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.

Thermo Cardiosystems Left Ventricular Assist Device as a Bridge to Cardiac Transplant

1991 ◽  
Vol 2 (3) ◽  
pp. 545-551
Author(s):  
Nancy L. Abou-Awdi
Keyword(s):  
New York ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Heart Association ◽  
Left Ventricular ◽  
Cardiac Transplant ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
End Stage

In 1986, clinical trials were initiated with a left ventricular assist device capable of supporting individuals in end-stage heart disease for extended periods of time (longer than 14 days). While supported by this device, patients were hemodynamically stabilized for future transplant and were afforded an opportunity to improve their overall health status. At initiation of support these patients were in New York Heart Association class IV, and within approximately 2 weeks, improved to class I. Their nutritional status improved, they were able to exercise regularly, and they became the “healthiest” candidates for cardiac transplant. Nursing care of a patient requiring the HeartMate provides the critical care nurse with new challenges

An Early Canadian Experience with the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass

2016 ◽  
Vol 11 (6) ◽  
pp. 434-438
Author(s):  
Hussein A. Al-Amodi ◽  
Christopher L. Tarola ◽  
Hamad F. Alhabib ◽  
Corey Adams ◽  
Linrui Ray Guo ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
New York Heart Association ◽  
Apical Connector ◽  
Aortic Valve Bypass

Objective Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or preexisting comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. Methods At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. Results In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. Conclusions Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical repro-ducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.

Real-Time Three-Dimensional Echocardiographic Study of Left Ventricular Function After Infarct Exclusion Surgery for Ischemic Cardiomyopathy

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Jian Xin Qin ◽  
Takahiro Shiota ◽  
Patrick M. McCarthy ◽  
Michael S. Firstenberg ◽  
Neil L. Greenberg ◽  
...  
Keyword(s):  
New York ◽  
Ischemic Cardiomyopathy ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Before And After ◽  
Infarct Exclusion ◽  
New York Heart Association ◽  
Lv Volume

Background —Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes. Methods and Results —Thirty patients who underwent IE (mean age 61±8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42±67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99±40, 67±26, and 71±31 mL/m 2 , respectively; ESVI 72±37, 40±21, and 42±22 mL/m 2 , respectively; P <0.05). LV ejection fraction increased significantly and remained higher (0.29±0.11, 0.43±0.13, and 0.42±0.09, respectively, P <0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22±12, 53±24, and 58±21 mL, respectively, P <0.005). New York Heart Association functional class at an average 285±144 days of clinical follow-up significantly improved from 3.0±0.8 to 1.8±0.8 ( P <0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman’s ρ=0.58 and 0.60, respectively). Conclusions —RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.

Sign in / Sign up

Export Citation Format

Share Document