Long-term-Outpatient Therapy with a Left Ventricular Assist Device

Swiss Surgery ◽  
2003 ◽  
Vol 9 (1) ◽  
pp. 27-30 ◽  
Author(s):  
Grapow ◽  
Todorov ◽  
Bernet ◽  
Zerkowski
Keyword(s):  
New York ◽  
Heart Association ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Association Class ◽  
Orthotope Herztransplantation ◽  
New York Heart Association ◽  
Ambulante Betreuung

Wir berichten über die erste erfolgreiche ambulante Langzeit-Betreuung eines Patienten mit kombinierter dilatativer und ischämischer Kardiomyopathie nach Implantation eines implantierbaren, pulsatilen Linksherzunterstützungssystem (LVAD; Novacor), in der Schweiz. Der Patient (112 kg, 191 cm, Blutgruppe A) entwickelte ein mit medizinischen Therapiemassnahmen nicht mehr behandelbares terminales Herzversagen (New York Heart Association Class (NYHA) IV), während er auf eine orthothope Herztransplantation wartete. Als selbstständiger Graphikdesigner befürchtete der Patient Langzeit-Hospitalisation gefolgt vom Konkurs seines Unternehmens. Aus diesen Gründen entschieden wir uns für eine Implantation eines Novacor LVAD und führten diesen Eingriff bei erneuter, nicht reversibler Dekompensation als Überbrückung bis zur Herztransplantation mit optional (bei günstigem Verlauf) ambulanter Betreuung durch. Der Patient wurde mehr als fünf Monate durch das System unterstützt. Er verbesserte sich funktionell gemäss NYHA-Klassifikation in Klasse I und wurde fünf Wochen nach Implantation aus der stationären Behandlung entlassen. Er kehrte zurück in sein "normales" Leben und begann wieder zu 100 % zu arbeiten. Das LVAD ermöglichte es ihm, nahezu alle Aktivitäten durchzuführen. Fünf Monate (151 Tage) nach Implantation erhielten wir ein passendes Organangebot und führten die orthotope Herztransplantation durch. Die Verwendung eines implantierbaren, pulsatilen Linksherzunterstützungssystem und erfolgreiche ambulante Betreuung unseres Patienten erwies sich als sicher, zuverlässig, lebensrettend, Lebensqualität verbessernd und könnte eine wichtige Alternative in puncto ökonomischer Belastung in der Herzinsuffizienztherapie sein.

scholarly journals Levels of Trimethylamine N-Oxide Remain Elevated Long Term After Left Ventricular Assist Device and Heart Transplantation and Are Independent From Measures of Inflammation and Gut Dysbiosis

2021 ◽  
Vol 14 (6) ◽  
Author(s):  
Melana Yuzefpolskaya ◽  
Bruno Bohn ◽  
Azka Javaid ◽  
Giulio M. Mondellini ◽  
Lorenzo Braghieri ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
New York ◽  
Heart Association ◽  
Left Ventricular ◽  
York Heart Association Class ◽  
Ventricular Assist ◽  
Gut Dysbiosis ◽  
Association Class ◽  
New York Heart Association

Background: Trimethylamine N-oxide (TMAO)—a gut-derived metabolite—is elevated in heart failure (HF) and linked to poor prognosis. We investigated variations in TMAO in HF, left ventricular assist device (LVAD), and heart transplant (HT) and assessed its relation with inflammation, endotoxemia, oxidative stress, and gut dysbiosis. Methods: We enrolled 341 patients. TMAO, CRP (C-reactive protein), IL (interleukin)-6, TNF-α (tumor necrosis factor alpha), ET-1 (endothelin-1), adiponectin, lipopolysaccharide, soluble CD14, and isoprostane were measured in 611 blood samples in HF (New York Heart Association class I–IV) and at multiple time points post-LVAD and post-HT. Gut microbiota were assessed via 16S rRNA sequencing among 327 stool samples. Multivariable regression models were used to assess the relationship between TMAO and (1) New York Heart Association class; (2) pre- versus post-LVAD or post-HT; (3) biomarkers of inflammation, endotoxemia, oxidative stress, and microbial diversity. Results: ln-TMAO was lower among HF New York Heart Association class I (1.23 [95% CI, 0.52–1.94] µM) versus either class II, III, or IV (1.99 [95% CI, 1.68–2.30], 1.97 [95% CI, 1.71–2.24], and 2.09 [95% CI, 1.83–2.34] µM, respectively; all P <0.05). In comparison to class II–IV, ln-TMAO was lower 1 month post-LVAD (1.58 [95% CI, 1.32–1.83] µM) and 1 week and 1 month post-HT (0.97 [95% CI, 0.60–1.35] and 1.36 [95% CI, 1.01–1.70] µM). ln-TMAO levels in long-term LVAD (>6 months: 1.99 [95% CI, 1.76–2.22] µM) and HT (>6 months: 1.86 [95% CI, 1.66–2.05] µM) were not different from symptomatic HF. After multivariable adjustments, TMAO was not associated with biomarkers of inflammation, endotoxemia, oxidative stress, or microbial diversity. Conclusions: TMAO levels are increased in symptomatic HF patients and remain elevated long term after LVAD and HT. TMAO levels were independent from measures of inflammation, endotoxemia, oxidative stress, and gut dysbiosis.

scholarly journals Impact of Left Ventricular Function and Heart Failure Symptoms on Outcomes Post Ablation of Atrial Fibrillation in Heart Failure

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Christian Sohns ◽  
Konstantin Zintl ◽  
Yan Zhao ◽  
Lilas Dagher ◽  
Dietrich Andresen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Ventricular Dysfunction ◽  
Heart Association ◽  
Left Ventricular ◽  
Pharmacological Therapy ◽  
York Heart Association Class ◽  
Association Class ◽  
New York Heart Association

Background: Recent data demonstrate promising effects on left ventricular dysfunction and left ventricular ejection fraction (LVEF) improvement following ablation for atrial fibrillation (AF) in patients with heart failure. We sought to study the relationship between LVEF, New York Heart Association class on presentation, and the end points of mortality and heart failure admissions in the CASTLE-AF study (Catheter Ablation for Atrial Fibrillation With Heart Failure) population. Furthermore, predictors for LVEF improvement were examined. Methods: The CASTLE-AF patients with coexisting heart failure and AF (n=363) were randomized in a multicenter prospective controlled fashion to ablation (n=179) versus pharmacological therapy (n=184). Left ventricular function and New York Heart Association class were assessed at baseline (after randomization) and at each follow-up visit. Results: In the ablation arm, a significantly higher number of patients experienced an improvement in their LVEF to >35% at the end of the study (odds ratio, 2.17; P <0.001). Compared with the pharmacological therapy arm, both ablation patient groups with severe (<20%) or moderate/severe (≥20% and <35%) baseline LVEF had a significantly lower number of composite end points (hazard ratio [HR], 0.60; P =0.006), all-cause mortality (HR, 0.54; P =0.019), and cardiovascular hospitalizations (HR, 0.66; P =0.017). In the ablation group, New York Heart Association I/II patients at the time of treatment had the strongest improvement in clinical outcomes (primary end point: HR, 0.43; P <0.001; mortality: HR, 0.30; P =0.001). Conclusions: Compared with pharmacological treatment, AF ablation was associated with a significant improvement in LVEF, independent from the severity of left ventricular dysfunction. AF ablation should be performed at early stages of the patient’s heart failure symptoms.

scholarly journals The Use of a Novel Heart Failure Agent in the Treatment of Pregnancy-Associated Cardiomyopathy

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Vamsi C. Gaddipati ◽  
Aarti A. Patel ◽  
Adam J. Cohen
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Association ◽  
Standard Of Care ◽  
Left Ventricular ◽  
The Novel ◽  
Current Standard ◽  
Association Class ◽  
New York Heart Association ◽  
Caucasian Female

Peripartum cardiomyopathy is an uncommon, pregnancy-related form of dilated cardiomyopathy that is associated with development of new-onset left ventricular dysfunction. Its etiology is presently unknown, but current standard of care involves the use of typical drug therapy for the treatment of heart failure. Pregnancy-associated cardiomyopathy (PACM) is a similar condition that refers to patients who develop such symptoms prior to the last month of pregnancy. We report the case of a nulliparous Caucasian female who develops early, severe PACM during her first pregnancy with postpartum persistence of New York Heart Association class II-III symptoms despite medical therapy. The use of the novel heart failure agent, sacubitril/valsartan (Entresto), is initiated with near-complete resolution of her symptoms.

Cardiac recovery following left ventricular assist device therapy: experience of complete device explantation including ventricular patch plasty

2020 ◽  
Author(s):  
Takayuki Gyoten ◽  
Sebastian V Rojas ◽  
Henrik Fox ◽  
Masatoshi Hata ◽  
Marcus-André Deutsch ◽  
...  
Keyword(s):  
New York ◽  
Ventricular Assist Device ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Myocardial Recovery ◽  
Assist Device ◽  
Ventricular Assist ◽  
New York Heart Association ◽  
Patch Plasty

Abstract   OBJECTIVES Myocardial recovery is a rare phenomenon in left ventricular assist device (LVAD) therapy. Surgical LVAD removal is associated with the risk of cardiac failure, and the individual evaluation of sufficient myocardial recovery is crucial. Thus, complete device explantation is not consistently performed to minimize perioperative risk. However, the remaining ventricular assist device components bear significant risks of infection or thrombosis. Therefore, we developed this study to evaluate a complete LVAD explantation protocol. METHODS All patients in our institution who had an LVAD explanted were enrolled in the study. Explant surgery involved removal of the driveline, pump housing, sewing ring and outflow graft. The ventricular wall was reconstructed by double patch plasty. Our analysis focused on surgical and postoperative outcome parameters, including all-cause mortality and major adverse cardiac and cerebrovascular events. RESULTS A total of 12 patients (HVAD, n = 5; HeartMate II, n = 3; HeartMate 3, n = 4) had myocardial recovery and qualified for our LVAD explantation study protocol [median age: 40 years, interquartile range (IQR) 33–52 years; 50% men]. Primary heart failure aetiology: myocarditis (n = 5), dilated cardiomyopathy (n = 4), toxic cardiomyopathy (n = 2) and valvular heart failure (n = 1). The median average duration on LVAD was 10 months (25–75%: IQR 8.5–30 months). The median left ventricular ejection fraction was 15% (IQR 13–18%) at LVAD implantation and 50% (IQR 45–50%) before LVAD explantation (P = 0.0025).The 30-day survival was 100%. The 1-year survival was 91.7%. All patients were discharged after a median 13 days (IQR 10–18 days) postoperatively. No patient had major adverse cardiac and cerebrovascular events. The New York Heart Association functional class remained consistent during the follow-up period (median New York Heart Association functional class: II, IQR II–II class) including preservation of ventricular function. CONCLUSIONS Complete LVAD explantation with ventricular patch plasty is feasible and has consistent long-term results.

Clinical significance of the relative apical sparing pattern of longitudinal strain in patients with cardiac amyloidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Saito ◽  
Y Nakao ◽  
R Higaki ◽  
Y Kawachi ◽  
Y Yokomoto ◽  
...  
Keyword(s):  
New York ◽  
Clinical Significance ◽  
Wall Thickness ◽  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
Heart Association ◽  
Left Ventricular ◽  
Association Class ◽  
New York Heart Association ◽  
Prognostic Prediction

Abstract Background The relative apical sparing pattern (RASP) of left ventricular (LV) longitudinal strain (LS) is frequently associated with cardiac amyloidosis (CA). However, some patients with CA do not show the RASP, and their clinical characteristics have not been fully clarified. We sought to investigate the clinical significance of RASP in patients with CA. Methods One hundred consecutive CA patients who were diagnosed by biopsy or myocardial pyrophosphate scintigraphy and evaluated for RASP (mean age: 76 years, male: 77%, LV mean wall thickness: 13.5 mm, light-chain [AL] type: 33 cases, transthyretin [TTR] type: 67 cases) were retrospectively enrolled. The RASP was semi-quantitatively and quantitatively assessed. Semi-quantitative RASP was defined as reduction of LS (≥−10%) in ≥5 (of 6) basal segments relative to preserved LS (&lt;−15%) in ≥1 apical segment. Quantitative RASP was calculated according to the following formula: Quantitative RASP = [Average apical LS] / [Average basal LS + Average mid LS]. We adapted three validated thresholds (&gt;1.00, &gt;0.90, and &gt;0.87) according to the literature. Results Semi-quantitative and binalized quantitative RASP (&gt;1.00, &gt;0.90, and &gt;0.87) were observed in 55, 55, 63, and 65 patients, respectively. RASP in each definition was more prevalent in the TTR group than in the AL group. Additionally, RASP was significantly associated with higher LV wall thickness even after adjustment for the CA subtypes (all, p&lt;0.05, Figure). After the RASP assessment, 35 all-cause deaths and 26 cardiac deaths were observed during the follow-up period (median, 1.1 years). Although these events were significantly associated with poor nutrition, lower blood pressure, higher New York Heart Association class, and the AL group, no association was found with RASP and LV wall thickness. Conclusions The incidence of RASP is low in the case of thin LV wall thickness in CA patients, which may indicate the difficulty of early diagnosis of CA using RASP in patients with mild LV hypertrophy. The prognostic prediction using RASP may be challenging in this cohort. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Minimally Invasive versus Full-Sternotomy Septal Myectomy for Hypertrophic Cardiomyopathy

2018 ◽  
Vol 13 (4) ◽  
pp. 261-266
Author(s):  
Farah N. Musharbash ◽  
Matthew R. Schill ◽  
Vivek H. Hansalia ◽  
Richard B. Schuessler ◽  
Jeremy E. Leidenfrost ◽  
...  
Keyword(s):  
New York ◽  
Minimally Invasive ◽  
Heart Association ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
York Heart Association Class ◽  
Septal Myectomy ◽  
Association Class ◽  
New York Heart Association

Objective Septal myectomy remains the criterion standard for the treatment of patients with hypertrophic obstructive cardiomyopathy refractory to medical therapy. There have been few reports of minimally invasive approaches. This study compared a minimally invasive septal myectomy performed at our institution with the traditional full-sternotomy approach. Methods Patients receiving a stand-alone septal myectomy were retrospectively reviewed from November 1999 to December 2016 (N = 120). Patients were stratified by surgical approach: traditional full sternotomy (n = 34) and ministernotomy (n = 86). Preoperative and perioperative variables were compared as well as follow-up symptomatic and echocardiographic outcomes. Results Both groups had a significant decrease in New York Heart Association class heart failure symptoms ( P < 0.001). At a mean ± SD follow-up time of 2.0 ± 3.4 years, postoperative New York Heart Association class distribution was similar between ministernotomy and full sternotomy ( P = 0.684). Follow-up resting left ventricular outflow tract gradient was also similar between ministernotomy and full sternotomy (11 mm Hg ± 15 vs 9 mm Hg ± 13, P = 0.381). Perioperatively, ministernotomy was not significantly different from full sternotomy in median cardiopulmonary bypass time (81 minutes vs 78 minutes, P = 0.101) but had a slightly longer median cross-clamp time (39 minutes vs 35 minutes, P = 0.017). Major complications were similar in the two groups. There was one 30-day mortality in the full-sternotomy group, but no in-hospital deaths. Conclusions Septal myectomy performed using a minimally invasive approach has similar outcomes to the criterion standard operation done through a full sternotomy. It represents a feasible option for patients with hypertrophic obstructive cardiomyopathy unresponsive to medications.

scholarly journals Clinical Outcomes of Autologous Stem Cell–Patch Implantation for Patients With Heart Failure With Nonischemic Dilated Cardiomyopathy

2021 ◽  
Author(s):  
Keitaro Domae ◽  
Shigeru Miyagawa ◽  
Yasushi Yoshikawa ◽  
Satsuki Fukushima ◽  
Hiroki Hata ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Dilated Cardiomyopathy ◽  
Heart Association ◽  
Left Ventricular ◽  
Pulmonary Capillary ◽  
Association Class ◽  
New York Heart Association ◽  
Nonischemic Dilated Cardiomyopathy ◽  
Wedge Pressure

Background Clinical effectiveness of autologous skeletal cell‐patch implantation for nonischemic dilated cardiomyopathy has not been clearly elucidated in clinical settings. This clinical study aimed to determine the feasibility, safety, therapeutic efficacy, and the predictor of responders of this treatment in patients with nonischemic dilated cardiomyopathy. Methods and Results Twenty‐four nonischemic dilated cardiomyopathy patients with left ventricular ejection fraction <35% on optimal medical therapy were enrolled. Autologous cell patches were implanted over the surface of the left ventricle through left minithoracotomy without procedure‐related complications and lethal arrhythmia. We identified 13 responders and 11 nonresponders using the combined indicator of a major cardiac adverse event and incidence of heart failure event. In the responders, symptoms, exercise capacity, and cardiac performance were improved postoperatively (New York Heart Association class II 7 [54%] and III 6 [46%] to New York Heart Association class II 12 [92%] and I 1 [8%], P <0.05, 6‐minute walk test; 471 m [370–541 m] to 525 m [425–555 m], P <0.05, left ventricular stroke work index; 31.1 g·m 2 ·beat [22.7–35.5 g·m 2 ·beat] to 32.8 g·m 2 ·beat [28–38.5 g·m 2 ·beat], P =0.21). However, such improvement was not observed in the nonresponders. In responders, the actuarial survival rate was 90.9±8.7% at 5 years, which was superior to the estimated survival rate of 70.9±5.4% using the Seattle Heart Failure Model. However, they were similar in nonresponders (47.7±21.6% and 56.3±8.1%, respectively). Multivariate regression model with B‐type natriuretic peptide, pulmonary capillary wedge pressure, and expression of histone H3K4me3 (H3 lysine 4 trimethylation) strongly predicted the responder of this treatment (B‐type natriuretic peptide: odds ratio [OR], 0.96; pulmonary capillary wedge pressure: ​OR, 0.58; H3K4me3: OR, 1.35, receiver operating characteristic–area under the curve, 0.96, P <0.001). Conclusions This clinical trial demonstrated that autologous skeletal stem cell–patch implantation might promise functional recovery and good clinical outcome in selected patients with nonischemic dilated cardiomyopathy, in addition to safety and feasibility. Registration URL: http://www.umin.ac.jp/english/ . Unique identifiers: UMIN000003273, UMIN0000012906 and UMIN000015892.

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