 PMCID: PMC7299088 DOI: 10.3389/fcvm.2020.00099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/16/2020] [Accepted: 05/11/2020] [Indexed: 01/25/2023] Open
Abstract
Objectives: Several mechanical circulatory assist devices are used to treat critically ill patients requiring hemodynamic support during post-myocardial infarction or cardiogenic shock. However, little guidance is available to choose an appropriate device to match a particular patient's needs. An increased understanding of hemodynamic effects of the pump systems and their impact on myocardial pre-/afterload might help to better understand their behavior in different clinical settings. Methods: This was an open-labeled, randomized acute animal experiment. A model of acute univentricular myocardial injury by temporary balloon occlusion was used. The experiment was carried out in 10 juveniles female Piétrain pigs. The animals were randomized to mechanical hemodynamic support either by peripheral veno-arterial (VA-)ECMO or Impella CP. Results: While both devices were able to provide flows above 3 L/min and maintain sufficient end-organ perfusion, support by Impella resulted in a significantly more pronounced immediate effect on myocardial unloading: At the onset of device support, the remaining native cardiac output was reduced by 23.5 ± 15.3% ECMO vs. 66.2 ± 36.2% (Impella, p = 0.021). Native stroke volume was significantly decreased by Impella support compared to ECMO, indicating less mechanical work being conducted by the Impella-supported hearts despite similar total assisted cardiac output. Conclusions: Peripheral VA-ECMO and the transaortic Impella pump resulted in contrasting hemodynamic fingerprints. Both devices provided sufficient hemodynamic support and reduce left ventricular end-diastolic pressure in the acute setting. Treatment with the Impella device resulted in a more effective volume unloading of the left ventricle. A significant reduction in myocardial oxygen consumption equivalent was achieved by both devices: The Impella device resulted in a left-shift of the pressure-volume loop and a decreased pressure-volume-area (PVA), while VA-ECMO increased PVA but decreased heart rate. These data highlight the importance of specifically targeting heart rate in the management of AMI patients on hemodynamic support.
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Affiliation(s)
- Christoph Nix
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany.,Abiomed Europe GmbH, Aachen, Germany
| | - Kiyotake Ishikawa
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospital UZ Leuven, Leuven, Belgium
| | - Shota Yasuda
- Department of Cardiac Surgery, University Hospital UZ Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiology, University Hospital UZ Leuven, Leuven, Belgium
| | | | - Rashad Zayat
- Department of Thoracic and Cardiovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Guillaume Lebreton
- Department of Cardiac Surgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
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Belani K, Moreno-Duarte I, White CW, Schroder JN, McCartney SL. Impella Placement in a Patient With d-Transposition of the Great Arteries After Mustard Procedure. J Cardiothorac Vasc Anesth 2020; 34:2731-2735. [PMID: 32505602 DOI: 10.1053/j.jvca.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Kiran Belani
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA.
| | - Ingrid Moreno-Duarte
- Duke University Medical Center, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Durham, NC
| | - Christopher W White
- New Brunswick Heart Centre, Saint John Regional Hospital, Department of Cardiac Surgery, Saint John, Canada
| | - Jacob N Schroder
- Duke University Medical Center, Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Durham, NC
| | - Sharon L McCartney
- Duke University Medical Center, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Durham, NC
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Bartoli CR, Zhang DM, Hennessy-Strahs S, Kang J, Restle DJ, Bermudez C, Atluri P, Acker MA. Clinical and In Vitro Evidence That Left Ventricular Assist Device-Induced von Willebrand Factor Degradation Alters Angiogenesis. Circ Heart Fail 2019; 11:e004638. [PMID: 30354363 DOI: 10.1161/circheartfailure.117.004638] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 12/16/2022]
Abstract
Background Gastrointestinal bleeding from angiodysplasia is a major problem in continuous-flow left ventricular assist device (LVAD) patients. LVAD shear stress causes pathologic degradation of VWF (von Willebrand factor). A mechanistic relationship between VWF degradation and angiodysplasia has not been explored. We tested 2 novel hypotheses: (1) clinical hypothesis: VWF fragments are elevated in LVAD patients that develop angiodysplasia and (2) in vitro hypothesis: VWF fragments generated during LVAD support alter angiogenesis, which may contribute to angiodysplasia. Methods and Results Clinical study: Paired blood samples were collected from continuous-flow LVAD patients (n=35). VWF was quantified with immunoblotting. In vitro experiments: (1) To investigate whether LVAD support alters angiogenesis, human endothelial cells were cultured with LVAD patient plasma (n=11). To investigate mechanism, endothelial cells were cultured with VWF fragments produced by exposing human VWF and ADAMTS-13 (VWF protease) to LVAD-like shear stress (175 dyne/cm2, n=8). Clinical study results: in all patients (n=35, mean support 666±430 days), LVAD support degraded high-molecular-weight VWF multimers ( P<0.0001) into low-molecular-weight VWF multimers ( P<0.0001) and VWF fragments ( P<0.0001). In patients with gastrointestinal bleeding from angiodysplasia (n=7), VWF fragments were elevated ( P=0.02) versus nonbleeders. In contrast, in patients with gastrointestinal bleeding without angiodysplasia, VWF fragments were not elevated versus nonbleeders ( P=0.96). In vitro experiments results: LVAD patient plasma caused abnormal angiogenesis with reduced tubule length ( P=0.04) and migration ( P=0.05). Similarly, endothelial cells grown with VWF degradation fragments exhibited reduced tubule length ( P<0.001) and migration ( P=0.01). Conclusions LVAD patients who bled from angiodysplasia had higher levels of VWF fragments than nonbleeders and gastrointestinal bleeders without angiodysplasia. VWF fragments caused abnormal angiogenesis in vitro. These findings suggest that VWF fragments may be a mechanistic link between LVAD support, abnormal angiogenesis, angiodysplasia, and gastrointestinal bleeding.
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Affiliation(s)
- Carlo R Bartoli
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B., S.H.-S., C.B., P.A., M.A.A.)
| | - David M Zhang
- Washington University, School of Medicine, St Louis, MO (D.M.Z.)
| | - Samson Hennessy-Strahs
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B., S.H.-S., C.B., P.A., M.A.A.)
| | - Jooeun Kang
- Vanderbilt University School of Medicine, Nashville, TN (J.K.)
| | | | - Christian Bermudez
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B., S.H.-S., C.B., P.A., M.A.A.)
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B., S.H.-S., C.B., P.A., M.A.A.)
| | - Michael A Acker
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B., S.H.-S., C.B., P.A., M.A.A.)
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7
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Chivukula VK, Beckman JA, Prisco AR, Dardas T, Lin S, Smith JW, Mokadam NA, Aliseda A, Mahr C. Left Ventricular Assist Device Inflow Cannula Angle and Thrombosis Risk. Circ Heart Fail 2019; 11:e004325. [PMID: 29666072 DOI: 10.1161/circheartfailure.117.004325] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 06/15/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND As heart failure prevalence continues to increase in the setting of a static donor supply, left ventricular assist device (LVAD) therapy for end-stage heart failure continues to grow. Anecdotal evidence suggests that malalignment of the LVAD inflow cannula may increase thrombosis risk, but this effect has not been explored mechanistically or quantified statistically. Our objective is to elucidate the impact of surgical angulation of the inflow cannula on thrombogenicity. METHODS AND RESULTS Unsteady computational fluid dynamics is used in conjunction with computational modeling and virtual surgery to model flow through the left ventricle for 5 different inflow cannula angulations. We use a holistic approach to evaluate thrombogenicity: platelet-based (Lagrangian) metrics to evaluate the platelet mechanical environment, combined with flow-based (Eulerian) metrics to investigate intraventricular hemodynamics. The thrombogenic potential of each LVAD inflow cannula angulation is quantitatively evaluated based on platelet shear stress history and residence time. Intraventricular hemodynamics are strongly influenced by LVAD inflow cannula angulation. Platelet behavior indicates elevated thrombogenic potential for certain inflow cannula angles, potentially leading to platelet activation. Our analysis demonstrates that the optimal range of inflow angulation is within 0±7° of the left ventricular apical axis. CONCLUSIONS Angulation of the inflow cannula >7° from the apical axis (axis connecting mitral valve and ventricular apex) leads to markedly unfavorable hemodynamics as determined by computational fluid dynamics. Computational hemodynamic simulations incorporating Lagrangian and Eulerian metrics are a powerful tool for studying optimization of LVAD implantation strategies, with the long-term potential of improving outcomes.
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Affiliation(s)
- Venkat Keshav Chivukula
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Jennifer A Beckman
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Anthony R Prisco
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Todd Dardas
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Shin Lin
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Jason W Smith
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Nahush A Mokadam
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Alberto Aliseda
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Claudius Mahr
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.).
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8
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Ambardekar AV, Weiser-Evans MCM, Li M, Purohit SN, Aftab M, Reece TB, Moulton KS. Coronary Artery Remodeling and Fibrosis With Continuous-Flow Left Ventricular Assist Device Support. Circ Heart Fail 2019; 11:e004491. [PMID: 29724722 DOI: 10.1161/circheartfailure.117.004491] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/16/2022]
Abstract
BACKGROUND Coronary artery fluid dynamics may be altered because of the nonphysiological flow seen in continuous-flow left ventricular assist devices (CF-LVADs). Our aim was to study the structure and composition of coronary vessels after CF-LVAD. METHODS AND RESULTS Coronary arteries were collected from patients with heart failure (HF) at the time of transplantation, of whom 15 were supported with a CF-LVAD before transplant (HF+LVAD group) and 9 were not (HF non-LVAD group). In addition, coronary samples were obtained from 5 nonfailing age-matched donors (nonfailing group). Histological analysis was performed to quantify coronary morphology, composition, vascular fibrosis, and vasa vasorum density. The age and sex mix of the 3 groups were similar, and the mean duration of LVAD support was 213 days. Compared with patients with HF and nonfailing donors, the arteries from patients with HF+LVAD had expansion of the adventitia, breakdown of the internal elastic lamina, and increased adventitial collagen deposition and density of vasa vasorum. CONCLUSIONS Among patients supported with CF-LVADs, the coronary arteries develop marked remodeling with increased adventitial fibrosis. The physiological consequences of these structural changes are unknown, but it is possible that arterial contractility may be impaired, thus limiting coronary flow reserve and promoting myocardial ischemia. This may contribute to CF-LVAD complications, such as ventricular arrhythmias and right ventricular failure. As more patients receive CF-LVADs and new pump technology attempts to modulate flow profiles and pulsatility, further research is needed to understand the mechanisms and long-term sequela of these changes in coronary arteries and other vascular beds.
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Affiliation(s)
- Amrut V Ambardekar
- Division of Cardiology, Department of Medicine (A.V.A., M.L., S.N.P., K.S.M.) .,Consortium for Fibrosis Research and Translation (A.V.A., M.C.M.W.-E., K.S.M.)
| | - Mary C M Weiser-Evans
- Consortium for Fibrosis Research and Translation (A.V.A., M.C.M.W.-E., K.S.M.).,Division of Renal Medicine and Hypertension, Department of Medicine (M.C.M.W.-E.)
| | - Marcella Li
- Division of Cardiology, Department of Medicine (A.V.A., M.L., S.N.P., K.S.M.)
| | - Suneet N Purohit
- Division of Cardiology, Department of Medicine (A.V.A., M.L., S.N.P., K.S.M.)
| | - Muhammad Aftab
- and Division of Cardiothoracic Surgery, Department of Surgery (M.A., T.B.R.), University of Colorado, Aurora
| | - T Brett Reece
- and Division of Cardiothoracic Surgery, Department of Surgery (M.A., T.B.R.), University of Colorado, Aurora
| | - Karen S Moulton
- Division of Cardiology, Department of Medicine (A.V.A., M.L., S.N.P., K.S.M.).,Consortium for Fibrosis Research and Translation (A.V.A., M.C.M.W.-E., K.S.M.)
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9
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Pinney SP, Chen JM. Pediatric Ventricular Assist Devices: A Quarter-Century of Support, Yet So Far to Go. J Am Coll Cardiol 2018; 72:416-418. [PMID: 30025577 DOI: 10.1016/j.jacc.2018.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Sean P Pinney
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
| | - Jonathan M Chen
- Division of Congenital Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington
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10
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Abstract
Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure compared with lower ordered animals. Yet despite years of such natural selection, the modern generation of continuous-flow left ventricular assist devices (CF-LVADs) that have been increasingly used for the last decade have created a unique physiology characterized by a nonpulsatile, nonlaminar blood flow profile with the absence of the usual large elastic artery Windkessel effect during diastole. Although outcomes and durability have improved with CF-LVADs, patients supported with CF-LVADs have a high rate of complications that were not as frequently observed with older pulsatile devices, including gastrointestinal bleeding from arteriovenous malformations, pump thrombosis, and stroke. Given the apparent fundamental biological role of the pulse, the purpose of this review is to describe the normal physiology of ventricular-arterial coupling from pulsatile flow, the effects of heart failure on this physiology and the vasculature, and to examine the effects of nonpulsatile blood flow on the vascular system and potential role in complications seen with CF-LVAD therapy. Understanding these concomitant vascular changes with CF-LVADs may be a key step in improving patient outcomes as modulation of pulsatility and flow characteristics may serve as a novel, yet simple, therapy for reducing complications.
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Affiliation(s)
- Suneet N Purohit
- Division of Cardiology, Department of Medicine (S.N.P., W.K.C, A.V.A.)
| | | | - Jay D Pal
- Division of Cardiothoracic Surgery, Department of Surgery (J.D.P.)
| | - JoAnn Lindenfeld
- University of Colorado, Aurora. Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)
| | - Amrut V Ambardekar
- Division of Cardiology, Department of Medicine (S.N.P., W.K.C, A.V.A.)
- Consortium for Fibrosis Research and Translation (A.V.A.)
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11
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Abstract
BACKGROUND The 30-day readmission rate for patients with a left ventricular assist device implantation at a large, urban, Midwest hospital system (from October 2013 to September 2014) was estimated at 32.1%. PROBLEM STATEMENT Readmission rates were a concern at this facility. Review of the readmissions, change in practice, and home expectations of patients and families have identified an opportunity to improve the transitions of care for this left ventricular assist device (LVAD) program. Therefore, the purpose of this project was to evaluate the effectiveness and feasibility of a transitional care model (TCM) for care of patients with left ventricular devices. METHODS Ten patients were enrolled in the pilot that was implemented in June 2015. A transitional care nurse trained to support patients with ventricular assist devices was used to facilitate patient flow. The goal was to create an individualized plan for the development or improvement of self-management skills to decrease readmission rates. The transitional care nurse collaborated with the ventricular device team. OUTCOMES The 30-day readmission rate during the pilot was 14.3% compared to the previous annual overall rate of 42.6%. IMPLICATIONS FOR PRACTICE Based on these results, further research is recommended into interventions consistent with the TCM to advance care coordination and to facilitate care transition in the this fragile patient population.
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Affiliation(s)
- Jackeline Iseler
- 1 College of Nursing, Michigan State University, East Lansing, MI, USA
| | - John Fox
- 2 Priority Health, Grand Rapids, MI, USA
| | - Kelly Wierenga
- 3 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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12
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Lash K, Oppel R, Hasse J. Successful Placement of Nasointestinal Feeding Tubes Using an Electromagnetic Sensor-Guided Enteral Access System in Patients With Left Ventricular Assist Devices. Nutr Clin Pract 2018. [PMID: 29532509 DOI: 10.1002/ncp.10065] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Technology advances have made it possible to prolong life for patients with heart failure who are not transplant candidates or while awaiting transplant. Many different cardiac devices are available that can be used as a bridge to transplant (temporary support) or as a destination therapy (permanent support). Placement of these devices can cause complications that, if not addressed, could negatively impact the nutrition status of patients. Placement of nasointestinal feeding tubes using an electromagnetic sensor-guided enteral access system (EMS-EAS) has been difficult in patients with implantable devices because of the potential for interference with the EMS-EAS and the left ventricular assist device (LVAD). The purpose of this paper was to report the results using a modified method to place nasointestinal tubes in patients with LVADs by elevating the receiver off the xiphoid process. There were 42 feeding tube placements in 25 patients. Results showed a 69% success rate of placement into the small bowel, 13 unsuccessful placements, and no adverse or sentinel events associated with tube placement using this method. Results indicated the modified method is a safe approach to help expedite feeding tube placement in a nutritionally compromised patient. The success rate is comparable with non-LVAD patient populations requiring nasointestinal tube placement via EMS-EAS. To our knowledge, this is the first published case series addressing a modified method for nasointestinal tube placement in patients with LVAD. More research is needed to determine ideal separation distances or other techniques to improve the success rate in this patient population.
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Affiliation(s)
- Kay Lash
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Rachelle Oppel
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Jeanette Hasse
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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Acharya D, Loyaga-Rendon RY, Pamboukian SV, Tallaj JA, Holman WL, Cantor RS, Naftel DC, Kirklin JK. Ventricular Assist Device in Acute Myocardial Infarction. J Am Coll Cardiol 2016; 67:1871-80. [PMID: 27102502 DOI: 10.1016/j.jacc.2016.02.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) complicated by acute heart failure or cardiogenic shock have high mortality with conventional management. OBJECTIVES This study evaluated outcomes of patients with AMI who received durable ventricular assist devices (VAD). METHODS Patients in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry who underwent VAD placement in the setting of AMI were included and compared with patients who received VAD for non-AMI indications. RESULTS VAD were implanted in 502 patients with AMI: 443 left ventricular assist devices; 33 biventricular assist devices; and 26 total artificial hearts. Median age was 58.3 years, and 77.1% were male. At implantation, 66% were INTERMACS profile 1. A higher proportion of AMI than non-AMI patients had pre-operative intra-aortic balloon pumps (57.6% vs. 25.3%; p < 0.01), intubation (58% vs. 8.3%; p < 0.01), extracorporeal membrane oxygenation (17.9% vs. 1.7%, p < 0.01), cardiac arrest (33.5% vs. 3.3%, p < 0.01), and higher-acuity INTERMACS profiles. At 1 month post-VAD, 91.8% of AMI patients were alive with ongoing device support, 7.2% had died on device, and 1% had been transplanted. At 1-year post-VAD, 52% of AMI patients were alive with ongoing device support, 25.7% had been transplanted, 1.6% had left VAD explanted for recovery, and 20.7% had died on device. The AMI group had higher unadjusted early phase hazard (hazard ratio [HR]: 1.24; p = 0.04) and reduced late-phase hazard of death (HR: 0.57; p = 0.04) than the non-AMI group did. After accounting for established risk factors, the AMI group no longer had higher early mortality hazard (HR: 0.89; p = 0.30), but it had lower late mortality hazard (HR: 0.55; p = 0.02). CONCLUSIONS Patients with AMI who receive VAD have outcomes similar to other VAD populations, despite being more critically ill pre-implantation. VAD therapy is an effective strategy for patients with AMI and acute heart failure or shock in whom medical therapy is failing.
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Affiliation(s)
- Deepak Acharya
- Section of Advanced Heart Failure, Transplant, and Mechanical Circulatory Support, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Renzo Y Loyaga-Rendon
- Section of Advanced Heart Failure, Transplant, and Mechanical Circulatory Support, University of Alabama at Birmingham, Birmingham, Alabama
| | - Salpy V Pamboukian
- Section of Advanced Heart Failure, Transplant, and Mechanical Circulatory Support, University of Alabama at Birmingham, Birmingham, Alabama
| | - José A Tallaj
- Section of Advanced Heart Failure, Transplant, and Mechanical Circulatory Support, University of Alabama at Birmingham, Birmingham, Alabama
| | - William L Holman
- Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ryan S Cantor
- Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - David C Naftel
- Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James K Kirklin
- Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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15
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Saxena P, Marasco SF. Tunneling a Pulmonary Artery Graft: A Simplified Way to Insert and Remove a Temporary Right Ventricular Assist Device. Tex Heart Inst J 2015; 42:540-2. [PMID: 26664306 DOI: 10.14503/thij-14-4855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Right ventricular failure can occur early or late after left ventricular assist device implantation. Support with a right ventricular assist device is needed in patients whose right ventricular failure does not respond to conservative management. The use of a temporary right ventricular assist device can enable the recovery of right ventricular function and avoid the use of a more permanent biventricular assist device, which is associated with complications and higher costs. We present our technique of instituting temporary right ventricular assist device support in patients who have undergone left ventricular assist device implantation.
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16
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Affiliation(s)
- John S Floras
- From University Health Network Divisions of Cardiology and Cardiovascular Surgery and Peter Munk Cardiac Centre, University of Toronto, ON, Canada.
| | - Vivek Rao
- From University Health Network Divisions of Cardiology and Cardiovascular Surgery and Peter Munk Cardiac Centre, University of Toronto, ON, Canada
| | - Filio Billia
- From University Health Network Divisions of Cardiology and Cardiovascular Surgery and Peter Munk Cardiac Centre, University of Toronto, ON, Canada
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17
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Mancini D, Colombo PC. Left Ventricular Assist Devices: A Rapidly Evolving Alternative to Transplant. J Am Coll Cardiol 2015; 65:2542-55. [PMID: 26065994 DOI: 10.1016/j.jacc.2015.04.039] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 01/17/2023]
Abstract
Left ventricular assist devices are becoming an increasingly prevalent therapy for patients with Stage D heart failure with reduced ejection fraction. Technological advances have improved the durability of these devices and have significantly lengthened survival in these patients. Quality of life is also improved, although adverse events related to device therapy remain common. Nevertheless, with the continuing organ donor shortage for cardiac transplantation, left ventricular assist devices are frequently serving as a substitute for transplant, particularly in the elderly patient.
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Sperry BW, Jacob MS, Menon V, Soltesz EG, Rodriguez ER, Popović ZB. Defying Dogma: Recovery After Left Ventricular Assist Device Implantation and Aortic Valve Replacement for Bicuspid Aortic Valve. Circ Heart Fail 2015. [PMID: 26199310 DOI: 10.1161/circheartfailure.115.002220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brett W Sperry
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (B.W.S., M.S.J., V.M., Z.B.P.), Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (E.G.S.), and Department of Anatomic Pathology (E.R.R.), Cleveland Clinic Foundation, OH.
| | - Miriam S Jacob
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (B.W.S., M.S.J., V.M., Z.B.P.), Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (E.G.S.), and Department of Anatomic Pathology (E.R.R.), Cleveland Clinic Foundation, OH
| | - Venu Menon
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (B.W.S., M.S.J., V.M., Z.B.P.), Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (E.G.S.), and Department of Anatomic Pathology (E.R.R.), Cleveland Clinic Foundation, OH
| | - Edward G Soltesz
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (B.W.S., M.S.J., V.M., Z.B.P.), Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (E.G.S.), and Department of Anatomic Pathology (E.R.R.), Cleveland Clinic Foundation, OH
| | - E Rene Rodriguez
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (B.W.S., M.S.J., V.M., Z.B.P.), Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (E.G.S.), and Department of Anatomic Pathology (E.R.R.), Cleveland Clinic Foundation, OH
| | - Zoran B Popović
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (B.W.S., M.S.J., V.M., Z.B.P.), Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (E.G.S.), and Department of Anatomic Pathology (E.R.R.), Cleveland Clinic Foundation, OH
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Idelchik GM, Loyalka P, Kar B. Percutaneous ventricular assist device placement during active cardiopulmonary resuscitation for severe refractory cardiogenic shock after acute myocardial infarction. Tex Heart Inst J 2007; 34:204-8. [PMID: 17622370 PMCID: PMC1894693] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Cardiogenic shock after acute myocardial infarction is associated with a high mortality rate despite modern reperfusion methods and intra-aortic balloon pump support. For myocardial infarction patients in cardiogenic shock that is refractory to intra-aortic ballon pump counterpulsation and pressors (severe refractory cardiogenic shock), there are limited means to rapidly provide additional hemodynamic support. We present the case of a 49-year-old man who presented with an anterior wall acute myocardial infarction complicated by cardiogenic shock. After resuscitation and stabilization with intra-aortic balloon pump and pressor support, the patient underwent successful emergent percutaneous transluminal coronary angioplasty and stenting of the left anterior descending coronary artery. Forty-eight hours later, the patient again went into severe refractory cardiogenic shock; pulseless electrical activity arrest followed. Cardiopulmonary resuscitation was started, and the patient underwent urgent placement of a TandemHeart percutaneous ventricular assist device. The device enabled the reversal of terminal hemodynamic collapse during active cardiopulmonary resuscitation, subsequent stabilization of the patient, and discharge of the patient from the hospital after device removal. In this patient, the percutaneous ventricular assist device was successful in the treatment of severe refractory cardiogenic shock after acute myocardial infarction.
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Affiliation(s)
- Gary M Idelchik
- Division of Cardiology, St. Luke's Episcopal Hospital and The Texas Heart Institute, Houston, Texas 77030, USA
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20
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Frank CM, Palanichamy N, Kar B, Wilson JM, Gregoric ID, Loyalka P, Civitello AB. Use of a percutaneous ventricular assist device for treatment of cardiogenic shock due to critical aortic stenosis. Tex Heart Inst J 2006; 33:487-9. [PMID: 17215976 PMCID: PMC1764950] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We present the case of a 72-year-old woman who was transferred to our institution in cardiogenic shock and with multiple-organ failure, due to critical aortic stenosis. She was considered too high-risk to undergo aortic valve replacement. A TandemHeart percutaneous ventricular assist device was used to stabilize the patient's condition before surgery, and she subsequently underwent successful aortic valve replacement. To our knowledge, this is the 1st report in the literature of this particular application of the TandemHeart device.
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Affiliation(s)
- Christopher M Frank
- Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA
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21
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Forrester MD, Myers TJ, Gregoric ID, Frazier OH. Saphenous vein graft flow during left ventricular assistance with an axial-flow pump. Tex Heart Inst J 2006; 33:222-4. [PMID: 16878632 PMCID: PMC1524688] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The effects of continuous-flow support on bypass graft flow have not been quantified clinically. Continuous-flow left ventricular assist devices unload the left ventricle throughout the cardiac cycle, which narrows pulse pressure and converts passive left ventricular filling during diastole to active flow throughout the cardiac cycle. We report the case of a 63-year-old man with severe congestive heart failure who underwent coronary artery bypass grafting and was supported with an axial-flow pump. In this patient, saphenous vein graft flow during left ventricular assistance provided adequate coronary perfusion.
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Affiliation(s)
- Matthew D Forrester
- Cardiopulmonary Transplant Service and Cardiovascular Surgical Research Laboratories, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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22
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Kar B, Butkevich A, Civitello AB, Nawar MA, Walton B, Messner GN, Gregoric ID, Feldman J, Myers TJ, Gemmato C, Delgado RM. Hemodynamic support with a percutaneous left ventricular assist device during stenting of an unprotected left main coronary artery. Tex Heart Inst J 2004; 31:84-6. [PMID: 15061632 PMCID: PMC387438] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Coronary artery bypass grafting prolongs survival in patients with left main coronary artery stenosis. However, this benefit is denied to patients who refuse the procedure or who are poor surgical candidates due to comorbid conditions. We describe a novel technique for the percutaneous revascularization of stenosis in an unprotected left main coronary artery in high-risk patients. The TandemHeart, a percutaneously inserted left ventricular assist device, was used to provide periprocedural hemodynamic support during angioplasty and stenting of an unprotected left main coronary artery for stenosis in a 70-year-old woman. The device was removed immediately after the procedure, and the patient was discharged from the hospital on the 2nd postprocedural day. The potential advantages of angioplasty with the support of percutaneous left ventricular assist devices in high-risk patients are discussed.
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Affiliation(s)
- Biswajit Kar
- Division of Cardiology, St. Luke's Episcopal Hospital, Texas Heart Institute, Houston, Texas 77030, USA.
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Messner GN, Prendergast P, Wadia Y, Chu T, Gregoric ID, Flamm SD, Frazier OH. Congenital absence of anterior pericardium at left ventricular assist device implantation. Tex Heart Inst J 2004; 31:87-9. [PMID: 15061633 PMCID: PMC387439] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We report a case of congenital absence of the anterior pericardium in a 41-year-old man who was undergoing implantation of a left ventricular assist device for treatment of congestive heart failure.
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Affiliation(s)
- Gregory N Messner
- Department of Cardiopulmonary Transplantation, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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Frazier OH, Delgado RM, Kar B, Patel V, Gregoric ID, Myers TJ. First clinical use of the redesigned HeartMate II left ventricular assist system in the United States: a case report. Tex Heart Inst J 2004; 31:157-9. [PMID: 15212127 PMCID: PMC427376] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Axial flow ventricular assist devices show great promise as a potential treatment for patients with end-stage heart failure. The HeartMate II system, redesigned on the basis of initial clinical experiences in Europe, is now in clinical trials in the United States. We report on the 1st use of the newly redesigned HeartMate II in the United States. The system has unique features, which include an accurate flow estimator and the ability to automatically detect and correct excessive left ventricular unloading. The new design also incorporates changes in the texturing of the blood-contacting surfaces to prevent thrombosis. The implantation technique and configuration are similar to those of the HeartMate XVE LVAS and require a median sternotomy for access. The 1st patient to receive the device in the United States has had an uncomplicated perioperative course and now awaits transplantation.
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Affiliation(s)
- O H Frazier
- The Department of Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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Baldwin RT, Radovancević B, Duncan JM, Wampler RK, Frazier OH. Management of patients supported on the Hemopump cardiac assist system. Tex Heart Inst J 1992; 19:81-6. [PMID: 15227419 PMCID: PMC326258] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The Hemopump Cardiac Assist System is a relatively new intraarterial, axial-flow circulatory assist device that offers temporary left ventricular support to patients in refractory cardiogenic shock, without requiring major surgery for insertion. Use of the Hemopump is associated with a low complication rate. Device-related morbidity is extremely rare. Because the Hemopump is safe for use in community hospitals, the number of patients supported by this device is expected to increase. In this report, we present general guidelines for the care of patients supported by the Hemopump. We describe techniques for the management of afterload reduction, supravalvular dislodgement, device malfunction, ventricular ectopy, intracardiac shunting, and inflow cannula obstruction.
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Affiliation(s)
- R T Baldwin
- The Section of Cardiovascular Surgery, Division of Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA
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