4: Less Frequency of Aortic Valve Opening and Continuous Flow Device Are Risk Factors for Late Onset of Aortic Regurgitation in Patients with Left Ventricular Assist Device

2010 ◽  
Vol 29 (2) ◽  
pp. S8-S8 ◽  
Author(s):  
M. Hatano ◽  
K. Kinugawa ◽  
T. Shiga ◽  
A. Yao ◽  
Y. Hirata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Continuous Flow ◽  
Late Onset ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Flow Device ◽  
Valve Opening

More continuous flow, better learning? The effect of aortic valve opening in patients with left ventricular assist device

2020 ◽  
pp. 039139882096328
Author(s):  
Mehmet Karahan ◽  
Sinan Sabit Kocabeyoglu ◽  
Umit Kervan ◽  
Dogan Emre Sert ◽  
Emel Erdogan Bakar ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Assist Device ◽  
Continuous Flow ◽  
Left Ventricular ◽  
Learning Performance ◽  
Assist Device ◽  
Ventricular Assist ◽  
Neurocognitive Functions ◽  
Left Ventricular Assist ◽  
Valve Opening

Purpose: The aim of this study was to analyze neurocognitive function in patients who underwent continuous flow left ventricular assist device (LVAD) implantation. Material and Method: This cross-sectional study included three groups: LVAD ( n = 31), heart failure patients ( n = 26), and healthy volunteers ( n = 27). The Rey Auditory-Verbal Learning Test (RAVLT), Judgement of Line Orientation Test (JLOT), Trail Making Test (TMT), Stroop Color-Word Interference Test (SCWIT), Verbal Fluency Test (VFT), Symbol-Digit Modality Test (SDMT) were used to assess the neurocognitive functions. Data were analyzed at a median 12 (3–47) months after LVAD implantation. The LVAD patients were also divided by aortic valve opening (AVO) into three subgroups as “closed” ( n = 9), “1–6” ( n = 8) and “7–10” ( n = 14) opening per ten beats and data were re-analyzed accordingly. Results: There was no significant difference among the groups according to SCWIT, JLOT, SDMT, TMT, and VFT scores. Post-hoc analyzes of RAVLT scores showed significant differences between the LVAD and the other two groups in favor of the LVAD group. Also, the patients with AVO “7–10” the response times were longer and learning scores were found to be lower than those without AVO. Conclusion: With continuous-flow LVAD, neurocognitive functions were not impaired. The learning performance was better in cases where there was no AVO and flow was completely device dependent. We may speculate that neurocognitive functions are not worsening with continuous cerebral blood flow and even it may improve learning performance.

Pulse assessment is important with blood pressure measurement in individuals with continuous flow left ventricular assist devices

2020 ◽  
pp. 039139882092702
Author(s):  
Hernan G Marcos-Abdala ◽  
Ana S Cruz-Solbes ◽  
Imad Hussain ◽  
Barry Trachtenberg ◽  
Guha Ashrith ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Continuous Flow ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
Valve Opening

While Doppler and cuff blood pressure techniques are prevalent methods of assessing blood pressure in patients with continuous flow left ventricular assist devices, the impact of pulsatility on measurement is not well established. Retrospective chart analysis of clinical variables including pulse perception, blood pressure (Doppler and standard cuff), and aortic valve opening on echo at clinic visit were abstracted. Stable outpatients on continuous flow left ventricular assist devices support with concomitant portable echo assessment were included. Mean average difference was calculated and Pearson’s correlation performed for all those patients who had both Doppler and cuff pressure obtained. In all, 74 Heartmate-II patients with a median time from implant of 380 days were analyzed. A pulse was perceived in 82% of patients with persistent aortic valve opening on portable echo and also in 30% of those who had a persistently closed aortic valve. The mean average difference between the Doppler and systolic cuff pressure was ~13 mmHg ( r = 0.5, p = 0.004) when a pulse was present and ~11 mmHg when aortic valve was open ( r = 0.68, p < 0.0001). Pulse presence seems to reflect aortic valve opening a majority of the time but not always. In the presence of a prominent pulse or persistent aortic valve opening, the Doppler pressure seems to be more reflective of a systolic pressure than mean perfusion pressure. Hence, assessment of pulsatility needs to be incorporated into blood pressure measurement methods for patients with continuous flow left ventricular assist devices.

scholarly journals Psychosocial Risk and Its Association With Outcomes in Continuous-Flow Left Ventricular Assist Device Patients

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Ersilia M. DeFilippis ◽  
Khadijah Breathett ◽  
Elena M. Donald ◽  
Shunichi Nakagawa ◽  
Koji Takeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Continuous Flow ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Psychosocial Risk Factors ◽  
Psychosocial Risk ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background: Advanced heart failure therapies such as left ventricular assist device (LVAD) implantation require intricate follow-up and complex care. We sought to explore the burden of psychosocial risk factors among patients with LVAD and their impact on postimplant outcomes using the Interagency Registry for Mechanically Assisted Circulatory Support. Methods: Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support requiring durable LVAD between 2008 and 2017 were included. Individuals were determined to have psychosocial risk if they had one of the following: (1) limited social support; (2) limited cognition; (3) substance abuse (alcohol and drug); (4) severe psychiatric disease (including major depression and other major psychiatric diagnosis); and (5) repeated noncompliance. Univariate and multivariate Cox proportional hazard regression models were used to analyze predictors of survival and complications. Results: A total of 15 403 continuous-flow LVAD recipients were included. A total of 3163 (20.5%) had one or more psychosocial risk factors. The most prevalent psychosocial risk factor was substance abuse in 1941 (12.6%) recipients. Patients with psychosocial risk factors were significantly younger at LVAD implant, less likely to be White, and less likely to be female compared with those without psychosocial risk, P <0.001 for all. Patients with psychosocial risk were significantly more likely to receive an LVAD as destination therapy, P <0.001. In adjusted models, patients with psychosocial risk were at increased hazards for device-related infection, gastrointestinal bleeding, pump thrombosis, and readmission and reduced hazards for cardiac transplantation ( P <0.05 for all). There was no statistically significant difference in survival on pump support or stroke. Conclusions: Psychosocial risk is an important component of patient selection for advanced heart failure therapies. Addressing these specific components may help improve access to advanced therapies and post-LVAD outcomes.

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