TY - JOUR. T1 - Heart transplantation versus continuous-flow left ventricular assist device. T2 - Comprehensive cost at 1 year. AU - Patel, Snehal R.. AU - Sileo, Alan. AU - Bello, Ricardo. AU - Gunda, Sampath. AU - Nguyen, Jenni. AU - Goldstein, Daniel. PY - 2015/2/1. Y1 - 2015/2/1. N2 - Background With health care reform firmly on the horizon, it is critical to understand the costs associated with new technologies such as continuous-flow left ventricular assist device (CF-LVAD) compared with well established treatments such as heart transplantation (HT). Scarce data exist describing the costs of these 2 therapies after 1 year of support. Methods and Results The study population consisted of 20 consecutive subjects who underwent implantation of a CF-LVAD and 20 consecutive subjects who underwent HT and survived ≥1 year. Comprehensive cost calculation included all direct and indirect costs from day of operation through 365 days and were inflation adjusted to 2010 US dollars. Hospital charges ...
Background: Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. There are scarce data about post-transplant outcomes in patients complicated with late RHF during LVAD support.. Objective: To assess whether development of late RHF during LVAD support adversely affected post-transplant survival.. Methods: Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD support as a bridge to transplant at our center. Late RHF was defined as HF requiring medical interventions ,4 weeks after LVAD implantation. During the same study period, 3 patients were bridged to transplant with concurrent right ventricular assist device (RVAD) support.. Results: The mean age of the study cohort was 54 ± 13 years, 81% were male, and 35% had an ischemic etiology. The mean duration of LVAD support before transplantation was 270 days. Twenty-three patients (16%) developed late RHF during waiting period. Of ...
TY - JOUR. T1 - Cessation of continuous flow left ventricular assist device-related gastrointestinal bleeding after heart transplantation. AU - Patel, Snehal R.. AU - Oh, Kyung Taek. AU - Ogriki, Tolulope. AU - Sims, Daniel. AU - Shin, J. Julia. AU - Madan, Shivank. AU - Saeed, Omar. AU - Goldstein, Daniel J.. AU - Jorde, Ulrich P.. PY - 2017/6/28. Y1 - 2017/6/28. N2 - Gastrointestinal bleeding (GIB) is a major complication of continuous flow left ventricular assist device (CF LVAD) therapy. The precise pathophysiology of CF LVAD-related bleeding remains poorly understood, and the effect of pump removal at the time of transplantation on actual bleeding frequency has not previously been studied. A single-center retrospective review was conducted on patients who received CF LVAD and subsequently developed GIB. Baseline demographics and markers of pulsatility (aortic valve opening and the HeartMate II [HM2] pulse index) were compared between those with and without GIB. In those patients who had GIB ...
Introduction: Stenosis in the continuous-flow left ventricular assist device (CF-LVAD) outflow graft can be caused by various mechanical and anatomical factors. Increasingly, percutaneous management has been utilized to re-establish adequate CF-LVAD flow. We sought to evaluate indications for such interventions and their outcomes. Methods: An electronic search was performed to identify all studies in the English literature reporting CF-LVAD outflow graft stenting for various etiologies. Twenty-one studies consisting of 26 patients were included in the analysis. Results: Median patient age was 59 years [45.8-67.0] and 65.4% (17/26) were male. 58.3% (14/24) of patients had HeartWare HVAD, 37.5% (9/24) had HeartMate II LVAD, and 4.2% (1/24) had HeartMate III LVAS. Median time from device placement to outflow graft stenting was 24.0 months [7.8-30.4]. 76.9% of patients (20/26) presented with heart failure. 34.6% (9/26) had outflow graft thrombosis, 34.6% (9/26) stenosis, 11.5% (3/26) kinking, 11.5% (3/26)
BACKGROUND New generation continuous-flow left ventricular assist devices (LVADs) utilise centrifugal pumps. Data concerning their effect on patient haemodynamics, ventricular function and tissue perfusion is limited. We aimed to document these parameters following HeartWare centrifugal continuous-flow LVAD (HVAD) implantation and to assess the impact of post-operative right heart failure (RHF). METHODS We reviewed 53 consecutive patients (mean age 49.5 ± 14.1 yrs) with HVAD implanted in the left ventricle, at St. Vincents Hospital, Sydney, between January 2007 and August 2012. Available paired right heart catheterisation (n=35) and echocardiography (n=39) data was reviewed to assess response of invasive haemodynamics and ventricular function to LVAD support. RESULTS A total of 28 patients (53%) were implanted from interim mechanical circulatory support. Seventeen patients (32%) required short-term post-implant veno-pulmonary artery extracorporeal membrane oxygenation. At 100 ± 61 days ...
TY - JOUR. T1 - Hemolysis from aortic regurgitation mimicking pump thrombosis in a patient with a HeartMate II left ventricular assist device. T2 - A case report. AU - Gopalan, Radha S.. AU - Arabia, Francisco A.. AU - Noel, Pierre. AU - Chandrasekaran, Krishnaswamy. PY - 2012/5. Y1 - 2012/5. N2 - Device-related hemolysis leading to anemia is a recognized chronic complication of a left ventricular assist device (LVAD). With the increased usage of the LVAD in the management of end-stage heart failure, an increased number of complications are being recognized. We present a case where a combination of elevated mean arterial pressure and development of aortic regurgitation resulted in increased hemolysis, power spikes, and anemia, mimicking device thrombus, resulting in a diagnostic dilemma.. AB - Device-related hemolysis leading to anemia is a recognized chronic complication of a left ventricular assist device (LVAD). With the increased usage of the LVAD in the management of end-stage heart ...
This thesis describes the management of patients treated with mechanical circulatory support devices for short- or long-term use. Twenty-four patients suffering from postcardiotomy heart failure were treated with a minimally invasive axial flow pump. The device was effective in unloading the failing left ventricle and in maintaining an adequate systemic circulation. The principles of perioperative monitoring, and pharmacological therapy are outlined. The pump was also used as an alternative to the heart-lung machine in conjunction with coronary artery bypass surgery. Together with a short-acting β-blocker, esmolol, the heart was decompressed and heart motion was reduced, facilitating bypass surgery on the beating heart. The anesthesiological considerations using this method are described.. An implantable left ventricular assist device was used as a bridge to heart transplantation in 10 patients. We were interested in assessing the possibility to establish such a treatment program at a ...
The purpose of this study is to determine the safety and effectiveness of the Thoratec HeartMate II Left Ventricular Assist System (LVAS) as a bridge to cardiac transplantation in end-stage heart failure patients who are listed for cardiac transplant but are at imminent risk of dying.. The HeartMate II LVAS was approved by the US FDA on April 21, 2008, as a bridge to cardiac transplantation (reference PMA P060040). It was approved for commercial distribution in Canada on May 20, 2009 (reference Medical Device Licence #79765). Patients enrolled into the clinical trial will continue to be followed until all have reached a clinical outcome. ...
TY - JOUR. T1 - Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation. AU - Grimm, Joshua C.. AU - Magruder, J. Trent. AU - Crawford, Todd C.. AU - Fraser, Charles D.. AU - Plum, William G.. AU - Sciortino, Christopher M.. AU - Higgins, Robert. AU - Whitman, Glenn. AU - Shah, Ashish S.. PY - 2016/10/1. Y1 - 2016/10/1. N2 - Background The aim of this study was to determine whether the duration of left ventricular device support (LVAD) influenced outcomes after orthotopic heart transplantation in a modern, bridge to transplant national cohort. Methods The United Network for Organ Sharing database, which has recently made pretransplant LVAD duration available, was queried for all adult bridge to transplant patients between January 2011 and December 2012. Three LVAD duration cohorts were generated, as follows: short (less than 90 days), intermediate (90 to 365 days), and prolonged (more than 365 days). Recipient, donor, and transplant-specific ...
Background: In this study, we aimed to investigate frequency, patterns, etiologies, and costs of unplanned readmissions after left ventricular assist device implantation.. Methods: Between April 2012 and September 2016, 99 unplanned readmissions of a total of 50 consecutive bridge-to-transplant patients (45 males, 5 females; mean age 46.9±10.3 years; range, 19 to 67 years) who were successfully discharged after left ventricular assist device implantation were retrospectively analyzed. Patient demographic data, hemodynamic measurements before implantation, and readmissions after discharge were recorded. Hospitalizations due to major problems which were unable to be managed in routine outpatient clinic were accepted as unplanned readmissions. Survival analysis was performed.. Results: The readmission rate was 1.7 per year after discharge. Survival of patients who were readmitted within the first 90 days was found to be significantly lower than those without early readmission. The most common ...
TY - JOUR. T1 - Left ventricular assist device therapy in patients with restrictive and hypertrophic cardiomyopathy. AU - Topilsky, Yan. AU - Pereira, Naveen Luke. AU - Shah, Dipesh K.. AU - Boilson, Barry. AU - Schirger, John A.. AU - Kushwaha, Sudhir S.. AU - Joyce, Lyle D.. AU - Park, Soon J.. PY - 2011/5. Y1 - 2011/5. N2 - Background-Left ventricular assist device (LVAD) is being increasingly used in patients with end-stage dilated and ischemic cardiomyopathy. There have been no clinical trials addressing the use of LVAD therapy in patients with end-stage heart failure caused by restrictive (RCM) or hypertrophic cardiomyopathy (HCM). The purpose of this study was therefore to analyze the outcome of LVAD therapy in these patients. Methods and Results-Eighty-three patients received continuous axial flow LVAD (Heart mate II, Thoratec, Pleasanton, CA) from February 2007 to May 2010 at our institution. We analyzed the baseline characteristics and surgical and long-term impact of LVAD therapy in 8 ...
In our cross-sectional cohort, iron deficiency was the most common cause of anemia. Notably, 49% of the iron-deficient patients were already on iron supplementation. In our retrospective cohort, 59% of the patients were anemic after 6 months of support. Anemic patients were older, had lower albumin, higher brain natriuretic peptide (BNP), worse renal function and New York Heart Association (NYHA) class. Anemia had a HR of 3.16 (95%CI 1.38-7.26) to predict a composite of 1-year death and HF readmissions, as well as HF-readmissions alone.. ...
Although heart transplantation is an effective interventional therapy for end-stage heart failure (HF), donor hearts are consistently in limited supply. Hence, patients who experience clinical deterioration before transplant availability are frequently given mechanical circulatory support in the form of a left ventricular assist device (LVAD), employed as a "bridge to transplant." To date, the utility, efficacy, and safety of LVAD support as a bridge to transplant has been widely recognized (1,2). Importantly, LVAD support, similar to all drugs that exert beneficial effects on mortality in patients with HF, also favorably impacts the left ventricular (LV) remodeling process (3-6). Recent evidence has demonstrated that unloading the LV in patients with end-stage HF by LVAD support can lead toward reverse remodeling of myocardial structure and function (6-15). Studies of LVAD-mediated reverse remodeling have described changes such as decreased myocyte size (8,12,14), increased myocyte ...
ABSTRACT: Objective. We sought to describe the use of the TandemHeart percutaneous left ventricular assist device (PVAD) in a group of high-risk patients undergoing complex cardiovascular procedures. Background. There is a substantial risk of acute decompensation and death in patients with cardiogenic shock or a reduced cardiac reserve undergoing high-risk cardiovascular interventions. The TandemHeart PVAD provides near-total hemodynamic support in this setting. Methods. Thirty-seven high-risk patients underwent placement of the TandemHeart PVAD during 38 separate proc
Background: A continuous flow left ventricular assist device (c-LVAD) provides a better clinical outcome for patients with severe heart failure than pulsatile flow LVAD (p-LAVD). However, the frequency of cerebrovascular events, crucial complications, is largely unknown, especially in patients with systemic infection. We examined the prevalence of stroke related to systemic infection in patients with these 2 LVAD types.. Methods: We reviewed 114 consecutive patients (c-LVAD group: n=47, 66.6 patient-years; p-LVAD group: n=67 patients, 63.5 patient-years) who received LVAD support at Osaka University Hospital from 2005-2012. Cerebrovascular complications were defined as a neurological deficit concomitant with a coinciding lesion shown by computed tomography. Anticoagulation was given according to the manufacturers recommendation. Stroke frequency was compared between the groups.. Results: During LVAD support, 8 patients (c-LVAD, 1; p-LVAD, 7) died from stroke. As for cerebral infarctions, 10 ...
The incorporation of complex medical device technologies into clinical practice is governed by critical oversight of the US Food and Drug Administration. This regulatory process requires a judicious balance between assuring safety and efficacy, while providing efficient review to facilitate access to innovative therapies. Recent contrasting views of the regulatory process have emphasized the difficulties in obtaining an optimal balance. Mechanical circulatory support has evolved to become an important therapy for patients with advanced heart failure with the advent of more durable, implantable ventricular assist devices. The regulatory oversight of these new technologies has been difficult owing to the complexities of these devices, associated adverse event profile, and severity of illness of the intended patient population. Maintaining a regulatory environment to foster efficient introduction of safe and effective technologies is critical to the success of ventricular assist device therapy and ...
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TY - JOUR. T1 - Short-term in vivo studies of surface thrombosis in a left ventricular assist system. AU - Yamanaka, Hanako. AU - Rosenberg, Gerson. AU - Weiss, William. AU - Snyder, Alan J.. AU - Zapanta, Conrad M.. AU - Siedlecki, Christopher. PY - 2006/5/1. Y1 - 2006/5/1. N2 - Thrombosis continues to be a major adverse and at times fatal event in patients with left ventricular assist systems (LVAS). To assess acute thrombosis in an LVAS, multiscale analysis of surface thrombosis was performed on LVAS blood sacs retrieved after implantation in seven calves for 3 days. Two study groups were evaluated: One group was given heparin and warfarin sodium throughout the study; the second received no postoperative anticoagulation. On explantation, the blood sacs were examined for macroscopic thrombi; microscale thrombosis was assessed with the use of scanning electron microscopy. Macroscopic thrombi about 1 mm in diameter were seen in all sacs from both groups. Although macroscopic thrombi occurred in ...
3518 Bowel Ischemia after Continuous Flow Ventricular Assist Device Therapy: A Single Center Analysis - Volume 3 Issue s1 - Ashley Y Choi, Jatin Anand, Muath Bishawi, Mani A. Daneshmand, Jacob N. Schroder, Suresh M. Agarwal, Carmelo A. Milano
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details ...
Mechanical circulatory support systems, such as continuous-flow left ventricular assist devices (CF-LVADs), are being increasingly used as destination therapy or bridge to heart transplantation in patients with end-stage heart failure. The rate of implantation has nearly doubled since 2010, with ,5,000 devices placed in the last 2 years in the United States alone (2). Despite survival improvement with these devices, the clinical course of the patient is punctuated by a number of adverse events, including residual heart failure, which frequently warrants additional investigations.. Inadequate left ventricular (LV) unloading, often as a consequence of suboptimal left ventricular assist device (LVAD) parameters or comorbidities, is central to the worsening symptoms; some of these events can be treated with simple but effective options (e.g., optimize the device settings, use diuretics). However, other causes, such as right ventricular (RV) failure, can present with heart failure-like symptoms ...
End-stage heart failure is associated with significant morbidity and mortality. Heart transplantation has the potential to offer a return to daily activities for critically ill patients and is the gold standard therapy. However, heart transplantations are decreasing yearly with a historic low in Germany in 2017. By striking contrast, both waiting list numbers and waiting time have increased owing to a lack of acceptable donor organs. Ventricular assist devices (VAD) represent a reasonable therapeutic alternative for patients on heart transplantation waiting lists. Patients ineligible for transplantation may undergo VAD implantation as a destination therapy. However, the necessity for life-long anticoagulation must be weighed against bleeding complications in potential VAD candidates. VAD-dependent patients also face risks of driveline infections, in addition to restricted activities of daily living owing to limited battery capacities. Given Germanys low transplantation rate, VAD implantation ...
Abbott Introduces HeartMate 3 Left Ventricular Assist System - the Latest Milestone In Therapy For Advanced Heart Failure Patients - Abbott pioneered the evolution of heart pumps; U.S. approval of the H
TY - JOUR. T1 - Use of Urinary Biomarkers of Renal Ischemia in a Lamb Preclinical Left Ventricular Assist Device Model. AU - Cooper, Timothy. AU - Zhong, Qing. AU - Nabity, Mary. AU - Rosenberg, Gerson. AU - Weiss, William. PY - 2012/9/1. Y1 - 2012/9/1. N2 - Evaluation of thrombogenicity is a critical component in the preclinical testing and development of blood pumps. Left ventricular assist devices (LVADs), because of their device routing, can produce thromboembolic showers to the kidney resulting in renal cortical ischemia or infarctions. Although postmortem evaluation of renal pathology can confirm ischemic events and infarctions, there are no validated and highly sensitive real-time measures of renal ischemia in the preclinical models. In this article, we report the evaluation of urinary biomarkers of ischemic tubular damage in a lamb preclinical LVAD model. We found that urinary excretion of glutathione-S-transferase-π, heat shock protein 1B, and hepatitis A virus cellular receptor 1 ...
AbstractRight heart failure (RHF), e.g. due to pulmonary hypertension (PH), is a serious health issue with growing occurrence and high mortality rate. Limited efficacy of medication in advanced stages of the disease constitutes the need for mechanical circulatory support of the right ventricle (RV). An essential contribution to the process of developing right ventricular assist devices (RVADs) is the in vitro test bench, which simulates the hemodynamic behavior of the native circulatory system. To model healthy and diseased arterial-pulmonary hemodynamics in adults (mild and severe PH and RHF), a right heart mock circulation loop (MCL) was developed. Incorporating an anatomically shaped silicone RV and a silicone atrium, it not only enables investigations of hemodynamic values but also suction events or the handling of minimal invasive RVADs in an anatomical test environment. Ventricular pressure-volume loops of all simulated conditions as well as pressure and volume waveforms were recorded and compared
Ventricular Assist Device Market (Product Type - Left Ventricular Assist Device (LVAD), Right Ventricular Assist Device (RVAD), Bi-Ventricular Assist Device (Bi-VAD), and Total Artificial Heart (TAH); Indication - Bridge to Transplant (BTT), Destination T
New life-saving treatments for Heart failure in clinical trial on Confirmation Trial of the Acorn CorCap Cardiac Support Device (CSD) at the Same Time as Mitral Valve Repair
Click on the title to purchase the article.. Summary:. "Over the past decade, continuous-flow rotary pumps have dramatically improved survival for patients with advanced systolic heart failure. Bleeding and thrombosis, however, continue to be the Achilles heel of left ventricular assist device (LVAD) therapy. There is a dynamic and complex interaction between the patient and pump. The net effect of a variety of hematologic derangements, such as hemolysis, high-molecular-weight von Willebrand degradation, platelet activation and diminished pulsatility, is poorly understood. A combination of these factors mediates the common adverse events of gastrointestinal bleeding, device thrombosis and stroke. In this review we incorporate information from translational investigations in LVAD patients to understand how continuous-flow pumps activate the coagulation system and platelets predisposing to thrombosis, while, in parallel, degrade high-molecular-weight von Willebrand factor and trigger abnormal ...
This brief CME publication explores clinical evidence for the use of left ventricular assist devices (LVADs) in patients with advanced heart failure. It also reviews the evolution of LVADs from first-generation to third-generation devices and discusses therapeutic indications and contraindications for LVADs. Additionally, in a short introductory video, a faculty expert discusses approaches for identifying patients who may be candidates for LVADs and the evolving role of these devices in the treatment of advanced heart failure.
The purpose of this study to evaluate patients when they have an Acorn CorCapTM Cardiac Support Device (CSD) placed around their heart for the treatment o
SAN DIEGO -- Continuous flow left ventricular assist devices (LVADs) for bridge to transplant appear to improve survival in the real world even more than in the pivotal clinical trial, according to a
Summary. GlobalData s new report, Egypt Cardiac Assist Devices Market Outlook to 2022, provides key market data on the Egypt Cardiac Assist Devices market. The report provides value, in millions of US dollars, volume (in units) and average price data (in US dollars), within market segments - Intra-Aortic Balloon Pumps and Ventricular Assist Devices.. Note: This is an on-demand report and will be delivered within 2-3 business days of the purchase (excluding weekends). The report also provides company shares and distribution shares data for the market category, and global corporate-level profiles of the key market participants. Based on the availability of data for the particular category and country, information related to pipeline products, news and deals is available in the report.. Browse Full Report with Toc : http://www.acutemarketreports.com/report/egypt-cardiac-assist-devices-market-outlook-to-2022. The data in the report is derived from dynamic market forecast models. GlobalData uses ...
In the present retrospective study, we have demonstrated that stroke after LVAD implantation has a right hemispheric predominance and right hemispheric stroke after LVAD implantation was more often associated with infection compared with left hemispheric stroke. The incidence of stroke after LVAD placement was reported previously to be 8.0% to 25.0%.2,4 The overall incidence of stroke in our cohort was 12.9%.. Regarding the hemispheric distribution of stroke, the results of our observation are consistent with previous reports describing the mechanism of right-hemispheric dominance of cardiogenic embolisms after cardiac surgery.5-8 Considering any thrombus inside the LVAD pump as a part of cardiac embolic material in addition to actual intracardiac thrombi, right-to-left propensity of stroke after LVAD can be easily explained by anatomic alignment of the arteries arising from aortic arch. Moreover, surgical manipulation of LVAD outflow cannula-to-ascending aorta anastomosis may also direct ...
Following ventricular assist device (VAD) implantation, and observing conventional post-operative care, most patients should be able to be weaned from mechanical ventilation and woken within a few hours, providing that they remain hemodynamically stable and meet CMV weaning criteria. To ensure a patients hemodynamic stability during the early postoperative period, they must maintain a normal sinus rhythm, mean arterial blood pressure (MAP) of 60-80mmHg, central venous (CVP) and pulmonary artery wedge (PAWP) pressures less than 15mmHg and a cardiac index above 2.51min-1m-2. Although CMV weaning criteria can differ depending on the institution, recommended criteria includes pH ,7.25, partial pressure of oxygen in the arterial blood (PaO2) ,60mmHg, fraction of inspired oxygen (FIO2) ,0.4, PaO2/FIO2 (P/F) ratio ,150mmHg, positive end expiratory pressure (PEEP) , 8cmH2O, and the patients capability of triggering the ventilator [14].. Ventilator settings. A common complication faced after LVAD ...
A cardiac support device formed from a plurality of compliant sections individually delivered and deployed at positions around the heart and interconnected to one another.
Baxter received pre-market approval from the FDA for Novacor Left Ventricular Assist System, a pump implanted in the abdomen of heart transplant patients.
DUBLIN, April 8, 2019 /PRNewswire/ -- The "Global Cardiac Assist Devices Market Forecast up to 2025" report has been added to ResearchAndMarkets.coms offering. The research report predicts that the global cardiac assist devices market will grow at a CAGR of 11.6% during the forecast period. The market has witnessed steady growth in the past few years and the advancement in technology coupled with the introduction of novel products have augmented the acceptance of heart assist devices in the market. The market is fueled by upsurge in the incidence of heart failure, growing elderly population, and shortage of heart donors for transplantation. The market continues to grow and the devices are most widely used for the functioning of heart in case of failure and weakened heart patients. The field is getting revolutionized with the availability of improved technology. The key market players are focusing towards approvals, new product launches, and targeting towards end-users perspective. The market ...
Introduction. Chronic heart failure (CHF) is a significant medical, social and economic problem. The introduction of ventricular assist devices (VADs) into clinical practice allowed a fresh look at the problem of CHF. Using the experience of one clinic, we aimed to demonstrate the implantation of left ventricular assist devices (LVADs) in the regions of the Republic of Kazakhstan.. Methods. At our center, on May 10, 2013, a male patient aged 55 years with the diagnosis: CHF, ischemic cardiomyopathy, was first implanted with LVAD.. Preoperative diagnostics results. Electrocardiography: Sinus rhythm of heart rate of 80 beats per min.. Echocardiography: SPAP - 60mmHg; after treatment SPAP - 35 mmHg, LVEDD - 6.5, LVESD-6.1, LVEF - 23%, RVEF - 40% (TAPSE 1.8cm), EDV- 239, ESV- 182, 6 minute walking test - 150 meters. Сoronary angiography: left anterior descending artery - 60% stenosis, left circumflex artery - 60% stenosis, and right coronary artery- 50% stenosis.. Catheterization result- BSA -1.6, ...
TY - JOUR. T1 - Survival After Orthotopic Heart Transplantation in Patients Undergoing Bridge to Transplantation With the HeartWare HVAD Versus the Heartmate II. AU - Magruder, J. Trent. AU - Grimm, Joshua C.. AU - Crawford, Todd C.. AU - Tedford, Ryan J.. AU - Russell, Stuart D.. AU - Sciortino, Christopher M.. AU - Whitman, Glenn. AU - Shah, Ashish S.. PY - 2016. Y1 - 2016. N2 - Background: Our objective was to determine whether the choice of a HeartWare HVAD as opposed to a Heartmate II left ventricular assist device (HMII LVAD), impacts survival after heart transplantation after controlling for patient, donor, and center characteristics. Methods: We queried the United Network for Organ Sharing (UNOS) database, which has recently made pretransplantation device duration available, for all adult patients undergoing bridge to transplantation (BTT) between January 2011 and March 2016. Recipient, donor, and transplant-specific characteristics were compared between patients receiving either device. ...
What Are VADs? Left Ventricular Assist Devices, or known more commonly as LVADs or simply VADs, are designed to take over the function of the weakened hearts left ventricle, which delivers oxygenated blood from the heart to the body. The device, which is implanted in the patients chest, consists of an electric motor and a driveline. A tube placed in the left ventricle diverts blood from the heart to the VAD pump. The pump then propels the blood back into the aorta and out to the rest of the body. This is also known as mechanical circulatory support.
The purpose of the study was to compare the outcome of Left ventricular assist device (LVAD) therapy with Levosimendan in patient eligible for heart
Evidence-based recommendations on the implantation of a left ventricular assist device for destination therapy in people ineligible for heart transplant
DISCUSSION. In general, patients with biventricular assist devices present lower survival rates in comparison with those with single LVAD (53% vs. 80%). The inferior survival rates of patients with biventricular support can be explained by patient selection and/ or increased incidence of associated comorbidities. However, considering the lack of best practices related to technique, VAD adjustments, anticoagulation, and postoperative management of patients implanted with intracorporeal biventricular support devices, it is possible that many of these complications could be prevented[1,3].. In our service, temporary ventricle support is performed by inserting pulmonary artery cannulation through the right jugular vein using a flexible wire-reinforced single-stage 17 Fr cannula. Venous drainage is performed using a multiple-stage 25 Fr cannula introduced through the right femoral artery into the RA. Flow can reach up to 5 L/min by connecting the cannula to a centrifugal pump (Centrimag or Sorin). A ...
Summary GlobalData s new report, Austria Cardiac Assist Devices Market Outlook to 2022, provides key market data on the Austria Cardiac Assist Devices
Treatment of ischemic stroke for a patient on left ventricular assist device (LVAD) by neurointerventional means is rare and many anesthesia providers are unfamiliar with both LVAD and neurointerventional protocols. Examples of this include: 1) filling for continuous-flow LVAD depend on preload and the flow is inversely related to afterload; as mean arterial pressure (MAP) increases above 80 to90 mmHg, flow decreases; 2) there may be no palpable pulse in patients with continuous flow LVADs; 3) pulse oximetry may not work when pump flow is high and native myocardial function is minimal; 4) increasing MAP above80 mmHg potentially will maintain ischemic brain tissue-the penumbra-until flow is restored. This latter example creates a paradoxical management goal: increasing the mean arterial pressure (MAP) above80 mmHg while maintaining ischemic brain tissue, may decrease flow to the LVAD. Finally, there is controversy regarding which type of anesthesia is most efficacious for neuro interventional
With advancements in technology leading to improvements in survival as well as quality of life,1,2 left ventricular assist devices (LVADs) are increasingly used to support patients with end-stage heart failure as either a bridge to cardiac transplantation (BTT) or as destination therapy (DT). Concurrent with the epidemic of heart failure,3 is also the problem of obesity which is present in greater...
Click on the title to purchase the article.. Summary:. "Bleeding events remain a significant and frequent complication of continuous-flow left ventricular assist devices (VADs). von Willebrand factor (VWF) is critical to hemostasis by acting as a bridging molecule at sites of vascular injury for normal platelet adhesion as well as promoting platelet aggregation under conditions of high shear. Clinical and experimental data support a role for acquired von Willebrand disease in VAD bleeding episodes caused by shear-induced qualitative defects in VWF. Pathologic shear induces VWF unfolding and proteolysis of large multimers into smaller less hemostatic multimers via ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13). This review outlines the pathobiology of VWF disruption in the context of VADs as well as current diagnostic and management strategies of the associated acquired von Willebrand disease."1. ...
Methods and Results Using a large US commercial insurance database, patients who received an LVAD (International Classification of Diseases, 9th Revision, Clinical Modification code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1‐year post‐LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post‐LVAD medication use and poor medication adherence (proportion of days covered ,0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and β‐blockers, ...
TY - JOUR. T1 - Model of right ventricular failure after global myocardial ischemia and mechanical left ventricular support. AU - Shuman, Todd A.. AU - Palazzo, Robert S.. AU - Jaquiss, Robert B.D.. AU - Harper, Baron D.. AU - Barzilai, Benico. AU - Cox, James Lewis. AU - Kouchoukos, Nicholas T.. AU - Wareing, Thomas H.. PY - 1991/7/1. Y1 - 1991/7/1. N2 - Postcardiotomy right ventricular (RV) failure after institution of mechanical left ventricular (LV) support is poorly understood. Using a canine model supported by cardiopulmonary bypass (CPB), the animals underwent 30 min of aortic clamping or no ischemia and were weaned to an LV assist device (LVAD). Echocardiographic measurements of LV and RV cavity size off support allowed calculation of percentage change in cavity area (fractional shortening). There were no differences at baseline. After 2 hrs on LVAD, there were significant differences between ischemic and control groups in both LV (38 ± 12 vs. 61 ± 6) and RV (15 ± 3 vs. 55 ± 12). The ...
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