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Sung-Min Cho, Nader Moazami, Stuart Katz, Randall Starling, Jennifer A Frontera
BACKGROUND: Little data exists regarding reversal and resumption of antithrombotics following left ventricular assist device (LVAD)-associated intracranial hemorrhage (ICH). METHODS: Prospectively collected data of LVAD patients with ICH was reviewed. Coagulopathy reversal agents, antithrombotic regimens and thrombotic (venous thromboembolism, ischemic stroke, myocardial infarction) and hemorrhagic (recurrent ICH, gastrointestinal bleed, anemia requiring transfusion) complications were recorded...
February 11, 2019: Annals of Thoracic Surgery
Pankaj Jain, Sajad Shehab, Michael Stevens, Peter Macdonald, Paul Jansz, Christopher Hayward
We evaluated mean, peak, and instantaneous pressure gradients across the outflow conduit in a pulsatile mock circulation loop which incorporated Heartware HVADs for left ventricular (LV) and right ventricular (RV) support. Steady-state 50 Hz measurements of left ventricular assist device (LVAD) flow (Q) and pressures within the proximal and distal outflow conduit were obtained at varying pump speed, LV contractility, hematocrit (HCT), heart rate (HR), and conduit diameter and length. Experiments were conducted using polyvinyl chloride (PVC) tubing and results confirmed in HVAD Gelweave conduit...
February 11, 2019: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Evan J Wiens, Jana Pilkey, Jonathan K Wong
With the increasing prevalence of the left ventricular assist device (LVAD) in patients with end-stage cardiomyopathies, an increasing number of these patients are dying of noncardiac conditions. It is likely that the palliative care clinician will have an ever-increasing role in managing end of life for patients with LVADs, including discontinuation of LVAD support. There exists a paucity of literature describing strategies for effective delivery of palliative care in patients requesting discontinuation of LVAD therapy...
February 12, 2019: Journal of Palliative Care
Andrew N Rosenbaum, Robert P Frantz, Sudhir S Kushwaha, John M Stulak, Simon Maltais, Atta Behfar
Background Left ventricular (LV) hemodynamic assessment has been sparsely performed in patients supported on continuous-flow LV assist devices (cf LVADs ). Insight into dynamic changes of left heart parameters during ramp studies may improve LV assist device optimization and evaluate pathology. Methods and Results To complement right heart catheterization, a novel technique for left heart catheterization in patients with a cf LVAD was developed. Patients implanted with cf LVAD s underwent hemodynamic ramp left heart catheterization and right heart catheterization with transthoracic echocardiography...
February 19, 2019: Journal of the American Heart Association
Zak Loring, Brett D Atwater, Xiaojuan Xia, Jimmy Axelsson, Igor Klem, Robin Nijveldt, Erik B Schelbert, Jean-Philippe Couderc, David G Strauss, Martin Ugander, Björn Wieslander
INTRODUCTION: We evaluated the association between a novel ECG marker of late, rightward electrocardiographic forces (termed the lead one ratio [LOR]) and left ventricular ejection fraction (LVEF), myocardial scar, and clinical outcomes in patients with left bundle branch block (LBBB). METHODS AND RESULTS: LOR was calculated in LBBB patients from a derivation cohort (n=240) and receiver operator characteristic curves identified optimal threshold values for predicting myocardial scar and LVEF <35%...
February 10, 2019: Journal of Cardiovascular Electrophysiology
Julia C Lea, Catherine K Floroff, Amanda I Ingemi, Gary R Zeevi
The association between time in therapeutic range (TTR) and clinical outcomes in patients with left ventricular assist devices (LVADs) on chronic warfarin therapy is not well understood. This study assessed TTR using the Rosendaal Method prior to suspected or confirmed pump thrombosis or ischemic stroke. Each patient served as their own control. Characteristics and TTR in 1, 2, and 3 months prior to thrombus (thrombus period) were compared to a thrombus-free period during 6 months to 3 months prior to thrombus (control period)...
February 9, 2019: Journal of Thrombosis and Thrombolysis
Suriya Punchai, Zubaidah Nor Hanipah, Gautam Sharma, Ali Aminian, Karen Steckner, Jacek Cywinski, James B Young, Stacy A Brethauer, Philip R Schauer
BACKGROUND: There is limited data in the literature evaluating outcomes of bariatric surgery in severely obese patients with left ventricular assist device (LVAD) as a bridge to make them acceptable candidates for heart transplantation. This study aims to assess the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in patients with previously implanted LVAD at our institution. METHODS: All the patients with end-stage heart failure (ESHF) and implanted LVAD who underwent LSG from2013 to January 2017 were studied...
February 5, 2019: Obesity Surgery
Stefaan Bouchez, Yves Van Belleghem, Filip De Somer, Michel De Pauw, Roland Stroobandt, Patrick Wouters
Mechanical circulatory support with continuous-flow left ventricular assist devices (LVADs) has emerged as a viable treatment modality for patients with advanced heart failure. LVAD support results in unique haemodynamic and echocardiographic alterations that must be understood to provide optimal care for these patients. In this review, we propose essential echocardiographic and haemodynamic elements for the assessment of optimal LVAD function based on the literature and the use of simulation software. A key element of LVAD physiology remains the interaction between an unloaded left ventricle and a loaded right ventricle...
January 30, 2019: European Heart Journal Cardiovascular Imaging
Fabiana G Marcondes-Braga, Marcely Gimenes Bonatto, Caio Ribeiro Alves Andrade, Fernando Bacal
PURPOSE: Heart transplantation is the gold standard treatment for advanced heart failure. Left ventricular assist devices (LVADs), despite being a good option for these patients, are not quite available in developing countries. Time spent in heart transplant waiting list has increased lately even in regions where the number of transplants has also risen showing that a new strategy should be sought. RECENT FINDINGS: Transplant process organization combined with multidisciplinary work are linked to better outcomes while improvement in donor's care and in pre-transplant evaluation might be opportunities to change the long waiting list scenario...
February 2, 2019: Current Heart Failure Reports
Randall Z Olmsted, Andre Critsinelis, Chitaru Kurihara, Masashi Kawabori, Tadahisa Sugiura, Andrew B Civitello, Jeffrey A Morgan
BACKGROUND: Left ventricular assist devices (LVADs) are being used more frequently for treating refractory, advanced heart failure. However, infection remains a frequent complication. In this study, we analyzed the incidence of severe infections in LVAD recipients to determine its impact on survival. METHODS: From May 2009 through March 2016, 437 patients with advanced heart failure underwent implantation of a continuous-flow LVAD (n = 314, HeartMate II LVAD [Abbott Laboratories, Abbott Park, IL]; n = 123 HeartWare HVAD [Medtronic, Minneapolis, MN])...
February 2, 2019: Journal of Cardiac Surgery
Brijesh Patel, Ashok Shiani, Andrea C Rodriguez, Seth Lipka, Ashley H Davis-Yadley, Kirbylee K Nelson, Roshanak Rabbanifard, Ambuj Kumar, Patrick G Brady
OBJECTIVES: Obscure overt gastrointestinal bleeding can be challenging to evaluate in patients with electronic cardiac devices such as continuous flow left ventricular assist devices (LVADs), pacemakers (PPMs), and implantable cardioverter defibrillators (ICDs). Limited data exist on the utility and safety of single balloon enteroscopy (SBE) in patients with cardiac devices. We aimed to evaluate the safety, efficacy, diagnostic, and therapeutic outcomes of the aforementioned devices in patients undergoing SBE...
February 2019: Southern Medical Journal
Mohamed Khayata, Sadeer G Al-Kindi, Guilherme H Oliveira
BACKGROUND: Familial dilated cardiomyopathy (FDCM) account for 20%-30% of non-ischemic cardiomyopathies (NICM). Previous published data showed that some patients with FDCM tend to have rapidly progressive disease; however, five-year mortality was not significantly different in the familial and non-familial forms of NICM with optimal medical therapy. AIM: To better define the characteristics and clinical outcomes of FDCM patients listed for heart transplantation (HT)...
January 26, 2019: World Journal of Cardiology
Teruhiko Imamura, Valluvan Jeevanandam, Gene Kim, Jayant Raikhelkar, Nitasha Sarswat, Sara Kalantari, Bryan Smith, Daniel Rodgers, Stephanie Besser, Ben Chung, Ann Nguyen, Nikhil Narang, Takeyoshi Ota, Tae Song, Colleen Juricek, Mandeep Mehra, Maria Rosa Costanzo, Ulrich P Jorde, Daniel Burkhoff, Gabriel Sayer, Nir Uriel
BACKGROUND: Left ventricular assist device (LVAD) therapy improves the hemodynamics of advanced heart failure patients. However, it is unknown whether hemodynamic optimization improves clinical outcomes. The aim of this study was to investigate whether hemodynamic optimization reduces hospital readmission rate in LVAD patients. METHODS AND RESULTS: LVAD patients undergoing an invasive hemodynamic ramp test were prospectively enrolled and followed for 1 year. LVAD speed was optimized using a ramp test, targeting the following goals: central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <18 mm Hg, and cardiac index >2...
February 2019: Circulation. Heart Failure
Dale Kenneth Jamison, Aaron F Yang, Reza Arsanjani, Yuxiang Zhou, Ming Yang
Technetium-99m (99m Tc) tagged RBC scintigraphy is the imaging modality of choice in the diagnosis of active gastrointestinal bleeding (GIB). Continuous-flow left ventricular assist devices (CF-LVADs) are the state-of-the-art treatment for advanced heart failure, with GIB as the most common complication. Recognition of the distinctive imaging feature of CF-LVADs on scintigraphic images could aid diagnosis of GIB.
January 29, 2019: Journal of Nuclear Medicine Technology
Liza Grosman-Rimon, Sarah Genevieve Hui, Danit Freedman, Gabby Elbaz-Greener, David Cherney, Vivek Rao
BACKGROUND/AIMS: Renal dysfunction or renal failure is a common complication in left ventricular assist device (LVAD) recipients and is associated with reduced survival. To date, serum creatinine and glomerular filtration rate (GFR) are used for the evaluation of kidney function. However, serum creatinine and GFR have limitations. The objective of our study is to assess the levels of kidney biomarkers in LVAD recipients compared to heart failure patients and healthy controls and to examine their association with conventional clinical biomarkers...
January 30, 2019: Cardiorenal Medicine
Michael P Thompson, Francis D Pagani, Qixing Liang, Lynze R Franko, Min Zhang, Jeffrey S McCullough, Raymond J Strobel, Keith D Aaronson, Robert L Kormos, Donald S Likosky
Importance: Hospitalizations for durable left ventricular assist device (LVAD) implants are expensive and increasingly common. Insights into center-level variation in Medicare spending for these hospitalizations are needed to inform value improvement efforts. Objective: To examine center-level variation in Medicare spending for durable LVAD implant hospitalizations and its association with clinical outcomes. Design, Setting, and Participants: Retrospective cohort study of linked Medicare administrative claims and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) clinical data comprising 106 centers in the United States providing durable LVAD implant...
January 30, 2019: JAMA Cardiology
Christopher A Wrobel, Mark H Drazner, Colby R Ayers, David D Pham, Ricardo M La Hoz, Justin L Grodin, Sonia Garg, Pradeep P A Mammen, Robert M Morlend, Faris Araj, Alpesh A Amin, William K Cornwell, Jennifer T Thibodeau
Bloodstream infections (BSIs) are common in patients with continuous-flow left ventricular assist devices (CF-LVADs). Whether CF-LVADs modulate the febrile response to BSIs is unknown. We retrospectively compared the febrile response to BSIs in patients with heart failure (HF) with CF-LVADs versus a control population of patients with HF receiving inotropic infusions. BSIs were adjudicated using the Centers for Disease Control and Prevention and the National Healthcare Safety Network criteria. Febrile status (temperature ≥38°C, 100...
January 29, 2019: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
Kurt J Smith, Ignacio M Suarez, Anna Scheer, Lauren C Chasland, Hannah J Thomas, Marilia A Correia, Lawrence G Dembo, Louise H Naylor, Andrew J Maiorana, Daniel J Green
INTRODUCTION: In healthy individuals cerebral blood flow (CBF) increases during exercise, but few studies have compared changes in CBF during exercise in patients with heart failure (HF) to healthy controls (CTRL), or assessed the effects of left ventricular assist devices (LVADs). We hypothesised that subjects implanted with LVADs would exhibit impaired cerebrovascular responses to cycle exercise when compared to age- and sex-matched healthy CTRL subjects, but enhanced responses relative to subjects with HF...
January 25, 2019: Medicine and Science in Sports and Exercise
Robert L Kormos, Jennifer Cowger, Francis D Pagani, Jeffrey J Teuteberg, Daniel J Goldstein, Jeffrey P Jacobs, Robert S Higgins, Lynne W Stevenson, Josef Stehlik, Pavan Atluri, Kathleen L Grady, James K Kirklin
BACKGROUND: The Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs), a joint effort among the National Heart, Lung, and Blood Institute, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, and others, was established in 2005 at the University of Alabama at Birmingham. The registry examined clinical outcomes and quality-of-life metrics of patients who received an Food and Drug Administration-approved durable mechanical circulatory support (MCS) device to treat advanced heart failure...
February 2019: Journal of Heart and Lung Transplantation
Robert L Kormos, Jennifer Cowger, Francis D Pagani, Jeffrey J Teuteberg, Daniel J Goldstein, Jeffrey P Jacobs, Robert S Higgins, Lynne W Stevenson, Josef Stehlik, Pavan Atluri, Kathleen L Grady, James K Kirklin
BACKGROUND: The Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs), a joint effort among the National Heart, Lung, and Blood Institute, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, and others, was established in 2005 at the University of Alabama at Birmingham. The registry examined clinical outcomes and quality-of-life metrics of patients who received an Food and Drug Administration-approved durable mechanical circulatory support (MCS) device to treat advanced heart failure...
February 2019: Annals of Thoracic Surgery
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