scholarly journals 183. Management of Left Ventricular Assist Device Infections at a Large Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Bliss Green ◽  
Danya Roshdy ◽  
Jane Revollo ◽  
Kiran Gajurel ◽  
Nicole CyrilleSuperville ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Medical Center ◽  
Academic Medical Center ◽  
Left Ventricular ◽  
Suppressive Therapy ◽  
Assist Device ◽  
Ventricular Assist ◽  
Academic Medical ◽  
Left Ventricular Assist

Abstract Background Left ventricular assist device infections (LVADIs) contribute significantly to morbidity and mortality. The lack of evidenced-based treatment recommendations results in substantial variability in clinical practice. The purpose of this study was to evaluate the management of LVADIs at our institution to better assess practice patterns and standardize treatment decisions. Methods This was a retrospective study including adults diagnosed with an initial LVADI from January 1, 2013 to July 1, 2019. Exclusion criteria included concomitant non-LVADI, patients with other mechanical circulatory systems, or pregnancy. Pertinent patient, LVAD, infection, management, and clinical outcome data was collected and described with descriptive statistics. Results A total of 49 patients were included, 37 of which had at least one recurrence, resulting in 57 recurrent and 106 total LVADIs. The majority of LVADIs were driveline infections (DLIs) (92%). There was an increase in the incidence of deep DLIs (35% vs. 10%) and bloodstream infections (26% vs. 4%) amongst recurrent vs. initial LVADIs. Staphylococcus aureus (51%) and nosocomial gram-negatives (20%) were the most common causative pathogens. Surgical interventions were common (55%). LVADIs treated predominately with oral antibiotics (54%) or IV antibiotics (46%) received a median duration of therapy of 31 and 35 days, respectively. Antibiotic regimens included anti-methicillin-resistant S.aureus coverage and anti-pseudomonal coverage in 49% and 22% of total cases, respectively. Suppressive antibiotics were commonly prescribed (54%). LVADI-related readmission (69%) and recurrence (76%) within one year of initial LVADI was frequent. Recurrent LVADI occurred regardless of receiving suppressive therapy in 60% of total recurrent cases. Conclusion This study offers unique insight into initial vs. recurrent LVADIs as well as infection characteristics and clinical outcomes at a large academic medical center. Future studies with additional focus on risk factors for recurrence would be beneficial for drawing conclusions on the efficacy of current practices and shaping future treatment guidelines. Disclosures All Authors: No reported disclosures

Abstract 15865: Analysis of Left Ventricular Assist Device Hemodynamics During Right Heart Catheterization Ramp Studies

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexander G Hajduczok ◽  
Katharine Julian ◽  
Carly Maucione ◽  
John P Boehmer
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Heart Function ◽  
Medical Center ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Right Heart ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background: Although hemodynamic-driven Left Ventricular Assist Device (LVAD) speed changes have been shown to improve patient outcomes, there is no standardized algorithm for how to best adjust LVAD speed for optimization of cardiac output (CO) and decompression of left sided filling pressures as measured by pulmonary capillary wedge (PCW). Methods: We performed a retrospective study of LVAD patients at Penn State Hershey Medical Center from 2015 to present, to identify those that ramp studies during right heart catheterizations. 470 patients were identified, of which 60 had ramp studies. Only studies with at least 4 of 5 standard ramp speeds were included. Any study that did not exhibit at least a 20% decrease in PCW, suggesting improper LVAD function or recovered heart function, was also excluded. 32 studies were included in final analysis: 11 HVAD, 12 HMIII, and 9 HMII. CO measured by thermodilution was reported. Standard ramp speeds, in rpm, were as follows: HVAD (2100, 2400, 2700, 3000, 3300), HMIII (4500, 5000, 5500, 6000, 6500), and HMII (8000, 9000, 10,000, 11,000, 12,000). Results: Combined data showed an average CO improvement of 22.3% and average PCW decrease of 89.7%. HMII and HMIII had similar improvements in CO, 44.4% and 43.8%, respectively; much greater than HVAD (17.2%). HMIII had the largest magnitude of decompression 141.5% versus 106.4% for HMII and 56.1% for HVAD. Suction events occurred at an overall rate of 9.4%, and were greatest in HVADs. Conclusion: We report the ramp study hemodynamics for three separate LVADs. Overall, our results suggest the HMIII is most responsive to changes in speed in terms of improvement of CO and decreased PCW. Addition of samples to this analysis may allow for algorithm development to provide clinical guidance regarding LVAD speed settings.

scholarly journals Two-Case Series of Heart Transplant at a Single Center in a SARS-CoV-2 Epicenter

2021 ◽  
Author(s):  
Marlena Sabatino ◽  
Cassandra Soto ◽  
Krish Dewan ◽  
Joshua Chao ◽  
Hirohisa Ikegami ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Academic Medical Center ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Post Transplant ◽  
Definitive Therapy ◽  
Left Ventricular Assist

As SARS-CoV-2 continues to challenge hospital systems, the safety of heart transplantation must be evaluated. Retrospective review of all heart recipients transplanted at a single academic medical center in a U.S. SARS-CoV-2 epicenter found two patients with non-ischemic dilated cardiomyopathy. The 34-year-old male (ejection fraction <10%) was bridged to transplant with extracorporeal membrane oxygenation and microaxial left ventricular assist device. His perioperative course was uncomplicated except for transient SARS-CoV-2 seropositivity two months post-transplant. He was asymptomatic and remained so eight months to follow. The 20-year-old female (ejection fraction 5%) was bridged to transplant with microaxial left ventricular assist device. She progresses well with SARS-CoV-2 seronegativity eight months post-transplant. Our early experience suggests that intentional recipient, donor, and provider testing, cautious organ procurement, strategic intrahospital patient organization and transport, and well-coordinated follow-up permits uninterrupted provision of this definitive therapy for heart failure without subjecting these patients to greater risk.

scholarly journals Predictors of All Cause Post Operative Bleeding in Patients with Left Ventricular Assist Device

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-33
Author(s):  
Natalie Elkayam ◽  
Nana Gegechkori ◽  
Aryeh Bernstein ◽  
Jay Lipshitz
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Medical Center ◽  
Left Ventricular ◽  
Adult Patients ◽  
Assist Device ◽  
Ventricular Assist ◽  
Post Surgery ◽  
Left Ventricular Assist ◽  
Gi Bleed

Background:Patients with implanted left ventricular assist device (LVAD) have been shown in multiple studies to have significantly increased bleeding rates, and yet independent risk factors for such complications remain poorly characterized. Objective:This study sought to assess factors associated with increased bleeding risks after LVAD implantation. Methods: The case-control study was represented by a retrospective electronic medical chart review for all adult patients above age 18, who had the LVAD implanted at Maimonides Medical Center from 2013-2018. The study comprised of a follow up period of 24 months after the LVAD implantation. 84 adult patients with implanted LVADs at Maimonides Medical Center were included in the study. The predictors among patients with any late postoperative bleeding (&gt;7 days post-surgery) within the study period were compared to those without any events of interest. The outcome measure was a composite variable reflecting any bleeding event, such as upper and lower gastrointestinal (GI) bleed, intracranial hemorrhage or hemorrhage in any other organ. Patients were considered to have GI bleed if they had one or more of the following symptoms: guaiac-positive stool with hemoglobin drop &gt;2g/dL, hematemesis, melena, active bleeding or blood within the GI tract at the time of endoscopy or colonoscopy. Intracranial or other organ bleeding was defined as appropriate clinical presentation and findings on imaging with hemoglobin levels reduced by more than or equal to 2 g/dl with no alternative explanation for anemia. Logistic regression was used to create a multivariable model to identify predictors associated with an increased risk of all cause bleeding within 24 months after LVAD implantation. Results: The study population consisted of 43 cases and 41 controls. Baseline characteristics were similar in both groups. A total of 43 (51%) patients had at least 1 episode of any type of bleed within study period. Multivariable analyses showed that blood urea nitrogen (BUN) &gt;20 before LVAD implantation and Creatinine &gt;1.2 at the time of bleeding were significantly associated with all cause bleeding risk within 24 months after surgery with odds ratio (OR): 4.46, 95% confidence interval (CI): 1.78 to 11.15 and OR 3.55, 95% CI 1.13 to 11.15 respectively. Conclusions: Perioperative BUN &gt;20 (p=0.001) and postoperative Creatinine &gt;1.2 (p=0.03) are associated with higher incidence of all cause bleeding within 24 months after surgery among patients with LVAD. Future studies should evaluate whether there are other factors accurately predicting bleeding events in order to improve outcomes. Disclosures No relevant conflicts of interest to declare.

scholarly journals Left Ventricular Assist Device Infections and the Potential Role for Dalbavancin: A Case Report

2019 ◽  
Vol 6 (9) ◽  
Author(s):  
Jessica Howard-Anderson ◽  
Stephanie M Pouch ◽  
Mary Elizabeth Sexton ◽  
Aneesh K Mehta ◽  
Andrew L Smith ◽  
...  
Keyword(s):  
Case Report ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Potential Role ◽  
Left Ventricular ◽  
Suppressive Therapy ◽  
Assist Device ◽  
Ventricular Assist ◽  
Intravenous Antibiotics ◽  
Left Ventricular Assist

Abstract Left ventricular assist device infections (LVADIs) are common but challenging to treat, often requiring prolonged courses of intravenous antibiotics. Dalbavancin could have a role in treating patients with chronic LVADIs given its less frequent dosing requirements. Here, we illustrate a case in which dalbavancin was used as suppressive therapy for an LVADI for greater than 7 months.

Ultrastructural observations of the aorta of calves implanted with a mechanical left ventricular assist device

1990 ◽  
Vol 48 (3) ◽  
pp. 834-835
Author(s):  
J P Cassella ◽  
V Salih ◽  
T R Graham
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Aortic Tissue ◽  
Assist Device ◽  
Ventricular Assist ◽  
Transmission Electron ◽  
Left Ventricular Assist ◽  
Preliminary Study

Left ventricular assist systems are being developed for eventual long term or permanent implantation as an alternative to heart transplantation in patients unsuitable for or denied the transplant option. Evaluation of the effects of these devices upon normal physiology is required. A preliminary study was conducted to evaluate the morphology of aortic tissue from calves implanted with a pneumatic Left Ventricular Assist device-LVAD. Two 3 month old heifer calves (calf 1 and calf 2) were electively explanted after 128 days and 47 days respectively. Descending thoracic aortic tissue from both animals was removed immediately post mortem and placed into karnovsky’s fixative. The tissue was subsequently processed for transmission electron microscopy (TEM). Some aortic tissue was fixed in neutral buffered formalin and processed for routine light microscopy.

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