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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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Schmitto JD, Mariani S, Li T, Dogan G, Hanke JS, Bara C, Pya Y, Zimpfer D, Krabatsch T, Garbade J, Rao V, Morshuis M, Beyersdorf F, Marasco S, Netuka I, Bauersachs J, Haverich A. Five-year outcomes of patients supported with HeartMate 3: a single-centre experience. Eur J Cardiothorac Surg 2021; 59:1155-1163. [PMID: 33585913 DOI: 10.1093/ejcts/ezab018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/24/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The HeartMate 3 left ventricular assist device was first implanted in 2014 and received the Conformité Européenne mark in 2015. Since then, several trials demonstrated its high haemocompatibility associated with good survival and low adverse events rates. Herein, we report our institutional experience with patients supported with HeartMate 3 for 5 years. METHODS This prospective cohort study included patients receiving a HeartMate 3 implantation in 2014 as part of the HeartMate 3 Conformité Européenne Mark clinical trial. Patients had follow-up visits every 3 months while on left ventricular assist device support, and all patients completed the 5-year follow-up. The primary end point was survival at 5 years. Secondary end points included adverse events, health status and quality of life. RESULTS Eight patients (men: 75%) aged 59 years (min-max: 52-66 years) were enrolled. At 5 years, survival was 100%. Patients remained on support for a median time of 1825 days (min-max: 101-1825 days); 2 patients successfully received cardiac transplants. No right heart failure, haemolysis, pump thrombosis, pump malfunction or neurological events occurred in any patients. A driveline infection was observed in 6 patients (0.25 events/patient-year). Compared to baseline, a significant improvement in quality of life and in New York Heart Association functional class was noted after the implant and for the whole follow-up time. A slight decline in kidney function and in the 6-min walk test results occurred after 3 years. CONCLUSIONS This study reports the longest single-centre follow-up of the HeartMate 3, showing excellent haemocompatibility over time with high survival and low complication rates at 5 years.
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Affiliation(s)
- Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Bara
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Yuriy Pya
- National Research Cardiac Surgery Center, Nur-Sultan, Kazakhstan
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Vivek Rao
- Department of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center, Bad Oeynhausen, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, and Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Silvana Marasco
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Mueller M, Hoermandinger C, Richter G, Mulzer J, Tsyganenko D, Krabatsch T, Starck C, Stein J, Schoenrath F, Falk V, Potapov E. Retrospective 1-year outcome follow-up in 200 patients supported with HeartMate 3 and HeartWare left ventricular assist devices in a single centre. Eur J Cardiothorac Surg 2021; 57:1160-1165. [PMID: 32298426 DOI: 10.1093/ejcts/ezaa017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/28/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Various trials have assessed the outcome and reliability of the HeartWare HVAD (HW) and HeartMate 3 (HM3) left ventricular assist devices. A direct comparison of clinical outcomes and of the complication profile of these 2 left ventricular assist devices is lacking. We present a retrospective analysis of patients supported with HM3 and HW as a left ventricular assist device. METHODS Preoperative data, complications and outcomes including a 1-year follow-up of patients supported with the HM3 and HW in a single centre were retrospectively analysed. Both pumps were implanted on- or off-pump, employing standard and minimally invasive techniques. For logistic reasons, the 2 device types were implanted in an alternating manner, thereby reducing the systematic bias for pump selection. We considered this to be an appropriate approach, as no differences in respect of survival or the complication profile of the two device types have been demonstrated. Anticoagulation was similar in patients with both pumps according to our anticoagulation protocol, with a target international normalized ratio of 2.5-3.0, a home monitoring system and blood pressure management with a mean arterial target pressure of 70-80 mmHg. RESULTS Between October 2015 and April 2017, 100 patients underwent implantation of the HW and 100 patients underwent implantation of the HM3. The median time on the device was 0.98 years (range 0-2.23 years). The median age was 58.5 (51-65) versus 57 (49-64) years (P = 0.456); the number of male patients was 87 versus 88 (P = 0.831). Of the HW patients, 73% were rated as having an INTERMACS level I or II, compared to 57% of the HM3 patients (P = 0.018). There were no further differences in preoperative data. A total of 14 patients had pre-, intra- or post-pump blood flow obstruction in the HW group versus 4 in the HM3 group [hazard ratio (HR) 2.5 (0.7-8.8), P = 0.103]. There were no differences regarding gastrointestinal bleeding [HR 1.25 (0.56-2.64), P = 0.624] or driveline infection (0.68 vs 0.8 events per patient-year, P = 0.0789). The incidence of ischaemic stroke was similar in both groups [HR 0.72 (0.25-2.09), P = 0.550]. Cerebral bleeding was more frequent in patients supported with HW [HR 6.79 (1.43-32.20), P = 0.016]. The incidence of cerebrovascular accidents, on the other hand, was similar in both groups [HR 1.85 (0.83-4.19), P = 0.13]. The incidence of haemocompatibility-related adverse events, however, was significantly higher in the HW group (113 points corresponding to 1.28 events per patient-year versus 69 points corresponding to 0.7 events per patient-year, P < 0.001). The 1-year survival was similar in both groups [62.2%, 95% confidence interval (CI) (0.53-0.73) vs 66.7%, 95% CI (0.58–0.767) [corrected]. CONCLUSIONS Our data show that the complication profile differs between the 2 pumps, but that early survival is comparable.
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Affiliation(s)
- Marcus Mueller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christoph Hoermandinger
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Gregor Richter
- Department of Vascular Surgery, St. Gertrauden Hospital, Berlin, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Dmytro Tsyganenko
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.,Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,ETH Zurich, Zurich, Switzerland
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
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Mueller M, Hoermandinger C, Richter G, Mulzer J, Tsyganenko D, Krabatsch T, Starck C, Stein J, Schoenrath F, Falk V, Potapov E. Corrigendum to 'Retrospective 1-year outcome follow-up in 200 patients supported with HeartMate 3 and HeartWare left ventricular assist devices in a single centre' [Eur J Cardiothorac Surg 2020;57:1160-5.]. Eur J Cardiothorac Surg 2020; 58:410. [PMID: 32667660 DOI: 10.1093/ejcts/ezaa207] [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: 11/13/2022] Open
Affiliation(s)
- Marcus Mueller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christoph Hoermandinger
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Gregor Richter
- Department of Vascular Surgery, St. Gertrauden Hospital, Berlin, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Dmytro Tsyganenko
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.,Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,ETH Zurich, Zurich, Switzerland
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
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de By TMMH, Mohacsi P, Gahl B, Zittermann A, Krabatsch T, Gustafsson F, Leprince P, Meyns B, Netuka I, Caliskan K, Castedo E, Musumeci F, Vincentelli A, Hetzer R, Gummert J. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio-Thoracic Surgery (EACTS): second report. Eur J Cardiothorac Surg 2019; 53:309-316. [PMID: 29029117 DOI: 10.1093/ejcts/ezx320] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [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: 02/14/2017] [Revised: 08/08/2017] [Accepted: 08/13/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was founded in Berlin, Germany. EUROMACS is supported fully by the European Association for Cardio-Thoracic Surgery (EACTS) and, since 2014, has functioned as a committee of the EACTS. The purpose of having the EUROMACS as a part of the EACTS is to accumulate clinical data related to long-term mechanical circulatory support for scientific purposes and to publish annual reports. METHODS Participating hospitals contributed surgical and cardiological pre-, peri- and long-term postoperative data of mechanical circulatory support implants to the registry. Data for all implants performed from 1 January 2011 to 31 December 2016 were analysed. Several auditing methods were used to monitor the quality of the data. Data could be provided for in-depth studies, and custom data could be provided at the request of clinicians and scientists. This report includes updates of patient characteristics, implant frequency, mortality rates and adverse events. RESULTS Fifty-two hospitals participated in the registry. This report is based on 2947 registered implants in 2681 patients. Survival of adult patients (>17 years of age) with continuous-flow left ventricular assist devices with a mean follow-up of 391 days was 69% (95% confidence interval 66-71%) 1 year after implantation. On average, patients were observed for 12 months (median 7 months, range 0-70 months). When we investigated for adverse events, we found an overall event rate per 100 patient-months of 3.56 for device malfunction, 6.45 for major bleeding, 6.18 for major infection and 3.03 for neurological events within the first 3 months after implantation. CONCLUSIONS Compared to the first EUROMACS report, the number of participating hospitals increased from 21 to 52 (+148%), whereas the number of registered implants more than tripled from 825 to 2947 (+257%). The increase in the number of participating hospitals led us to increase the quality control measures through data input control, on-site audits and statistical analyses.
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Affiliation(s)
| | - Paul Mohacsi
- Swiss Cardiovascular Center, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Brigitta Gahl
- Swiss Cardiovascular Center, University Hospital Bern (Inselspital), Bern, Switzerland
| | | | | | | | - Pascal Leprince
- Université Pierre et Marie Curie, Hôpital La-Pitié Salpetrière, Paris, France
| | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Evaristo Castedo
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - André Vincentelli
- Centre Hospitalier Régional Universitaire de Lille, France, Lille, France
| | | | - Jan Gummert
- Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
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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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Garbade J, Gustafsson F, Shaw S, Lavee J, Saeed D, Pya Y, Krabatsch T, Schmitto JD, Morshuis M, Chuang J, Zimpfer D. Postmarket Experience With HeartMate 3 Left Ventricular Assist Device: 30-Day Outcomes From the ELEVATE Registry. Ann Thorac Surg 2019; 107:33-39. [DOI: 10.1016/j.athoracsur.2018.07.092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/15/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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8
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Lavee J, Mulzer J, Krabatsch T, Marasco S, McGiffin D, Garbade J, Schmitto JD, Zimpfer D, Potapov EV. An international multicenter experience of biventricular support with HeartMate 3 ventricular assist systems. J Heart Lung Transplant 2018; 37:1399-1402. [DOI: 10.1016/j.healun.2018.08.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 02/02/2023] Open
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Knierim J, Heck R, Pieri M, Schoenrath F, Soltani S, Stawowy P, Dreysse S, Stein J, Müller M, Mulzer J, Dandel M, Falk V, Krabatsch T, Potapov E. Outcomes from a recovery protocol for patients with continuous-flow left ventricular assist devices. J Heart Lung Transplant 2018; 38:440-448. [PMID: 30503053 DOI: 10.1016/j.healun.2018.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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] [Received: 07/06/2018] [Revised: 10/27/2018] [Accepted: 11/09/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In this retrospective analysis we evaluated a standardized echocardiographic assessment and an invasive technique for patient selection for successful continuous-flow left ventricular assist device (CF-LVAD) explantation. METHODS Inclusion criteria for LVAD recovery assessment were: clinically stable condition; LVAD support for >6 months; physical activity; normal echocardiography findings; and no more than mild valvular disease and aortic valve opening. In a second step, echocardiography was performed under CF-LVAD reduction and stop conditions (PStopE). In the third step, patients who presented with stable parameters underwent right heart catheterization under CF-LVAD stoppage and occlusion of the outflow graft with a balloon catheter. Criteria for explantation were normal pulmonary artery pressure and pulmonary capillary wedge pressure <16 mmHg. RESULTS Thirty-three of 424 patients entered the second step of evaluation and 20 entered the third step. Fourteen presented positive results and the pump was successfully explanted. The PCWP at baseline was 8.5 (2.8) mmHg in the explantation group and 10.6 (2.8) mmHg in the non-explantation group (p = 0.105). It increased to 10.9 (3.0) mmHg vs 20.8 (4.9) mmHg under outflow graft occlusion. The wedge pressure was significantly higher in the non-explantation group (p < 0.001). Median duration of follow-up after explantation was 9.74 (interquartile range 4.3 to 20.60) months, with survival of 93%. CONCLUSIONS The protocol presented is feasible and safe. The criteria applied provide good patient selection for sustained mid-term myocardial recovery after LVAD explantation.
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Affiliation(s)
- Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
| | - Roland Heck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sajjad Soltani
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Philipp Stawowy
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany; Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Stephan Dreysse
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Julia Stein
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany; DHZB Dienstleistungs GmbH, Berlin, Germany
| | - Marcus Müller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Michael Dandel
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
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Mueller M, Potapov E, Krabatsch T. Usefulness of a temporary endovascular left ventricular assist system as a bridge to facilitate treatment of mediastinitis associated with a permanent device. J Heart Lung Transplant 2018; 38:476-478. [PMID: 30396846 DOI: 10.1016/j.healun.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marcus Mueller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Evjenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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11
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Gustafsson F, Shaw S, Lavee J, Saeed D, Pya Y, Krabatsch T, Schmitto J, Morshuis M, Chuang J, Damme L, Zimpfer D, Garbade J. Six-month outcomes after treatment of advanced heart failure with a full magnetically levitated continuous flow left ventricular assist device: report from the ELEVATE registry. Eur Heart J 2018; 39:3454-3460. [DOI: 10.1093/eurheartj/ehy513] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/05/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Finn Gustafsson
- Rigshospitalet, Department of Cardiology, University of Copenhagen 9 Blegdamsvej, Copenhagen, Denmark
| | - Steven Shaw
- Manchester University NHS Foundation Trust, Southmoor Road, Manchester, UK
| | - Jacob Lavee
- Heart Transplantation Unit, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Hasomer, Ramat Gan, Israel
| | - Diyar Saeed
- Cardiovascular Surgery, University Hospital of Duesseldorf, Moorenstrasse 5, Dusseldorf, Germany
| | - Yuriy Pya
- National Research Cardiac Surgery Center, 38 Turan Street, Astana, Kazakhstan
| | | | - Jan Schmitto
- Hannover Medical School, Carl-Neuberg Strasse 1, Hannover, Germany
| | - Michiel Morshuis
- Department of Cardiothoracic Surgery, Herz- und Diabeteszentrum NRW, Georgstrasse 11, Bad Oeynhausen, Germany
| | - Joyce Chuang
- Abbott, Abbott Park Road, Abbott Park, Chicago, IL, USA
| | - Laura Damme
- Abbott, Abbott Park Road, Abbott Park, Chicago, IL, USA
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18–20, Vienna, Austria
| | - Jens Garbade
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Struempellstr. 39, Leipzig, Germany
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12
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Eulert-Grehn JJ, Lanmüller P, Schönrath F, Solowjowa N, Müller M, Mulzer J, Kaufmann F, Starck C, Krabatsch T, Falk V, Potapov E. Two implantable continuous-flow ventricular assist devices in a biventricular configuration: technique and results†. Interact Cardiovasc Thorac Surg 2018; 27:938-942. [DOI: 10.1093/icvts/ivy228] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/12/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jaime-Jürgen Eulert-Grehn
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Pia Lanmüller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Felix Schönrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marcus Müller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Friedrich Kaufmann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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13
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Schmitto JD, Pya Y, Zimpfer D, Krabatsch T, Garbade J, Rao V, Morshuis M, Beyersdorf F, Marasco S, Sood P, Damme L, Netuka I. Long-term evaluation of a fully magnetically levitated circulatory support device for advanced heart failure-two-year results from the HeartMate 3 CE Mark Study. Eur J Heart Fail 2018; 21:90-97. [PMID: 30052304 DOI: 10.1002/ejhf.1284] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [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: 12/05/2017] [Revised: 06/11/2018] [Accepted: 06/26/2018] [Indexed: 01/25/2023] Open
Abstract
AIM This study aimed to assess safety and outcomes of patients, 2 years after implantation with the HeartMate 3 Left Ventricular Assist System. METHODS AND RESULTS This study included 50 adults with New York Heart Association (NYHA) class IIIB or IV symptoms or American College of Cardiology/American Heart Association stage D heart failure with an ejection fraction ≤25% and a cardiac index ≤2.2 L/min/m2 without inotropes, or inotrope-dependent with optimal medical management, or listed for heart transplant. The median duration of left ventricular assist device support was 694 days (range: 19-833 days). At baseline, cardiac index was 1.8 ±0.5 L/min/m2 , 58% of patients were receiving inotropes, and 92% were INTERMACS profiles 2-4. At 2 years, Kaplan-Meier survival was 74 ±6%, 5 (10%) patients were transplanted, and 32 patients (64%) remain with support. Adverse event rates include bleeding requiring surgery (16%), gastrointestinal bleeding (20%), driveline infection (24%), ischaemic stroke (16%), haemorrhagic stroke (8%), right heart failure (14%), and outflow graft thrombosis (2%). Notably, no haemolysis, pump thrombosis, or pump malfunction events occurred. At 2 years, 47% of patients remained in NYHA class I and 41% in NYHA class II (P <0.0001). From baseline to 2 years, the mean six-minute walk distance increased from 239 m to 347 m (P <0.0001), and the mean EQ-5D quality of life score improved from 48.2 to 70.6 (P < 0.0001). CONCLUSIONS Two years post-HeartMate 3 implantation, results show expected and acceptable survival, enhanced haemocompatibility, improved patient functional status and quality of life. This corroborates the success of HeartMate 3 since its first-in-man implantation case in Germany. ClinicalTrials.gov: NCT02170363.
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Affiliation(s)
| | - Yuriy Pya
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | | | | | | | - Vivek Rao
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada
| | - Michiel Morshuis
- Thoracic and Cardiovascular Surgery Clinic, Bad Oeynhausen, Germany
| | - Friedhelm Beyersdorf
- University Heart Center Freiburg-Bad Krozingen, Medical Faculty, Albert Ludwigs-University, Freiburg, Germany
| | | | | | | | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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14
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Otten A, Kurz S, Anwar S, Potapov E, Krall C, O'Brien B, Habazettl H, Krabatsch T, Kukucka M. Corrigendum to 'Prognostic value of 3-dimensional echocardiographical heart volume assessment in patients scheduled for left ventricular assist device implantation' [Eur J Cardiothorac Surg doi:10.1093/ejcts/ezy002]. Eur J Cardiothorac Surg 2018; 53:1300. [PMID: 29648625 DOI: 10.1093/ejcts/ezy151] [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: 11/12/2022] Open
Affiliation(s)
- Albert Otten
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Stephan Kurz
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Sibtain Anwar
- Department of Perioperative Medicine, Barts Heart Centre, London, UK
| | - Evgenij Potapov
- Department of Cardiothoracic Surgery, German Heart Centre Berlin, Berlin, Germany.,DZHK (German Centre for Cardiothoracic Research), Partner Site, Berlin, Germany
| | - Christian Krall
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Benjamin O'Brien
- Department of Perioperative Medicine, Barts Heart Centre, London, UK
| | - Helmut Habazettl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic Surgery, German Heart Centre Berlin, Berlin, Germany
| | - Marian Kukucka
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department of Perioperative Medicine, Barts Heart Centre, London, UK
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15
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Abstract
Background The novel HeartMate 3 (Abbott, Chicago, IL, USA) left ventricular assist device (LVAD) was worldwide first implanted by Prof. Schmitto and his team in 2014 at the Hannover Medical School, Germany and received CE Mark approval in October, 2015 following completion of a clinical trial. Methods Although HeartMate 3 implantation in the clinical trial was restricted to conventional sternotomy, the small size of the pump allows for less-invasive implantation, generally associated with less trauma and reduced perioperative complication rates. Herein we describe our first experiences with a less-invasive implantation of the HeartMate 3 using an upper hemi-sternotomy combined with anterior lateral thoracotomy approach. Results Results demonstrate the feasibility of this novel, less invasive technique for HeartMate 3 LVAD implantation with diminished surgical trauma, less postoperative bleeding, maintenance of the chest stability, reduced need of blood product transfusion and earlier recovery. Conclusions The results of our study indicate that less-invasive implantation of the HeartMate 3 is technically feasible and offers several benefits for surgical outcome and may become the standard of care for LVAD implantation techniques.
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Affiliation(s)
- Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thomas Krabatsch
- Department of Cardiac Surgery, German Heart Centre, Berlin, Germany
| | | | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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16
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17
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Müller M, Richter G, Hoermandinger C, Schoenrath F, Falk V, Potapov E, Krabatsch T. SINGLE CENTER EXPERIENCE: COMPARISON OF ONE YEAR SURVIVAL OF MORE THAN 120 PATIENTS WITH HEARTMATE 3 AND HEARTWARE HVAD. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31519-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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18
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Soliman OI, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, Gummert JF, de By TM, Bogers AJ, Zijlstra F, Mohacsi P, Caliskan K. Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices. Circulation 2018; 137:891-906. [DOI: 10.1161/circulationaha.117.030543] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [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: 07/15/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022]
Abstract
Background:
The aim of the study was to derive and validate a novel risk score for early right-sided heart failure (RHF) after left ventricular assist device implantation.
Methods:
The EUROMACS (European Registry for Patients with Mechanical Circulatory Support) was used to identify adult patients undergoing continuous-flow left ventricular assist device implantation with mainstream devices. Eligible patients (n=2988) were randomly divided into derivation (n=2000) and validation (n=988) cohorts. The primary outcome was early (<30 days) severe postoperative RHF, defined as receiving short- or long-term right-sided circulatory support, continuous inotropic support for ≥14 days, or nitric oxide ventilation for ≥48 hours. The secondary outcome was all-cause mortality and length of stay in the intensive care unit. Covariates found to be associated with RHF (exploratory univariate
P
<0.10) were entered into a multivariable logistic regression model. A risk score was then generated using the relative magnitude of the exponential regression model coefficients of independent predictors at the last step after checking for collinearity, likelihood ratio test, c index, and clinical weight at each step.
Results:
A 9.5-point risk score incorporating 5 variables (Interagency Registry for Mechanically Assisted Circulatory Support class, use of multiple inotropes, severe right ventricular dysfunction on echocardiography, ratio of right atrial/pulmonary capillary wedge pressure, hemoglobin) was created. The mean scores in the derivation and validation cohorts were 2.7±1.9 and 2.6±2.0, respectively (
P
=0.32). RHF in the derivation cohort occurred in 433 patients (21.7%) after left ventricular assist device implantation and was associated with a lower 1-year (53% versus 71%;
P
<0.001) and 2-year (45% versus 58%;
P
<0.001) survival compared with patients without RHF. RHF risk ranged from 11% (low risk score 0–2) to 43.1% (high risk score >4;
P
<0.0001). Median intensive care unit stay was 7 days (interquartile range, 4–15 days) versus 24 days (interquartile range, 14–38 days) in patients without versus with RHF, respectively (
P
<0.001). The c index of the composite score was 0.70 in the derivation and 0.67 in the validation cohort. The EUROMACS-RHF risk score outperformed (
P
<0.0001) previously published scores and known individual echocardiographic and hemodynamic markers of RHF.
Conclusions:
This novel EUROMACS-RHF risk score outperformed currently known risk scores and clinical predictors of early postoperative RHF. This novel score may be useful for tailored risk-based clinical assessment and management of patients with advanced HF evaluated for ventricular assist device therapy.
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Affiliation(s)
- Osama I.I. Soliman
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
| | - Sakir Akin
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
- Intensive Care (S.A.)
| | - Rahatullah Muslem
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
- Cardiothoracic Surgery (R.M., A.J.J.C.B.)
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
| | - Olivier C. Manintveld
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
| | - Thomas Krabatsch
- Erasmus Medical Center, University Medical Centre Rotterdam, the Netherlands. Department of Cardiac Surgery, German Heart Centre Berlin, Germany (T.K.)
| | - Jan F. Gummert
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (J.F.G.)
| | | | | | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
| | - Paul Mohacsi
- Department of Cardiology, University Hospital Bern, University of Bern, Switzerland (P.M.)
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter (O.I.I.S., S.A., R.M., E.B., O.C.M., F.Z., K.C.)
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19
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Otten A, Kurz S, Anwar S, Potapov E, Krall C, O’Brien B, Habazettl H, Krabatsch T, Kukucka M. Prognostic value of 3-dimensional echocardiographical heart volume assessment in patients scheduled for left ventricular assist device implantation. Eur J Cardiothorac Surg 2018; 54:169-175. [DOI: 10.1093/ejcts/ezy002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/29/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Albert Otten
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Stephan Kurz
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Sibtain Anwar
- Department of Perioperative Medicine, Barts Heart Centre, London, UK
| | - Evgenij Potapov
- Department of Cardiothoracic Surgery, German Heart Centre Berlin, Berlin, Germany
- DZHK (German Centre for Cardiothoracic Research), Partner Site, Berlin, Germany
| | - Christian Krall
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Benjamin O’Brien
- Department of Perioperative Medicine, Barts Heart Centre, London, UK
| | - Helmut Habazettl
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic Surgery, German Heart Centre Berlin, Berlin, Germany
| | - Marian Kukucka
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Perioperative Medicine, Barts Heart Centre, London, UK
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20
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Tsyganenko D, Hennig F, Kaufmann F, Starck C, Falk V, Müller M, Krabatsch T, Potapov E. Extracorporeal Life Support (ECLS) has been Applied Increasingly in Recent Years in Patients Suffering from Cardiogenic Shock. If Myocardial Recovery does not Occur, ECLS becomes a Bridge to Decision with Subsequent Left Ventricular Assist Device (LVAD) Implantation. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628088] [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: 10/28/2022]
Affiliation(s)
| | - F. Hennig
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - F. Kaufmann
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - C. Starck
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - V. Falk
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - M. Müller
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - E. Potapov
- Deutsches Herzzentrum Berlin, Berlin, Germany
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21
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Tsyganenko D, Hennig F, Kaufmann F, Starck C, Schönrath F, Falk V, Müller M, Krabatsch T, Potapov E. Predictors for Early and Midterm Outcome after Bridge to Left Ventricular Assist Device by Extracorporeal Life Support. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627937] [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: 10/28/2022]
Affiliation(s)
| | - F. Hennig
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - F. Kaufmann
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - C. Starck
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - V. Falk
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - M. Müller
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - E. Potapov
- Deutsches Herzzentrum Berlin, Berlin, Germany
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22
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Petrou A, Pergantis P, Ochsner G, Amacher R, Krabatsch T, Falk V, Meboldt M, Daners MS. Response of a physiological controller for ventricular assist devices during acute patho-physiological events: an in vitro study. BIOMED ENG-BIOMED TE 2017; 62:623-633. [PMID: 28182575 DOI: 10.1515/bmt-2016-0155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 07/12/2016] [Accepted: 01/05/2017] [Indexed: 11/15/2022]
Abstract
The current paper analyzes the performance of a physiological controller for turbodynamic ventricular assist devices (tVADs) during acute patho-physiological events. The numerical model of the human blood circulation implemented on our hybrid mock circulation was extended in order to simulate the Valsalva maneuver (VM) and premature ventricular contractions (PVCs). The performance of an end-diastolic volume (EDV)-based physiological controller for VADs, named preload responsive speed (PRS) controller was evaluated under VM and PVCs. A slow and a fast response of the PRS controller were implemented by using a 3 s moving window, and a beat-to-beat method, respectively, to extract the EDV index. The hemodynamics of a pathological circulation, assisted by a tVAD controlled by the PRS controller were analyzed and compared with a constant speed support case. The results show that the PRS controller prevented suction during the VM with both methods, while with constant speed, this was not the case. On the other hand, the pump flow reduction with the PRS controller led to low aortic pressure, while it remained physiological with the constant speed control. Pump backflow was increased when the moving window was used but it avoided sudden undesirable speed changes, which occurred during PVCs with the beat-to-beat method. In a possible clinical implementation of any physiological controller, the desired performance during frequent clinical acute scenarios should be considered.
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23
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Schoenrath F, Kikhney J, Kursawe L, Schoenrath K, Hajduczenia MM, Schulze J, Potapov E, Krabatsch T, Kaufmann F, Falk V, Moter A. Life on the driveline: Molecular detection and fluorescence in situ hybridization-based visualization of microbial species in patients with left ventricular assist devices. J Heart Lung Transplant 2017; 37:163-166. [PMID: 29056458 DOI: 10.1016/j.healun.2017.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/10/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Judith Kikhney
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Biofilm Center, German Heart Center Berlin, Berlin, Germany; Institute for Microbiology and Hygiene, Berlin, Germany
| | - Laura Kursawe
- Biofilm Center, German Heart Center Berlin, Berlin, Germany
| | - Katharina Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Maria M Hajduczenia
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; Biofilm Center, German Heart Center Berlin, Berlin, Germany
| | - Julia Schulze
- Biofilm Center, German Heart Center Berlin, Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Friedrich Kaufmann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Annette Moter
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Biofilm Center, German Heart Center Berlin, Berlin, Germany
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24
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Ovroutski S, Miera O, Krabatsch T, Berger F, Photiadis J, Potapov E. Two Pumps for Single Ventricle: Mechanical Support for Establishment of Biventricular Circulation. Ann Thorac Surg 2017; 104:e143-e145. [PMID: 28734437 DOI: 10.1016/j.athoracsur.2017.02.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 01/25/2017] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 10/19/2022]
Abstract
A 31-year-old patient with a univentricular heart and double-inlet left ventricle, moderate pulmonary stenosis, and severe mitral valve regurgitation experienced irreversible heart failure after mitral valve replacement. "Biventricular" mechanical circulatory support was initiated. The systemic circulation was supported using the HeartWare ventricular assist device (HVAD) (HeartWare, Framingham, MA) pump in the usual manner. The second pump was inserted into the right atrium and connected to the pulmonary artery after closure of the pulmonary valve and atrial separation. This solution allowed optimal circulatory support, reduction of pulmonary resistance, and normal peripheral oxygen saturation. Thus the patient was listed for heart transplantation.
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Affiliation(s)
- Stanislav Ovroutski
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Berlin, Germany.
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Berlin, Germany
| | - Joachim Photiadis
- Department of Surgery for Congenital Heart Disease and Pediatric Cardiac Surgery, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Berlin, Germany
| | - Evgenii Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
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Grüger T, Kaufmann F, Dreysse S, Falk V, Krabatsch T, Potapov E. Late post-pump blood flow obstruction in a novel left ventricular assist device: The unusual case of a twisted outflow graft. J Thorac Cardiovasc Surg 2017; 155:e33-e35. [PMID: 28958598 DOI: 10.1016/j.jtcvs.2017.08.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/17/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Volkmar Falk
- German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany; Department of Cardiovascular Surgery, Charité - Universitätsmedizin, Berlin, Germany
| | - Thomas Krabatsch
- German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Evgenij Potapov
- German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.
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Richter G, Mueller M, Kaufmann F, Hoermandinger C, Falk V, Potapov E, Krabatsch T. P3275Single center experience with HeartMate 3 and HeartWare HVAD: midterm outcome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3275] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Scandroglio AM, Kaufmann F, Pieri M, Kretzschmar A, Müller M, Pergantis P, Dreysse S, Falk V, Krabatsch T, Potapov EV. Diagnosis and Treatment Algorithm for Blood Flow Obstructions in Patients With Left Ventricular Assist Device. J Am Coll Cardiol 2017; 67:2758-2768. [PMID: 27282897 DOI: 10.1016/j.jacc.2016.03.573] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [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: 01/25/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thrombosis is an uncommon, but severe complication of left ventricular assist devices (LVADs). OBJECTIVES This study analyzed experience with obstruction of blood flow through the LVAD with the purpose of developing optimal diagnosis and treatment of LVAD-related thrombosis. METHODS Between October 2009 and July 2015, a total of 652 LVAD were implanted in 557 patients. Blood flow abnormalities in patients with LVAD (n = 524) were identified and classified as "high-power" and "low-flow" events. RESULTS Three types of late blood flow obstructions were identified: 1) pre-pump via thrombus obstructing the inflow cannula (26 events; 0.037 events per patient-year); 2) intra-pump (70 events; 0.1 events per patient-year); and 3) post-pump via thrombosis of the outflow graft or stenosis of the anastomosis to the aorta (4 events; 0.006 events per patient-year). Pre-pump obstruction was treated by washout maneuver in 9 cases (success rate, 100%), thrombolysis in 9 patients (success rate, 56%), and pump exchange in 9 cases (success rate, 100%); 1 patient died without treatment and 2 were weaned from LVAD. Intra-pump obstruction was treated by thrombolysis (n = 9; success rate, 33%), pump exchange (n = 53; success rate, 94%), and removal due to myocardial recovery (n = 3; success rate, 100%); 7 patients died without treatment and parameters spontaneously normalized in 2 cases. Post-pump obstruction was treated in 2 patients by stenting (success rate, 100%), and was left untreated in 2 cases. CONCLUSIONS We identified 3 types of LVAD-related blood flow obstruction, and developed an algorithm for optimal diagnosis and treatment.
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Affiliation(s)
- Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Friedrich Kaufmann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexandra Kretzschmar
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marcus Müller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Panagiotis Pergantis
- Department of Internal Medicine - Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Stephan Dreysse
- Department of Internal Medicine - Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Krabatsch T, Netuka I, Schmitto JD, Zimpfer D, Garbade J, Rao V, Morshuis M, Beyersdorf F, Marasco S, Damme L, Pya Y. Heartmate 3 fully magnetically levitated left ventricular assist device for the treatment of advanced heart failure -1 year results from the Ce mark trial. J Cardiothorac Surg 2017; 12:23. [PMID: 28376837 PMCID: PMC5379553 DOI: 10.1186/s13019-017-0587-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [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: 11/15/2016] [Accepted: 03/24/2017] [Indexed: 12/22/2022] Open
Abstract
Background The HeartMate 3 Left Ventricular Assist System (LVAS) (St. Jude Medical Inc., St Paul, MN) with full magnetic levitation allows for wide and consistent blood flow paths and an artificial pulse designed for enhanced hemocompatibility. The HeartMate 3 received market approval in the European Union in 2015 following completion of a multicenter study. After reaching the 6-month study endpoint, patients continue to be followed for 2 years with the 1-year results presented herein. Methods A prospective, non-randomized study included adults with advanced heart failure and ejection fraction (EF) ≤ 25%, cardiac index (CI) ≤ 2.2 L/min/m2 while not on inotropes, or inotrope dependent, or on optimal medical management for 45/60 days. Results Fifty patients—54% bridge to transplant (BTT) and 46% destination therapy (DT)—were enrolled and implanted with the HeartMate 3. At baseline, 92% of the patients were INTERMACS profiles 2–4, with cardiac index 1.8 + 0.5 L/min/m2 and 58% were supported with inotropes. At 1 year, 74% of the patients remain on support, 18% expired, 6% transplanted, and 2% explanted. The adverse events include 12% gastrointestinal bleeding, 16% driveline infections, 18% strokes, and 2% outflow graft thrombosis. There was no hemolysis, pump thrombosis or pump malfunction through 1 year. The six-minute walk test distance increased from a mean of 273 m to 371 m (P <0.0001). EQ-5D quality-of-life score increased from a mean of 52.7 to 70.8 (P = 0.0006). Conclusions The 1-year HeartMate 3 LVAS results show survival and adverse-event profile are similar to other approved devices, with no pump thrombosis or pump failure. Patient’s functional status and quality of life significantly improved over time. Trial registration Clinicaltrials.gov registration number: NCT02170363. Registered June 19, 2014.
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Affiliation(s)
- Thomas Krabatsch
- German Heart Center, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany.
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Vídenská 1958/9 Praha 4, Prague, Czech Republic
| | - Jan D Schmitto
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Daniel Zimpfer
- University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Jens Garbade
- Heart Center Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Vivek Rao
- Toronto General Hospital, 4N-464 200 Elizabeth St.,, Toronto, ON, M5G 2C4, Canada
| | - Michiel Morshuis
- Herz- und Diabeteszentrum NRW, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Friedhelm Beyersdorf
- University Heart Center Freiburg-Bad Krozingen, Hugstetterstr 55, D-79106, Freiburg, Germany
| | - Silvana Marasco
- The Alfred Hospital, 55 Commercial Road, Prahran, VIC, 3181, Melbourne, Australia
| | - Laura Damme
- St. Jude Medical, 11 Da Vincilaan, Zaventem, 1935, Belgium
| | - Yuriy Pya
- National Research Cardiac Surgery Center, 010000, 38 Turan St., Astana, Kazakhstan
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Hannan M, Xie R, Cowger J, Schueler S, de By T, Dipchand A, Chu V, Cantor R, Koval C, Krabatsch T, Hayward C, Kirklin J. The Epidemiology of Infection in MCS from the IMACS Database: January 2013 to December 2015. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.057] [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: 10/19/2022] Open
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Schönrath F, Kikhney J, Kursawe L, Schönrath K, Schulze J, Potapov E, Krabatsch T, Kaufmann F, Falk V, Moter A. Life on the Driveline. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.639] [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: 10/19/2022] Open
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Vierecke J, Schweiger M, Feldman D, Potapov E, Kaufmann F, Germinario L, Hetzer R, Falk V, Krabatsch T. Emergency procedures for patients with a continuous flow left ventricular assist device. Emerg Med J 2016; 34:831-841. [DOI: 10.1136/emermed-2015-204912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/19/2016] [Accepted: 09/23/2016] [Indexed: 11/03/2022]
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Scandroglio AM, Kaufmann F, Pieri M, Kretzschmar A, Müller M, Pergantis P, Dreysse S, Falk V, Krabatsch T, Potapov EV. Reply: Is 3D Echo With Ramp Test Indicated in Detecting Blood Flow Obstructions in HeartWare LVAD? J Am Coll Cardiol 2016; 68:2127-2128. [PMID: 27810058 DOI: 10.1016/j.jacc.2016.07.777] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 11/24/2022]
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Scandroglio A, Potapov E, Pieri M, Arlt G, Falk V, Krabatsch T. Three-stage treatment of late mediastinitis after implantation of left ventricular assist device. Med Intensiva 2016; 40:514-516. [DOI: 10.1016/j.medin.2016.01.005] [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] [Received: 11/24/2015] [Revised: 01/14/2016] [Accepted: 01/22/2016] [Indexed: 11/25/2022]
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Pieri M, Scandroglio AM, Müller M, Pergantis P, Kretzschmar A, Kaufmann F, Falk V, Krabatsch T, Arlt G, Potapov E, Kukucka M. Surgical management of driveline infections in patients with left ventricular assist devices. J Card Surg 2016; 31:765-771. [PMID: 27766677 DOI: 10.1111/jocs.12860] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Driveline infections in patients with implantable left ventricular assist devices (VAD) carry increasing risk for pump infection, thromboembolic events, decreased quality of life, and increased hospitalization. We report our experience with a surgical technique for refractory driveline infections without mediastinitis consisting of translocation and wrapping of the driveline with greater omentum tissue. METHODS We retrospectively reviewed data of VAD patients who underwent surgical treatment by translocation and wrapping with omentum for severe chronic driveline infection. RESULTS Thirteen patients were treated between January 2010 and October 2015; 12 (92%) were male, and the mean age was 56 ± 14 years. Ten patients (77%) were managed with driveline sheathing with omentum and repositioning with a new exit site, and three (23%), suffering from driveline fistula, with driveline covering with omentum maintaining the previous exit site. Three episodes of postoperative bleeding (23%) required surgical revision. Twelve patients (92%) were discharged from the hospital and one (8%) died. Nine patients (69%) were free from infection at the time of discharge, and three (23%) had recurrence of infection within the first postoperative year. Only four patients (31%) required admission to the intensive care unit; overall median hospital stay was 23 days (range 7-205 days). CONCLUSIONS Driveline relocation with use of omentum is a feasible and effective procedure in selected cases of chronic severe driveline infection. The risk for perioperative bleeding should be taken into consideration and carefully monitored.
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Affiliation(s)
- Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marcus Müller
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Panagiotis Pergantis
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alexandra Kretzschmar
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Friedrich Kaufmann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic Surgery, Charitè Medicine University, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Georg Arlt
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Marian Kukucka
- Department of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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de By TM, Castedo E, Krabatsch T, Mohacsi P, Meyns B, Netuka I, Gummert J. The EUROMACS Registry of patients who receive mechanical circulatory support: Role and perspectives. Cirugía Cardiovascular 2016. [DOI: 10.1016/j.circv.2016.06.012] [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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Potapov EV, Kukucka M, Falk V, Krabatsch T. Biventricular support using 2 HeartMate 3 pumps. J Heart Lung Transplant 2016; 35:1268-1270. [PMID: 27569985 DOI: 10.1016/j.healun.2016.07.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/13/2016] [Accepted: 07/17/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Marian Kukucka
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Department of Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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Zimpfer D, Netuka I, Schmitto JD, Pya Y, Garbade J, Morshuis M, Beyersdorf F, Marasco S, Rao V, Damme L, Sood P, Krabatsch T. Multicentre clinical trial experience with the HeartMate 3 left ventricular assist device: 30-day outcomes. Eur J Cardiothorac Surg 2016; 50:548-54. [PMID: 27436871 DOI: 10.1093/ejcts/ezw169] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 09/06/2015] [Accepted: 01/11/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe the operative experience and 30-day outcomes of patients implanted with the HeartMate 3 Left Ventricular Assist System (LVAS) during the Conformité Européenne (CE) Mark clinical trial. METHODS Adult patients met inclusion and exclusion criteria defining advanced-stage heart failure and included the indications of bridge to transplant and destination therapy. Operative parameters, outcomes, adverse events, physical status and quality-of-life parameters were assessed in the first 30 days after LVAS implant. RESULTS Fifty patients were implanted with the HeartMate 3 at 10 centres in 6 countries. The 30-day survival rate was 98%. The median operative and cardiopulmonary bypass times were 200 (range: 95-585) min and 84 (range: 47-250) min, respectively. Patients required transfusion with packed red blood cells (3.6 ± 2.3 units), fresh frozen plasma (6.5 ± 5 units) and platelets (2 ± 1 units). Six patients (12%) required reoperation for postoperative bleeding and 10 patients (20%) did not require blood transfusion. The median intensive care time was 6 days (range: 1-112 days) and the total hospital stay was 28 days (range: 14-116 days). The most common adverse events were bleeding (15, 30%), arrhythmia (14, 28%) and infection (10, 20%). There were 2 (4%) strokes. CONCLUSIONS The 30-day outcomes following implantation of the HeartMate 3 demonstrates excellent survival with low adverse event rates. The LVAD performed as intended with no haemolysis or device failure. CLINICALTRIALSGOV IDENTIFIER NCT02170363. HeartMate 3™ CE Mark Clinical Investigation Plan (HM3 CE Mark).
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Affiliation(s)
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Yuriy Pya
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | | | - Michiel Morshuis
- Thoracic and Cardiovascular Surgery Clinic, Bad Oeynhausen, Germany
| | | | | | - Vivek Rao
- Toronto General Hospital, Toronto, Canada
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Saito T, Wassilew K, Gorodetski B, Stein J, Falk V, Krabatsch T, Potapov E. Aortic Valve Pathology in Patients Supported by Continuous-Flow Left Ventricular Assist Device. Circ J 2016; 80:1371-7. [PMID: 27151333 DOI: 10.1253/circj.cj-15-1188] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/09/2022]
Abstract
BACKGROUND Continuous-flow left ventricular assist devices (CF-LVAD) may induce pathological changes to the aortic wall and aortic valve. We assessed histological changes in the relevant anatomic structures exposed to continuous flow over time and compared the histological results with clinical features in patients supported with CF-LVAD. METHODS AND RESULTS A retrospective histological analysis was performed of 38 explanted hearts supported with CF-LVAD from patients who received heart transplantation between July 2003 and February 2014. Sections of formalin-fixed paraffin-embedded tissue showing the continuity of aortic wall and left-sided valves were examined histologically. Thickness of aorta, aortic root and aortic valve as well as 3 layers of the aortic cusps were measured individually on Elastica van Gieson-stained slides using specific software. Clinical parameters concerning aortic valve dysfunction were evaluated and validated against the histology. The aortic valve spongiosa and fibrosa layers showed no significant differences in thickness with regard to support duration or occurrence of aortic insufficiency. Longer CF-LVAD support duration correlated with a thinner aortic valve ventricularis layer (rS=-0.496). CONCLUSIONS Long-term CF-LVAD support appears to cause involution of the ventricularis layer of the aortic valve cusp, consistent with more pronounced degenerative change with longer LVAD exposure, which may be explained by continuous coaptation of the cusps. (Circ J 2016; 80: 1371-1377).
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Affiliation(s)
- Tomohiro Saito
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin
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Netuka I, Sood P, Pya Y, Zimpfer D, Krabatsch T, Garbade J, Rao V, Morshuis M, Marasco S, Beyersdorf F, Damme L, Schmitto JD. Fully Magnetically Levitated Left Ventricular Assist System for Treating Advanced HF: A Multicenter Study. J Am Coll Cardiol 2016; 66:2579-2589. [PMID: 26670056 DOI: 10.1016/j.jacc.2015.09.083] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [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: 07/24/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND The HeartMate 3 left ventricular assist system (LVAS) is intended to provide long-term support to patients with advanced heart failure. The centrifugal flow pump is designed for enhanced hemocompatibility by incorporating a magnetically levitated rotor with wide blood-flow paths and an artificial pulse. OBJECTIVES The aim of this single-arm, prospective, multicenter study was to evaluate the performance and safety of this LVAS. METHODS The primary endpoint was 6-month survival compared with INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support)-derived performance goal. Patients were adults with ejection fraction ≤ 25%, cardiac index ≤ 2.2 l/min/m(2) without inotropes or were inotrope-dependent on optimal medical management, or listed for transplant. RESULTS Fifty patients were enrolled at 10 centers. The indications for LVAS support were bridge to transplantation (54%) or destination therapy (46%). At 6 months, 88% of patients continued on support, 4% received transplants, and 8% died. Thirty-day mortality was 2% and 6-month survival 92%, which exceeded the 88% performance goal. Support with the fully magnetically levitated LVAS significantly reduced mortality risk by 66% compared with the Seattle Heart Failure Model-predicted survival of 78% (p = 0.0093). Key adverse events included reoperation for bleeding (14%), driveline infection (10%), gastrointestinal bleeding (8%), and debilitating stroke (modified Rankin Score > 3) (8%). There were no pump exchanges, pump malfunctions, pump thrombosis, or hemolysis events. New York Heart Association classification, 6-min walk test, and quality-of-life scores showed progressive and sustained improvement. CONCLUSIONS The results show that the fully magnetically levitated centrifugal-flow chronic LVAS is safe, with high 30-day and 6-month survival rates, a favorable adverse event profile, and improved quality of life and functional status. (HeartMate 3™ CE Mark Clinical Investigation Plan [HM3 CE Mark]; NCT02170363).
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Affiliation(s)
- Ivan Netuka
- Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | - Poornima Sood
- Clinical Affairs, St. Jude Medical, Burlington, Massachusetts
| | - Yuriy Pya
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | - Jens Garbade
- Heart Center Leipzig, Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany
| | - Vivek Rao
- Toronto General Hospital, Toronto, Canada
| | - Michiel Morshuis
- Thoracic and Cardiovascular Surgery Clinic, Bad Oeynhausen, Germany
| | - Silvana Marasco
- Cardiothoracic Surgical Unit, The Alfred Hospital, Melbourne, Australia
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery Freiburg, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Laura Damme
- Clinical Affairs, St. Jude Medical, Burlington, Massachusetts
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Hanke JS, Krabatsch T, Rojas SV, Deniz E, Ismail I, Martens A, Shrestha M, Haverich A, Netuka I, Schmitto JD. In Vitro Evaluation of Inflow Cannula Fixation Techniques in Left Ventricular Assist Device Surgery. Artif Organs 2016; 41:272-275. [DOI: 10.1111/aor.12735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/12/2016] [Accepted: 02/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jasmin S. Hanke
- Department of Cardiac-; Thoracic-, Transplantation and Vascular Surgery Hannover Medical School; Hannover
| | | | - Sebastian V. Rojas
- Department of Cardiac-; Thoracic-, Transplantation and Vascular Surgery Hannover Medical School; Hannover
| | - Ezin Deniz
- Department of Cardiac-; Thoracic-, Transplantation and Vascular Surgery Hannover Medical School; Hannover
| | - Issam Ismail
- Department of Cardiac-; Thoracic-, Transplantation and Vascular Surgery Hannover Medical School; Hannover
| | - Andreas Martens
- Department of Cardiac-; Thoracic-, Transplantation and Vascular Surgery Hannover Medical School; Hannover
| | - Malakh Shrestha
- Department of Cardiac-; Thoracic-, Transplantation and Vascular Surgery Hannover Medical School; Hannover
| | - Axel Haverich
- Department of Cardiac-; Thoracic-, Transplantation and Vascular Surgery Hannover Medical School; Hannover
| | | | - Jan D. Schmitto
- Department of Cardiac-; Thoracic-, Transplantation and Vascular Surgery Hannover Medical School; Hannover
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Pieri M, Scandroglio A, Arlt G, Falk V, Krabatsch T, Potapov E. Surgical Management of Driveline Infections in Patients with Ventricular Assist Devices. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.723] [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: 10/22/2022] Open
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Teuteberg J, Aaronson K, Mahr C, Reichenspurner H, Krabatsch T, Patel C, Strueber M, Kiernan M, Zimpfer D, Jacoski M, Schueler S. Agreeing to Disagree: A Comparison of Antiplatelet and Anticoagulant Management Strategies at US versus International HVAD Implanting Centers. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1142] [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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Krabatsch T, Schmitto J, Pya Y, Zimpfer D, Garbade J, Rao V, Morshuis M, Marasco S, Beyersdorf F, Sood P, Damme L, Netuka I. HeartMate 3 Fully Magnetically Levitated Left Ventricular Assist Device for the Treatment of Advanced Heart Failure -1 Year Results from the CE Mark Trial. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.024] [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: 10/21/2022] Open
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Pieri M, Arlt G, Müller M, Falk V, Krabatsch T, Potapov E. Surgical Treatment of Mediastinitis with Omentoplasty in Ventricular Assist Device Patients: Report of Referral Center Experience. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.720] [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: 10/22/2022] Open
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Kaufmann F, Krabatsch T. Using medical imaging for the detection of adverse events (“incidents”) during the utilization of left ventricular assist devices in adult patients with advanced heart failure. Expert Rev Med Devices 2016; 13:463-74. [DOI: 10.1586/17434440.2016.1166051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schulz A, Krabatsch T, Schmitto JD, Hetzer R, Seidel M, Dohmen PM, Hotz H. Preliminary Results From the C-Pulse OPTIONS HF European Multicenter Post-Market Study. Med Sci Monit Basic Res 2016; 22:14-9. [PMID: 26887528 PMCID: PMC4792223 DOI: 10.12659/msmbr.896959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The C-Pulse® System is an extra-aortic balloon counterpulsation device. It is used to treat patients with heart failure disease in NYHA functional class III or ambulatory class IV. Material/Methods We present preliminary site-reported 6-month data from 3 centers in Germany as part of the prospective observational post-market OPTIONS HF study. Results Between May 2013 and March 2014, the C-Pulse System was implanted in 8 patients (7 male) with a mean age of 61.6±9.3 years. Four had ischemic and 4 had non-ischemic cardiomyopathy. No stroke, myocardial infarction, major bleeding, or major infection due to the device were reported. One patient developed non-device-related refractory tachycardia with worsening heart failure 12 h after surgery and underwent left ventricular assist device implantation. Within 6 months of observation, functional status improved from NYHA III to II in 5 patients, and 2 remained in NYHA III. Mean left ventricular ejection fraction increased from 24.3±7.9% to 44.5±4.5% (p<0.0001). Mean Kansas City Cardiomyopathy Questionnaire overall score improved from 28.6±19.1 to 59.1±22.5 (p=0.0183). Six-minute walk test was performed in 6 out of 7 patients at follow-up. The mean distance improved from 252.0±85.1 m to 279.2±87.5 m (p>0.05). One patient was weaned off the device after 6 months of support. Conclusions The C-Pulse System provides a therapeutic option for patients with moderate-to-severe heart failure and seems to improve quality of life and cardiac function over time.
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Affiliation(s)
- Antonia Schulz
- Cardio Centrum Berlin, Academic Teaching Institution of Charité, Medical University Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Roland Hetzer
- Cardio Centrum Berlin, Academic Teaching Institution of Charité, Medical University Berlin, Berlin, Germany
| | - Mirko Seidel
- Department of Cardiology, Unfallkrankenhaus Berlin, Academic Teaching Hospital of Charité, Medical University Berlin, Berlin, Germany
| | - Pascal M Dohmen
- Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany
| | - Holger Hotz
- Cardio Centrum Berlin, Academic Teaching Institution of Charité, Medical University Berlin, Berlin, Germany
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Hetzer R, Kaufmann MEng F, Potapov E, Krabatsch T, Delmo Walter EM. Rotary Blood Pumps as Long-Term Mechanical Circulatory Support: A Review of a 15-Year Berlin Experience. Semin Thorac Cardiovasc Surg 2016; 28:12-23. [PMID: 27568128 DOI: 10.1053/j.semtcvs.2016.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/11/2022]
Abstract
This article reports our 15-year single-center experience with rotary blood pumps (RBPs) as long-term mechanical circulatory support (MCS) with emphasis on outcomes. For more than 15-year period, we have used various RBPs as bridge to transplantation or to myocardial recovery. Our group performed the first human implantation worldwide of RBCs, the MicroMed DeBakey ventricular assist device in November 1998 in a patient with end-stage heart failure who was supported for 47 days until his death. Based on this initial experience, we recognized the feasibility of providing long-term support and since then it has been our primary armamentarium in treating patients with heart failure. Between 1987 and September 2013, we have implanted 2208 ventricular assist devices ranging from pulsatile to continuous-flow systems, as short-term, long-term, or permanent support in patients with end-stage heart failure. In total, 1009 RBPs were implanted on 908 patients, and their outcomes are reported here. We have shared some milestones in MCS including the first implantation of Jarvik 2000 on the oldest patient (81-year old) in 2008 and the first worldwide implantation of a biventricular HeartWare. Over time, implantation techniques, anticoagulation, and postoperative care have been modified and individualized. A relevant aspect of our experience has been the incidence of pump thrombosis. This is particularly frustrating because the problem has occurred in the setting of full anticoagulation and antiplatelet therapy, guided by strict anticoagulation monitoring. It has become clear to us that the devices are still not perfect. Technical pump failures such as cable breaks also occur, prompting urgent pump exchange, and infection. A 15-year cumulative mortality rate is 46.9%. This report emphasizes that MCS with RBPs has evolved into a routine treatment in heart failure and is a highly feasible option for permanent therapy particularly for elderly patients.
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Affiliation(s)
- Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Friedrich Kaufmann MEng
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Eva Maria Delmo Walter
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
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Potapov EV, Krabatsch T, Buz S, Falk V, Kempfert J. Cerebral protection system applied during washout of thrombus occluding inflow cannula of HeartWare HVAD left ventricular assist device. J Heart Lung Transplant 2015; 34:1640-1. [DOI: 10.1016/j.healun.2015.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/08/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
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Netuka I, Pya Y, Zimpfer D, Krabatsch T, Garbade J, Rao V, Morshuis M, Marasco S, Beyersdorf F, Sood P, Damme L, Schmitto JD. HeartMate 3, Fully Magnetically Levitated Left Ventricular Assist Device for the Treatment of Advanced Heart Failure –Results from the CE Mark Trial. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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