Arrhythmias in children with ventricular assist devices

2013 ◽  
Vol 25 (2) ◽  
pp. 255-260
Author(s):  
W. Buck Kyle ◽  
Jamie Decker ◽  
Scott L. Macicek ◽  
Santiago O. Valdes ◽  
David Morales ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Assist Device ◽  
Transplant Rejection ◽  
Decompensated Heart Failure ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Risk Of Death ◽  
The Impact

AbstractBackground: Children with decompensated heart failure are at high risk for arrhythmias, and ventricular assist device placement is becoming a more common treatment strategy. The impact of ventricular assist devices on arrhythmias and how arrhythmias affect the clinical course of this population are not well described. Methods and results: A single-centre retrospective analysis of children receiving a ventricular assist device between 1998 and 2011 was performed. In all, 45 patients received 56 ventricular assist devices. The median age at initial placement was 13 years (interquartile range 6–15). The median duration of support was 10 days (range 2–260). The aetiology of heart failure included cardiomyopathy, transplant rejection, myocarditis, and congenital heart disease. In all, 32 patients (71%) had an arrhythmia; 19 patients (42%) had an arrhythmia before ventricular assist device and eight patients (18%) developed new arrhythmias on ventricular assist device. Ventricular tachycardia was most common (25/32, 78%). There was no correlation between arrhythmia and risk of death or transplantation (p=0.14). Of the 15 patients who weaned from ventricular assist device, post-ventricular assist device arrhythmias occurred in nine (60%), with five (33%) having their first arrhythmia after weaning. Patients with ventricular dysfunction after ventricular assist device were more likely to have arrhythmias (p<0.02). Conclusions: Arrhythmias, especially ventricular, are common in children requiring ventricular assist device. They frequently persist for those able to wean from ventricular assist device.

scholarly journals Novel Risk Model to Predict Emergency Department Associated Mortality for Patients Supported With a Ventricular Assist Device: The Emergency Department–Ventricular Assist Device Risk Score

2022 ◽  
Author(s):  
Jonathan B. Edelson ◽  
Jonathan J. Edwards ◽  
Hannah Katcoff ◽  
Antara Mondal ◽  
Feiyan Chen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Score ◽  
Ventricular Assist Device ◽  
Risk Model ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Predictors Of Mortality ◽  
Risk Of Death

Background The past decade has seen tremendous growth in patients with ambulatory ventricular assist devices. We sought to identify patients that present to the emergency department (ED) at the highest risk of death. Methods and Results This retrospective analysis of ED encounters from the Nationwide Emergency Department Sample includes 2010 to 2017. Using a random sampling of patient encounters, 80% were assigned to development and 20% to validation cohorts. A risk model was derived from independent predictors of mortality. Each patient encounter was assigned to 1 of 3 groups based on risk score. A total of 44 042 ED ventricular assist device patient encounters were included. The majority of patients were male (73.6%), <65 years old (60.1%), and 29% presented with bleeding, stroke, or device complication. Independent predictors of mortality during the ED visit or subsequent admission included age ≥65 years (odds ratio [OR], 1.8; 95% CI, 1.3–4.6), primary diagnoses (stroke [OR, 19.4; 95% CI, 13.1–28.8], device complication [OR, 10.1; 95% CI, 6.5–16.7], cardiac [OR, 4.0; 95% CI, 2.7–6.1], infection [OR, 5.8; 95% CI, 3.5–8.9]), and blood transfusion (OR, 2.6; 95% CI, 1.8–4.0), whereas history of hypertension was protective (OR, 0.69; 95% CI, 0.5–0.9). The risk score predicted mortality areas under the curve of 0.78 and 0.71 for development and validation. Encounters in the highest risk score strata had a 16‐fold higher mortality compared with the lowest risk group (15.8% versus 1.0%). Conclusions We present a novel risk score and its validation for predicting mortality of patients with ED ventricular assist devices, a high‐risk, and growing, population.

Ventricular Assist Devices

2012 ◽  
Vol 23 (1) ◽  
pp. 69-83 ◽  
Author(s):  
Genevieve O’Shea
Keyword(s):  
Heart Failure ◽  
Ventricular Assist Device ◽  
Advanced Heart Failure ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Nursing Management ◽  
Assist Device ◽  
Physiological Basis ◽  
Ventricular Assist ◽  
Assist Devices

Patients with advanced heart failure have limited treatment options despite advances in medical management. Ventricular assist devices represent a surgical option that offers improved end-organ function, survival, and quality of life. Postoperative nursing management involves the most complicated aspects of care following cardiac surgery as well as issues unique to advanced heart failure and mechanical circulatory support. Despite growing numbers of ventricular assist device implants, literature about the challenging care of patients following ventricular assist device implantation is limited. This article focuses on the physiological basis for postoperative nursing management strategies and the most important complications of which critical care nurses need to be aware.

Blood damage in Left Ventricular Assist Devices: Pump thrombosis or system thrombosis?

2018 ◽  
Vol 42 (3) ◽  
pp. 113-124 ◽  
Author(s):  
Matteo Selmi ◽  
Wei-Che Chiu ◽  
Venkat Keshav Chivukula ◽  
Giulio Melisurgo ◽  
Jennifer Ann Beckman ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Pump Thrombosis ◽  
Left Ventricular Assist

Introduction: Despite significant technical advancements in the design and manufacture of Left Ventricular Assist Devices, post-implant thrombotic and thromboembolic complications continue to affect long-term outcomes. Previous efforts, aimed at optimizing pump design as a means of reducing supraphysiologic shear stresses generated within the pump and associated prothrombotic shear-mediated platelet injury, have only partially altered the device hemocompatibility. Methods: We examined hemodynamic mechanisms that synergize with hypershear within the pump to contribute to the thrombogenic potential of the overall Left Ventricular Assist Device system. Results: Numerical simulations of blood flow in differing regions of the Left Ventricular Assist Device system, that is the diseased native left ventricle, the pump inflow cannula, the impeller, the outflow graft and the anastomosed downstream aorta, reveal that prothrombotic hemodynamic conditions might occur at these specific sites. Furthermore, we show that beyond hypershear, additional hemodynamic abnormalities exist within the pump, which may elicit platelet activation, such as recirculation zones and stagnant platelet trajectories. We also provide evidences that particular Left Ventricular Assist Device implantation configurations and specific post-implant patient management strategies, such as those allowing aortic valve opening, are more hemodynamically favorable and reduce the thrombotic risk. Conclusion: We extend the perspective of pump thrombosis secondary to the supraphysiologic shear stress environment of the pump to one of Left Ventricular Assist Device system thrombosis, raising the importance of comprehensive characterization of the different prothrombotic risk factors of the total system as the target to achieve enhanced hemocompatibility and improved clinical outcomes.

scholarly journals 1180. Colonization with Multidrug-Resistant Organisms Is Associated with Subsequent Infection in the Ventricular Assist Device Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S423-S423
Author(s):  
Scott C Roberts ◽  
Jonathan D Rich ◽  
Duc T Pham ◽  
Rebecca Harap ◽  
Valentina Stosor
Keyword(s):  
Ventricular Assist Device ◽  
Retrospective Cohort ◽  
Multidrug Resistant ◽  
Ventricular Assist Devices ◽  
Resistant Organism ◽  
Subsequent Infection ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Multidrug Resistant Organisms

Abstract Background Infection is a leading cause of morbidity and mortality in the ventricular assist device (VAD) population. We performed a retrospective cohort study outlining the epidemiology of multidrug-resistant organism (MDRO) colonization and infection rates in this population. Methods We performed a longitudinal retrospective cohort of all patients receiving continuous-flow (axial and centrifugal) ventricular assist devices from July 2008 to September 2018 at Northwestern Memorial Hospital. Peri-operative prophylaxis from July 2008 to June 2013 was vancomycin, rifampin, ciprofloxacin, and fluconazole, and vancomycin plus cefuroxime from June 2013 to September 2018. VAD-specific and VAD-related Infections were classified according to ISHLT 2013 definitions. Patients were screened for methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis or Enterococcus faecium, or extended-spectrum β-lactamase producing Gram-negative rods. Statistics were performed using IBM® SPSS Statistics version 25.0. Comparative statistics were performed using two-sided Fisher’s exact test with a P-value of <0.05 deemed significant. Results A total of 89 patients with ventricular assist devices developed either VAD-specific or VAD-related infections and were included in the analysis. 77% of patients (n = 66) were colonized with an MDRO; 29% (n = 25) with MRSA, 73% (n = 63) with VRE, and 24% (n = 21) with an ESBL organism. 17.9% (n = 16) of patients who went on to develop infection was secondary to MDROs. Colonization with an MDRO was associated with subsequent infection secondary to these organisms (P = 0.018). Conclusion Colonization rates of multidrug-resistant organisms in the VAD population are high. VRE rates were significantly higher than MRSA or ESBL, possible as a result of peri-implantation utilization of vancomycin as surgical site prophylaxis. MDRO colonization was associated with progression to VAD-specific or VAD-related Infection. Disclosures All authors: No reported disclosures.

scholarly journals Širdies nepakankamumo gydymas implantuojant dirbtinį skilvelį INCOR

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Kęstutis Ručinskas ◽  
Saulius Miniauskas ◽  
Gintaras Rasimavičius ◽  
Rimantas Bubulis ◽  
Stanislovas Stankevič ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
University Hospital ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Key Words Heart ◽  
Key Words Heart Failure ◽  
Vilnius University

Kęstutis Ručinskas1, Saulius Miniauskas1, Gintaras Rasimavičius1, Rimantas Bubulis2, Stanislovas Stankevič2, Vaclovas Jurkuvėnas2, Gitana Žemaitytė3, Vytė Valerija Maneikienė3, Vytautas Sirvydis1, Aleksandras Taucevičius41 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Anesteziologijos,intensyviosios terapijos ir skausmo gydymo centras, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius4 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Dirbtinis implantuojamas pastovios tėkmės kairysis skilvelis INCOR Vilniaus universiteto Širdies chirurgijos centre naudojamas nuo 2003 metų. Pacientams, kuriems nustatytas kraštutinis širdies nepakankamumas, implantuota 14 dirbtinių skilvelių. Po prijungimo 9 pacientai buvo išrašyti į namus, 4 iš jų sulaukė širdies persodinimo operacijos. Šiuo metu ambulatoriškai stebimi 4 pacientai, kuriems implantuotas INCOR skilvelis. Bendras pacientų stebėjimo laikas yra daugiau kaip 8,5 metų. Dirbtinio skilvelio INCOR implantacija yra labai efektyvus atrinktos grupės pacientų širdies nepakankamumo gydymo būdas. Pagrindiniai žodžiai: širdies nepakankamumas, dirbtinis skilvelis, širdies persodinimas Treatment of heart failure by implanting an INCOR left ventricular assist device Kęstutis Ručinskas1, Saulius Miniauskas1, Gintaras Rasimavičius1, Rimantas Bubulis2, Stanislovas Stankevič2, Vaclovas Jurkuvėnas2, Gitana Žemaitytė3, Vytė Valerija Maneikienė3, Vytautas Sirvydis1, Aleksandras Taucevičius41 Cardial Surgery Centre, Vilnius University, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“, Anesthesiology,Intensive Care and Pain Management Center, Santariškių str. 2, LT-08661 Vilnius, Lithuania 3 Cardial Surgery Centre of Vilnius University Hospital „Santariškių klinikos“,Santariškių str. 2, LT-08661 Vilnius, Lithuania4 Vilnius University, Clinic of Cardiovascular Diseases,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Continuous blood flow ventricular assist devices, INCOR, are used at Vilnius University Cardial Surgery Centre since 2003. Fourteen of them were implanted to terminal heart failure patients. After the procedure, 9 patients were discharged home and 4 received heart transplant. At the present time, four patients with INCOR are being observed at home. The cumulative time of the patients with the INCOR assist device is 8.5 years. Effective treatment for a selected group of patients with heart failure is ventricular assist device INCOR implantation. Key words: heart failure, assist device, heart transplantation

Outcome for children following admission to hospital with a first episode of heart failure, due to heart muscle disease, in the ventricular assist device (VAD) era

2019 ◽  
Vol 29 (7) ◽  
pp. 888-892
Author(s):  
Andres Rico-Armada ◽  
David S. Crossland ◽  
Louise Coats ◽  
Zdenka Reinhardt ◽  
Anthony Hermuzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Muscle ◽  
Recovery Of Function ◽  
Muscle Disease ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
First Episode ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices

AbstractAims:Most reports on the outcome of children who present with heart failure, due to heart muscle disease, are from an era when ventricular assist devices were not available. This study provides outcome data for the current era where prolonged circulatory support can be considered for most children.Methods & Results:Data was retrieved on 100 consecutive children, who presented between 2010 – 2016, with a first diagnosis of unexplained heart failure. Hospital outcome was classified as either death, transplantation, recovery of function or persistent heart failure. Median age at presentation was 24 months and 58% were < 5 years old. Hospital mortality was 12% and 59% received a heart transplant. Most, 79%, of the transplants were carried out on patients with a device. Recovery of function was observed in 18% and 10% stabilised on oral therapy. Eighty-four percent of the deaths occurred in the <5 year old group. Shorter duration of support was associated with survival (34 days in survivors versus 106 in non-survivors, p = 0.01) and 72% were on an assist device at time of death.Conclusion:Heart failure in children who require referral to a transplant unit is a serious illness with a high chance of either transplantation or death. Modifications in assist devices will be required to improve safety, especially for children < 5 years old where the donor wait may be prolonged. The identification of children who may recover function requires further study.

Poor outcomes resulting from ventricular assist devices implanted in hospitals without dedicated ventricular assist device programs

2011 ◽  
Vol 2 (1) ◽  
pp. 11826574 ◽  
Author(s):  
Anelechi C. Anyanwu ◽  
Sean Pinney ◽  
Kimmarie Hammond ◽  
Kimberly Ashley ◽  
David H. Adams
Keyword(s):  
Ventricular Assist Device ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Poor Outcomes

scholarly journals Extended right posterior liver sectionectomy for HCC in a patient with left ventricular assist device—a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Lea Timmermann ◽  
Moritz Schmelzle ◽  
Evgenij Potapov ◽  
Marcus Müller ◽  
Christian Lojewski ◽  
...  
Keyword(s):  
Case Report ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Abstract Successful implementation of left ventricular assist devices lead to a prolonged survival in patients with chronic terminal heart failure. Thus, patients with pre-existing left ventricular assist devices with abdominal comorbidities requiring abdominal surgery, e.g. for malignancy, are upcoming issues. We carried out a major liver resection for hepatocellular carcinoma in a patient with pre-existing left ventricular assist device. The importance of this case report is that it outlines the significance of oncologic resections in patients with left ventricular assist devices as an upcoming issue and provides an interdisciplinary approach.

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