Midterm follow-up of patients who underwent removal of a left ventricular assist device after cardiac recovery from end-stage dilated cardiomyopathy

Objectives: The main aim was a systematic evaluation of the current evidence on outcomes for patients undergoing right ventricular assist device (RVAD) implantation following left ventricular assist device (LVAD) implantation. Methods: This systematic review was registered on PROSPERO (CRD42019130131). Reports evaluating in-hospital as well as follow-up outcome in LVAD and LVAD/RVAD implantation were identified through Ovid Medline, Web of Science and EMBASE. The primary endpoint was mortality at the hospital stay and at follow-up. Pooled incidence of defined endpoints was calculated by using random effects models. Results: A total of 35 retrospective studies that included 3260 patients were analyzed. 30 days mortality was in favour of isolated LVAD implantation 6.74% (1.98–11.5%) versus 31.9% (19.78–44.02%) p = 0.001 in LVAD with temporary need for RVAD. During the hospital stay the incidence of major bleeding was 18.7% (18.2–19.4%) versus 40.0% (36.3–48.8%) and stroke rate was 5.6% (5.4–5.8%) versus 20.9% (16.8–28.3%) and was in favour of isolated LVAD implantation. Mortality reported at short-term as well at long-term was 19.66% (CI 15.73–23.59%) and 33.90% (CI 8.84–59.96%) in LVAD respectively versus 45.35% (CI 35.31–55.4%) p ⩽ 0.001 and 48.23% (CI 16.01–80.45%) p = 0.686 in LVAD/RVAD group respectively. Conclusion: Implantation of a temporary RVAD is allied with a worse outcome during the primary hospitalization and at follow-up. Compared to isolated LVAD support, biventricular mechanical circulatory support leads to an elevated mortality and higher incidence of adverse events such as bleeding and stroke.

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Evaluation of myocardial function in patients with end-stage heart failure during support with the Jarvik 2000 left ventricular assist device

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2003.09.044 ◽

2005 ◽

Vol 24 (2) ◽

pp. 226-228 ◽

Cited By ~ 15

Author(s):

Markus Ferrari ◽

Kamuran A. Kadipasaoglu ◽

Mihai Croitoru ◽

Jeff Conger ◽

Tim Myers ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Myocardial Function ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Left Ventricular Assist ◽

End Stage Heart Failure ◽

End Stage

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SHARED CARE: A NOVEL APPROACH TO LEFT VENTRICULAR ASSIST DEVICE (LVAD) IMPLANT FOLLOW UP

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31401-7 ◽

2020 ◽

Vol 75 (11) ◽

pp. 774

Author(s):

Ganesh Gajanan ◽

Kulpreet Barn ◽

Jerome Thomas ◽

Mauricio Garrido ◽

Rohinton Morris ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Shared Care ◽

Assist Device ◽

Ventricular Assist ◽

Novel Approach ◽

Left Ventricular Assist

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127. Novel Treatment Approach for Left Ventricular Assist Device-related Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.202 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S92-S93

Author(s):

Yunus C Yalcin ◽

Nelianne Verkaik ◽

Hannelore I Bax ◽

Peter D Croughs ◽

Ad J J C Bogers ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Hospital Admissions ◽

Severe Heart Failure ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Left Ventricular Assist ◽

Clinical Records

Abstract Background Left ventricular assist device (LVAD) implantation has become an effective treatment option for patients with severe heart failure. However, infections remain a substantial risk. Therefore, the aim of this study was to gain insight in the incidence and outcome of LVAD infections in our center and develop an up-to-date flowchart for the management of LVAD-related infections. Methods A retrospective study was performed which included all patients with an LVAD implanted between 2006 until 2019, along with a rigorous review of the current literature. Clinical records and microbiological laboratory results of all patients were reviewed. In view of local infectious complications, a flowchart was developed for the contemporary management of LVAD-related infections (Figure 1). Results Overall, 106 patients (median age 54 years [IQR 47–60], 78% male) were included, of whom 92 (87%) as bridge-to-transplantation/decision and 14 (13%) as destination therapy. LVAD-related infections occurred in n = 30 (28%) of the patients. The median time until first infection was 308 days [IQR 115–528], and the median duration of hospital stay was 16 days [IQR 4–29]. Eighty percent of LVAD-related infections were driveline-related. The most common causative pathogen was Staphylococcus aureus, which was present in almost half of the cases (40%). Patients who experienced infections were younger (46 [IQR 37–57] vs. 56 [IQR 52–62]; P < 0.001).The survival rate at 3 years was 76% in the infected vs. 94% not infected patients; P = 0.037). A secondary infection occurred in 10 patients (33%). At 3 years of follow-up, 31 patients were successfully transplanted. Six patients with deep S. aureus driveline infections were treated according to the standardized protocol of whom 2 with suppressive therapy by cephalexin, with clinical success so far. Conclusion LVAD infections occur frequently and lead to prolonged periods of hospital admissions and death. The lack of standardized treatment regimens complicates the treatment of LVAD-related infections. A comprehensive flowchart to treat future LVAD-related infections in a protocolized fashion was developed, based on our single-center experience. While the preliminary results look promising, more follow-up time of the treated patients is needed. Disclosures All authors: No reported disclosures.

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