Secondary hemochromatosis and mechanical circulatory support with a total artificial heart

2015 ◽  
Vol 34 (11) ◽  
pp. 1492-1493
Author(s):  
Inna Tchoukina ◽  
Maureen P. Flattery ◽  
Keyur B. Shah
Keyword(s):  
Artificial Heart ◽  
Mechanical Circulatory Support ◽  
Total Artificial Heart ◽  
Circulatory Support

scholarly journals Durable Mechanical Circulatory Support in Patients With Amyloid Cardiomyopathy

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Katherine C. Michelis ◽  
Lin Zhong ◽  
W.H. Wilson Tang ◽  
James B. Young ◽  
Matthias Peltz ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Artificial Heart ◽  
Mechanical Circulatory Support ◽  
Restrictive Cardiomyopathy ◽  
Interquartile Range ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Device Implantation ◽  
Included Patient ◽  
Amyloid Cardiomyopathy

Background: Many patients with amyloid cardiomyopathy (ACM) develop advanced heart failure, and durable mechanical circulatory support (MCS) may be a consideration. However, data describing clinical outcomes after MCS in this population are limited. Methods: Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support with dilated cardiomyopathy (DCM, n=19 921), nonamyloid restrictive cardiomyopathy (RCM, n=248), or ACM (n=46) between 2005 and 2017 were included. Patient and device characteristics were compared between cardiomyopathy groups. The primary end point was the cumulative incidence of death with heart transplantation as a competing risk. Results: Patients with ACM (n=46) were older (61 years [interquartile range, 55–69 years] versus 58 years [interquartile range, 49–66 years] for DCM and 55 years [interquartile range, 46–62 years] for nonamyloid RCM, P <0.001) and were more commonly Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30.4% versus 17.9% for DCM and 21.0% for nonamyloid RCM, P =0.04) at device implantation. Use of biventricular support (biventricular assist device or total artificial heart) was the highest for patients with ACM (41.3% versus 6.7% and 19.4% for patients with DCM and nonamyloid RCM, respectively, P =0.014). The cumulative incidence of death was highest for patients with ACM relative to those with DCM or nonamyloid RCM ( P <0.001) but did not differ significantly between groups for those who required biventricular MCS. Conclusions: Compared with patients with DCM or nonamyloid RCM who received durable MCS, those with ACM experienced the highest use of biventricular support and the worst survival. These data highlight concerns with the use of durable MCS for patients with ACM.

Abstract WMP66: Cerebrovascular Hemodynamics of Mechanical Circulatory Support Device Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kara R Melmed ◽  
Konrad H Shlick ◽  
Brenda Rinsky ◽  
Shlee S Song ◽  
Patrick D Lyden
Keyword(s):  
Continuous Flow ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Normative Values ◽  
Mean Flow ◽  
Mean Velocity ◽  
Ventricular Assist ◽  
Cerebrovascular Hemodynamics

Background: Multiple types of mechanical circulatory support (MCS) devices are commonly used in heart failure patients. These devices carry risk for neurologic complications, specifically cardioembolic stroke. Alterations in blood flow play a role in the pathophysiology, however there is limited data regarding cerebrovascular hemodynamics in MCS patients. We used transcranial Doppler (TCD) to define hemodynamics of commonly used MCS devices. Methods: We retrospectively examined charts from 2/2013 through 6/2016 for patients with MCS who underwent TCD, and obtained the following: peak systolic,end-diastolic velocities, mean flow velocities, pulsatility indices (PI) and number of high-intensity transient signals (HITS). Waveform morphologies were compared between devices. Results: Of 1,796 TCDs studies screened, 62 TCD studies were from 32 MCS patients. Of these, 21 were on extracorporeal membrane oxygenation (ECMO), 15 had a left ventricular assist device (LVAD), 18 had total artificial heart (TAH), and 2 had intra-aortic balloon pumps (IABP). Waveforms in patients supported by ECMO demonstrated continuous flow without clear systolic peaks. The averaged mean MCA velocity was 57.57 (SD= 21.00) cm/sec and mean PI is 0.35 (0.17). LVAD averaged mean MCA velocity was 57.57 (14.38) cm/sec and mean PI of 0.45 (0.28). PIs were low in patients with continuous-flow LVADs. Impella patients had morphologically distinct pulsatile waveforms compared to other types of VADs. IABP had averaged mean velocity of 56.21 (14.78) cm/sec and mean PI of 0.77 (0.15). These waveforms demonstrated pronounced diastolic upstrokes not present in other devices. In TAH patients, mean MCA velocity was 73.69 (33.00) cm/sec and PI of 0.86 (0.40). Emboli detection was performed in 46 studies, and HITS were detected in 29 (63%). Of these 15 (51%) were administered 100% oxygen which suppressed >50% HITS in 10 (67%) patients. Conclusion: Patients supported by MCS devices produce unique and characteristic waveforms on TCD studies. Further studies will describe normative values in this special population. HITS were not universally present and intermittently suppressible by oxygen, suggesting some may be gaseous in nature. Risk of stroke in patients with MCS and HITS is under study.

scholarly journals Success of Thrombectomy in Management of Ischemic Stroke in Two Patients with SynCardia Total Artificial Heart in Bridge-to-Transplantation

2021 ◽  
Vol 8 (9) ◽  
pp. 126
Author(s):  
Brendan Le Picault ◽  
Charles-Henri David ◽  
Pierre-Louis Alexandre ◽  
Cédric Lenoble ◽  
Philippe Bizouarn ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Artificial Heart ◽  
Mechanical Thrombectomy ◽  
Total Artificial Heart ◽  
Neurological Deficits ◽  
Circulatory Support ◽  
Hemorrhagic Complication ◽  
Bridge To Transplant ◽  
End Stage

Introduction: Circulatory assistance from a SynCardia Total Artificial Heart (SynCardia-TAH) is a reliable bridge-to-transplant solution for patients with end-stage biventricular heart failure. Ischemic strokes affect about 10% of patients with a SynCardia-TAH. We report for the first time in the literature two successful thrombectomies to treat the acute phase of ischemic stroke in two patients treated with a SynCardia-TAH in the bridge-to-transplant (BTT). Case report: We follow two patients with circulatory support from a SynCardia-TAH in the bridge-to-transplant for terminal biventricular cardiac failure with ischemic stroke during the support period. An early in-hospital diagnosis enables the completion of a mechanical thrombectomy within the first 6 h of the onset of symptoms. There was no intracranial hemorrhagic complication during or after the procedure and the patients fully recovered from neurological deficits, allowing a successful heart transplant. Conclusion: This case report describes the possibility of treating ischemic strokes under a SynCardia-TAH by mechanical thrombectomy following the same recommendations as for the general population with excellent results and without any hemorrhagic complication during or after the procedure.

Impact of mechanical circulatory support on post-transplant stroke risk

2021 ◽  
Vol 44 (10) ◽  
pp. 675-680
Author(s):  
Nandini Nair ◽  
Shengping Yang ◽  
Enrique Gongora
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Mechanical Circulatory Support ◽  
Stroke Risk ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Study Cohort ◽  
Mechanical Support ◽  
Ischemic Time ◽  
Post Transplant

The effect of type of mechanical circulatory support on stroke risk during the early post-transplant period remains undefined in patients bridged to transplant. This study assesses if the type of circulatory support device affects stroke risk in this population. The study cohort of 4257 adult patients bridged with mechanical support to cardiac transplant were derived from the UNOS transplant registry data. Risk factors assessed were age, gender, ischemic time, diabetes (recipient), durable mechanical support at listing and mechanical ventilation pre-transplant. Descriptive statistics were used to describe characteristics of the study cohort. Univariate logistic regression was used to test if there is a significant association between stroke event and all the potential risk factors. Multivariate logistic regression was used to test such associations while adjusting for all other risk factors. Odds ratios (ORs) and their 95% confidence intervals (CIs) in parenthesis, were calculated. p < 0.05 was considered significant. Patients on Extracorporeal membrane oxygenation (ECMO) had the highest risk of stroke immediately post-transplant prior to discharge (OR 3.03, {1.16, 7.95}) followed by Total Artificial Heart (TAH) (OR 2.03, {1.01, 4.07) as compared to those only on a Left Ventricular Assist Device (LVAD). Ischemic time (OR 1.3 {1.09, 1.45}) and diabetes (OR 1.8 {1.29, 2.51}) were significant risk factors. Patients on ECMO and TAH had a 203% and 103% increase respectively in the odds of having a stroke prior to discharge as compared to those only on LVADS.

Mechanical Bridge to Transplantation with the Vienna Heart in TAH and LVAD Configuration

1992 ◽  
Vol 15 (3) ◽  
pp. 147-167 ◽  
Author(s):  
A. Moritz ◽  
A. Rokitansky ◽  
H. Schima ◽  
A. Prodinger ◽  
G. Laufer ◽  
...  
Keyword(s):  
Artificial Heart ◽  
Clinical Problem ◽  
Left Ventricular ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Septic Focus ◽  
Left Ventricular Assist ◽  
Liver And Kidney ◽  
Kidney Insufficiency

The Vienna heart uses a vacuum formed, pellethane pulsatile ventricle and is available in left ventricular assist (LVAD) and total artificial heart (TAH) configurations. This device was used as mechanical support of the failing heart in nine patients intended for heart transplantation. In two patients with cardiomyopathy an orthotopic TAH was implanted; one survived despite severe preoperative ischemic liver damage, and the other died of sepsis. In seven patients an atrio-aortic LVAD was implanted; six had suffered an acute myocardial infarction with cardiogenic shock, and one could not be weaned off bypass. Three patients survived. These included one 65-year-old with incipient ARDS at operation, and a 40-year-old with preoperative liver and kidney insufficiency who was transplanted in septicemia. In this patient the septic focus, natural and artificial heart, were removed at transplantation. Four patients died. In one we were unable to establish satisfactory circulation, one died after failure of the transplanted heart, one suffered a lethal cerebral embolism and one developed multi-organ failure after repeated attacks of ventricular fibrillation. With the Vienna heart sufficient circulatory support could be established with cardiac outputs between 6 and 8 l/min for the TAH and 3.5 to 4.5 I/min for the LVAD. With this type of support an overall survival rate of 44% could be achieved. Mechanical hemolysis was not a clinical problem and no device failure occurred.

Device Selection for Short- and Long-Term Mechanical Circulatory Support

2019 ◽  
pp. 61-69
Author(s):  
Rabea Asleh ◽  
Sarah Schettle
Keyword(s):  
Mechanical Circulatory Support ◽  
Tissue Perfusion ◽  
Time Frame ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Short Term ◽  
Ventricular Assist ◽  
Device Selection ◽  
Selection For

Mechanical circulatory support has expanded to meet the needs of a variety of patient populations requiring short-term and long-term applications and is utilized internationally. Short-term support devices offer treatment for cardiogenic shock and consist of varying support mechanisms, including univentricular and biventricular support options to improve hemodynamics and tissue perfusion. Investigational devices offer additional options to consider in device selection. Long-term support with ventricular assist devices or total artificial heart offers dischargeable options for lifelong support, recovery, or while patients await organ transplantation. Consideration of device availability, expenses and coverage, operator expertise, and technical challenges should be undertaken when determining patient support strategies. Reviewing patient comorbidities and time frame needed for support is imperative when considering device options to ensure appropriate device selection for each individual patient, thus mitigating risks and maximizing outcomes. Innovation will continue to drive progress in mechanical circulatory support with ongoing development of novel strategies to afford new options to optimize support of patients with heart failure.

Caring for Pediatric Heart Failure Patients With Long-Term Mechanical Circulatory Support

2018 ◽  
Vol 38 (5) ◽  
pp. 44-56
Author(s):  
Kari Hyotala
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Congenital Defects ◽  
Specific Information ◽  
Device Implantation ◽  
Assessment Skills ◽  
Pediatric Heart Failure

Pediatric cardiac failure is a significant problem that may be caused by cardiomyopathy, myocarditis, or congenital defects that cannot be surgically repaired. Long-term mechanical circulatory support (LTMCS) devices provide hemodynamic support for patients in heart failure as a bridge to heart transplant and, sometimes, cardiac recovery or destination therapy. Critical care nurses must have a comprehensive understanding of LTMCS device function and keen assessment skills to detect signs of impaired perfusion and device failure. Nurses should anticipate postoperative interventions, prevent adverse events, and be prepared to respond during emergencies. Patient care should be family centered and nurses must strive to maximize patients’ quality of life throughout device implantation. This article provides a basic guide to caring for pediatric patients receiving LTMCS, including specific information regarding 4 devices that are often used for pediatric heart failure: Berlin Heart EXCOR, SynCardia Total Artificial Heart, HeartWare HVAD, and HeartMate II.

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