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Yoo HJ, Shin S. Moving forwards to patient-centred care for patients with ventricular assist devices: A mixed methods study of nurses' perspectives. Intensive Crit Care Nurs 2024; 82:103635. [PMID: 38340544 DOI: 10.1016/j.iccn.2024.103635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To identify nurses' caring behaviours toward patients with left ventricular assist devices and deepen their understanding of experiences in nursing care. Patients with left ventricular assist devices require care in many aspects, but there is limited in-depth research about caring behaviours and experiences from the perspective of nurses providing care. RESEARCH METHODOLOGY/DESIGN Mixed methods study with a sequential explanatory design. Data were collected from clinical nurses with experience caring for patients using left ventricular assist devices in South Korea between May-August 2022. MAIN OUTCOME MEASURES Quantitative data (n = 79) were collected through an online survey of the Caring Behaviours Inventory - 24 and analysed using descriptive statistics. For qualitative data (n = 15), nurses' caring experiences were collected through individual interviews and analysed using Colaizzi's phenomenological method. RESULTS The overall average of caring behaviours was 4.80 ± 0.85, specifically, 'knowledge and skill' (5.04 ± 0.78), 'assurance' (5.01 ± 0.79), 'respect' (4.85 ± 0.90), and 'connectedness' (4.04 ± 0.99), respectively. The experience of caring was trapped in the uncomfortable reality of left ventricular assist device nursing, causing device-focused care, and approaching the essence of nursing through care focused on the patient's wholeness. CONCLUSIONS Caring for patients with a left ventricular assist devices was challenging for nurses. However, through the care process, they realised the meaning of patient-centred care, reflected in the essence of nursing, and sublimated it into an opportunity to grow. IMPLICATIONS FOR CLINICAL PRACTICE Nurses must focus on patient-centred care for left ventricular assist devices. To achieve this, it is essential to create a clinical environment and educational system for nurses to provide effective nursing care and enhance patient participation.
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Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, South Korea
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2
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Chehade M, Murali KP, Dickson VV, McCarthy MM. Intersection of social determinants of health with ventricular assist device therapy: An integrative review. Heart Lung 2024; 66:56-70. [PMID: 38583277 DOI: 10.1016/j.hrtlng.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) may influence the clinical management of patients with heart failure. Further research is warranted on the relationship between SDOH and Ventricular Assist Device (VAD) therapy for heart failure. OBJECTIVES The purpose of this integrative review was to synthesize the state of knowledge on the intersection of SDOH with VAD therapy. METHODS Guided by Whittemore and Knafl's methodology, this literature search captured three concepts of interest including VAD therapy, SDOH, and their domains of intersection with patient selection, decision-making, treatment outcome, and resource allocation. CINAHL, Embase, PsycINFO, PubMed, and Web of Science were searched in March 2023. Articles were included if they were peer-reviewed publications in English, published between 2006 and 2023, conducted in the United States, and examined VAD therapy in the context of adult patients (age ≥ 18 years). RESULTS 22 quantitative studies meeting the inclusion criteria informed the conceptualization of SDOH using the Healthy People 2030 framework. Four themes captured how the identified SDOH intersected with different processes relating to VAD therapy: patient decision-making, healthcare access and resource allocation, patient selection, and treatment outcomes. Most studies addressed the intersection of SDOH with healthcare access and treatment outcomes. CONCLUSION This review highlights substantial gaps in understanding how SDOH intersect with patient and patient selection for VAD. More research using mixed methods designs is warranted. On an institutional level, addressing bias and discrimination may have mitigated health disparities with treatment outcomes, but further research is needed for implementing system-wide change. Standardized assessment of SDOH is recommended throughout clinical practice from patient selection to outpatient VAD care.
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Affiliation(s)
- Mireille Chehade
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States.
| | - Komal Patel Murali
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
| | - Victoria Vaughan Dickson
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
| | - Margaret M McCarthy
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
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3
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Kim JH, Kim JH, Kim AY, Shin YR. Successful Bridge to Heart Transplantation through Ventricular Assist Device Implantation and Concomitant Fontan Completion in a Patient with Glenn Physiology: A Case Report. J Chest Surg 2024; 57:312-314. [PMID: 38057952 PMCID: PMC11089050 DOI: 10.5090/jcs.23.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023] Open
Abstract
A 3-year-old boy with Glenn physiology exhibited refractory heart failure with reduced ejection fraction. To improve the patient's oxygen saturation, he underwent ventricular assist device (VAD) implantation with concomitant Fontan completion. The extracardiac conduit Fontan operation was performed with a 4-mm fenestration. For VAD implantation, Berlin Heart cannulas were positioned at the left ventricular apex and the neo-aorta. Following weaning from cardiopulmonary bypass, a temporary continuous-flow VAD, equipped with an oxygenator, was utilized for support. After a stabilization period of 1 week, the continuous-flow VAD was replaced with a durable pulsatile-flow device. Following 3 months of support, the patient underwent transplantation without complications. The completion of the Fontan procedure at the time of VAD implantation, along with the use of a temporary continuous-flow device with an oxygenator, may aid in stabilizing postoperative hemodynamics. This approach could contribute to a safe transition to a durable pulsatile VAD in patients with Glenn physiology.
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Affiliation(s)
- Ji Hong Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Kim
- Department of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Rim Shin
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Soghoyan KZ, Guglin M. Durable ventricular assist device in adult patients with single ventricle: a systematic literature review. Heart Fail Rev 2024; 29:707-711. [PMID: 38341840 DOI: 10.1007/s10741-024-10391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
The worldwide experience with mechanical circulatory support in adult patients with single ventricle and Fontan palliation is limited. We aimed to see the outcomes in such patients on durable left ventricular assist device. We systematically reviewed the English language literature found on PubMed and Google Scholar, searching the terms "Fontan," "single ventricle," "ventricular assist device," "LVAD," and "mechanical circulatory support," and selected all individual cases with reported outcomes. We identified 4 patients on pulsatile left ventricular assist device, all of whom were successfully bridged to transplant, and 15 patients on continuous flow LVAD, age 25.9 ± 5.8, predominantly males. Mean time on LVAD support was 718.6 ± 616.5 days, and only 2 patients (13.3%) died. Durable left ventricular assist device support in adult patients with Fontan provides excellent results and should be used more frequently.
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Affiliation(s)
- Kengo Z Soghoyan
- Krannert Institute of Cardiology, Indiana University School of Medicine, 1801 Senate Blvd Suite 2000, Indianapolis, IN, 46202, USA
| | - Maya Guglin
- Krannert Institute of Cardiology, Indiana University School of Medicine, 1801 Senate Blvd Suite 2000, Indianapolis, IN, 46202, USA.
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Tadokoro N, Tonai K, Kainuma S, Kawamoto N, Suzuki K, Hirayama M, Fukushima S. Management of aortic valve insufficiency in patients with continuous-flow left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs. J Artif Organs 2024:10.1007/s10047-024-01439-x. [PMID: 38594483 DOI: 10.1007/s10047-024-01439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
Since 2011, implantable ventricular assist devices have been a standard treatment for severe heart failure alongside heart transplantation in Japan. However, the limited availability of donors has led to a prolonged wait for transplants, now averaging 1719 days, intensifying the issue of aortic insufficiency in patients with continuous flow ventricular assist devices. These devices limit the opening of the aortic valve, leading to sustained closure and increased shear stress, which accelerates valve degradation. Risk factors for aortic insufficiency include having a smaller body surface area, being of advanced age, and the presence of mild aortic insufficiency prior to device implantation. In patients presenting with mild or moderate aortic regurgitation at the time of ventricular assist device implantation, interventions such as aortic valve repair or bioprosthetic valve replacement are performed with the aim of halting its progression. The choice of surgical procedure should be tailored to each patient's individual condition. The management of de novo aortic insufficiency in patients with continuous flow ventricular assist devices remains challenging, with no clear consensus on when to intervene. Interventions for significant aortic insufficiency typically consider the patient's symptoms and aortic insufficiency severity. De novo aortic insufficiency progression in continuous flow ventricular assist devices patients necessitates careful monitoring and intervention based on individual patient assessments and valve condition. This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2023 (Vol. 52, No. 1, pp. 77-80), with some modifications.
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Affiliation(s)
- Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
| | - Kohei Tonai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Kota Suzuki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Masaya Hirayama
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
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Brandewie K, Lorts A, Luchtman-Jones L, Gao Z, Geer B, Villa C, Perry T. Impact of inflammation and steroids on anti-coagulation in children supported on a ventricular assist device. J Artif Organs 2024:10.1007/s10047-024-01442-2. [PMID: 38581568 DOI: 10.1007/s10047-024-01442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/06/2024] [Indexed: 04/08/2024]
Abstract
Critically ill pediatric patients supported on ventricular assist devices (VADs) are increasingly being anticoagulated on bivalirudin, but with difficulty monitoring anticoagulation. Activated partial thromboplastin time (aPTT) has recently been shown to poorly correlate with bivalirudin plasma concentrations, while dTT had excellent correlation. However, aPTT is the more common monitoring test and dTT testing is rarely used. In addition, effects of frequent clinical VAD scenarios (such as inflammation) on the accuracy of aPTT and dTT testing remains uncertain. We reviewed the effects of clinical scenarios (infection/inflammation, chylothorax, and steroids administration) on anticoagulation monitoring in 10 pediatric VAD patients less than 3 years at Cincinnati Children's Hospital Medical Center from 10/27/2020 to 5/6/2022 using bivalirudin for anticoagulation. There were 16 inflammation/infection, 3 chylothorax, and 6 steroids events. Correlation between dTT and aPTT was significantly lower after infection/inflammation, with dTT increasing prior to inflammation/infection while aPTT remained unchanged. In addition, steroids are administered to VAD patients to reduce inflammation and thus additionally stabilize anticoagulation. However, this anticoagulation stabilization effect was reflected more accurately by dTT compared to aPTT. In children requiring VAD support utilizing bivalirudin anticoagulation, inflammation/infection is a common occurrence resulting in anticoagulation changes that may be more accurately reflected by dTT as opposed to aPTT.
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Affiliation(s)
- Katie Brandewie
- Cincinnati Children's Hospital Medical Center, Main Street, Cincinnati, OH, 77030, USA.
| | - Angela Lorts
- Cincinnati Children's Hospital Medical Center, Main Street, Cincinnati, OH, 77030, USA
| | - Lori Luchtman-Jones
- Cincinnati Children's Hospital Medical Center, Main Street, Cincinnati, OH, 77030, USA
| | - Zhiqian Gao
- Cincinnati Children's Hospital Medical Center, Main Street, Cincinnati, OH, 77030, USA
| | - Becca Geer
- Cincinnati Children's Hospital Medical Center, Main Street, Cincinnati, OH, 77030, USA
| | - Chet Villa
- Cincinnati Children's Hospital Medical Center, Main Street, Cincinnati, OH, 77030, USA
| | - Tanya Perry
- Cincinnati Children's Hospital Medical Center, Main Street, Cincinnati, OH, 77030, USA.
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7
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Idrovo A, Hollander SA, Neumayr TM, Bell C, Munoz G, Choudhry S, Price J, Adachi I, Srivaths P, Sutherland S, Akcan-Arikan A. Long-term kidney outcomes in pediatric continuous-flow ventricular assist device patients. Pediatr Nephrol 2024; 39:1289-1300. [PMID: 37971519 DOI: 10.1007/s00467-023-06190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Continuous-flow ventricular assist devices (CF-VADs) are used increasingly in pediatric end-stage heart failure (ESHF) patients. Alongside common risk factors like oxidant injury from hemolysis, non-pulsatile flow constitutes a unique circulatory stress on kidneys. Post-implantation recovery after acute kidney injury (AKI) is commonly reported, but long-term kidney outcomes or factors implicated in the evolution of chronic kidney disease (CKD) with prolonged CF-VAD support are unknown. METHODS We studied ESHF patients supported > 90 days on CF-VAD from 2008 to 2018. The primary outcome was CKD (per Kidney Disease Improving Global Outcomes (KDIGO) criteria). Secondary outcomes included AKI incidence post-implantation and CKD evolution in the 6-12 months of CF-VAD support. RESULTS We enrolled 134 patients; 84/134 (63%) were male, median age was 13 [IQR 9.9, 15.9] years, 72/134 (54%) had preexisting CKD at implantation, and 85/134 (63%) had AKI. At 3 months, of the 91/134 (68%) still on a CF-VAD, 34/91 (37%) never had CKD, 13/91 (14%) developed de novo CKD, while CKD persisted or worsened in 49% (44/91). Etiology of heart failure, extracorporeal membrane oxygenation use, duration of CF-VAD, AKI history, and kidney replacement therapy were not associated with different CKD outcomes. Mortality was higher in those with AKI or preexisting CKD. CONCLUSIONS In the first multicenter study to focus on kidney outcomes for pediatric long-term CF-VAD patients, preimplantation CKD and peri-implantation AKI were common. Both de novo CKD and worsening CKD can happen on prolonged CF-VAD support. Proactive kidney function monitoring and targeted follow-up are important to optimize outcomes.
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Affiliation(s)
- Alexandra Idrovo
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's, Houston, TX, USA.
- Renal Section, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Seth A Hollander
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tara M Neumayr
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School, St. Louis, MO, USA
- Division of Nephrology, Department of Pediatrics, Washington University School, St. Louis, MO, USA
| | - Cynthia Bell
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Genevieve Munoz
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School, St. Louis, MO, USA
| | - Swati Choudhry
- Pediatrics, Cardiology Section, Baylor College of Medicine/Texas Children's, Houston, TX, USA
| | - Jack Price
- Pediatrics, Cardiology Section, Baylor College of Medicine/Texas Children's, Houston, TX, USA
| | - Iki Adachi
- Division of Congenital Heart Surgery, Department of Pediatrics, Baylor College of Medicine/Texas Children's, Houston, TX, USA
| | - Poyyapakkam Srivaths
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's, Houston, TX, USA
| | - Scott Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ayse Akcan-Arikan
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's, Houston, TX, USA
- Department of Pediatrics Critical Care Section, Baylor College of Medicine, Texas Children's, Houston, TX, USA
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8
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Alonso-Gonzalez R, Agorrody G. Special Considerations for Mechanical Circulatory Support or Device Therapy in Adult Congenital Heart Disease Heart Failure. Heart Fail Clin 2024; 20:155-165. [PMID: 38462320 DOI: 10.1016/j.hfc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heart failure has become the leading cause of mortality in adult congenital heart disease (ACHD) patients after the fifth decade of life. There is scanty evidence supporting the use of guideline-directed medical therapy in ACHD, especially in systemic right ventricle or single ventricle physiology. In complex patients, diagnosing heart failure and timely referral for advanced therapies are challenging. Mechanical circulatory support has been significantly developed over the past decade and has recently emerged as a feasible therapeutic option for these patients. This review summarizes current evidence of mechanical circulatory support in this population, its potential uses, and challenges.
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Affiliation(s)
- Rafael Alonso-Gonzalez
- Toronto ACHD Program, Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Avenue, 5N-525, Toronto, Ontario, M5G 2N2, Canada.
| | - Guillermo Agorrody
- Toronto ACHD Program, Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Avenue, 5N-525, Toronto, Ontario, M5G 2N2, Canada
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Huang X, Shen Y, Liu Y, Zhang H. Current status and future directions in pediatric ventricular assist device. Heart Fail Rev 2024:10.1007/s10741-024-10396-9. [PMID: 38530587 DOI: 10.1007/s10741-024-10396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
A ventricular assist device (VAD) is a form of mechanical circulatory support that uses a mechanical pump to partially or fully take over the function of a failed heart. In recent decades, the VAD has become a crucial option in the treatment of end-stage heart failure in adult patients. However, due to the lack of suitable devices and more complicated patient profiles, this therapeutic approach is still not widely used for pediatric populations. This article reviews the clinically available devices, adverse events, and future directions of design and implementation in pediatric VADs.
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Affiliation(s)
- Xu Huang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
| | - Yi Shen
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
| | - Yiwei Liu
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
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10
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Umetsu A, Taira M, Hasegawa M, Watanabe T, Tominaga Y, Ueno T, Yoshioka D, Shimamura K, Miyagawa S. Left ventricular assist device temporary explantation as a strategy for infection control in a pediatric patient. J Artif Organs 2024:10.1007/s10047-024-01432-4. [PMID: 38520590 DOI: 10.1007/s10047-024-01432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/30/2023] [Indexed: 03/25/2024]
Abstract
We report a case of temporary Berlin Heart EXCOR® explantation in a pediatric patient with idiopathic dilated cardiomyopathy who suffered an uncontrollable inflow cannulation site infection while on bridge-to-transplantation. Despite failure to thrive and catheter-related infections, once free of the device, the patient was cured of infection using systemic antibiotics and surgical debridement. The patient underwent EXCOR® reimplantation after four months, and is awaiting heart transplantation in stable condition. A life-threatening ventricular assist device-related infection may require device explantation under conditions that may not fulfill conventional explantation criteria despite risks. Temporary explantation can be an effective strategy if isolated systolic dysfunction is managed carefully.
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Affiliation(s)
- Akiko Umetsu
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Taira
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Moyu Hasegawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takuji Watanabe
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuji Tominaga
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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11
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Rosales RM, Mountris KA, Oliván-Viguera A, Pérez-Zabalza M, Cedillo-Servin G, Iglesias-García O, Hrynevich A, Castilho M, Malda J, Prósper F, Doblaré M, Mazo MM, Pueyo E. Experimentally-guided in silico design of engineered heart tissues to improve cardiac electrical function after myocardial infarction. Comput Biol Med 2024; 171:108044. [PMID: 38335818 DOI: 10.1016/j.compbiomed.2024.108044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/23/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
Engineered heart tissues (EHTs) built from human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) showed promising results for cardiac function restoration following myocardial infarction. Nevertheless, human iPSC-CMs have longer action potential and lower cell-to-cell coupling than adult-like CMs. These immature electrophysiological properties favor arrhythmias due to the generation of electrophysiological gradients when hiPSC-CMs are injected in the cardiac tissue. Culturing hiPSC-CMs on three-dimensional (3D) scaffolds can promote their maturation and influence their alignment. However, it is still uncertain how on-scaffold culturing influences the overall electrophysiology of the in vitro and implanted EHTs, as it requires expensive and time consuming experimentation. Here, we computationally investigated the impact of the scaffold design on the EHT electrical depolarization and repolarization before and after engraftment on infarcted tissue. We first acquired and processed electrical recordings from in vitro EHTs, which we used to calibrate the modeling and simulation of in silico EHTs to replicate experimental outcomes. Next, we built in silico EHT models for a range of scaffold pore sizes, shapes (square, rectangular, auxetic, hexagonal) and thicknesses. In this setup, we found that scaffolds made of small (0.2 mm2), elongated (30° half-angle) hexagons led to faster EHT activation and better mimicked the cardiac anisotropy. The scaffold thickness had a marginal role on the not engrafted EHT electrophysiology. Moreover, EHT engraftment on infarcted tissue showed that the EHT conductivity should be at least 5% of that in healthy tissue for bidirectional EHT-myocardium electrical propagation. For conductivities above such threshold, the scaffold made of small elongated hexagons led to the lowest activation time (AT) in the coupled EHT-myocardium. If the EHT conductivity was further increased and the hiPSC-CMs were uniformly oriented parallel to the epicardial cells, the total AT and the repolarization time gradient decreased substantially, thus minimizing the likelihood for arrhythmias after EHT transplantation.
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Affiliation(s)
- Ricardo M Rosales
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Aragón, Spain; CIBER-BBN, ISCIII, Madrid, Spain; Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Aragón, Spain.
| | | | - Aida Oliván-Viguera
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Aragón, Spain; CIBER-BBN, ISCIII, Madrid, Spain; Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Aragón, Spain.
| | - María Pérez-Zabalza
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Aragón, Spain; CIBER-BBN, ISCIII, Madrid, Spain; Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Aragón, Spain; Defense University Centre (CUD), Zaragoza, Spain.
| | - Gerardo Cedillo-Servin
- Regenerative Medicine Center, Utrecht, The Netherlands; Department of Orthopedics, University Medical Center, Utrecht, The Netherlands.
| | - Olalla Iglesias-García
- Regenerative Medicine Program, CIMA Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Spain.
| | - Andrei Hrynevich
- Regenerative Medicine Center, Utrecht, The Netherlands; Department of Orthopedics, University Medical Center, Utrecht, The Netherlands.
| | - Miguel Castilho
- Department of Orthopedics, University Medical Center, Utrecht, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Jos Malda
- Regenerative Medicine Center, Utrecht, The Netherlands; Department of Orthopedics, University Medical Center, Utrecht, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
| | - Felipe Prósper
- Regenerative Medicine Program, CIMA Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Spain; Hematology and Cell Therapy, Clínica Universidad de Navarra, Pamplona, Spain; CIBER de Cáncer (CIBERONC, team CB16/12/00489), Pamplona, Spain.
| | - Manuel Doblaré
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Aragón, Spain; CIBER-BBN, ISCIII, Madrid, Spain; Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Aragón, Spain.
| | - Manuel M Mazo
- Regenerative Medicine Program, CIMA Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Spain; Hematology and Cell Therapy, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Esther Pueyo
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Aragón, Spain; CIBER-BBN, ISCIII, Madrid, Spain; Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Aragón, Spain.
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12
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Mitra A, Castleberry A, Urban M, Siddique A. Does concomitant tricuspid valve intervention at the time of left ventricular assist device placement for patients with significant tricuspid regurgitation lead to improved outcomes compared to isolated left ventricular assist device placement? Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae005. [PMID: 38216526 PMCID: PMC10850842 DOI: 10.1093/icvts/ivae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with advanced heart failure (HF) and moderate to severe functional tricuspid regurgitation (TR) undergoing left ventricular assist device (LVAD) placement is concomitant tricuspid valve intervention (TVI) superior for the clinical outcomes of survival, right ventricular failure, rehospitalizations for HF, functional status, and quality of life?' Altogether, 56 papers were found using the reported search, of which 12 papers represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Our search found no significant clinical benefit for concomitant TVI at the time of LVAD placement. We conclude that patient with moderate-to-severe TR should not routinely undergo concomitant TVI with LVAD placement.
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Affiliation(s)
- Ananya Mitra
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anthony Castleberry
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marian Urban
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Aleem Siddique
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE, USA
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Jimba T, Hatano M, Fujiwara T, Akazawa H, Watanabe M, Kinugawa K, Ono M, Komuro I. A case of progressive right ventricular failure with ventricular arrhythmia and aortic insufficiency after implantable left ventricular assist device implantation. J Cardiol Cases 2024; 29:7-10. [PMID: 38188322 PMCID: PMC10770093 DOI: 10.1016/j.jccase.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 01/09/2024] Open
Abstract
Right ventricular failure (RVF) is a serious complication after left ventricular assist device (LVAD) implantation. In this report, a case of RVF that developed over two years after LVAD implantation is presented. The patient was a 12-year-old male with dilated phase of hypertrophic cardiomyopathy. He had no risk factors for early or late-onset RVF. However, his right ventricular function worsened after he developed ventricular arrhythmia (VA), and right ventricular dysfunction became exacerbated with an increasing frequency of VAs. He also developed moderate aortic insufficiency (AI), which became severe. Two years after implantation, he was admitted for treatment of recurrent ventricular tachycardia and became inotropic-dependent during hospitalization. Finally, he underwent successful heart transplantation 2 years and 9 months after LVAD implantation. This case suggests that vicious cycle of RV dysfunction, recurrent VAs and severe AI could lead to RVF in patients without known risk factors for RVF, even long after LVAD implantation. Learning objective This report shows a progressive right ventricular failure (RVF) two years after left ventricular assist device (LVAD) implantation. Although the patient had no known risk factor, vicious circle of RV dysfunction, ventricular arrhythmias (VAs) and aortic insufficiency (AI) lead to RVF. Patients with LVAD as destination therapy will increase and require long-term LVAD management. We should recognize that these patients could develop RVF even years after LVAD implantation in association with VAs and AI.
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Affiliation(s)
- Takahiro Jimba
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaru Hatano
- Department of Advanced Medical Center for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Fujiwara
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Akazawa
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Minoru Ono
- Department of Thoracic Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Hsu CY, Tzeng IS, Song JY, Tsai KT, Shen TC. Extended and Safe Support with the CentriMag® Temporary Ventricular Assist Device Implanted with Skirted-Cannula Technique. Acta Cardiol Sin 2024; 40:70-76. [PMID: 38264079 PMCID: PMC10801426 DOI: 10.6515/acs.202401_40(1).20230817a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/17/2023] [Indexed: 01/25/2024]
Abstract
Objectives CentriMag® (Abbott, Pleasanton, CA, USA) is indicated for temporary circulatory support for up to 30 days. Extended support is not uncommon, and the results vary considerably. Herein, we review our experience on extended support. Methods We retrospectively analyzed 19 patients supported with CentriMag as a bridge to recovery, long-term ventricular assist device or transplantation from September 2011 to October 2021. Results Nineteen patients (16 men and 3 women; mean age 51.7 ± 9.2 years) had CentriMag left ventricular assist device (LVAD) implantation with the skirted-cannula technique. Twelve (63.2%), 6 (31.6%), and 1 (5.3%) patient were in INTERMACS 1, 2, and 3, respectively. The aims of support were bridge-to-decision in 3 patients (15.8%), and bridge-to-transplantation in 16 patients (84.2%). Fourteen patients were supported for longer than 30 days, while 5 patients had their CentriMag removed before 30 days. Of the 5 patients supported for less than 30 days, 3 died early after implantation due to complications of prolonged shock. The other 2 patients were successfully transplanted. Among the 14 patients supported for longer than 30 days, 1 patient died after transplantation and 13 patients survived either after transplantation or weaning off CentriMag. The overall 1-year survival rate was 73.7%. The duration of support for all patients ranged from 6 to 191 days (64 ± 61 days; median 41 days). Conclusions The skirted cannula technique for apical cannulation in implantation of CentriMag LVAD is an easy, safe and durable technique. Immediate post-operative and long-term complications are not common. Its use over 30 days is associated with acceptable survival.
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Affiliation(s)
- Chan-Yang Hsu
- Division of Cardiovascular Surgery, Department of Surgery
| | - I-Shiang Tzeng
- Department of Research, Cooperative Research Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Jenn-Yeu Song
- Division of Cardiovascular Surgery, Department of Surgery
| | - Kuei-Ton Tsai
- Division of Cardiovascular Surgery, Department of Surgery
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ta-Chung Shen
- Division of Cardiovascular Surgery, Department of Surgery
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Spielmann H, Albert W, Semmig-Könze S, Lauenroth V, Spitz-Köberich C, Staus P, Tigges-Limmer K, Kugler C. High level of psychosocial adjustment in patients on ongoing ventricular assist device support in the years one to three after VAD implantation-A national multi-center Study. Heart Lung 2024; 63:92-97. [PMID: 37837720 DOI: 10.1016/j.hrtlng.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Advanced heart failure therapies such as durable ventricular assist device (VAD) support require psychosocial adjustment for those affected. Since VAD implantation has become an established treatment strategy, a focus on psychosocial factors is needed. OBJECTIVES To investigate the construct of psychosocial adjustment and to further understand the role of social support. METHODS In a nation-wide, multi-center, cross-sectional study, we recruited 393 participants with ongoing VAD support (3mts-3yrs on device; clinicaltrials.gov ID: NCT04234230). Patient demographics, psychosocial adjustment (perceived social support, anxiety, depression, and quality of life), and major adverse events (thromboembolic events, bleeding, driveline infections) were assessed. RESULTS Overall, 85.8 % of the sample were male; mean age was 58.3 years (range 18-85). The majority of the sample (89.3 %) reported normal to high perceived social support. Participants expressed symptoms of anxiety within the normal range (M=6.0±3.9), mildly elevated depressive symptoms (HADS: M=7.6±2.9; PHQ-9: M=6.2±4.7), and good quality of life (KCCQ: M=65.3±17.9). Higher perceived social support was associated with lower levels of anxiety and depression, and higher levels of quality of life within our sample (all p<0.001). Driveline infection was the most prevalent adverse event (0.304 infections per person-years [32.6 % of patients]). Binary logistic regression models did not identify significant associations for the occurrence of adverse events and variables of psychosocial adjustment. CONCLUSION Our sample perceived high levels of psychosocial adjustment. High perceived social support was associated with better outcomes in levels of anxiety, depression, and quality of life, demonstrating potential for the future development and evaluation of targeted multi-professional social support interventions including peer- and caregiver support.
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Affiliation(s)
- Hannah Spielmann
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Breisacher Str. 153, Freiburg 79110, Germany
| | | | | | - Volker Lauenroth
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christine Spitz-Köberich
- Department Pediatric Cardiology, Medical Center - University of Freiburg, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Paulina Staus
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Germany
| | - Katharina Tigges-Limmer
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christiane Kugler
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Breisacher Str. 153, Freiburg 79110, Germany.
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Oran E, Abo-Serie E, Jewkes J, Henry M, Oran B. Design and optimisation of an Intra-Aortic Shrouded rotor axial pump. J Biomech 2024; 162:111858. [PMID: 37989028 DOI: 10.1016/j.jbiomech.2023.111858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
Undesirable side effects in patients with a LVAD (Left Ventricular Assist Device) pump fitted include blood damage, thrombosis, blood traumatisation, and End-Organ Disfunctions. These side effects have generally been attributed to the high wall shear stresses and the induced turbulent flow. In this study, we introduce a novel design to address these effects by lowering the rotational speed and providing an optimum flow path design to minimise blood damage. We present an initial scheme for a new Intra-Aortic Shrouded Rotary Axial Pump and develop a sequence of pump geometries, for which the Taguchi Design Optimisation Method has been applied. We apply CFD tools to simulate the pressure rise, pump performance, hydraulic efficiency, wall shear stress, exposure time and mass flow rate. A prototype pump has been tested in a mock cardiovascular circuit using a water-glycerol solution. The optimum design delivered the desired pressure/mass flow rate characteristics at a significantly low rpm (2900 rpm). As a result, the estimated blood damage index is low, matching the design requirements. The theoretical performance was matched by experimental results.
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Affiliation(s)
- Elif Oran
- Coventry University, Centre for Fluid and Complex Systems, Coventry, UK
| | - Essam Abo-Serie
- University of Leicester, School of Engineering, Leicester, UK.
| | - James Jewkes
- University of Leicester, School of Engineering, Leicester, UK
| | - Manus Henry
- Coventry University, Centre for Fluid and Complex Systems, Coventry, UK; University of Oxford, Department of Engineering Science, Oxford, UK
| | - Bulent Oran
- Medicana International Hospital, Department of Pediatric Cardiology, Izmir, Turkey
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17
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Hérion FX, Beurton A, Oddos C, Nubret K, Aguerreche C, Quessard A, Faure M, Gerbaud E, Pernot M, Imbault J, Ouattara A. Multidisciplinary cardiogenic shock team approach improves the long-term outcomes of patients suffering from refractory cardiogenic shock treated with short-term mechanical circulatory support. Eur Heart J Acute Cardiovasc Care 2023; 12:821-830. [PMID: 37713615 DOI: 10.1093/ehjacc/zuad108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Abstract
AIMS Short-term mechanical circulatory support (STMCS) may be used as an intentional escalation strategy to treat refractory cardiogenic shock (rCS). However, with growing technical possibilities, making the right choice at the right time can be challenging. We established a shock team in January 2013 comprising a cardiac anaesthetist-intensivist, an interventional cardiologist, and a cardiac surgeon. Since then, a diagnosis of rCS has triggered a multidisciplinary team meeting based on a common algorithm. This study aimed to compare the decision-making process for STMCS for rCS before (2007-2013) and after (2013-2019) the creation of the shock team. METHODS AND RESULTS This before-and-after cohort study was conducted over a 156-month period. Post-cardiotomy rCS were excluded. The primary outcome was a 1-year survival rate. In total, 250 consecutive adult patients were included in the analysis (84 in the control group and 166 in the shock team group). At baseline, the CardShock score was not different between the two groups (5[3-5] vs. 5[4-6], P = 0.323). The 1-year survival rate was significantly higher in the shock team group compared with the control group (59% vs. 45%, P = 0.043). After a Cox regression analysis, the shock team intervention was independently associated with a significantly improved 1-year survival rate (HR: 0.592, 95% CI: 0.398-0.880, P = 0.010). CONCLUSION A multidisciplinary shock team-based decision for STMCS device implantation in rCS is associated with better 1-year survival rates.
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Affiliation(s)
- François-Xavier Hérion
- Department of Cardiovascular Anaesthesia and Critical Care, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
- University Bordeaux, INSERM, U1034 Biologie des maladies cardiovasculaires, 1 Av. Magellan, 33600 Pessac, France
| | - Antoine Beurton
- Department of Cardiovascular Anaesthesia and Critical Care, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
- University Bordeaux, INSERM, U1034 Biologie des maladies cardiovasculaires, 1 Av. Magellan, 33600 Pessac, France
| | - Claire Oddos
- Department of Cardiovascular Anaesthesia and Critical Care, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
| | - Karine Nubret
- Heart Failure Unit, Cardiology Department, Hôpital Cardiologique du Haut Lévêque, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
| | - Clément Aguerreche
- Department of Cardiovascular Anaesthesia and Critical Care, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
| | - Astrid Quessard
- Department of Cardiovascular Anaesthesia and Critical Care, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
| | - Maxime Faure
- Heart Failure Unit, Cardiology Department, Hôpital Cardiologique du Haut Lévêque, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
| | - Edouard Gerbaud
- Department of Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, University Hospital of Bordeaux, Plateforme Technologique d'Innovation Biomédicale, Avenue du Haut Lévêque, 33600 Pessac, France
| | - Mathieu Pernot
- University Bordeaux, INSERM, U1034 Biologie des maladies cardiovasculaires, 1 Av. Magellan, 33600 Pessac, France
- Department of Cardiovascular Surgery, Hôpital Cardiologique du Haut Lévêque, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
| | - Julien Imbault
- Department of Cardiovascular Anaesthesia and Critical Care, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
- University Bordeaux, INSERM, U1034 Biologie des maladies cardiovasculaires, 1 Av. Magellan, 33600 Pessac, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anaesthesia and Critical Care, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France
- University Bordeaux, INSERM, U1034 Biologie des maladies cardiovasculaires, 1 Av. Magellan, 33600 Pessac, France
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Furukawa S, Kinoshita O, Ando M, Ono M. EVAHEART 2 with double cuff tipless inflow cannula is suitable for long-term support atrial switch operation in transposition of great arteries. J Artif Organs 2023; 26:326-329. [PMID: 36690768 DOI: 10.1007/s10047-023-01380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/31/2022] [Indexed: 01/25/2023]
Abstract
Implantation of continuous-flow left ventricular assist device in a narrow lumen is technically challenging to secure an optimal support. We experienced a patient with the transposition of the great arteries after the Senning procedure who was initially implanted with Jarvik 2000®. She presented with worsening heart failure symptoms 2 years after implanting Jarvik 2000®. We assumed that the inflow cannula was stuck in the highly developed trabeculae on the interventricular septum, which disturbed the VAD to maintain an expected support. After converting to the EVAHEART® 2, we successfully obtained an adequate inflow. We consider that the tipless cannula of EVAHEART® 2 is the most suitable when there is no sufficient room to place a conventional inflow cannula in the systemic ventricle.
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Affiliation(s)
- Sawako Furukawa
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Osamu Kinoshita
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Masahiko Ando
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Barua S, Conte SM, Cherrett C, Kearney KL, Robson D, Bragg C, Macdonald PS, Muthiah K, Hayward CS. Major adverse kidney events predict reduced survival in ventricular assist device supported patients. ESC Heart Fail 2023; 10:3463-3471. [PMID: 37712126 PMCID: PMC10682875 DOI: 10.1002/ehf2.14533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS There is limited data describing major adverse kidney events (MAKE) in patients supported with ventricular assist devices (VAD). We aim to describe the association between MAKE and survival, risk factors for MAKE, and renal trajectory in VAD supported patients. METHODS AND RESULTS We conducted a single-centre retrospective analysis of consecutive VAD implants between 2010 and 2019. Baseline demographics, biochemistry, and adverse events were collected for the duration of VAD support. MAKE was defined as the first event to occur of sustained drop (>50%) in estimated glomerular filtration rate (eGFR), progression to stage V chronic kidney disease, initiation or continuation of renal replacement therapy beyond implant admission or death on renal replacement therapy at any time. One-hundred and seventy-three patients were included, median age 56.8 years, 18.5% female, INTERMACS profile 1 or 2 in 75.1%. Thirty-seven patients experienced MAKE. On multivariate analysis, post-implant clinical right ventricular failure and the presence of chronic haemolysis, defined by the presence of schistocytes on blood film analysis, were significantly associated with increased risk of MAKE (adjusted odds ratio 9.88, P < 0.001 and adjusted odds ratio 3.33, P = 0.006, respectively). MAKE was associated with reduced survival (hazard ratio 4.80, P < 0.001). Patients who died or experienced MAKE did not demonstrate the expected transient 3-month improvement in eGFR, seen in other cohorts. CONCLUSIONS MAKE significantly impacts survival. In our cohort, MAKE was predicted by post-implant right ventricular failure and chronic haemolysis. The lack of early eGFR improvement on VAD support may indicate higher risk for MAKE.
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Affiliation(s)
- Sumita Barua
- Heart and Lung Transplant UnitSt Vincent's HospitalSydneyAustralia
- School of MedicineUniversity of New South Wales SchoolSydneyAustralia
- Cardiac Mechanics LaboratoryVictor Chang Cardiac Research InstituteSydneyAustralia
| | - Sean M. Conte
- Heart and Lung Transplant UnitSt Vincent's HospitalSydneyAustralia
- School of MedicineUniversity of New South Wales SchoolSydneyAustralia
- School of MedicineUniversity of Notre Dame AustraliaSydneyAustralia
| | - Callum Cherrett
- Heart and Lung Transplant UnitSt Vincent's HospitalSydneyAustralia
- School of MedicineUniversity of New South Wales SchoolSydneyAustralia
| | - Katherine L. Kearney
- Heart and Lung Transplant UnitSt Vincent's HospitalSydneyAustralia
- School of MedicineUniversity of New South Wales SchoolSydneyAustralia
- Cardiac Mechanics LaboratoryVictor Chang Cardiac Research InstituteSydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Desiree Robson
- Heart and Lung Transplant UnitSt Vincent's HospitalSydneyAustralia
| | | | - Peter S. Macdonald
- Heart and Lung Transplant UnitSt Vincent's HospitalSydneyAustralia
- School of MedicineUniversity of New South Wales SchoolSydneyAustralia
- Cardiac Mechanics LaboratoryVictor Chang Cardiac Research InstituteSydneyAustralia
| | - Kavitha Muthiah
- Heart and Lung Transplant UnitSt Vincent's HospitalSydneyAustralia
- School of MedicineUniversity of New South Wales SchoolSydneyAustralia
- Cardiac Mechanics LaboratoryVictor Chang Cardiac Research InstituteSydneyAustralia
| | - Christopher S. Hayward
- Heart and Lung Transplant UnitSt Vincent's HospitalSydneyAustralia
- School of MedicineUniversity of New South Wales SchoolSydneyAustralia
- Cardiac Mechanics LaboratoryVictor Chang Cardiac Research InstituteSydneyAustralia
- Faculty of HealthUniversity of TechnologySydneyAustralia
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20
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Inchaustegui CA, Patel A, Lamba HK, Brown A, Arunthamakun J, Ting K, Chatterjee S, Nair AP, George JK, Shafii AE, Liao KK, Civitello AB. Impact of time off anticoagulation in patients with continuous-flow left ventricular assist devices. J Artif Organs 2023; 26:275-286. [PMID: 36208373 DOI: 10.1007/s10047-022-01367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/20/2022] [Indexed: 10/10/2022]
Abstract
Patients with left ventricular assist devices (LVADs) receive anticoagulation to decrease the risk of thrombosis. Various circumstances require discontinuing anticoagulation in LVAD patients, but the risks entailed are not well defined. In a retrospective review of LVAD implantation procedures, we examined the effect of time off anticoagulation on thrombosis and mortality rates after implantation. An international normalized ratio ≤ 1.5 was used to screen for patients taken off anticoagulation. Patients were divided into three groups by the cumulative number of days off anticoagulation: no discontinuation, short-term discontinuation (< 30 days), and long-term discontinuation (≥ 30 days). Rates of ischemic stroke, pump thrombosis, and mortality were compared among groups. Of 245 patients who underwent LVAD implantation during the study, 70 (28.6%) were off anticoagulation during follow-up: 37 (15.1%) had short-term discontinuation (median, 11 days), and 33 (13.5%) had long-term discontinuation (median, 124 days). Patients with long-term discontinuation had a higher rate of ischemic stroke (adjusted hazard ratio 8.5, p = 0.001) and death (adjusted hazard ratio 3.9, p = 0.001). The three groups did not differ in pump thrombosis rate. We conclude that after LVAD implantation, discontinuing anticoagulation for ≥ 30 days is independently associated with an increased risk of ischemic stroke and death.
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Affiliation(s)
- Christian A Inchaustegui
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA.
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA.
| | - Ashley Patel
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA
| | - Harveen K Lamba
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Andrew Brown
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA
| | - Justin Arunthamakun
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA
| | - Kevin Ting
- Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Texas Heart Institute, Houston, TX, USA
| | - Ajith P Nair
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Joggy K George
- Texas Heart Institute, Houston, TX, USA
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexis E Shafii
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Kenneth K Liao
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew B Civitello
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Texas Heart Institute, Houston, TX, USA
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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21
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Heima D, Takeda M, Tabata Y, Minatoya K, Yamashita JK, Masumoto H. Therapeutic potential of human iPS cell-derived cardiac tissue in an ischemic model with unloaded condition mimicking left ventricular assist device. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01095-4. [PMID: 37981100 DOI: 10.1016/j.jtcvs.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE This study aimed to explore the therapeutic potential of hiPSC-derived cardiac tissues (HiCTs) in the emerging approach of "Bridge to recovery (BTR)" for severe heart failure with ventricular assist devices (VADs). We utilized a rat model of heterotopic heart transplantation (HTx) to mimic VAD support and heart unloading. METHODS HiCTs were created by inserting gelatin hydrogel microspheres between cell sheets made from hiPSC-derived cardiovascular cells. Male athymic nude rats underwent myocardial infarction (MI) and were divided into the following groups: MI (loaded, untreated control), MI+HTx (unloaded, untreated control), MI+HTx+HiCT (unloaded, treated), and MI+HiCT (loaded, treated). HiCTs were placed on the epicardium of the heart in treated groups. We evaluated HiCT engraftment, fibrosis, neovascularization using histological analysis. RESULTS After four weeks, HiCTs successfully engrafted in five out of six rats in the MI+HTx+HiCT group (83.3%). The engrafted HiCT area was greater under unloaded conditions (MI+HTx+HiCT) than loaded conditions (MI+HiCT) (P<0.05). MI+HTx+HiCT had a significantly smaller infarct area compared to MI and MI+HTx. The MI+HTx+MiCT group exhibited higher vascular density in the border zone than MI and MI+HTx. HiCT treatment suppressed cardiomyocyte atrophy due to LV unloading (P=0.001). The protein level of MuRF1, an atrophy-related ubiquitin ligase, was lower in the MI+HTx+HiCT group than MI+HTx (P=0.036). However, HiCT treatment did not significantly improve LV systolic function in unloaded hearts. CONCLUSIONS Transplanting HiCTs into ischemic hearts under unloaded conditions promoted engraftment, neovascularization, attenuated infarct remodeling, and suppressed myocyte atrophy. These results suggest that HiCT treatment could contribute to future advancements in BTR. (250 words).
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Affiliation(s)
- Daisuke Heima
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan; Present affiliation: Department of Cardiovascular Surgery, Kansai Medical University, Hirakata, Japan
| | - Masafumi Takeda
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan; Present affiliation: Department of Cardiology, Saiseikai Hyogoken Hospital, Kobe, Japan
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun K Yamashita
- Department of Cell Growth and Differentiation, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan; Present affiliation: Department of Cellular and Tissue Communications, Graduate School of Medicine, The University of Tokyo. Tokyo, Japan.
| | - Hidetoshi Masumoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Clinical Translational Research Program, RIKEN Center for Biosystems Dynamics Research, Kobe, Japan.
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22
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Eckman PM, Rajagopalan N, Henriksen J, Targonski PV, Meidunas K, Larsen N, Graff P, Lewis M. Considerations of Left Ventricular Assist Device Therapy in the United States' Prison System. J Card Fail 2023; 29:1564-1570. [PMID: 37558087 DOI: 10.1016/j.cardfail.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023]
Abstract
Left ventricular assist device therapy for advanced heart failure is contraindicated if a patient lives in an unsafe environment and recent guidelines declare that "legal history is pertinent for determining personal constraints or financial responsibilities due to parole requirements, pending charges, and possible imprisonment," implying that incarceration would be a contraindication. International guidelines and precedent in the United States establish that medical care for incarcerated persons should match access in the community. We present a case example and practical considerations for advanced heart failure programs faced with the challenge of partnering with patients with heart failure who may be incarcerated and their correctional health systems in the care of their chronic condition. We encourage the heart failure community to not let incarceration be a contraindication to left ventricular assist device therapy.
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Affiliation(s)
- Peter M Eckman
- Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
| | | | | | - Paul V Targonski
- University of Virginia, Charlottesville, Virginia; Virginia Department of Corrections, Richmond, Virginia
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23
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Townsend M, Pidborochynski T, Cantor RS, Khoury M, Campbell P, Halpin A, Urschel S, Kim D, Nahirniak S, West LJ, Buchholz H, Conway J. Prospective examination of HLA sensitization after VAD implantation in children and adults. Transpl Immunol 2023; 80:101892. [PMID: 37419373 DOI: 10.1016/j.trim.2023.101892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Ventricular assist devices (VADs) have improved survival to heart transplantation (HTx). However, VADs have been associated with development of antibodies against human leukocyte antigen (HLA-Ab) which may limit the donor pool and decrease survival post-HTx. Since HLA-Ab development after VAD insertion is poorly understood, the purpose of this prospective single-center study was to quantify the incidence of and evaluate risk factors for HLA-Ab development across the age spectrum following VAD implantation. METHODS Adult and pediatric patients undergoing VAD placement as bridge to transplant or transplant candidacy between 5/2016 and 7/2020 were enrolled. HLA-Ab were assessed pre-VAD and at 1-, 3-, and 12-months post-implant. Factors associated with HLA-Ab development post-VAD implant were explored using univariate and multivariate logistic regression. RESULTS 15/41 (37%) adults and 7/17 (41%) children developed new HLA-Ab post-VAD. The majority of patients (19/22) developed HLA-Ab within two months of implant. New class I HLA-Ab were more common (87% adult, 86% pediatric). Prior pregnancy was strongly associated with HLA-Ab development in adults post-VAD (HR 16.7, 95% CI 1.8-158, p = 0.01). Of the patients who developed new HLA-Ab post-VAD, in 45% (10/22) the HLA-Ab resolved while in 55% (12/22) the HLA-Ab persisted. CONCLUSION More than one-third of adult and pediatric VAD patients developed new HLA-Ab early after VAD implant with the majority having class I antibodies. Prior pregnancy was strongly associated with post-VAD HLA-Ab development. Further studies are needed to predict regression or persistence of HLA-Ab developed post-VAD, to understand modulation of individuals' immune responses to sensitizing events, and to determine whether transiently detected HLA-Ab post-VAD recur and have long-term clinical impact post-heart transplantation.
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Affiliation(s)
- Madeleine Townsend
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
| | - Tara Pidborochynski
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Ryan S Cantor
- Kirklin Solutions, Birmingham, AL, United States of America
| | - Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada; Canada Donation And Transplantation Research Program, University of Alberta, Edmonton, AB, Canada
| | - Patricia Campbell
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada; Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada; Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anne Halpin
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada; Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada; Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada; Canada Donation And Transplantation Research Program, University of Alberta, Edmonton, AB, Canada; Department of Surgery, University of Alberta, Edmonton, AB, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - Daniel Kim
- Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada; Department of Medicine, University of Alberta, Edmonton, AB, Canada; Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Susan Nahirniak
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Lori J West
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada; Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada; Canada Donation And Transplantation Research Program, University of Alberta, Edmonton, AB, Canada; Department of Surgery, University of Alberta, Edmonton, AB, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - Holger Buchholz
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; Department of Medicine, University of Alberta, Edmonton, AB, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
| | - Jennifer Conway
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada
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24
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Nakamura M, Imamura T, Ueno H, Kinugawa K. Impact of the elevated angiopoietin-2 levels during Impella support on the short-term prognosis. J Artif Organs 2023; 26:184-191. [PMID: 35932355 DOI: 10.1007/s10047-022-01347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
Elevated serum angiopoietin-2 levels in patients with acute myocardial infarction-related cardiogenic shock with and without intra-aortic balloon pump as well as acute decompensated heart failure are associated with short-term mortality. However, its prognostic impact in patients with cardiogenic shock supported by Impella-incorporated mechanical circulatory support (MCS) remains unknown. Patients who received temporary MCS (Impella alone or Impella and veno-arterial extracorporeal membrane oxygenation) in our institute between August 2018 and January 2022 were included in this prospective study. The serum levels of angiopoietin-2 were measured just before and following the initiation of temporary MCS therapy. Association between the levels of serum angiopoietin-2 and 30-day mortality was investigated. A total of 38 patients (median 72 years old, 63% men) were included. The median levels of serum angiopoetin-2 tended to decrease from baseline to 4 days following the initiation of temporary MCS from 5.2 (3.3, 10.5) ng/mL to 4.8 (2.7, 6.8) ng/mL (p = 0.132). A higher angiopoietin-2 (> 6.8 ng/mL) following the initiation of temporary MCS was associated with higher 30-day mortality (89.7% versus 44.4%, p = 0.0048) with an odds ratio 18.946 (95% confidence interval 1.624-218.695, p = 0.018) adjusted for potential confounders. A higher serum angiopoietin-2 level following the initiation of Impella-incorporated temporary MCS, instead of baseline angiopoetin-2 level, was associated with higher short-term mortality.
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Affiliation(s)
- Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan.
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan
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25
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Fleck T, Bobrowski A. Invited commentary on: Myocardial recovery in children supported with a durable ventricular assist device - a systematic approach. Eur J Cardiothorac Surg 2023; 64:ezad277. [PMID: 37606999 DOI: 10.1093/ejcts/ezad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 08/23/2023] Open
Affiliation(s)
- Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexej Bobrowski
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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26
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Lee J, Hong SB, Kim YH, Kim HW, Kim DY. Left ventricular assist device implantation combined with hemiarch replacement for severe aortic atherosclerosis. J Thorac Dis 2023; 15:3979-3983. [PMID: 37559595 PMCID: PMC10407482 DOI: 10.21037/jtd-23-255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/25/2023] [Indexed: 08/11/2023]
Abstract
Implantation of the left ventricular assist device (LVAD) has emerged as a widely employed therapeutic approach for specifically chosen individuals suffering from severe heart failure. Stroke is a well-known complication of LVAD implantation. Concomitant aortic surgeries in patients requiring LVAD implantation to avoid outflow graft anastomosis to a severe atherosclerotic aorta are unknown. We illustrate a successful LVAD implantation with hemiarch replacement for severe aortic atherosclerosis to decrease the risk of postoperative stroke. A 72-year-old male patient with advanced heart failure has chosen to undergo LVAD treatment. Preoperative examinations detected severe atherosclerosis in the ascending aorta. It was determined that clamping the ascending aorta and directly connecting the outflow graft could increase the risk of stroke after surgery. Therefore, it was decided to replace the diseased ascending aorta entirely. The HeartMate 3 was implanted under cardiopulmonary bypass (CPB) using right axillary artery cannulation. And moderate hypothermia and bilateral antegrade cerebral perfusion were utilized to perform hemiarch replacement. Subsequently, the outflow graft was connected to an artificial ascending aortic graft. The patient did not exhibit any specific complications, such as neurological abnormalities, after the surgery. Based on our observations, it appears that LVAD implantation combined with aortic replacement could be a viable option for specific patients, particularly those who have a perioperative stroke risk due to aortic atherosclerosis.
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Affiliation(s)
- June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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27
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Bonde R, Bonde P. Futuristic perspectives: novel MCS devices. Indian J Thorac Cardiovasc Surg 2023; 39:190-197. [PMID: 37525706 PMCID: PMC10387008 DOI: 10.1007/s12055-023-01519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 08/02/2023] Open
Abstract
Treatment of heart failure needs a firm understanding of anatomy and physiology of the circulatory system and the heart. Ancient India takes credit for the "modern concepts" of human circulation. This short review encompasses futuristic perspectives on mechanical circulatory devices (MCS). The heart is a complex structure which has evolved over millennia both in its structure and mechanical functionality. Evolving from a simple tube with peristaltic action such as in annelids, it evolved rapidly to form a more complexity as animals evolved from oceanic to terrestrial adaptation. The major advance is the innovation of placing the actuation mechanism within the blood flow path, such as in continuous flow technology (axial or centrifugal) when contrasted to the positive displacement pumps. We present novel concepts but also touch upon what we would consider as fundamental problems or paradigms that need to be addressed to move this field ahead. Finally, we propose what would be termed a "futuristic" MCS device.
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Affiliation(s)
- Riya Bonde
- Bonde Artificial Heart Lab, Division of Cardiac Surgery, Yale School of Medicine, 204 Boardman 330 Cedar Street, New Haven, CT 06510 USA
| | - Pramod Bonde
- Bonde Artificial Heart Lab, Division of Cardiac Surgery, Yale School of Medicine, 204 Boardman 330 Cedar Street, New Haven, CT 06510 USA
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28
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Sweeney J, Pahwa S, Trivedi J, Slaughter MS. Durable left ventricular assist device implant-how I teach it. Indian J Thorac Cardiovasc Surg 2023; 39:114-122. [PMID: 37525699 PMCID: PMC10387025 DOI: 10.1007/s12055-023-01533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 08/02/2023] Open
Abstract
Left ventricular assist devices (LVADs) have become a mainstay of advanced heart failure therapy. The technical aspects of performing a device implant are nuanced and attention to these details allows for successful therapy with good outcomes. As more patient with heart failure are expected to benefit from mechanical circulatory support, the need for a concise and consistent technique for LVAD implantation is needed. Teaching this procedure is most comprehensible when broken down into separate steps, as with many other procedures. Here, we describe our standard protocol for LVAD implantation, as well as rudimentary outcomes of 6-year experience in our center. We hope this will provide some insight and guidance to centers who are expanding into the field of mechanical circulatory support and can help them form a foundation with which to build their own experience and success.
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Affiliation(s)
- Joseph Sweeney
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA
| | - Siddharth Pahwa
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA
| | - Jaimin Trivedi
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA
| | - Mark Sullivan Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA
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29
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Sohn SH, Kang Y, Hwang HY, Chee HK. Optimal timing of heart transplantation in patients with an implantable left ventricular assist device. Korean J Transplant 2023; 37:79-84. [PMID: 37435145 PMCID: PMC10332290 DOI: 10.4285/kjt.23.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 07/13/2023] Open
Abstract
Heart transplantation (HTPL) has been established as the gold-standard surgical treatment for end-stage heart failure. However, the use of a left ventricular assist device (LVAD) as a bridge to HTPL has been increasing due to the limited availability of HTPL donors. Currently, more than half of HTPL patients have a durable LVAD. Advances in LVAD technology have provided many benefits for patients on the waiting list for HTPL. Despite their advantages, LVADs also have limitations such as loss of pulsatility, thromboembolism, bleeding, and infection. In this narrative review, the benefits and shortcomings of LVADs as a bridge to HTPL are summarized, and the available literature evaluating the optimal timing of HTPL after LVAD implantation is reviewed. Because only a few studies have been published on this issue in the current era of third-generation LVADs, future studies are needed to draw a definite conclusion.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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30
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Chun KH, Kang SM. Advanced heart failure: a contemporary approach. Korean J Intern Med 2023:kjim.2023.159. [PMID: 37369524 DOI: 10.3904/kjim.2023.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Advanced heart failure (HF) is defined as the persistence of severe symptoms despite the use of optimized medical, surgical, and device therapies. These patients require timely advanced treatments, such as heart transplantation or long-term mechanical circulatory support (MCS). Inotropic agents are often used to reduce congestion and increase cardiac output, while renal replacement therapy may be beneficial if necessary. Cardiac resynchronization therapy has clear benefits in patients with HF with reduced ejection fraction, particularly with left bundle branch block (QRS duration > 130 ms). The role of implantable cardioverter-defibrillators in advanced HF patients requires further investigation considering the introduction of novel HF medications. In selected patients with significant secondary mitral regurgitation, transcatheter edge-to-edge repair can help delay heart transplantation or long-term MCS. In later stages, the appropriateness of heart transplantation should be evaluated, and the use of short- or long-term MCS may be considered. A multidisciplinary HF management program is crucial for patients with advanced HF. Recent treatment advances, including drugs, devices, and MCS, have broadened the options available to patients with advanced HF and this trend is expected to continue.
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Affiliation(s)
- Kyeong-Hyeon Chun
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Bernhardt AM, Reichenspurner H. Bridging with surgical implanted Impella devices. Eur J Cardiothorac Surg 2023; 63:ezad213. [PMID: 37233201 DOI: 10.1093/ejcts/ezad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/25/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Januszewska K. Ventricular assist device in children with dilated cardiomyopathy as a bridge to recovery-can we know this at the time of implantation? Eur J Cardiothorac Surg 2023:7160915. [PMID: 37171878 DOI: 10.1093/ejcts/ezad197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/14/2023] Open
Affiliation(s)
- Katarzyna Januszewska
- Department of Cardiac Surgery, Polish Mother's Memorial Hospital-Research Institute, Łódź, Poland
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Greenberg JW, Bryant R, Villa C, Fields K, Fynn-Thompson F, Zafar F, Morales DLS. Racial disparity exists in the utilization and post-transplant survival benefit of ventricular assist device support in children. J Heart Lung Transplant 2023; 42:585-592. [PMID: 36710094 PMCID: PMC10121747 DOI: 10.1016/j.healun.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 12/04/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Children of minority race and ethnicity experience inferior outcomes postheart transplantation (HTx). Studies have associated ventricular assist device (VAD) bridge-to-transplant (BTT) with similar-to-superior post-transplant-survival (PTS) compared to no mechanical circulatory support. It is unclear whether racial and ethnic discrepancies exist in VAD utilization and outcomes. METHODS The United Network for Organ Sharing (UNOS) database was used to identify 6,121 children (<18 years) listed for HTx between 2006 and 2021: black (B-22% of cohort), Hispanic (H-21%), and white (W-57%). VAD utilization, outcomes, and PTS were compared between race/ethnicity groups. Multivariable Cox proportional analyses were used to study the association of race and ethnicity on PTS with VAD BTT, using backward selection for covariates. RESULTS Black children were most ill at listing, with greater proportions of UNOS status 1A/1 (p < 0.001 vs H & W), severe functional limitation (p < 0.001 vs H & W), and greater inotrope requirements (p < 0.05 vs H). Non-white children had higher proportions of public insurance. VAD utilization at listing was: B-11%, H-8%, W-8% (p = 0.001 for B vs H & W). VAD at transplant was: B-24%, H-21%, W-19% (p = 0.001 for B vs H). At transplant, all VAD patients had comparable clinical status (functional limitation, renal/hepatic dysfunction, inotropes, mechanical ventilation; all p > 0.05 between groups). Following VAD, hospital outcomes and one-year PTS were equivalent but long-term PTS was significantly worse among non-whites-(p < 0.01 for W vs B & H). On multivariable analysis, black race independently predicted mortality (hazard ratio 1.67 [95% confidence interval 1.22-2.28]) while white race was protective (0.54 [0.40-0.74]). CONCLUSIONS Pediatric VAD use is, seemingly, equitable; the most ill patients receive the most VADs. Despite similar pretransplant and early post-transplant benefits, non-white children experience inferior overall PTS after VAD BTT.
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Affiliation(s)
- Jason W Greenberg
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Roosevelt Bryant
- Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - Chet Villa
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katrina Fields
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Gómez-Bueno M, Pérez de la Sota E, Forteza Gil A, Ortiz-Berbel D, Castrodeza J, García-Cosío Carmena MD, Barge-Caballero E, Rangel Sousa D, Díaz Molina B, Manrique Antón R, Almenar-Bonet L, Uribarri González A, Barrio-Rodríguez A, Castel Lavilla MÁ, López-López L, Dobarro Pérez D, Pastor Pérez F, Burgos-Palacios V, Álvarez-García J, Garrido-Jiménez JM, González-Fernández Ó, Codina P, López-Granados A, Grau-Sepulveda A, González-Costello J. Durable ventricular assist device in Spain (2007-2020). First report of the REGALAD registry. Rev Esp Cardiol (Engl Ed) 2023; 76:227-237. [PMID: 36055642 DOI: 10.1016/j.rec.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES This report presents the clinical characteristics, outcomes and complications of all consecutive patients implanted with a long-term mechanical circulatory support device in Spain between 2007 and 2020. METHODS Analysis of the Spanish Registry of durable ventricular assist devices (REGALAD) including data form Spanish centers with a mechanical circulatory support program. RESULTS During the study period, 263 ventricular assist devices were implanted in 22 hospitals. The implanted device was an isolated continuous-flow left ventricular assist device in 182 patients (69%), a pulsatile-flow device (58 isolated left ventricular and 21 biventricular) in 79 (30%), and a total artificial heart in 2 patients (1%). The strategy of the implant was as bridge to heart transplant in 78 patients (30%), bridge to candidacy in 110 (42%), bridge to recovery in 3 (1%) and destination therapy in 72 patients (27%). Overall survival at 6, 12 and 24 months was 79%, 74% and 69%, respectively, and was better in continuous-flow left ventricular assist devices (84%, 80%, and 75%). The main adverse events related to this therapy were infections (37% of patients), bleeding (35%), neurological (29%), and device malfunction (17%). CONCLUSIONS Durable ventricular assist devices have emerged in Spain in the last few years as a useful therapy for patients with advanced heart failure. As in other international registries, the current trend is to use continuous-flow intracorporeal left ventricular devices, which are associated with better results. Adverse events continue to be frequent and severe.
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Affiliation(s)
- Manuel Gómez-Bueno
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana (IDIPHISA), Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | | | - Alberto Forteza Gil
- Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana (IDIPHISA), Majadahonda, Madrid, Spain
| | - Daniel Ortiz-Berbel
- Servicio de Cirugía Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Castrodeza
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - María Dolores García-Cosío Carmena
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital 12 de Octubre, Instituto de Investigación Sanitaria (imas12), Madrid, Spain
| | - Eduardo Barge-Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Diego Rangel Sousa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Beatriz Díaz Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Rebeca Manrique Antón
- Servicio de Cirugía Cardiaca, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Luis Almenar-Bonet
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - María Ángeles Castel Lavilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura López-López
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Dobarro Pérez
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Francisco Pastor Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Virginia Burgos-Palacios
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Jesús Álvarez-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Pau Codina
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Andrés Grau-Sepulveda
- Servicio de Cardiología, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - José González-Costello
- Servicio de Cardiología, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Shinkawa T, Ichihara Y, Saito S, Ishido M, Inai K, Niinami H. Ventricular assist device for end-stage adult congenital heart disease patients: Current status. J Cardiol 2023; 81:378-384. [PMID: 36152979 DOI: 10.1016/j.jjcc.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
As long-term surgical outcome of congenital heart disease has continued to improve, most pediatric patients with congenital heart disease are able to reach adulthood. However, adult congenital heart disease (ACHD) patients have increased risk of arrhythmia, valvular diseases, infectious endocarditis, and heart failure. The end-stage ACHD patients with advanced heart failure may require mechanical circulatory support to improve the heart failure symptoms or to recover from circulatory collapse, and may eventually aim to heart transplant or destination therapy. In general, long-term mechanical support for dilated cardiomyopathy or ischemic cardiomyopathy has been achieved with left ventricular assist device with excellent survival outcomes and improved quality of life. However, the ventricular assist device for end-stage ACHD patients can be challenging due to patient-specific anatomical feature, multiple histories of surgical and catheter-based interventions and possible multiple end-organ dysfunctions, and offered less frequently compared to non-ACHD patients. The Interagency Registry for Mechanically Assisted Circulatory Support data published recently showed that ACHD patients receiving long-term mechanical circulatory support consisted <1 % of all registrants and had higher mortality after mechanical support than non-ACHD patients. However, the ACHD patients supported with left ventricular assist device had similar survival with non-ACHD patients and a large proportion of the mortality difference between ACHD and non-ACHD patients seemed to result from operative and perioperative factors. Therefore, the ventricular assist device therapy can be an excellent treatment for selected ACHD patients. In this paper, we describe the current status of ventricular assist device support for end-stage ACHD patients and consideration to the future.
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Affiliation(s)
- Takeshi Shinkawa
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan.
| | - Yuki Ichihara
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
| | - Satoshi Saito
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
| | - Mikiko Ishido
- Tokyo Women's Medical University, Department of Pediatric and Adult Congenital Cardiology, Tokyo, Japan
| | - Kei Inai
- Tokyo Women's Medical University, Department of Pediatric and Adult Congenital Cardiology, Tokyo, Japan
| | - Hiroshi Niinami
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
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Yuerek M, Kozyak BW, Shankar VR. Advances in Extracorporeal Support Technologies in Critically Ill Children. Indian J Pediatr 2023; 90:501-509. [PMID: 36988821 PMCID: PMC10049895 DOI: 10.1007/s12098-023-04545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
The field of pediatric heart failure is evolving, and the patient population is growing as survival after complex congenital heart surgeries is improving. Mechanical circulatory support and extracorporeal respiratory support in critically ill children has progressed to a mainstay rescue modality in pediatric intensive care medicine. The need for mechanical circulatory support is growing, since the number of organ donors does not meet the necessity. This article aims to review the current state of available mechanical circulatory and respiratory support systems in acute care pediatrics, with an emphasis on the literature discussing the challenges associated with these complex support modalities.
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Affiliation(s)
- Mahsun Yuerek
- Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA.
| | - Benjamin W Kozyak
- Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Venkat R Shankar
- Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
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Toda K, Ako J, Hirayama A, Kinugawa K, Kobayashi Y, Ono M, Nishimura T, Sato N, Shindo T, Takayama M, Yasukochi S, Shiose A, Sawa Y. Three-year experience of catheter-based micro-axial left ventricular assist device, Impella, in Japanese patients: the first interim analysis of Japan registry for percutaneous ventricular assist device (J-PVAD). J Artif Organs 2023; 26:17-23. [PMID: 35467195 DOI: 10.1007/s10047-022-01328-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
Catheter-based micro-axial ventricular assist device Impella® (Abiomed, Danvers, MA) has been used in Japanese patients with drug-refractory acute heart failure (AHF) since 2017. This is the first interim analysis of the ongoing Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD) to investigate the safety and efficacy of Impella support. Between October 2017 and January 2020, 823 Japanese patients, who were treated with the Impella 2.5, CP, or 5.0 pump, were enrolled. The primary endpoints were safety profiles and cumulative 30-day survival. Among them, 44.8% of patients were acute myocardial infarction with cardiogenic shock. The Impella pumps were unable to implant in 4 patients. The Impella 2.5, CP, and 5.0 pumps were used in 72.4%, 6.2%, and 16.6%, respectively, and mean support duration was 8.1 ± 10.2 days. Combination use of Impella and venoarterial extracorporeal membrane oxygenation (VA-ECMO) was applied for 387 patients (47.3%). Pump stop occurred 22 patients (2.7%). Major adverse events included hemolysis (11.2%), hemorrhage/hematoma (6.1%), peripheral ischemia (1.6%), and stroke (1.6%). The overall 30-day survival was 62.2%. Survival of patients with single Impella support was significantly higher than patients with Impella combined with VA-ECMO support (81.1% vs 49.6%; p < 0.01), who had lower blood pressure, lower left ventricular ejection fraction, and higher degree of inotropic support. Results suggest that short-term outcome of Impella support for Japanese patients was favorable with acceptable safety profiles.
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Affiliation(s)
- Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | | | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Ehime University, Ehime, Japan
| | - Naoki Sato
- Department of Cardiology, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Takahiro Shindo
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Nagano Children's Hospital, Nagano, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, Japan.
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Abstract
Heart failure (HF) is one of the leading causes of global health impairment. Current drugs are still limited in their effectiveness in the treatment and reversal of HF: for example, drugs for acute HF (AHF) help to reduce congestion and relieve symptoms, but they do little to improve survival; most conventional drugs for HF with preserved ejection fraction (HFpEF) do not improve the prognosis; and drugs have extremely limited effects on advanced HF. In recent years, progress in device therapies has bridged this gap to a certain extent. For example, the availability of the left ventricular assist device has brought new options to numerous advanced HF patients. In addition to this recognizable device, a range of promising novel devices with preclinical or clinical trial results are emerging that seek to treat or reverse HF by providing circulatory support, repairing structural abnormalities in the heart, or providing electrical stimulation. These devices may be useful for the treatment of HF. In this review, we summarized recent advances in novel devices for AHF, HFpEF, and HF with reduced ejection fraction (HFrEF) with the aim of providing a reference for clinical treatment and inspiration for novel device development.
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Affiliation(s)
- Renjie Tang
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Chang
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Abstract
Historically, transplantation of a female donor heart to male recipient has been viewed with caution given evidence of suboptimal outcomes, particularly in special populations such as patients with pulmonary hypertension or those supported by ventricular assist devices. However, the use of predicted heart mass ratio for donor-recipient size matching demonstrated that the size of the organ rather than sex of the donor was most responsible for the outcomes. With the advent of the predicted heart mass ratio, avoiding female donor hearts for male recipients is no longer justified and may result in unnecessary waste of available organs. In this review, we highlight the value of donor-recipient sizing by predicted heart mass ratio and summarize the evidence of different approaches to the donor-to-recipient size and sex matching. We conclude that the utilization of predicted heart mass is currently considered a preferred method of matching heart donors and recipients.
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Greenberg JW, Guzman-Gomez A, Kulshrestha K, Dani A, Lehenbauer DG, Chin C, Zafar F, Morales DLS. Contemporary Outcomes of Heart Transplantation in Children with Heterotaxy Syndrome: Sub-Optimal Pre-Transplant Optimization Translates into Early Post-Transplant Mortality. Pediatr Cardiol 2023:10.1007/s00246-023-03122-z. [PMID: 36811659 DOI: 10.1007/s00246-023-03122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023]
Abstract
Patients with heterotaxy syndrome and congenital heart disease (CHD) experience inferior cardiac surgical outcomes. Heart transplantation outcomes are understudied, however, particularly compared to non-CHD patients. Data from UNOS and PHIS were used to identify 4803 children (< 18 years) undergoing first-time heart transplant between 2003 and 2022 with diagnoses of heterotaxy (n = 278), other-CHD (n = 2236), and non-CHD cardiomyopathy (n = 2289). Heterotaxy patients were older (median 5 yr) and heavier (median 17 kg) at transplant than other-CHD (median 2 yr and 12 kg), and younger and lighter than cardiomyopathy (median 7 yr and 24 kg) (all p < 0.001). UNOS status 1A/1 at listing was not different between groups (65-67%; p = 0.683). At transplant, heterotaxy and other-CHD patients had similar rates of renal dysfunction (12 and 17%), inotropes (10% and 11%), and ventilator-dependence (19 and 18%). Compared to cardiomyopathy, heterotaxy patients had comparable renal dysfunction (9%, p = 0.058) and inotropes (46%, p = 0.097) but more hepatic dysfunction (17%, p < 0.001) and ventilator-dependence (12%, p = 0.003). Rates of ventricular assist device (VAD) were: heterotaxy-10%, other-CHD-11% (p = 0.839 vs. heterotaxy), cardiomyopathy-37% (p < 0.001 vs. heterotaxy). The 1-year incidence of acute rejection post-transplant was comparable between heterotaxy and others (p > 0.05). While overall post-transplant survival was significantly worse for heterotaxy than others (p < 0.05 vs. both), conditional 1-year survival was comparable (p > 0.3 vs. both). Children with heterotaxy syndrome experience inferior post-heart transplant survival, although early mortality appears to influence this trend, with 1-year survivors having equivalent outcomes. Given similar pre-transplant clinical status to others, heterotaxy patients are potentially under risk-stratified. Increased VAD utilization and pre-transplant end-organ function optimization may portend improved outcomes.
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Affiliation(s)
- Jason W Greenberg
- Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Amalia Guzman-Gomez
- Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Kevin Kulshrestha
- Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Alia Dani
- Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - David G Lehenbauer
- Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Clifford Chin
- Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Farhan Zafar
- Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - David L S Morales
- Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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Fu HY, Chou HW, Lai CH, Tsao CI, Lu CW, Lin MT, Chen CA, Chiu SN, Wang JK, Wu MH, Wu ET, Huang SC, Chen YS. Outcomes of pediatric patients supported with ventricular assist devices single center experience. J Formos Med Assoc 2023; 122:172-81. [PMID: 36192294 DOI: 10.1016/j.jfma.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/12/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There has been a remarkable increase in the number of pediatric ventricular assist device (VAD) implanted over the past decade. Asian pediatric heart centers had not participated in the multicenter registries among the Western countries. This article aimed to report the outcomes of pediatric VAD in our hospital. METHODS The study enrolled all patients aged <18 years at the time of VAD implantation in our institution between 2008 and 2021. RESULTS There were 33 patients with diagnosis of acute fulminant myocarditis (n = 9), congenital heart disease (n = 5), dilated cardiomyopathy (n = 16), and others. Paracorporeal continuous-flow pump was the most frequently implanted (n = 27). Most of the devices were implanted in patients with INTERMACS profile 1 (n = 24). The median duration on VAD was 22 days (range 2-254). The proportion of patients attaining positive outcomes (alive on device, bridge to transplantation or recovery) was 72.7% at 1 month, 67.7% at 3 months, and 67.7% at 6 months. Most of the deaths on device occurred within the first month post-implant (n = 9), with neurological complications being the most frequent cause of death. All recovered cases were successfully weaned off the device within the first month of implantation. CONCLUSION We demonstrated a favorable outcome in pediatric patients supported with VAD at our institution.
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Aryana A, Sarcon A, Bowers MR, O'Neill PG, Gandhavadi M, d'Avila A. Three-dimensional mapping, recording and ablation in simulated and induced ventricular tachyarrhythmias during mechanical circulatory support using the percutaneous heart pump. J Interv Card Electrophysiol 2023; 66:99-107. [PMID: 34988846 DOI: 10.1007/s10840-021-01098-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Due to their internal rotating magnets, conventional impeller-driven percutaneous ventricular assist devices (PVADs) yield high-frequency electrogram artifact and electromagnetic interference (EMI) when used with magnetic-based 3D electroanatomic mapping systems. The new percutaneous heart pump (PHP; Abbott, Chicago, IL) is a 14-French, 5-L/min, impeller axial-flow PVAD with a novel design that utilizes an external motor. METHODS We evaluated the feasibility of 3D mapping and radiofrequency ablation (RFA) in vivo during PHP mechanical circulatory support (MCS) in simulated ventricular tachycardia (pacing at 300 ms) and ventricular flutter (VFL, pacing at 200 ms) and also during ventricular fibrillation (VF) in a porcine model. Anterograde (right ventricular), transseptal, retrograde, and epicardial right and left ventricular 3D mapping (EnSite/CARTO) and RFA were performed in 6 swine using high-density mapping and force-sensing RFA catheters (TactiCath/ThermoCool). Surface and intracardiac electrograms and 3D maps were analyzed for noise/interference with and without MCS using PHP in sinus rhythm and simulated VT/VFL and VF. RESULTS Mapping and RFA proved feasible in the presence of MCS using PHP. The mean arterial pressure in sinus rhythm was 55 ± 2 mmHg (baseline) and 84 ± 4 mmHg during MCS with PHP and well-maintained during simulated VT (73 ± 8 mmHg) and VFL (65 ± 2 mmHg) and even in VF (65 ± 5 mmHg). No electrogram noise/artifact, EMI, or 3D map distortions were observed during mapping/RFA with either of two mapping systems. CONCLUSIONS Endocardial and epicardial 3D mapping and RFA in the presence of PHP are feasible and offer significant MCS during simulated VT/VFL and VF. Furthermore, PHP yielded no electrogram noise/artifact, EMI, or 3D mapping distortions in conjunction with magnetic-based 3D mapping systems.
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Affiliation(s)
- Arash Aryana
- Cardiovascular Services, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA.
| | - Anna Sarcon
- UCSF Cardiac Electrophysiology and Arrhythmia Service, San Francisco, CA, USA
| | - Mark R Bowers
- Cardiovascular Services, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA
| | - Padraig Gearoid O'Neill
- Cardiovascular Services, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA
| | - Maheer Gandhavadi
- Cardiovascular Services, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA
| | - André d'Avila
- The Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Stiller B, Kubicki R. The little ones are catching up-mechanical circulatory support with a pulsatile pneumatic ventricular assist device. Eur J Cardiothorac Surg 2022; 63:6935787. [PMID: 36534818 DOI: 10.1093/ejcts/ezac570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Brigitte Stiller
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Centre Freiburg, Medical Centre-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Rouven Kubicki
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Centre Freiburg, Medical Centre-University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Rohde S, Sandica E, Veen K, Kraemer US, Thiruchelvam T, Miera O, Lopez MLP, Sliwka J, Amodeo A, Bogers AJJC, de By TMMH. Outcomes in small children on Berlin Heart EXCOR support: age and body surface area as clinical predictive factors. Eur J Cardiothorac Surg 2022; 63:6809124. [PMID: 36346169 PMCID: PMC9825200 DOI: 10.1093/ejcts/ezac516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/25/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The Berlin Heart EXCOR (BHE) offers circulatory support across all paediatric ages. Clinically, the necessary care and the outcomes differ in various age groups. The EUROMACS database was used to study age- and size-related outcomes for this specific device. METHODS All patients <19 years of age from the EUROMACS database supported with a BHE between 2000 and November 2021 were included. Maximally selected rank statistics were used to determine body surface area (BSA) cut-off values. Multivariable Cox proportional hazard regression using ridge penalization was performed to identify factors associated with outcomes. RESULTS In total, 303 patients were included [mean age: 2.0 years (interquartile range: 0.6-8.0, males: 48.5%)]. Age and BSA were not significantly associated with mortality (n = 74, P = 0.684, P = 0.679). Factors associated with a transplant (n = 175) were age (hazard ratio 1.07, P = 0.006) and aetiology other than congenital heart disease (hazard ratio 1.46, P = 0.020). Recovery rates (n = 42) were highest in patients with a BSA of <0.53 m2 (21.8% vs 4.3-7.6% at 1 year, P = 0.00534). Patients with a BSA of ≥0.73 m2 had a lower risk of early pump thrombosis but a higher risk of early bleeding compared to children with a BSA of <0.73 m2. CONCLUSIONS Mortality rates in Berlin Heart-supported patients cannot be predicted by age or BSA. Recovery rates are remarkably high in the smallest patient category (BSA <0.53 m2). This underscores that the BHE is a viable therapeutic option, even for the smallest and youngest patients.
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Affiliation(s)
- Sofie Rohde
- Corresponding author. Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. E-mail: (S. Rohde)
| | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kevin Veen
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ulrike S Kraemer
- Department of Paediatric Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maria L Polo Lopez
- Department of Pediatric and Congenital Cardiac Surgery, La Paz University Hospital, Madrid, Spain
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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Weingarten N, Song C, Iyengar A, Herbst DA, Helmers M, Meldrum D, Guevara-Plunkett S, Dominic J, Atluri P. Antithrombotic therapy for durable left ventricular assist devices - current strategies and future directions. Indian J Thorac Cardiovasc Surg 2022; 38:628-636. [PMID: 36258825 PMCID: PMC9569275 DOI: 10.1007/s12055-022-01409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/31/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022] Open
Abstract
Left ventricular assist devices (LVADs) improve survival and quality of life for patients with advanced heart failure but are associated with high rates of thromboembolic and hemorrhagic complications. Antithrombotic therapy is required following LVAD implantation, though practices vary. Identifying a therapeutic strategy that minimizes the risks of thromboembolic and hemorrhagic complications is critical to optimizing patient outcomes and is an area of active investigation. This paper reviews strategies for initiating and maintaining antithrombotic therapy in durable LVAD recipients, focusing on those with centrifugal-flow devices.
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Affiliation(s)
- Noah Weingarten
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Cindy Song
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - David Alan Herbst
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Mark Helmers
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Danika Meldrum
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Sara Guevara-Plunkett
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Jessica Dominic
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
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Opris CE, Suciu H, Banias L, Banceu CM, Opris C, Harpa M, Ispas M, Gurzu S. Staphylococcus-induced proliferative glomerulonephritis and cerebral hemorrhage - fatal complications in a young female with postpartum cardiomyopathy and an implanted left ventricular assist device: a case report and review of the literature. Acta Chir Belg 2022; 122:225-232. [PMID: 35075982 DOI: 10.1080/00015458.2022.2033928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: The continuous-flow left ventricular assist device (CF-LVAD) is used to save the lives of patients in the final stage of congestive heart failure, replacing the pump function of the left ventricle. Although quality of life increases significantly, CF-LVAD-related complications might prove fatal, as in the case presented in this paper.Methods: A 20-year-old female, during her second pregnancy, presented with signs of heart failure. Emergency caesarean section was necessary to save the baby, but peripartum cardiomyopathy developed in the mother. The use of an implantable cardioverter-defibrillator (ICD) was necessary 5 years later. As the clinical progression was unfavorable under medical treatment, with the patient reaching INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profile 1 (refractory cardiogenic shock), the treatment of choice was the implantation of a CF-LVAD.Results: After 3 years of follow-up (at the age of 28), the patient presented with a positive hemoculture for Staphylococcus aureus. Prolonged antibiotic therapy and attentive follow-up was prescribed. Although an effective antiplatelet and anticoagulant treatment was applied, and despite therapeutic values of prothrombin time and international normalized ratio (INR), the patient died as result of a fatal cerebral hemorrhage. The autopsy also revealed septic emboli, disseminated intravascular coagulation, and focal proliferative glomerulonephritis.Conclusions: Although the benefits of CF-LVAD are significant, bleeding episodes can be severe and LVAD-associated infection can trigger glomerular injury and increase mortality.
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Affiliation(s)
- Carmen Elena Opris
- Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, Targu Mures, Romania
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures Romania
| | - Horatiu Suciu
- Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, Targu Mures, Romania
- Department of Surgery, Emil Palade University of Medicine, Pharmacy, Sciences and Technology, George, Targu Mures Romania
| | - Laura Banias
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures Romania
| | - Cosmin Marian Banceu
- Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, Targu Mures, Romania
- Department of Surgery, Emil Palade University of Medicine, Pharmacy, Sciences and Technology, George, Targu Mures Romania
| | - Cosmin Opris
- Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, Targu Mures, Romania
| | - Marius Harpa
- Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, Targu Mures, Romania
- Department of Surgery, Emil Palade University of Medicine, Pharmacy, Sciences and Technology, George, Targu Mures Romania
| | - Mihaela Ispas
- Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, Targu Mures, Romania
| | - Simona Gurzu
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures Romania
- Research Center of Oncopathology and Translational Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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Friedland-Little JM, Joong A, Shugh SB, O'Connor MJ, Bansal N, Davies RR, Ploutz MS. Patient and Device Selection in Pediatric MCS: A Review of Current Consensus and Unsettled Questions. Pediatr Cardiol 2022; 43:1193-1204. [PMID: 35325280 DOI: 10.1007/s00246-022-02880-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/15/2022] [Indexed: 01/24/2023]
Abstract
The field of pediatric ventricular assist device (VAD) support has expanded significantly over the past 20 years, with one third of pediatric heart transplant recipients currently being bridged to transplant with a VAD. Despite increased pediatric VAD utilization, however, there remains little formalized guidance for patient or device selection. The population of children with advanced heart failure is quite heterogeneous, and the available data suggest that VAD outcomes vary significantly based upon patient size, anatomy, level of illness, and type of device implanted. In an effort to better understand current practice patterns and identify populations for whom there does not appear to be a consensus approach to achieving optimal VAD outcomes, the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) has surveyed clinical decision-making among member sites and conducted a review of the available literature regarding patient population-specific VAD outcomes and center-specific practices related to patient and device selection. Rather than aiming to provide clinical guidelines, this document offers an overview of contemporary approaches to patient and device selection, highlighting specific populations for whom there is not a consensus approach to achieving reliably good VAD outcomes, as these populations may benefit most from future research and quality improvement efforts directed toward identifying best practice.
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Affiliation(s)
| | - Anna Joong
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Svetlana B Shugh
- Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Matthew J O'Connor
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Neha Bansal
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan R Davies
- UT Southwestern Medical Center and Children's Health, Dallas, TX, USA
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Akhtar W, Butcher C, Morley‐Smith A, Riesgo Gil F, Dar O, Baston V, Dunning J, Lyster H. Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices. ESC Heart Fail 2022; 9:4340-4343. [PMID: 35906098 PMCID: PMC9773711 DOI: 10.1002/ehf2.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS We present a single-centre retrospective experience using oral milrinone in patients with a left ventricular assist device (LVAD) and concurrent refractory right ventricular failure. METHODS AND RESULTS All patients implanted with LVAD between January 2013 and July 2021 from a high-volume advanced heart failure service were reviewed. Eight patients were initiated on oral milrinone during this period. Oral milrinone was started 1.5 [inter-quartile range (IQR) 1-2.3] years after LVAD implantation and continued for 1.2 (IQR 0.5-2.8) years. Therapeutic milrinone levels were achieved (232.2 ± 153.4 ng/mL) with 62.4 ± 18% of time within the therapeutic range. Two patients had adverse events (non-sustained ventricular tachycardia and ventricular fibrillation effectively treated by internal cardioverter defibrillator) but did not require milrinone discontinuation. Four deaths occurred, one after transplant and three from disease progression determined to be unrelated to oral milrinone use. Three patients continue oral milrinone therapy in the community. There was no significant difference found after the initiation of oral milrinone on any of the physiological measures; however, there were trends in reduction of New York Heart Association class from 3.4 ± 0.5 to 3.0 ± 0.8 (P = 0.08), reduction of right atrial/wedge pressure from 0.9 ± 0.3 to 0.5 ± 0.2 (P = 0.08), and improvement of right ventricular stroke work index from 3.8 ± 2 to 5.8 ± 2.7 (P = 0.16). CONCLUSIONS Oral milrinone appears safe for long-term use in the outpatient setting when combined with therapeutic monitoring in this complex medical cohort with limited management options. Further study is needed to ascertain whether this treatment is effective in reducing heart failure symptoms and admissions.
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Affiliation(s)
- Waqas Akhtar
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Charles Butcher
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Andrew Morley‐Smith
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Fernando Riesgo Gil
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Owais Dar
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Veronica Baston
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - John Dunning
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK
| | - Haifa Lyster
- Department of Advanced Heart Failure, Transplant and Mechanical SupportHarefield HospitalHill End RoadHarefieldUB9 6JHUK,King's College LondonLondonUK
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Rohde S, Sandica E, Veen K, Miera O, Amodeo A, Napoleone CP, Özbaran M, Sliwka J, Thiruchelvam T, Zimpfer D, Schubert S, Bogers AJJC, de By TMMH. Cerebrovascular accidents in paediatric patients supported by the Berlin Heart EXCOR. Eur J Cardiothorac Surg 2022; 62:6645748. [PMID: 35849328 PMCID: PMC9789740 DOI: 10.1093/ejcts/ezac381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/16/2022] [Accepted: 07/13/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Ventricular assist device support as a bridge to transplant or recovery is a well-established therapy in children on the cardiac transplant waiting list. The goal of this study was to investigate the incidence of and the associated factors for cerebrovascular accidents in paediatric patients supported by a Berlin Heart EXCOR. METHODS All patients <19 years of age supported by a Berlin Heart EXCOR between January 2011 and January 2021 from the European Registry for Patients with Mechanical Circulatory Support were included. RESULTS In total, 230 patients were included. A total of 140 (60.9%) patients had a diagnosis of dilated cardiomyopathy. 46 patients (20.0%) sustained 55 cerebrovascular accidents, with 70.9% of the episodes within 90 days after the ventricular assist device was implanted. The event rate of cerebrovascular accidents was highest in the first era (0.75). Pump thrombosis and secondary need for a right ventricular assist device were found to be associated with a cerebrovascular accident (hazard ratio 1.998, P = 0.040; hazard ratio 11.300, P = 0.037). At the 1-year follow-up, 44.4% of the patients had received a transplant, 13.1% were weaned after recovery and 24.5% had died. Event rates for mortality showed a significantly decreasing trend. CONCLUSIONS Paediatric ventricular assist device support is associated with important adverse events, especially in the early phase after the device is implanted. Pump thrombosis and the need for a secondary right ventricular assist device are associated with cerebrovascular accidents. Furthermore, an encouragingly high rate of recovery in this patient population was shown, and death rates declined. More complete input of data into the registry, especially concerning anticoagulation protocols, would improve the data.
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Affiliation(s)
- Sofie Rohde
- Corresponding author. Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. e-mail: (S. Rohde)
| | | | - Kevin Veen
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Carlo Pace Napoleone
- Pediatric Cardiac Surgery Department, Regina Margherita Children’s Hospital, Torino, Italy
| | | | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | | | - Stephan Schubert
- Center of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center North Rhine Westfalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Yoshioka D, Toda K, Ono M, Fukushima N, Shiose A, Saiki Y, Usui A, Wakasa S, Niinami H, Matsumiya G, Arai H, Sawa Y, Miyagawa S. Effect of Diabetes Mellitus on Outcomes in Patients With Left Ventricular Assist Device - Analysis of Data From a Japanese National Database. Circ J 2022; 86:1950-1958. [PMID: 35786688 DOI: 10.1253/circj.cj-21-1056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study is to investigate the effect of preoperative diabetes on all-cause mortality and major postoperative complications among patients with continuous-flow left ventricular assist device (LVAD) by using data from a national database.Methods and Results: The 545 study patients who underwent primary HeartMateII implantation between 2013 and 2019 were divided into 2 groups according to their diabetes mellitus (DM) status; patients with DM (n=116) and patients without DM (n=429). First, the on-device survival and incidence of adverse events were evaluated. Second, after adjusting for patients' backgrounds, the change of laboratory data in the 2 groups were compared. Overall, on-device survival at 1, 2, and 3 years was almost equivalent between the 2 groups; it was 95%, 94%, and 91% in patients without DM, and 93%, 91%m and 91% in patients with DM (P=0.468) The incidence of adverse events was similar between 2 groups of patients, except for driveline exit site infection in the adjusted cohort. Cox proportional hazards regression analysis revealed younger age (HR: 0.98 (95% confidence interval (CI): 0.97-0.99, P=0.001) and presence of DM (HR: 1.83 (95% CI: 1.14-2.88), P=0.016) as significant predictors of driveline infection. Laboratory findings revealed no differences between groups throughout the periods. CONCLUSIONS The clinical results after LVAD implantation in DM patients were comparable with those in non-DM patients, except for the driveline exit site infection.
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Affiliation(s)
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital
| | | | | | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University
| | | | - Akihiko Usui
- Department of Cardiovascular Surgery, Nagoya University Hospital
| | - Satoru Wakasa
- Department of Cardiovascular Surgery, Hokkaido University
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University
| | | | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Hospital
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