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Aissaoui, Nadia, Jerome Jouan, Melissa Gourjault, Benoit Diebold, Sofia Ortuno, Amer Hamdan, Christian Latremouille, Romain Pirracchio, and Michiel Morshuis. "Understanding Left Ventricular Assist Devices." Blood Purification 46, no. 4 (2018): 292–300. http://dx.doi.org/10.1159/000491872.
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Background/Aims: Long-term mechanical assist devices are now commonly used in the treatment of severe heart failure to unload the failing ventricle, maintain sufficient end-organ perfusion and improve functional capacity. Depending on the assisted ventricles, 3 categories of long-term assist devices are available: left ventricular assist device (LVAD), biventricular assist device and total artificial heart. Improvements in technology, especially the advent of smaller, durable continuous flow pumps, have led to the use of LVADs in a much broader population of patients in the last 10 years. Both the number of patients living with LVADs and the life expectancy of these patients are increasing. Regarding this growing number of patients with LVAD, intensivists need to understand the physiology of the devices, their functioning, potential complications and their management. Methods: We performed a narrative review of relevant medical literature regarding the physiology of patients with LVAD and management of common complications relevant to the critical care physicians. Results: The most frequent complications occurring in the LVAD patients after the post-operative period are bleeding, driveline infections, thrombosis, device malfunction, right ventricular failure and arrhythmias. Bleeding is the most frequent adverse event in LVAD due to a combination of anticoagulation and acquired von Willebrand disease secondary to shear stress produced within the pump. Their management includes antiplatelet therapy arrest, reduction of the anticoagulation regimen and specific therapy if feasible. Infection is the second most common cause of death after cardiac failure in LVAD patients. All infections must be aggressively treated to avoid seeding the device. Device thrombosis can develop even when patients are adequately anticoagulated and taking antiplatelet therapy because the LVAD is responsible for a chronic hypercoagulable state. Conclusion: Management of these unique patients in the ICU is best accomplished with a multidisciplinary team that includes specialists in advanced heart failure, LVAD nurse coordinators and intensivists.
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Gwyn, Jennifer CV. "Left ventricular assist devices." Journal of the Intensive Care Society 21, no. 4 (June 8, 2020): 355–58. http://dx.doi.org/10.1177/1751143720930583.
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Background There is a growing population of patients in the UK with advanced heart failure who are receiving a left ventricular assist device (LVAD) as a bridge to transplant. This is due to the plateauing number of heart transplantations and the increasing evidence of the effectiveness of these devices. It is, therefore, important that all clinicians working in an intensive care setting have an understanding of how LVADs work, whether as a district general physician referring a patient for consideration of implantation or a tertiary centre healthcare professional managing the complications. Presentation This case study describes the journey of a patient presenting with decompensated heart failure who failed to improve despite maximal medical intervention. The patient was not eligible for a heart transplant at the time, so an LVAD was inserted as a bridge to recovery of organ dysfunction and then eventual cardiac transplantation. Discussion This article will focus on providing an overview of the indications and anatomy of LVADs as well as the evidence behind their use so that intensive care professionals are aware of the potential of these devices. There will also be further discussion around complications of these devices and practical points to consider when managing a patient who has an LVAD in situ.
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Angud, Marc. "Left Ventricular Assist Device Driveline Infections." AACN Advanced Critical Care 26, no. 4 (October 1, 2015): 300–305. http://dx.doi.org/10.4037/nci.0000000000000108.
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Heart failure is a chronic progressive disease that affects millions of people in the United States. Although medical management of heart failure has helped improve quality of life and survival, end-stage heart failure ultimately requires a heart transplant or long-term left ventricular assist device (LVAD) support. With more patients awaiting transplant, the demand for hearts outweighs the supply of donor hearts. The use of LVADs is increasing in patients with advanced heart failure as a treatment option for those awaiting a heart transplant or as a long-term solution if they are ineligible for a transplant. Although the LVAD is a marvel of modern medicine, infection is a cause of concern because today’s LVADs are powered externally through a percutaneous driveline that can be a major source of infection.
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Puhlman, Mark. "Continuous-Flow Left Ventricular Assist Device and the Right Ventricle." AACN Advanced Critical Care 23, no. 1 (January 1, 2012): 86–90. http://dx.doi.org/10.4037/nci.0b013e31823ef240.
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Left ventricular assist devices (LVADs) have become accepted as treatment for heart failure as a result of improvements in diagnosing and treating left ventricular failure and limited donor availability. In the Pivotal Study of the HeartMate II in the bridge to transplantation population, the incidence of right ventricular failure without the implantation of a right ventricular assist device was 14%, with an additional 6% of the participants ill enough that they required implantation of a right ventricular assist device. This complication increases mortality, cost, and length of stay. This article reviews the screening of LVAD candidates for the probability of right ventricular failure postoperatively, the evaluation of right ventricular function in LVAD candidates, and the optimal management of the right ventricle during the perioperative care of LVAD patients.
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Cheung, Anson, Jia-Lin Soon, Jamil Bashir, Annemarie Kaan, and Andrew Ignaszewski. "Minimal-Access Left Ventricular Assist Device Implantation." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, no. 4 (July 2014): 281–85. http://dx.doi.org/10.1097/imi.0000000000000086.
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Objective The left ventricular assist device (LVAD) is typically implanted through a full sternotomy on cardiopulmonary bypass (CPB). Minimally invasive surgery (MIS) modifications include multiple smaller incisions, using “virgin” territory, and minimized CPB time. Methods Forty-two LVAD implantations were retrospectively reviewed. Twenty-five minimally invasive implantations (MIS, 20 HeartMate II and 5 HeartWare) were compared with 17 sternotomy implantations (12 HeartMate II and 5 HeartWare). The choice of MIS incisions was device dependent: (1) three separate incisions for the HeartMate II or (2) two incisions for the HeartWare device. Four HeartWare LVADs were implanted off-pump (three using the MIS approach). Results The median patient age was 52 years (range, 18–69 years). Overall survival was 81% at a mean (SD) follow-up of 495 (375) days. Thirty-day mortality was 9.5% (one MIS and three sternotomy patients). Five patients (11.9%) died while on LVAD, 18 (42.9%) underwent transplantation, 6 (14.3%) underwent weaning and explantation, and 13 (31.0%) remained on support. Preoperative ventilatory and circulatory supports were more common in the sternotomy group. The MIS patients had shorter CPB time [51.4 (34.9) vs 83.6 (40.4) minutes, P = 0.014] and showed a trend toward lower red blood cell and platelet transfusion requirement. The durations of hospitalization, inotropic support, intensive care unit stay, and LVAD support were not significantly different. Conclusions Minimally invasive surgery LVAD implantation is feasible. The shorter CPB duration and off-pump approach may be advantageous. Avoiding sternotomy may also reduce adhesions encountered during subsequent cardiac transplantation.
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Ross, Daniel W., Gerin R. Stevens, Rimda Wanchoo, David T. Majure, Sandeep Jauhar, Harold A. Fernandez, Massini Merzkani, and Kenar D. Jhaveri. "Left Ventricular Assist Devices and the Kidney." Clinical Journal of the American Society of Nephrology 13, no. 2 (October 25, 2017): 348–55. http://dx.doi.org/10.2215/cjn.04670417.
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Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR. In this review, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience. In light of the growing number of patients using LVADs as a destination therapy, it is important to understand the effect of these devices on the kidney. Additional research and long-term data are required to better understand the relationship between the LVAD and the kidney.
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Clement, Alexandra, Larisa Anghel, Radu Sascău, and Cristian Stătescu. "Left Ventricular Assist Device-Related Complications." Journal Of Cardiovascular Emergencies 6, no. 3 (September 1, 2020): 50–58. http://dx.doi.org/10.2478/jce-2020-0014.
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AbstractLeft ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.
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Kakino, Takamori, Keita Saku, Takafumi Sakamoto, Kazuo Sakamoto, Takuya Akashi, Masataka Ikeda, Tomomi Ide, Takuya Kishi, Hiroyuki Tsutsui, and Kenji Sunagawa. "Prediction of hemodynamics under left ventricular assist device." American Journal of Physiology-Heart and Circulatory Physiology 312, no. 1 (January 1, 2017): H80—H88. http://dx.doi.org/10.1152/ajpheart.00617.2016.
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Left ventricular assist device (LVAD) saves lives in patients with severe left ventricular (LV) failure. However, predicting how much LVAD boosts total cardiac output (CO) remains difficult. This study aimed to develop a framework to quantitatively predict the impact of LVAD on hemodynamics. We adopted the circulatory equilibrium framework and incorporated LVAD into the integrated CO curve to derive the circulatory equilibrium. In anesthetized dogs, we ligated left coronary arteries to create LV failure and inserted a centrifugal pump as LVAD. Using CO and right (PRA) and left atrial pressure (PLA) measured before LVAD support, we predetermined the stressed volume (V) and logarithmic slope of right heart CO curve (SR). Next, we initiated LVAD at maximum level and then decreased LVAD flow stepwise while monitoring hemodynamic changes. We predicted LVAD-induced CO and PRA for given PLA from the predetermined SR and V and compared with those measured experimentally. The predicted CO [ r2 = 0.907, SE of estimate (SEE) = 5.59 ml·min−1·kg−1, P < 0.001] and PRA ( r2 = 0.967, SEE = 0.307 mmHg, P < 0.001) matched well with measured values indicating the validity of the proposed framework. We further conducted simulation using the validated framework to analyze the impact of LVAD on PRA under various right ventricular (RV) functions. It indicated that PRA is relatively insensitive to changes in RV end-systolic elastance or pulmonary arterial resistance, but sensitive to changes in V. In conclusion, the circulatory equilibrium framework predicts quantitatively the hemodynamic impact of LVAD. This knowledge would contribute to safe management of patients with LV failure undergoing LVAD implantation. NEW & NOTEWORTHY Hemodynamic response to left ventricular assist device (LVAD) has not been quantitatively investigated. This is the first report of quantitative prediction of the hemodynamics on LVAD using circulatory equilibrium framework. The validated framework allows us to simulate the impact of LVAD on right atrial pressure under various right ventricular functions.
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Cheung, Anson, and Jia-Lin Soon. "Minimal-Access Left Ventricular Assist Device Explantation." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 7, no. 4 (July 2012): 300–302. http://dx.doi.org/10.1097/imi.0b013e3182746a6e.
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Patients on left ventricular assist device (LVAD) support can be successfully bridged to recovery. A novel explantation technique is reviewed. Six HeartMate II patients were successfully explanted off-pump through a combination of a left anterior minithoracotomy and a subxiphoid incision. A retrospective review of the institutional LVAD database was performed. The median LVAD support duration was 191 days (range, 69–307 days). There was no procedural or 30-day mortality associated with the LVAD explantation, and all patients are in New York Heart Association I to II at a median follow-up of 688 days (range, 127–1033 days). This procedure was associated with minimal blood transfusion and short intensive care unit stay (median, 1 day; range, 1–5 days) and hospitalization (median, 4.5 days; range, 3–19 days). One postexplant embolic cerebral infarct occurred. The HeartMate II LVAD can be safely explanted through a less conventional minimal-access approach.
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Camp, Debi. "The Left Ventricular Assist Device (LVAD)." Critical Care Nursing Clinics of North America 12, no. 1 (March 2000): 61–68. http://dx.doi.org/10.1016/s0899-5885(18)30124-2.
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Yalcin, Yunus C., Claudette Kooij, Dominic A. M. J. Theuns, Alina A. Constantinescu, Jasper J. Brugts, Olivier C. Manintveld, Sing-Chien Yap, Tamas Szili-Torok, Ad J. J. C. Bogers, and Kadir Caliskan. "Emerging electromagnetic interferences between implantable cardioverter-defibrillators and left ventricular assist devices." EP Europace 22, no. 4 (January 31, 2020): 584–87. http://dx.doi.org/10.1093/europace/euaa006.
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Abstract Aims To investigate the prevalence of electromagnetic interference (EMI) between left ventricular assist devices (LVADs) and implantable cardioverter-defibrillators (ICDs)/pacemakers (PMs). Methods and results A retrospective single-centre study was conducted, including all patients undergoing HeartMate II (HMII) and HeartMate 3 (HM3) LVAD implantation (n = 106). Electromagnetic interference was determined by the inability to interrogate the ICD/PM. Overall, 85 (mean age 59 ± 8, 79% male) patients had an ICD/PM at the time of LVAD implantation; 46 patients with HMII and 40 patients with HM3. Among the 85 LVAD patients with an ICD’s/PM’s, 11 patients (13%) experienced EMI; 6 patients (15%) with an HMII and 5 patients (11%) with an HM3 (P = 0.59). Electromagnetic interference from the HMII LVADs was only present in patients with a St Jude/Abbott device; 6 of the 23 St Jude/Abbott devices. However, in the HM3 patients, EMI was mainly present in patients with Biotronik devices: 4 of the 18 with only one (1/25) patient with a Medtronic device. While initial interrogation of these devices was not successful, none of the 11 cases experienced pacing inhibition or inappropriate shocks. Conclusion In summary, the prevalence of EMI between ICDs in the older and newer type of LVAD's remains rather high. While HMII patients experienced EMI with a St Jude/Abbott device (which was already known), HM3 LVAD patients experience EMI mainly with Biotronik devices. Prospective follow-up, preferably in large registries, is warranted to investigate the overall prevalence and impact of EMI in LVAD patients.
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lacovoni, Attilio, Claudia Vittori, Alessandra Fontana, Alessandra Carobbio, Carlo Fino, Emilia D'Elia, Amedeo Terzi, and Michele Senni. "Echocardiographic Outflow Pump Ramp Test in Centrifugal-Flow Left Ventricular Assist Device." International Journal of Artificial Organs 40, no. 3 (March 2017): 128–31. http://dx.doi.org/10.5301/ijao.5000573.
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This study sought to develop a novel echocardiogram outflow ramp test to detect device malfunctions in centrifugal-flow left ventricular assist devices (LVADs). This new ramp pump test is based on the direct analyses of systolic and diastolic ratio (S/D) Doppler velocity in the outflow cannula in the HeartWare LVAD during progressive increases in speed. The results showed that in patients with normal pump function, the Doppler velocity S/D ratio gradually decreased during LVAD speed increases. This test is easily performed and seems promising to detect normal pump function in patients assisted by a centrifugal flow LVAD.
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Anselmi, Amedeo, Vincent Galand, André Vincentelli, Stéphane Boule, Camille Dambrin, Clément Delmas, Laurent Barandon, et al. "Current results of left ventricular assist device therapy in France: the ASSIST-ICD registry." European Journal of Cardio-Thoracic Surgery 58, no. 1 (April 16, 2020): 112–20. http://dx.doi.org/10.1093/ejcts/ezaa055.
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Abstract OBJECTIVES Our goal was to provide a picture of left ventricular assist device (LVAD) activity in France between 2007 and 2016 based on the multicentric ASSIST-ICD registry. METHODS We retrospectively collected 136 variables including in-hospital data, follow-up survival rates and adverse events from 671 LVAD recipients at 20 out of 24 LVAD implant centres in France. The average follow-up time was 1.2 years (standard deviation: 1.4); the total follow-up time was 807.5 patient-years. RESULTS The included devices were the HeartMate II®, HeartWare LVAS® or Jarvik 2000®. The overall likelihood of being alive while on LVAD support or having a transplant (primary end point) at 1, 2, 3 and 5 years postimplantation was 65.2%, 59.7%, 55.9% and 47.7%, respectively, given a cumulative incidence of 29.2% of receiving a transplant at year 5. At implantation, 21.5% of patients were on extracorporeal life support. The overall rate of cardiogenic shock at implantation was 53%. The major complications were driveline infection (26.1%), pump pocket or cannula infection (12.6%), LVAD thrombosis (12.2%), ischaemic (12.8%) or haemorrhagic stroke (5.4%; all strokes 18.2%), non-cerebral haemorrhage (9.1%) and LVAD exchange (5.2%). The primary end point (survival) was stratified by age at surgery and by the type of device used, with inference from baseline profiles. The primary end point combined with an absence of complications (secondary end point) was also stratified by device type. CONCLUSIONS The ASSIST-ICD registry provides a real-life picture of LVAD use in 20 of the 24 implant centres in France. Despite older average age and a higher proportion of patients chosen for destination therapy, survival rates improved compared to those in previous national registry results. This LVAD registry contrasts with other international registries because patients with implants have more severe disease, and the national policy for graft attribution is distinct. We recommend referring patients for LVAD earlier and suggest a discussion of the optimal timing of a transplant for bridged patients (more dismal results after the second year of support?).
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Raheja, Suraj, Hassan Nemeh, Celeste Williams, Cristina Tita, Yelena Selektor, Themistokles Chamogeorgiakis, and David Lanfear. "Pulmonary Function Testing and Outcomes after Left Ventricular Assist Device Implantation." Heart Surgery Forum 22, no. 3 (May 8, 2019): E202—E206. http://dx.doi.org/10.1532/hsf.2299.
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Background: Pulmonary function testing (PFT) is often done during workup prior to left ventricular assist devices (LVAD), but its utility for predicting outcomes and changes in pulmonary function post-LVAD is not well established. We assessed the association of baseline PFT metrics with outcomes after LVAD, and quantified the changes in PFTs post-LVAD.
Methods and results: A retrospective study of 178 patients receiving continuous flow LVADs was conducted. A total of 129 subjects had baseline PFT data and 54 of these had repeat tests after LVAD. We collected PFT data (FEV1, FVC, FEV1/FVC ratios, and DLCO) at baseline and post-LVAD, and tested the association with survival, right heart failure, quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]) and functional capacity (six-minute walking distance [6MWD]). Proportional hazards and linear regressions determined relationships between baseline PFT data and survival time and functional outcomes, respectively. Paired t-tests compared pre- and post- LVAD PFT variables. There was no association of baseline PFT parameters with survival time post-LVAD (all P > .2), nor the incidence of perioperative RV failure (all P > .15). There were no significant associations of the baseline PFT metrics with the change in KCCQ or 6MWD. There were statistically significant declines in FEV1, FEV1/FVC ratio, and DLCO after LVAD (P < .05).
Conclusion: In this single center study, there was no relationship between baseline PFTs and post-LVAD outcomes, and PFT parameters often worsened after LVAD. Further studies are needed to determine whether PFTs are useful in this setting, and what, if any, impact LVAD therapy has on pulmonary function.
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Burkhoff, Daniel, Veli K. Topkara, Gabriel Sayer, and Nir Uriel. "Reverse Remodeling With Left Ventricular Assist Devices." Circulation Research 128, no. 10 (May 14, 2021): 1594–612. http://dx.doi.org/10.1161/circresaha.121.318160.
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This review provides a comprehensive overview of the past 25+ years of research into the development of left ventricular assist device (LVAD) to improve clinical outcomes in patients with severe end-stage heart failure and basic insights gained into the biology of heart failure gleaned from studies of hearts and myocardium of patients undergoing LVAD support. Clinical aspects of contemporary LVAD therapy, including evolving device technology, overall mortality, and complications, are reviewed. We explain the hemodynamic effects of LVAD support and how these lead to ventricular unloading. This includes a detailed review of the structural, cellular, and molecular aspects of LVAD-associated reverse remodeling. Synergisms between LVAD support and medical therapies for heart failure related to reverse remodeling, remission, and recovery are discussed within the context of both clinical outcomes and fundamental effects on myocardial biology. The incidence, clinical implications and factors most likely to be associated with improved ventricular function and remission of the heart failure are reviewed. Finally, we discuss recognized impediments to achieving myocardial recovery in the vast majority of LVAD-supported hearts and their implications for future research aimed at improving the overall rates of recovery.
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Pantalos, G. M., J. D. Marks, J. B. Riebman, N. A. Burton, R. Depaulis, and W. J. Kolff. "Hemodynamic and Energetic Assessment of Calves Implanted with a Left Ventricular Assist Device (LVAD)." International Journal of Artificial Organs 11, no. 2 (March 1988): 119–26. http://dx.doi.org/10.1177/039139888801100212.
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Hemodynamic and ventricular energetic parameters were measured in calves implanted with the air driven Utah Ventricular Assist Device (UVAD). Uptake site was varied to determine the effect of control mode and vacuum augmentation of filling. Uptake was drawn solely from the left atrium or combined with a left ventricular apical vent. LVAD outflow returned to the descending, thoracic aorta. Control modes examined included asynchronous pumping as well as 1:1 and 1:2 synchronous diastolic counterpulsation. The 85cc LVAD, vacuum formed from PELLETHANE®, was implanted acutely in four animals and chronically in six (7, 49 and 116 days paracorporeally, 1, 28 and 32 days intrathoracically). Instantaneous blood pressures, intramyocardial pressure, aortic outflow, oxygen consumption, LVAD output and drive parameters were recorded. LVAD output was independent of control mode when the natural heart rate was ≥ 80 beats per minute. Intrathoracically positioned LVADs pumped a mean flow of ≈5 liters/min without vacuum augmentation of filling. Paracorporeally positioned LVADs pumped ≈3 liters/min mean flow without vacuum augmentation and up to ≈6 liters/min with 38 mm Hg of vacuum augmentation of filling. Instantaneous ascending aortic pressure and flow showed distinct beat-to-beat variation depending on LVAD control mode. Lower average ventricular afterload was observed when pumping the LVAD asynchronously or 1:2 synchronously. In one acute preparation, left ventricular myocardial oxygen consumption was reduced from the unassisted average control level by 37% for the asynchronous and 1:1 synchronous control modes with left atrial uptake. With combined uptake, oxygen consumption was reduced an additional 30% during asynchronous control or 11% during 1:1 synchronous control without any change in LVAD output. Endocardial/epicardial blood flow ratio was similar and ≥1.12 for all test conditions. Renal and brain blood flow was maintained, or slightly elevated during ventricular assistance. Intramyocardial pressures were monitored using Millar catheter tip transducers. In an acute preparation, left ventricular assistance reduced peak intramyocardial pressure. Changing from atrial to combined uptake cannulation further reduced peak intramyocardial pressure for asynchronous and 1:1 synchronous LVAD control. Reduced end-diastolic intramyocardial pressures were seen with all modes of LVAD control. These data demonstrate excellent UVAD pumping function and suggest that left ventricular assistance does not compromise endocardial blood flow while sustaining blood flow to other major organs. Regardless of the uptake site, asynchronous or 1:2 synchronous LVAD control may be clinically preferable for effective reduction of left ventricular myocardial oxygen consumption.
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Singal, Amit, Preeti N. Malani, Larry J. Day, Francis D. Pagani, and Nina M. Clark. "RoseomonasInfection Associated With a Left Ventricular Assist Device." Infection Control & Hospital Epidemiology 24, no. 12 (December 2003): 963–65. http://dx.doi.org/10.1086/502168.
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AbstractRoseomonasspecies have been increasingly noted as causes of human infection. We present what we believe is the first case of left ventricular assist device (LVAD) infection secondary toRoseomonas. The clinical characteristics ofRoseomonasinfection and the pertinent features of LVAD infection are reviewed.
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Sundbom, Per, Michael Roth, Hans Granfeldt, Daniel M. Karlsson, Henrik Ahn, Fredrik Gustafsson, and Laila Hubbert. "Sound analysis of a left ventricular assist device: A technical evaluation of iOS devices." International Journal of Artificial Organs 41, no. 5 (March 9, 2018): 254–60. http://dx.doi.org/10.1177/0391398818762352.
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Introduction: The use of left ventricular assist device (LVAD) has grown rapidly. Adverse events do continue to occur. In recent years, analysis of LVAD sound recordings emerged as a means to monitor pump function and detect pump thrombosis. The aim of this study was to characterize the sounds from HeartMate II and to evaluate the use of handheld iOS devices for sound recordings. Method: Signal analysis of LVAD sound recordings, with dedicated recording equipment and iOS devices, was performed. Two LVADs running in mock loop circuits were compared to an implanted LVAD. Spectral analysis and parametric signal models were explored to quantify the sound and potentially detect changes in it. Results: The sound recordings of two LVADs in individual mock loop circuits and a third one implanted in a patient appeared to be similar. Qualitatively, sound characteristics were preserved following changes in pump speed. Recordings using dedicated equipment showed that HeartMate II sound comprises low-frequency components corresponding to pump impeller rotation, as well as high-frequency components due to a pulse width modulation of the electric power to the pump. These different signal components interact and result in a complicated frequency spectrum. The iPhone and iPod recordings could not reproduce the sounds as well as the dedicated equipment. In particular, lower frequencies were affected by outside disturbances. Discussion: This article outlines a systematic approach to LVAD sound analysis using signal processing methods to quantify and potentially detect changes, and describes some of the challenges, for example, with the use of inexpensive recording devices.
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From, Robert P., David Hasan, Michael T. Froehler, and Jennifer L. Goerbig-Campbell. "Stroke and Left Ventricular Assist Device (LVAD)." Open Journal of Anesthesiology 03, no. 01 (2013): 51–56. http://dx.doi.org/10.4236/ojanes.2013.31014.
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Takahama, T., F. Kanai, and K. Onishi. "ANTICOAGULATION FOR LEFT VENTRICULAR ASSIST DEVICE (LVAD)." ASAIO Journal 45, no. 2 (March 1999): 153. http://dx.doi.org/10.1097/00002480-199903000-00135.
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Griffin, Jan M., and Jason N. Katz. "The Burden of Ventricular Arrhythmias Following Left Ventricular Assist Device Implantation." Arrhythmia & Electrophysiology Review 3, no. 3 (2014): 145. http://dx.doi.org/10.15420/aer.2014.3.3.145.
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Few innovations in medicine have so convincingly and expeditiously improved patient outcomes more than the development of the left ventricular assist device (LVAD). Where optimal pharmacotherapy once routinely failed those with end-stage disease, the LVAD now offers considerable hope for the growing advanced heart failure population. Despite improvements in mortality, however, mechanical circulatory support is not without its limitations. Those supported with an LVAD are at increased risk of several complications, including infection, bleeding, stroke and arrhythmic events. While once considered benign, ventricular arrhythmias in the LVAD patient are being increasingly recognised for their deleterious influence on patient morbidity and quality of life. In addition, the often multifactorial aetiology to these episodes makes treatment difficult and optimal therapeutic management controversial. Novel strategies are clearly needed to better predict, prevent, and eradicate these arrhythmias in order to allow future generations of heart failure patients to reap the full benefits of LVAD implantation.
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Rustum, Saad, Julia Neuser, Jan Dieter Schmitto, Thomas Aper, Jasmin Sarah Hanke, Axel Haverich, and Mathias Wilhelmi. "Vascular procedures in patients with left ventricular assist devices: single-center experience." Indian Journal of Thoracic and Cardiovascular Surgery 37, no. 5 (May 27, 2021): 514–20. http://dx.doi.org/10.1007/s12055-021-01192-3.
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Abstract Objective A growing number of patients suffering from heart failure is living with a left ventricular assist device (LVAD) and is in the need for non-cardiac surgery. Vascular procedures due to ischemia, bleeding, or other device-related complications may be required and pose a challenge to the caregivers in terms of monitoring and management of these patients. Therefore, we reviewed our experience with LVAD patients undergoing vascular surgery. Methods From January 2010 until March 2017, a total of 54 vascular procedures were performed on 41 LVAD patients at our institution. Patient records were reviewed retrospectively in terms of incidence of LVAD-related complications, including thrombosis, stroke, bleeding, wound healing, and survival associated with vascular surgery. The type of surgery was recorded, as well as various clinical demographic variables. Results Vascular procedures were performed in 35 men (85.4%) and 6 women (14.6%) with LVADs. There were no perioperative strokes, device thromboses, or device malfunctions. Thirty-day mortality overall was 26.8% (eleven patients), with most patients dying within 30 days after LVAD implantation due to multi-organ failure. In 25 procedures (46.3%), a blood transfusion was necessary. Conclusion Patients on LVAD support are a complex cohort with a high risk for perioperative complications. In a setting where device function and anticoagulation are monitored closely, vascular surgery in these patients is feasible with an acceptable perioperative risk.
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Nayak, Jasmir G., Christopher White, Wayne Nates, Rajan Sharda, David Horne, Kam Kaler, Mark Lytwyn, Hilary P. Grocott, Darren H. Freed, and Thomas McGregor. "Laparoscopic nephroureterectomy in a patient with a left ventricular assist device." Canadian Urological Association Journal 7, no. 9-10 (October 9, 2013): 640. http://dx.doi.org/10.5489/cuaj.400.
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Left ventricular assist device (LVAD) therapy is an established treatment option for select patients with advanced heart failure. Advances in technology and patient management have resulted in improved post-implant outcomes. Consequently, more patients with LVADs are presenting for evaluation and care of non-cardiac surgical disease. However, there is a paucity of literature regarding the optimal perioperative and surgical management of such patients. We present the case of a 71-year-old male with a HeartMate II (Thoratec Corporation, Pleasanton, CA) LVAD, who underwent a laparoscopic left nephroureterectomy for an upper urinary tract transitional cell carcinoma. His perioperative course was uneventful due to the multidisciplinary efforts of cardiac surgery, cardiac anesthesia, nephrology and urology. To our knowledge, this is the first reported case of a laparoscopic nephroureterectomy in a patient with a HeartMate II LVAD.
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Neyt, Mattias, Ann Van den Bruel, Yolba Smit, Nicolaas De Jonge, Michiel Erasmus, Diederik Van Dijk, and Joan Vlayen. "COST-EFFECTIVENESS OF CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES." International Journal of Technology Assessment in Health Care 29, no. 3 (June 14, 2013): 254–60. http://dx.doi.org/10.1017/s0266462313000238.
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Objectives: Mechanical circulatory support through left ventricular assist devices (LVADs) improves survival and quality of life for patients with end-stage heart failure who are ineligible for cardiac transplantation. Our aim was to calculate the cost-effectiveness of continuous-flow LVADs.Methods: A cost-utility analysis from a societal perspective was performed. A lifetime Markov model was set up in which continuous-flow LVAD was compared with optimal medical therapy (OMT). The treatment effect was modeled indirectly combining the results of the REMATCH trial comparing OMT with a pulsatile-flow LVAD and the HeartMate II Destination Therapy Trial comparing a pulsatile-flow LVAD with a continuous-flow LVAD. Cost data were based on real-world financial data of sixty-nine patients with a HeartMate II implantation from the University Medical Centre Utrecht (the Netherlands). One-way and probabilistic sensitivity analyses were performed.Results: Comparing the continuous-flow HeartMate II with OMT, 3.23 (95 percent confidence interval [CI], 2.18–4.49) life-years were gained (LYG) or 2.83 (95 percent CI, 1.91–3.90) quality-adjusted life-years (QALYs). The cost of an LVAD implant was approximately €126,000, of which the device itself represented the largest cost, being €70,000. Total incremental costs amounted to €299,100 (95 percent CI, 190,500–521,000). This resulted in an incremental cost-effectiveness ratio of €94,100 (95 percent CI, 59,100–160,100) per LYG or €107,600 (95 percent CI, 66,700–181,100) per QALY. Sensitivity analyses showed these results were robust.Conclusions: Although LVAD destination therapy improves survival and quality of life, it remains a relatively expensive intervention which renders the reimbursement of this therapy questionable.
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Shaikh, Asad, Susan Joseph, Brian Lima, Shelley Hall, Rajasekhar Malyala, Aldo Rafael, Gonzalo Gonzalez-Stawinski, and Themistokles Chamogeorgakis. "HeartMate II Left Ventricular Assist Device Pump Exchange: A Single-Institution Experience." Thoracic and Cardiovascular Surgeon 65, no. 05 (November 30, 2016): 410–14. http://dx.doi.org/10.1055/s-0036-1593867.
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Background Left ventricular assist devices (LVADs) have revolutionized the treatment of patients with end-stage heart failure. These devices are replaced when pump complications arise if heart transplant is not possible. We present our experience with HeartMate II (HMII (Thoratec, Plesanton, California, United States)) LVAD pump exchange. Materials and Methods We retrospectively reviewed all cases that required pump exchange due to LVAD complication from November 2011 until June 2016 at a single high-volume institution. The indications, demographics, and outcome were extracted and analyzed. Results Of 250 total patients with implanted HMII LVADs, 16 (6%) required pump exchange during the study period. The initial indications for LVAD placement in these patients were bridge to transplantation (n = 6 [37.5%]) or destination therapy (n = 10 [62.5%]). Fifteen patients (93.8%) required pump exchange due to pump thrombosis and 1 (6.2%) due to refractory driveline infection. Nine patients (56.2%) underwent repeat median sternotomy while a left subcostal approach was used in the remaining seven patients. Fifteen patients (93.7%) survived until hospital discharge. During the follow-up period (median, 155 days), 11 patients remained alive and 4 of these underwent successful cardiac transplantation. Conclusion HMII LVAD pump exchange can be safely performed for driveline infection or pump thrombosis when heart transplantation is not an option.
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Nascimbene, Angelo, Sriram Neelamegham, O. H. Frazier, Joel L. Moake, and Jing-fei Dong. "Acquired von Willebrand syndrome associated with left ventricular assist device." Blood 127, no. 25 (June 23, 2016): 3133–41. http://dx.doi.org/10.1182/blood-2015-10-636480.
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Abstract Left ventricular assist devices (LVAD) provide cardiac support for patients with end-stage heart disease as either bridge or destination therapy, and have significantly improved the survival of these patients. Whereas earlier models were designed to mimic the human heart by producing a pulsatile flow in parallel with the patient’s heart, newer devices, which are smaller and more durable, provide continuous blood flow along an axial path using an internal rotor in the blood. However, device-related hemostatic complications remain common and have negatively affected patients’ recovery and quality of life. In most patients, the von Willebrand factor (VWF) rapidly loses large multimers and binds poorly to platelets and subendothelial collagen upon LVAD implantation, leading to the term acquired von Willebrand syndrome (AVWS). These changes in VWF structure and adhesive activity recover quickly upon LVAD explantation and are not observed in patients with heart transplant. The VWF defects are believed to be caused by excessive cleavage of large VWF multimers by the metalloprotease ADAMTS-13 in an LVAD-driven circulation. However, evidence that this mechanism could be the primary cause for the loss of large VWF multimers and LVAD-associated bleeding remains circumstantial. This review discusses changes in VWF reactivity found in patients on LVAD support. It specifically focuses on impacts of LVAD-related mechanical stress on VWF structural stability and adhesive reactivity in exploring multiple causes of AVWS and LVAD-associated hemostatic complications.
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Sherazi, Saadia, Peter Kouides, Charles Francis, Charles Julian Lowenstein, Majed Refaai, Grace Conley, Brent Alan Johnson, et al. "Prospective analysis of bleeding events in left ventricular assist device patients." International Journal of Artificial Organs 41, no. 5 (March 22, 2018): 269–76. http://dx.doi.org/10.1177/0391398818762353.
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Background: Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation. Methods: A prospective study was performed on 30 patients with HeartMate II implantation at the University of Rochester Medical Center, Rochester, New York, United States. Blood was collected within 1 week before implantation, and at 1, 3, and 30 ± 10 days after implantation. Blood samples were analyzed for prothrombin time (PT), international normalized ratio (INR), von Willebrand factor (vWF) activity, vWF antigen, vWF multimers, collagen binding assay, factor VIII, and epinephrine closure time. The first bleeding event within 1 year of implantation was recorded. Results: There were 17 (57%) patients with a bleeding event. The cumulative incidence of bleeding was 50% at 304 days. Age at the time of LVAD implantation was associated with higher risk of bleeding (hazard ratio (HR) = 1.05, 95% confidence interval (CI) = 1.01–1.10, p = 0.013). Higher baseline INR was also associated with increased risk of bleeding after adjusting for age at the time of implant (HR = 6.58, 95% CI = 1.21–35.70, p = 0.028). The bleeders and non-bleeders had similar hemostatic markers at all four time points. Prior to LVAD, mean epinephrine closure time was similar between bleeders and non-bleeders. However, post LVAD measurement of epinephrine, closure time was frequently limited by platelet clumping. Conclusion: Older age and baseline INR are associated with higher risk of bleeding in LVAD patients. Platelet clumping may suggest underlying platelet dysfunction and associated high risk of bleeding
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Mayer, Rory R., Steven W. Hwang, Gaddum D. Reddy, David L. Morales, William E. Whitehead, Daniel J. Curry, Robert J. Bollo, Thomas G. Luerssen, and Andrew Jea. "Neurosurgical complications of left ventricular assist devices in children." Journal of Neurosurgery: Pediatrics 10, no. 5 (November 2012): 370–75. http://dx.doi.org/10.3171/2012.7.peds12161.
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Object Left ventricular assist devices (LVADs) are continuous or pulsatile flow devices that could potentially be life-saving measures for patients with end-stage heart failure. These devices have clear advantages over extracorporeal membrane oxygenation (ECMO) and are often used in adults. They are only recently being commonly used in the pediatric age group. As the use of LVADs becomes more mainstream in children, it is important to determine the complication profile associated with these devices. Furthermore, with the increasing application of LVADs in children, pediatric neurosurgeons are seeing a correlative increase in associated neurological complications. In this study, the authors reviewed the incidence of neurological complications due to LVAD use in the pediatric age group and the role of neurosurgery in treatment. Methods The authors examined data regarding patients with LVADs from the Texas Children's Hospital Heart Center database (July 01, 2007, to June 30, 2011) and recorded neurological complications requiring neurosurgical consultation. They identified 2 children who underwent craniotomies during LVAD treatment. Results Intracranial hemorrhage occurred in 3 (6.5%) of the 46 patients treated with an LVAD at the authors' institution. Of these patients, 2 were treated with craniotomies for life-threatening intracranial hemorrhages. The 3 patients in the neurosurgical cohort presented with cerebral infarction, decreased level of consciousness, and/or seizure. At the last follow-up (286, 503, and 550 days), 1 patient (Case 2) had no decline in neurological status, underwent a successful heart transplant, and was discharged home; 1 patient (Case 1) died of refractory cardiac failure; and 1 patient (Case 3) was on an LVAD for destination therapy (that is, the LVAD is not a bridge to transplantation but rather the final treatment). This patient was discharged from the hospital, but he died of overwhelming fungemia at 286 days while on VAD support. Conclusions Intracranial hemorrhage is a serious and feared complication of LVAD treatment. While the surgical risk is substantial due to systemic anticoagulation and significant medical comorbidities, neurosurgical evacuation of hemorrhage plays an important life-saving role that can yield successful and acceptable outcomes.
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Pal, Nirvik, Samuel H. Gay, Charles G. Boland, and Aaron C. Lim. "Heart Transplantation After Ventricular Assist Device Therapy: Benefits, Risks, and Outcomes." Seminars in Cardiothoracic and Vascular Anesthesia 24, no. 1 (January 12, 2020): 9–23. http://dx.doi.org/10.1177/1089253219898985.
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Heart transplantation is an established treatment for end-stage heart failure. Due to the increase in demand and persistent scarcity of organ, mechanical circulatory devices have played a major role in therapy for advanced heart failure. Usage of left ventricular assist device (LVAD) has gone up from 6% in 2006 to 43% in 2013 as per the United Network of Organ Sharing database. Majority of patients presenting for a heart transplantation are often bridged with an assist device prior for management of heart failure while on wait-list. On one hand, it is well established that LVADs improve survival on wait-list; on the other hand, the effect of LVAD on morbidity and survival after a heart transplantation is still unclear. In this article, we review the available literature and attempt to infer the outcomes given the risks and benefits of heart transplantation with prior LVAD patients.
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Shealy, Stephanie, Alexander Milgrom, Stephen burns, Hunter Ferraro, Amanda Collins, Jenna Cox, Caroline Derrick, et al. "704. Evaluation of Risk Factors and Outcomes of Early Left Ventricular Assist Device Infections." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S403. http://dx.doi.org/10.1093/ofid/ofaa439.896.
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Abstract Background Infection is a major complication of placement of left ventricular assist devices (LVADs) for patients with end stage heart failure. This study aimed to identify risk factors and evaluate outcomes of early LVAD specific and related infections in a community teaching hospital. Methods This was a single-center, retrospective cohort study that included adult patients with placement of LVAD from October 2012 – December 2019. LVAD specific infection was defined as a pump, cannula, pocket, or percutaneous driveline infection and LVAD related infection was defined as infective endocarditis, mediastinitis, or bloodstream infection. The primary outcome was early LVAD specific or related infection within 90 days of implantation. Secondary outcomes included time to infection, risk factors of and time to recurrent infection, and time to death. Multivariate logistic regression was used to ascertain risk factors for early infection. Cox regression was used to ascertain association with time to outcome variables. Results Of 160 patients who had LVADs placed during the study period, 26 experienced early LVAD infection. The majority of infections were caused by Staphylococcus spp. (32.1%). Risk factors for early infection are summarized in Table 1. Risk factors identified included placement of HeartMate III device when compared to HeartMate II and BMI > 40kg/m2. Increased hazard rate of infection was demonstrated for patients with HeartWare and HeartMate III devices compared to HeartMate II (HR 2.344; 95% CI 1.22,4.496; p-value 0.01; and HR 2.858; 95% CI 1.231, 6.635; p-value 0.015, respectively), those with BMI >40 (HR 2.437; 95% CI 1.131, 5.252; p-value 0.023), and those with history of diabetes (HR 1.736; 95% CI 1.012, 2.987; p-value 0.045). No risk factors were identified in the multivariate regression model for recurrent infection. Time to death was increased among patients with A1C > 6.4 at baseline (HR 1.028; 95% CI 1.002, 1.054; p-value: 0.032) and among patients who experienced early LVAD infection (HR 3.824; 95% CI 1.928, 7.584; p-value < 0.001). Conclusion HeartMate III device and BMI > 40kg/m2 were identified as risk factors for early LVAD infection. Time to mortality was decreased among patients that experienced an early LVAD infection. Disclosures Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)
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Aburjania, Nana, Saadia Sherazi, Vakhtang Tchantchaleishvili, Jeffrey D. Alexis, and Christine M. Hay. "Stopping Conventional Showering Decreases Pseudomonas Infections in left Ventricular Assist Device Patients." International Journal of Artificial Organs 40, no. 6 (April 18, 2017): 282–85. http://dx.doi.org/10.5301/ijao.5000590.
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Background Left ventricular assist device (LVAD) exit-site infections represent a major challenge in the era of modern LVADs. Infections caused by Pseudomonas are particularly difficult to treat due to limited antibiotic susceptibility. We hypothesized that keeping the LVAD exit site dry while bathing could result in reduced incidence of Pseudomonas infections. Methods Starting in April 2013, all patients who underwent placement of HeartMate II (HM II) LVAD were instructed not to take conventional showers and to keep the exit site dry while bathing. We retrospectively reviewed patients who underwent HeartMate II LVAD implantation at our institution. Overall and Pseudomonas exit-site infections were compared between two groups: Group 1 was implanted with an LVAD prior to intervention (4/1/2013) and Group 2 after the intervention. Both groups were subjected to cumulative hazard analysis and compared using log-rank test. Results From November 2006 to September 2015, 283 patients underwent HM II LVAD placement at a single institution (Group 1, 163 patients; Group 2, 120 patients). Median age was 59 years (interquartile range [IQR] 50–65), and 57 (20%) were female. Overall, driveline infection was noted in 86 (30%) patients. Pseudomonas was the causative or coexisting organism in 16 (6%) patients. Median days to infection were 347 (IQR, 162–568). Driveline infection was identified in 69 (42%) patients in Group 1 and 17 (14 %) in Group 2. Pseudomonas was an infectious organism in 15 (9%) patients of Group 1 and one (1%) patient of Group 2. The incidence of Pseudomonas exit-site infections (p = 0.077) decreased substantially after the intervention. Conclusions Stopping conventional showering may reduce the rate of Pseudomonas LVAD exit-site infections. Additional, multi-institutional data are needed to further evaluate these findings.
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Coffin, Samuel T., Dia R. Waguespack, Nicholas A. Haglund, Simon Maltais, Jamie P. Dwyer, and Mary E. Keebler. "Kidney Dysfunction and Left Ventricular Assist Device Support: A Comprehensive Perioperative Review." Cardiorenal Medicine 5, no. 1 (2015): 48–60. http://dx.doi.org/10.1159/000369589.
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Left ventricular assist devices (LVADs) are used increasingly as a bridge to transplantation or as destination therapy in end-stage heart failure patients who do not respond to optimal medical therapy. Many of these patients have end-organ dysfunction, including advanced kidney dysfunction, before and after LVAD implantation. Kidney dysfunction is a marker of adverse outcomes, such as increased morbidity and mortality. This review discusses kidney dysfunction and associated management strategies during the dynamic perioperative time period of LVAD implantation. Furthermore, we suggest potential future research directions to better understand the complex relationship between renal pathophysiology and mechanical circulatory support.
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Doligalski, Christina Teeter, and Douglas L. Jennings. "Device-Related Thrombosis in Continuous-Flow Left Ventricular Assist Device Support." Journal of Pharmacy Practice 29, no. 1 (November 24, 2015): 58–66. http://dx.doi.org/10.1177/0897190015615894.
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Advanced heart failure therapy has been revolutionized with the advent of continuous-flow ventricular assist devices (CF-LVADs) which have improved both survival and quality of life. Despite this, support with CF-LVADs is frequently complicated, with 70% of recipients experiencing a major complication in the first year of durable support. The most concerning of these complications to emerge is device-related thrombosis, which is associated with increased morbidity and mortality. Pathophysiology and diagnosis are multifaceted and complex, with pump-specific and patient-specific factors to be considered. Incidence estimates are evolving with increases seen in the past 2 years compared with earlier implant data. Evidence for treatment is limited to case series and reports, which are subject to significant publication bias. Finally, appropriate primary and secondary prophylaxis is imprecise with multiple antiplatelet and antithrombotic strategies described. This review seeks to summarize the current literature surrounding the pathophysiology, diagnosis, and management of thrombosis in CF-LVAD recipients.
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Heikhmakhtiar, Aulia Khamas, and Ki Moo Lim. "Computational Analysis of Pumping Efficacy of a Left Ventricular Assist Device according to Cannulation Site in Heart Failure with Valvular Regurgitation." Computational and Mathematical Methods in Medicine 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/6930482.
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Mitral valve regurgitation (MR) causes blood to flow in two directions during contraction of the left ventricle (LV), that is, forward into the aorta and backward into the left atrium (LA). In aortic valve regurgitation (AR), leakage occurs from the aorta into the LV during diastole. Our objective is to analyze the contribution of a left ventricular assist device (LVAD) to MR and AR for the following two different cannulation sites: from the LA to the aorta (LAAO) and from the LV to the aorta (LVAO). Using a computational method, we simulated three ventricular conditions (normal [HF without valvular regurgitation], 5% MR, and 5% AR) in three groups (control [no LVAD], LAAO, and LVAO). The results showed that LVAD with LAAO cannulation is appropriate for recovery of the MR heart, and the LVAD with LVAO cannulation is appropriate for treating the AR heart.
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Kolff, Willem J., and Sony Jacob. "MINIMALLY INVASIVE LEFT VENTRICULAR ASSIST DEVICE (mi-LVAD)." ASAIO Journal 48, no. 2 (March 2002): 166. http://dx.doi.org/10.1097/00002480-200203000-00166.
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Zhigalov, Konstantin, Michel Pompeu Barros Oliveira Sá, Arian Arjomandi Rad, Robert Vardanyan, Lukas Goerdt, Thomas Chrosch, Alina Zubarevich, et al. "The Impact of Obesity on Left Ventricular Assist Device Outcomes." Medicina 56, no. 11 (October 23, 2020): 556. http://dx.doi.org/10.3390/medicina56110556.
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Background and Objectives: The understanding of high body mass index (BMI) and outcomes after Left Ventricular Assist Device (LVAD) implantation continues to evolve and the relationship has not been established yet. In this study, we investigated the effects of obesity (BMI > 30 kg/m2) on post–LVAD implantation outcomes. HeartWare LVAD and Heart Mate III LVAD were implanted. The primary outcome that was measured was mortality (in-hospital and on follow-up). The secondary outcomes that were measured were major adverse events. Materials and Methods: At our institution, the West German Heart and Vascular Center (Essen, Germany), from August 2010 to January 2020, a total of 210 patients received a long-term LVAD. Patients were stratified according to BMI ≥ 30 kg/m2 representing the obesity threshold. The first group (n = 162) had an average BMI of 24.2 kg/m2 (±2.9), and the second group (n = 48) had an average BMI of 33.9 kg/m2 (±3.2). Baseline demographics were analysed alongside comorbidities per group. Results: Overall mortality was not significantly different between the obese group (51.1% n = 24) and the nonobese group (55.2%, n = 85) (p = 0.619). The difference between the mean duration of survival of patients who expired after hospital discharge was insignificant (2.1 years ± 1.6, group 1; 2.6 years ± 1.5, group 2; p = 0.29). In-hospital mortality was unvaried between the two groups: group 1: n = 34 (44% out of overall group 1 deaths); group 2: n = 11 (45.8% out of overall group 2 deaths) (p > 0.05). Postoperative complications were unvaried between the obese and the non-obese group (all with p > 0.05). However, a significant difference was found with regards to follow-up neurological complications (18.5% vs. 37.8%, p = 0.01) and LVAD thrombosis (14.7% vs. 33.3%, p = 0.01), as both were higher in the obese population. Conclusion: Obesity does not form a barrier for LVAD implantation in terms of mortality (in-hospital and on follow up). However, a significantly higher incidence of follow-up LVAD thrombosis and neurological complications has been found in the obese group of patients.
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Segura, Ana Maria, Lamia Dris, Edward K. Massin, Fred J. Clubb, L. Maximilian Buja, O. H. Frazier, and Heinrich Taegtmeyer. "Heart Failure in Remission for More than 13 Years after Removal of a Left Ventricular Assist Device." Texas Heart Institute Journal 41, no. 4 (August 1, 2014): 389–94. http://dx.doi.org/10.14503/thij-13-4029.
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Mechanical cardiac unloading with use of a left ventricular assist device (LVAD) is associated with substantial improvements in left ventricular function and enables subsequent LVAD explantation in some patients. We describe the case of a 35-year-old man with dilated nonischemic cardiomyopathy who was supported with an LVAD for 9 months. After the device was removed, he led a normal life for 13 years and 4 months. However, at 49 years of age, he presented with new signs and symptoms of heart failure, necessitating implantation of a 2nd LVAD. Afterwards, he has remained asymptomatic. This case is unique in that the patient lived a normal life for longer than a decade before renewed left ventricular decompensation necessitated repeat LVAD therapy. Histologic examination revealed few changes between the first device's removal in 1999 and the 2nd device's implantation in 2012.
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Walenga, Jeanine M., Tania A. Torres, Walter P. Jeske, Jeffrey Schwartz, Vicki Escalante, Joshua D. Newman, and Mamdouh Bakhos. "Protein C Pathway, Inflammation, and Pump Thrombosis in Patients With Left Ventricular Assist Devices." Clinical and Applied Thrombosis/Hemostasis 26 (January 1, 2020): 107602962095972. http://dx.doi.org/10.1177/1076029620959724.
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Use of left ventricular assist devices (LVADs) for management of advanced heart failure is becoming increasingly common; however, device associated thrombosis remains an important cause of mortality in this patient population. We hypothesize that inflammation in LVAD implanted patients dysregulates the protein C pathway, creating a hypercoagulable state leading to thrombosis. Plasma samples from 22 patients implanted with the Thoratec HeartMate II LVAD were analyzed by commercial ELISAs. Retrospective sample selection included those collected 1-3 months prior to and within 1 month after a thrombotic or bleeding event. Unrelated to warfarin dosing, total protein S and free protein S ( p = 0.033) levels were 20% lower in patients with LVAD-thrombosis than in patients with LVAD-bleeding. Levels of protein C, soluble endothelial cell protein C receptor, and soluble thrombomodulin were similar in both groups before and after the event. Compared to normal, C-reactive protein levels were 25-fold elevated in LVAD-thrombosis patients but only 9-fold elevated in LVAD-bleeding patients. This study suggests that protein S, influenced by the inflammatory state, is a gatekeeper for the function of protein C in patients with LVAD-associated thrombosis.
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Reich, Heidi J., Aamir Shah, Babak Azarbal, Jon Kobashigawa, Jaime Moriguchi, Lawrence Czer, and Fardad Esmailian. "Microaxial Flow Left Ventricular Assist Device as a Bridge to Transplantation after LVAD Malfunction." Texas Heart Institute Journal 42, no. 6 (December 1, 2015): 572–74. http://dx.doi.org/10.14503/thij-14-4654.
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Evolving technology and improvements in the design of modern, continuous-flow left ventricular assist devices have substantially reduced the rate of device malfunction. As the number of implanted devices increases and as survival prospects for patients with a device continue to improve, device malfunction is an increasingly common clinical challenge. Here, we present our initial experience with an endovascular microaxial flow left ventricular assist device as a successful bridge to transplantation in a 54-year-old man who experienced left ventricular assist device malfunction.
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Tasoulis, Athanasios, Georgios Tzanis, Ioannis Vasileiadis, Stavros Dimopoulos, Eleftherios Karatzanos, Serafim Nanas, and Christos Charitos. "Effects of left ventricular assist device implantation on respiratory drive." Health & Research Journal 5, no. 2 (July 1, 2019): 77. http://dx.doi.org/10.12681/healthresj.20877.
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Background: Patients with heart failure (HF) suffer from ventilatory abnormalities that are related to poor prognosis.Aim: The aim of the study was to investigate the respiratory drive in HF patients early after left ventricular assist device (LVAD) implantation. Methods: We enrolled eight HF patients after LVAD (HeartMate II) implantation and 8 patients with advanced HF (control group). Patients were evaluated with cardiopulmonary exercise testing, respiratory function tests and transthoracic echocardiographic examination at 1, 3 and 6 months. Respiratory drive was estimated by the mouth occlusion pressure-P0.1 and the P0.1/Pimax ratio.Results: LVAD patients at 1, 3 and 6 months after implantation had significantly improved P0.1/Pimax% ratio (4.17±0.43 vs 3.29±1.0 vs 2.56±0.35 respectively,p<0.01) as well as significantly increased in Pimax. No changes where observed in the HF control group. A significant decrease in LVEDD, LVESD and an improvement in LVEF is also observed during follow up.Conclusions: Our results imply LVAD implantantion induces a progressive and significant improvement of respiratory drive and Left ventricle reverse remodeling during a 6 month follow-up period.
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Murillo-Garcia, David R., Julian Galindo, Natalia Pinto, Gabriel Motoa, Esther Benamu, Carlos Franco-Paredes, Daniel B. Chastain, and Andrés F. Henao-Martínez. "Anaerobic Bacteremias in Left Ventricular Assist Devices and Advanced Heart Failure." Case Reports in Infectious Diseases 2019 (December 19, 2019): 1–5. http://dx.doi.org/10.1155/2019/7571606.
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Left ventricular assisted devices (LVADs) have revolutionized the treatment of advanced heart failure, providing meaningful increases in survival, functional capacity, and quality of life. There are two categories of LVADs patients: (1) bridge-to-transplant and (2) destination therapy. Advanced heart failure and destination LVADs often carry a poor prognosis. The overall 1-year mortality rate remains as high as 30%. LVAD-specific infections, LVAD-related infections, and non-LVAD-related infections represent important emerging clinical problems in this setting. With an incidence ranging from 30 to 50%, these lead to high rates of hospitalization, morbidity, and mortality. Bacteremias caused by anaerobic pathogens in patients with LVAD are underreported. Herein, we describe the microbiological findings, treatment, and clinical outcome of four patients with LVADs and advanced heart failure with anaerobic bacteremias. Fusobacterium species was the most frequent etiological agent. Most patients had a relatively favorable short-term outcome with survival rates of 100% at 30 days and of 50% at 90 days. However, due to other multiple long-term complications, overall mortality remains at 50% during the first year and increases to 75% beyond the first year. Anaerobic bacteremia sources included the oral cavity from odontogenic infections and aspiration pneumonia. Anaerobic bacteremia constitutes an unfavorable mortality prognostic factor in patients with destination LVADs. We recommend implementing preventive strategies with a comprehensive dental care evaluation in patients with LVADs and advanced heart failure.
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Lundgren, Scott, Cecilia Y. M. Poon, Ahmed Selim, Brian D. Lowes, Ronald Zolty, Adam Burdorf, Yael Potashnik-Peled, Michael J. Moulton, John Y. Um, and Eugenia Raichlin. "Depression and anxiety in patients undergoing left ventricular assist device implantation." International Journal of Artificial Organs 41, no. 2 (January 11, 2017): 76–83. http://dx.doi.org/10.5301/ijao.5000650.
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Background: Depression and anxiety are associated with a worse prognosis in heart failure patients. The aim of this study was to identify the prevalence of depression and anxiety in left ventricular assist device (LVAD) candidates and assess their effect on post-LVAD outcomes. Methods: Based on the pre-LVAD psychological assessment, the total cohort of 246 patients were divided into 4 groups: 1) no depression or anxiety (NDep&Anx group, n = 138); 2) isolated depression (Dep group, n = 42); 3) isolated anxiety (Anx group, n = 32), and 4) combined depression and anxiety (Dep&Anx group, n = 34). Results: The Dep&Anx group was associated with higher prevalence of female gender (p = 0.03), higher body mass index (p = 0.03), elevated E/E’ (p = 0.003), and increased Model For End-Stage Liver Disease (MELD) XI score (p = 0.04) prior to LVAD as compared to the other 3 subgroups. The prevalence of other major psychiatric disorders (p = 0.03) and narcotic dependence (p = 0.004) was higher in the Dep&Anx group. Post-LVAD implantation, heart rate and filling pressures were elevated and readmission rate was higher (p = 0.001) in the Dep&Anx group. There was no difference in survival between the groups (p = 0.40, Log-Rank test). Conclusions: Pre-existing anxiety and depression was associated with worse HF pre- and post-LVAD implantation and higher readmissions rate after LVAD implantation.
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Salna, Michael, A. Reshad Garan, Ajay J. Kirtane, Dimitrios Karmpaliotis, Phil Green, Hiroo Takayama, Joseph Sanchez, et al. "Novel percutaneous dual-lumen cannula-based right ventricular assist device provides effective support for refractory right ventricular failure after left ventricular assist device implantation." Interactive CardioVascular and Thoracic Surgery 30, no. 4 (January 27, 2020): 499–506. http://dx.doi.org/10.1093/icvts/ivz322.
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Abstract OBJECTIVES Right heart failure after left ventricular assist device (LVAD) implantation is associated with significant morbidity and mortality. A new generation of percutaneous right ventricular assist devices (RVADs) may mitigate the need for invasive surgical RVAD implantation. The purpose of this study was to evaluate the safety and efficacy of the Protek Duo (TandemLife, Pittsburgh, PA, USA) RVAD in patients who developed severe acute right heart failure in the intensive care unit after LVAD implantation. METHODS This was a retrospective cohort study of 27 patients who received a Protek Duo after LVAD implantation from January 2016 to March 2019 at our centre. The primary outcome of interest was survival to hospital discharge. Secondary outcomes included procedural success, device-related complications and conversion to a surgical RVAD. RESULTS The median age of patients was 63 years (interquartile range 58–71), 78% were men and 78% were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 or 2. Patients were on a median of 2 inotropes and 2 pressors prior to Protek Duo insertion. The device successfully implanted on the first attempt in all patients a median of 1 day (interquartile range 1–2) after LVAD implantation and the median duration of support was 11 days (interquartile range 7–16). Device weaning occurred in 86% of patients, with 15% in-hospital mortality. Major complications related to the device included new moderate-to-severe tricuspid regurgitation (36%), haemolysis (14%) and cannula migration (7%). Three patients (11%) required conversion to surgical RVAD. Overall survival to 1 year was 81%. CONCLUSIONS The use of the Protek Duo as a percutaneous RVAD is a safe and feasible treatment for patients who develop acute right heart failure after LVAD implantation.
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Yalcin, Yunus C., Nelianne Verkaik, Hannelore I. Bax, Peter D. Croughs, Ad J. J. C. Bogers, and Kadir Caliskan. "127. Novel Treatment Approach for Left Ventricular Assist Device-related Infections." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S92—S93. http://dx.doi.org/10.1093/ofid/ofz360.202.
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Abstract Background Left ventricular assist device (LVAD) implantation has become an effective treatment option for patients with severe heart failure. However, infections remain a substantial risk. Therefore, the aim of this study was to gain insight in the incidence and outcome of LVAD infections in our center and develop an up-to-date flowchart for the management of LVAD-related infections. Methods A retrospective study was performed which included all patients with an LVAD implanted between 2006 until 2019, along with a rigorous review of the current literature. Clinical records and microbiological laboratory results of all patients were reviewed. In view of local infectious complications, a flowchart was developed for the contemporary management of LVAD-related infections (Figure 1). Results Overall, 106 patients (median age 54 years [IQR 47–60], 78% male) were included, of whom 92 (87%) as bridge-to-transplantation/decision and 14 (13%) as destination therapy. LVAD-related infections occurred in n = 30 (28%) of the patients. The median time until first infection was 308 days [IQR 115–528], and the median duration of hospital stay was 16 days [IQR 4–29]. Eighty percent of LVAD-related infections were driveline-related. The most common causative pathogen was Staphylococcus aureus, which was present in almost half of the cases (40%). Patients who experienced infections were younger (46 [IQR 37–57] vs. 56 [IQR 52–62]; P < 0.001).The survival rate at 3 years was 76% in the infected vs. 94% not infected patients; P = 0.037). A secondary infection occurred in 10 patients (33%). At 3 years of follow-up, 31 patients were successfully transplanted. Six patients with deep S. aureus driveline infections were treated according to the standardized protocol of whom 2 with suppressive therapy by cephalexin, with clinical success so far. Conclusion LVAD infections occur frequently and lead to prolonged periods of hospital admissions and death. The lack of standardized treatment regimens complicates the treatment of LVAD-related infections. A comprehensive flowchart to treat future LVAD-related infections in a protocolized fashion was developed, based on our single-center experience. While the preliminary results look promising, more follow-up time of the treated patients is needed. Disclosures All authors: No reported disclosures.
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Casida, Jesus M., Rosalind M. Peters, and Morris A. Magnan. "Self-Care Demands of Persons Living With an Implantable Left-Ventricular Assist Device." Research and Theory for Nursing Practice 23, no. 4 (November 2009): 279–93. http://dx.doi.org/10.1891/1541-6577.23.4.279.
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Heart failure (HF) is a growing public health problem affecting approximately 23 million people worldwide. Treatment options for advanced HF patients have moved beyond pharmacologic therapy to include left-ventricular assist devices (LVADs). Patients with an LVAD must manage a complex regimen of care. This article proposes the use of self-care deficit nursing theory (SCDNT) as a framework to identify and organize the care needs of patients with an LVAD from a nursing perspective. Within SCDNT, self-care refers to actions designed to meet self-care requisites to achieve regulatory goals. When formalized, self-care requisites have two components: the general action to be taken and a “factor” to be controlled. The reformulation of health-deviation self-care requisites common to LVAD patients are presented and may serve as an exemplar for other technology-assisted living situations. The strengths and limitations of using the SCDNT for patients with such complex needs, as well as implications for clinical practice, research, and advancement of nursing science, are examined.
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Lin, Peter T., and Sarah Thomas. "Forensic Considerations in a Series of 14 Deaths of Patients with a Left Ventricular Assist Device." Academic Forensic Pathology 9, no. 3-4 (September 2019): 200–211. http://dx.doi.org/10.1177/1925362119893459.
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Introduction: To better understand the forensic implications of death with a left ventricular assist device (LVAD), we reviewed all deaths that were reported to a regional medical examiner jurisdiction involving patients who had an LVAD. Methods: Medical examiner case files between January 2012 and September 2018 were searched for “LVAD” and “left ventricular assist device” to identify deaths that were reported to the medical examiner involving a decedent who had an LVAD at the time of death. Results: During the study period, a total of 14 deaths were reported to the regional medical examiner involving decedents who had an implanted LVAD at the time of death. The average age at death was 64 years, with a range from 40 to 81 years. The underlying cardiac disease leading to LVAD implantation was ischemic heart disease (n = 9), nonischemic dilated cardiomyopathy (n = 4), and chemotherapy-related cardiotoxicity (n = 1). Of these 14 deaths, 2 deaths were due to loss of power to the LVAD, 1 death was due to traumatic subdural hemorrhage occurring in the setting of anticoagulation therapy required by LVAD implantation, and 1 death was due to femur fracture following a fall. Discussion: Medical examiners should be familiar with the potential complications of LVADs, especially those complications that may prompt consideration of non-natural manners of death. Medical examiners should also be aware of the tools and investigative strategies that may assist in the investigation of LVAD-related deaths.
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Cho, Sung-Min, Pouya Tahsili-Fahadan, Ahmet Kilic, Chun Woo Choi, Randall C. Starling, and Ken Uchino. "A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke." Seminars in Neurology 41, no. 04 (April 13, 2021): 411–21. http://dx.doi.org/10.1055/s-0041-1726328.
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AbstractThe use of left ventricular assist devices (LVADs) has been increasing in the last decade, along with the number of patients with advanced heart failure refractory to medical therapy. Ischemic stroke and intracranial hemorrhage remain the leading causes of morbidity and mortality in LVAD patients. Despite the common occurrence and the significant outcome impact, underlying mechanisms and management strategies of stroke in LVAD patients are controversial. In this article, we review our current knowledge on pathophysiology and risk factors of LVAD-associated stroke, outline the diagnostic approach, and discuss treatment strategies.
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KUCI, Saimir, Alfred IBRAHIMI, Ermal LIKAJ, Marsela GOGA, Ervin BEJKO, Stavri LLAZO, and Jacob ZEITANI. "Anesthesia in Patient with Left Ventricular Assist Device Support. A Case Report." Albanian Journal of Trauma and Emergency Surgery 4, no. 2 (July 20, 2020): 716–19. http://dx.doi.org/10.32391/ajtes.v4i2.112.
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Background; Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor's heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to devise exchange, urgent transplantation, and even death of the patient. Infections with multidrug-resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface-associated colonization of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug-resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms.
Case presentation; A 48-year-old patient 72 kg, height 172 cm with dilated cardiomyopathy, his course was complicated by pump failure requiring LVAD HeartMate III placement 3 years (Milan Italy). The parameters of the LVAD pump were determined for the patient from the moment of the Pump speed 5300 rpm Flow 4.4 lpm was set. The patient performed moderate activity under normal conditions. The patient regularly took Coumadin to keep the recommended INR levels at the recommended target values 2.5. At the site of the exit of the cavity from the skin in the region of the right hypochondrium, there was an infection that for a long time was treated with various schemes with ambulatory antibiotics
Conclusions; In the present case we showed that successful eradication of a chronic LVAD driveline infection was only possible when approached both surgically and conservatively. It is important to note that a good knowledge of the physiopathology of heart failure, the widest possible information on the treatment of heart failure with the help of LVAD implantation is very important in the treatment and survival of these patients.
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Bottle, Alex, Puji Faitna, Paul P. Aylin, and Martin R. Cowie. "Five-year outcomes following left ventricular assist device implantation in England." Open Heart 8, no. 1 (May 2021): e001658. http://dx.doi.org/10.1136/openhrt-2021-001658.
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ObjectiveImplant rates of mechanical circulatory supports such as left ventricular assist devices (LVAD) have steadily increased in the last decade. We assessed the utility of administrative data to provide information on hospital use and outcomes.MethodsUsing 2 years of national hospital administrative data for England linked to the death register, we identified all patients with an LVAD and extracted hospital activity for 5 years before and after the LVAD implantation date.ResultsIn the two index years April 2011 to March 2013, 157 patients had an LVAD implanted. The mean age was 50.9 (SD 15.4), and 78.3% were men. After 5 years, 92 (58.6%) had died; the recorded cause of death was noncardiovascular in 67.4%. 42 (26.8%) patients received a heart±lung transplantation. Compared with the 12 months before implantation, the 12 months after but not including the month of implantation saw falls in total inpatient and day case admissions, a fall in admissions for heart failure (HF), a rise in non-HF admissions, a fall in emergency department visits not ending in admission and a rise in outpatient appointments (all per patient at risk). Postimplantation complications were common in the subsequent 5 years: 26.1% had a stroke, 23.6% had a device infection and 13.4% had a new LVAD implanted.ConclusionsDespite patients’ young age, their mortality is high and their hospital use and complications are common in the 5 years following LVAD implantation. Administrative data provide important information on resource use in this patient group.
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Martinez, Sara C., Elisa A. Bradley, Eric L. Novak, Ravi Rasalingam, Ari M. Cedars, Gregory A. Ewald, Scott C. Silvestry, and Susan M. Joseph. "Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction." Texas Heart Institute Journal 41, no. 3 (June 1, 2014): 262–72. http://dx.doi.org/10.14503/thij-13-3604.
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Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e′ and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (<0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed. The average SLAM in patients with an LVEF <0.35 was 11.6 cm/s (95% confidence interval, 10.4–12.8); SLAM had a moderately strong correlation with E/e′ in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P <0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF <0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity. Evaluating ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD.