One year improvement of exercise capacity in patients with mechanical circulatory support as bridge to transplantation

We describe the successful use of long-term biventricular continuous-flow mechanical circulatory support as a bridge to transplantation in a small-framed 63-year-old woman with long-standing nonischemic cardiomyopathy. After placement of a left-sided HeartWare HVAD, persistent right-sided heart failure necessitated implantation of a second HeartWare device for long-term right ventricular support. After 262 days, the patient underwent successful orthotopic heart transplantation and was discharged from the hospital. This report indicates the feasibility of biventricular device support in older patients of relatively small stature, and our results may encourage others to consider this therapy in similar patient populations.

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Bridge to transplantation from mechanical circulatory support: a narrative review

Journal of Thoracic Disease ◽

10.21037/jtd-21-832 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Alice L. Zhou ◽

Eric W. Etchill ◽

Katherine A. Giuliano ◽

Benjamin L. Shou ◽

Kavita Sharma ◽

...

Keyword(s):

Mechanical Circulatory Support ◽

Narrative Review ◽

Circulatory Support ◽

Bridge To Transplantation

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Circulatory Assist with Centrifugal Pump as a Bridge to Recovery: Mathematical Analysis

The International Journal of Artificial Organs ◽

10.1177/039139880703000708 ◽

2007 ◽

Vol 30 (7) ◽

pp. 604-610 ◽

Cited By ~ 1

Author(s):

G. Arpesella ◽

E. Mikus ◽

M. Arabia ◽

A. Loforte ◽

P. M. Mikus

Keyword(s):

Mechanical Circulatory Support ◽

Heart Function ◽

Circulatory Support ◽

Model Parameters ◽

Bridge To Transplantation ◽

Mechanical Working ◽

Centrifugal Blood Pump ◽

Function Recovery ◽

Temporary Support ◽

End Stage

Mechanical circulatory support is an essential issue in the management of patients with end-stage cardiac failure. The aim of this study is to evaluate the efficacy of temporary support with a centrifugal blood pump as bridge to heart function recovery or bridge to transplantation. Heart recovery is achieved by improving ventricular mechanical working conditions with proper modifications of preload and afterload. This article assesses the advantages of a novel “cardiac chambers” cannulation setting versus the traditional one, in the case of biventricular or isolated right ventricular failure. The study was conducted using a numerical computer model based on the work by Guyton, Sagawa, Westerhof, and Noordergraaf. Simulation of the planned trials was achieved by changing the model parameters, the pump angular velocity, and the inflow and outflow settings. (Int J Artif Organs 2007; 30: 604–10)

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One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support

PLoS ONE ◽

10.1371/journal.pone.0256377 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256377

Author(s):

Jahanzeb Malik ◽

Faizan Younus ◽

Asmara Malik ◽

Muhammad Umar Farooq ◽

Ahmed Kamal ◽

...

Keyword(s):

Survival Analysis ◽

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Operative Mortality ◽

Surgical Repair ◽

Univariate Analysis ◽

Categorical Variables ◽

Circulatory Support ◽

The Mean ◽

One Year

Background and objective The effectiveness of deferred surgical repair of ventricular septal rupture (VSR) post-myocardial infarction (MI) with cardiogenic shock remains limited to case reports. Our study aimed to investigate the outcomes and survival analysis following mechanical circulatory support (MCS) in patients after VSR who develop cardiogenic shock. Methods We analyzed 27 patients with post-MI VSR and cardiogenic shock who received deferred surgical repair while stabilized on MCS between January 2018 and March 2020. After normality test adjustments, continuous variables were expressed as mean ± standard deviation (SD). These were compared using the Mann-Whitney U test and Student’s t-test. Categorical variables were compared using chi-square or Fisher’s exact test. To identify predictors of operative mortality, univariate analysis of clinical characteristics and interventions followed by logistic regression was carried out. P-value of < 0.05 was considered significant. Results All patients had preoperative MCS. Emergency repair was avoided in all the patients. The mean age of the participants was 64.96 with the majority being males (74.1%). On average, the mean time from MI to VSR repair was 18.85 days. Delayed revascularization was associated with increased mortality (OR 17.500, 95% CI 2.365–129.506, P = 0.005). Other factors associated with increased mortality were ejection fraction (EF), three-vessel disease, Killip class, early surgery, and prolonged use of inotropes. The operative mortality was 11% with an overall mortality of 33.3%. The one-year survival rate was 66.7%. Conclusion The use of MCS in adjunct to a deferred surgical approach shows an improved survival outcome of patients with VSR complicated by cardiogenic shock. Further investigations are required regarding the optimal time for MCS and surgical repair.

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Optimal bridge to transplantation strategy using short‐term mechanical circulatory support devices

Clinical Transplantation ◽

10.1111/ctr.13993 ◽

2020 ◽

Vol 34 (10) ◽

Author(s):

Teruhiko Imamura

Keyword(s):

Mechanical Circulatory Support ◽

Circulatory Support ◽

Bridge To Transplantation ◽

Short Term ◽

Mechanical Circulatory Support Devices ◽

Support Devices

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Peripheral vascular disease and/or need for dialysis predicts mortality in acute myocardial infarction with shock treated with mechanical circulatory support

European Heart Journal ◽

10.1093/ehjci/ehaa946.1794 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Ortiz ◽

G Stouffer ◽

J Rossi

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Mechanical Circulatory Support ◽

Left Ventricular ◽

Circulatory Support ◽

Prior History ◽

Peripheral Vascular ◽

One Year

Abstract Background Acute myocardial infarction (AMI) with left ventricular systolic dysfunction remains the largest cause for cardiogenic shock (CS) admissions. Aside for prompt revascularization few therapies have been shown to improve survival in this patient population. In the last decade, the use of mechanical circulatory support devices (MCS) for CS has increased, despite little evidence guiding their use. Purpose To explore for different baseline factors which may favor treatment with MCS vs pharmacological circulatory support (PCS) in AMI related CS. Methods Baseline clinical and procedural variables were retrospectively collected for all patient presenting to the cardiac cath lab with an AMI and CS at a large health care system. Patients were stratified by whether they received MCS or only PCS. The outcomes of interest were 30 day and one year mortality. Results Between 01/2014 andv08/2018, 205 patients presented to the cath lab with an AMI complicated by CS. The vast majority of cases were STEMIs (133/205, 65%). Overall mortality for the cohort at 30 days and one year were 41% and 50% respectively. There was no difference in 30 day or 1 year mortality between the MCS and PCS groups. A STEMI presentation was associated with increase 30 day mortality in the MCS group but the association was not seen at one year. Interestingly having a prior history peripheral vascular disease (PVD) and/or being on dialysis prior to the procedure was predictive of one year mortality in the MCS group (OR 3.8, 1.4–10.6, p=0.006) but not in the PCS. Conclusion Patients presenting with AMI complicated by CS have a high mortality despite successful revascularization. In our cohort having PVD and/or needing dialysis was predictive of mortality in patients receiving MCS. Patient selection is an important factor in choosing appropriate circulatory support, further prospective studies are needed. Figure 1 Funding Acknowledgement Type of funding source: None

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