Preoperative Strategies for Optimizing Mechanical Circulatory Support

2019 ◽  
pp. 41-46
Author(s):  
Evan C. Klein ◽  
Mitchell T. Saltzberg
Keyword(s):  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Preoperative Treatment ◽  
Risk Models ◽  
Organ Systems ◽  
The Status ◽  
Ventricular Support ◽  
And Function ◽  
Postsurgical Outcomes

Several validated risk models can help determine whether patients with advanced heart failure should be considered for mechanical circulatory support based on its potential survival advantage. Once a patient is a candidate for device therapy, an understanding of these risk models can help inform decisions about modifying risk factors to provide the best postsurgical outcomes. Specific preoperative factors that can be addressed include the adequacy of perfusion, volume status, and the status of non-cardiac organ systems (e.g., the pulmonary, infectious, hematologic, renal systems). Additionally, an understanding of preoperative right ventricular hemodynamics and function can help alert providers to patients with an increased need for postoperative right-ventricular support. The chapter reviews several risk-stratification models, as well as the approach used by the authors’ institution to optimize the preoperative treatment of patients before implementing mechanical circulatory support.

scholarly journals Long-Term Continuous-Flow Biventricular Support in a 63-Year-Old Woman

2018 ◽  
Vol 45 (2) ◽  
pp. 110-112
Author(s):  
Andrew C.W. Baldwin ◽  
William E. Cohn ◽  
Jeffrey A. Morgan ◽  
O.H. Frazier
Keyword(s):  
Continuous Flow ◽  
Older Patients ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Orthotopic Heart Transplantation ◽  
Nonischemic Cardiomyopathy ◽  
Bridge To Transplantation ◽  
Similar Patient ◽  
Ventricular Support

We describe the successful use of long-term biventricular continuous-flow mechanical circulatory support as a bridge to transplantation in a small-framed 63-year-old woman with long-standing nonischemic cardiomyopathy. After placement of a left-sided HeartWare HVAD, persistent right-sided heart failure necessitated implantation of a second HeartWare device for long-term right ventricular support. After 262 days, the patient underwent successful orthotopic heart transplantation and was discharged from the hospital. This report indicates the feasibility of biventricular device support in older patients of relatively small stature, and our results may encourage others to consider this therapy in similar patient populations.

scholarly journals Mechanical shear stress and leukocyte phenotype and function: Implications for ventricular assist device development and use

2018 ◽  
Vol 42 (3) ◽  
pp. 133-142 ◽  
Author(s):  
Gemma Radley ◽  
Sabrina Ali ◽  
Ina Laura Pieper ◽  
Catherine A Thornton
Keyword(s):  
Heart Failure ◽  
Shear Stress ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Modern World ◽  
Mechanical Trauma ◽  
Ventricular Assist ◽  
End Stage ◽  
And Function ◽  
The Impact

Heart failure remains a disease of ever increasing prevalence in the modern world. Patients with end-stage heart failure are being referred increasingly for mechanical circulatory support. Mechanical circulatory support can assist patients who are ineligible for transplant and stabilise eligible patients prior to transplantation. It is also used during cardiopulmonary bypass surgery to maintain circulation while operating on the heart. While mechanical circulatory support can stabilise heart failure and improve quality of life, complications such as infection and thrombosis remain a common risk. Leukocytes can contribute to both of these complications. Contact with foreign surfaces and the introduction of artificial mechanical shear stress can lead to the activation of leukocytes, reduced functionality and the release of pro-inflammatory and pro-thrombogenic microparticles. Assessing the impact of mechanical trauma to leukocytes is largely overlooked in comparison to red blood cells and platelets. This review provides an overview of the available literature on the effects of mechanical circulatory support systems on leukocyte phenotype and function. One purpose of this review is to emphasise the importance of studying mechanical trauma to leukocytes to better understand the occurrence of adverse events during mechanical circulatory support.

scholarly journals Using aortic arch short axis views during transesophageal echocardiographic examination facilitates right ventricular assist device imaging

2021 ◽  
Author(s):  
Alyssa Tutunjian ◽  
Jamel Ortoleva ◽  
Yong Zhan ◽  
Frederick Chen ◽  
Gregory Couper ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Aortic Arch ◽  
Mechanical Circulatory Support ◽  
Subsequent Development ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Short Axis ◽  
Ventricular Assist ◽  
Echocardiographic Examination ◽  
Right Ventricular Assist Device

Given the increased need for mechanical circulatory support and subsequent development of right ventricular assist devices (RVAD), appropriate imaging needs to be described to facilitate care in patients with cardiogenic shock and heart failure. We present three cases in which the upper esophageal aortic arch short axis (UE AA SAX) view on transesophageal echocardiography (TEE) was utilized to effectively image RVADs: to confirm normal positioning, to detect and guide repositioning, and to visualize malfunction. These cases support the importance of the UE AA SAX TEE view in RVAD outflow imaging and, when obtainable, should be included in routine RVAD assessment.

Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report

2020 ◽  
Vol 15 (2) ◽  
pp. 173-176 ◽  
Author(s):  
Alexander M. Schurman ◽  
Michael T. Cain ◽  
David L. Joyce ◽  
Lucian A. Durham ◽  
David Ishizawar ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Pulseless Electrical Activity ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Spontaneous Circulation ◽  
Circulatory Support ◽  
Salvage Procedure ◽  
Pulmonary Thromboendarterectomy ◽  
Successful Recovery

A 64-year-old man being evaluated for pulmonary thromboendarterectomy (PTE) preoperatively experienced pulseless electrical activity secondary to right ventricular failure while undergoing bronchoscopy. After return of spontaneous circulation, a percutaneous right ventricular assist device (RVAD) was placed through the right internal jugular vein. He continued on right ventricular support with demonstration of right ventricular recovery over the following 8 days, and subsequently underwent PTE for treatment of his primary condition. He recovered and was weaned from his RVAD support uneventfully. The need for RVAD support has traditionally been a contraindication for PTE; however, circulatory assist devices have been used as a salvage procedure for right-heart failure after PTE. This case highlights the potential for percutaneous mechanical circulatory support in treating severe perioperative right ventricular dysfunction, and to facilitate successful recovery in patients undergoing PTE.

scholarly journals Catheter‐based embolectomy prior to right ventricular mechanical circulatory support placement after heart transplantation

2020 ◽  
Vol 7 (5) ◽  
pp. 3215-3218
Author(s):  
Vikrant S. Jagadeesan ◽  
Laura J. Davidson ◽  
Andrei Churyla ◽  
Keith H. Benzuly
Keyword(s):  
Heart Transplantation ◽  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Circulatory Support
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