scholarly journals The Risk of Cardiac Device-Related Infection in Bacteremic Patients Is Species Specific: Results of a 12-Year Prospective Cohort

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Stacey A Maskarinec ◽  
Joshua T Thaden ◽  
Derek D Cyr ◽  
Felicia Ruffin ◽  
Maria Souli ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Prospective Cohort ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Cardiac Device ◽  
Gram Negative ◽  
Cardiac Devices ◽  
Increased Risk ◽  
Species Specific

Abstract Background The species-specific risk of cardiac device-related infection (CDRI) among bacteremic patients is incompletely understood. Methods We conducted a prospective cohort study of hospitalized patients from October 2002 to December 2014 with a cardiac device (CD) and either Staphylococcus aureus bacteremia (SAB) or Gram-negative bacteremia (GNB). Cardiac devices were defined as either prosthetic heart valves (PHVs), including valvular support rings, permanent pacemakers (PPMs)/automatic implantable cardioverter defibrillators (AICDs), or left ventricular assist devices (LVADs). Results During the study period, a total of 284 patients with ≥1 CD developed either SAB (n = 152 patients) or GNB (n = 132 patients). Among the 284 patients, 150 (52.8%) had PPMs/AICDs, 72 (25.4%) had PHVs, 4 (1.4%) had LVADs, and 58 (20.4%) had >1 device present. Overall, 54.6% of patients with SAB and 16.7% of patients with GNB met criteria for definite CDRI (P < .0001). Multivariable logistic regression analysis revealed that 3 bacterial species were associated with an increased risk for CDRI: Staphylococcus aureus (odds ratio [OR] = 5.57; 95% confidence interval [CI], 2.16–14.36), Pseudomonas aeruginosa (OR = 50.28; 95% CI, 4.16–606.93), and Serratia marcescens (OR = 7.75; 95% CI, 1.48–40.48). Conclusions Risk of CDRI among patients with bacteremia varies by species. Cardiac device-related infection risk is highest in patients with bacteremia due to S aureus, P aeruginosa, or S marcescens. By contrast, it is lower in patients with bacteremia due to other species of Gram-negative bacilli. Patients with a CD who develop bacteremia due to either P aeruginosa or S marcescens should be considered for diagnostic imaging to evaluate for the presence of CDRI.

scholarly journals Impact of Obesity on Heart Transplantation Outcomes

2021 ◽  
Vol 10 (23) ◽  
Author(s):  
Fouad Chouairi ◽  
Aidan Milner ◽  
Sounok Sen ◽  
Avirup Guha ◽  
James Stewart ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Organ Procurement ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Allocation System ◽  
Increased Risk ◽  
The Impact ◽  
Transplantation Outcomes

Background Patients with obesity and advanced heart failure face unique challenges on the path to heart transplantation. There are limited data on waitlist and transplantation outcomes in this population. We aimed to evaluate the impact of obesity on heart transplantation outcomes, and to investigate the effects of the new organ procurement and transplantation network allocation system in this population. Methods and Results This cohort study of adult patients listed for heart transplant used the United Network for Organ Sharing database from January 2006 to June 2020. Patients were stratified by body mass index (BMI) (18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and 40–55 kg/m 2 ). Recipient characteristics and donor characteristics were analyzed. Outcomes analyzed included transplantation, waitlist death, and posttransplant death. BMI 18.5 to 24.9 kg/m 2 was used as the reference compared with progressive BMI categories. There were 46 645 patients listed for transplantation. Patients in higher BMI categories were less likely to be transplanted. The lowest likelihood of transplantation was in the highest BMI category, 40 to 55 kg/m 2 (hazard ratio [HR], 0.19 [0.05–0.76]; P =0.02). Patients within the 2 highest BMI categories had higher risk of posttransplantation death (HR, 1.29; P <0.001 and HR, 1.65; P <0.001, respectively). Left ventricular assist devices among patients in obese BMI categories decreased after the allocation system change ( P <0.001, all). After the change, patients with obesity were more likely to undergo transplantation (BMI 30–35 kg/m 2 : HR, 1.31 [1.18–1.46], P <0.001; BMI 35–55 kg/m 2 : HR, 1.29 [1.06–1.58]; P =0.01). Conclusions There was an inverse relationship between BMI and likelihood of heart transplantation. Higher BMI was associated with increased risk of posttransplant mortality. Patients with obesity were more likely to undergo transplantation under the revised allocation system.

scholarly journals Thrombogenicity and Antithrombotic Strategies in Structural Heart Interventions and Nonaortic Cardiac Device Therapy—Current Evidence and Practice

2019 ◽  
Vol 119 (10) ◽  
pp. 1590-1605
Author(s):  
Tobias Geisler ◽  
Rezo Jorbenadze ◽  
Aron-Frederik Popov ◽  
Karin L. Mueller ◽  
Dominik Rath ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Current Evidence ◽  
Left Ventricular Assist Devices ◽  
Cardiac Device ◽  
Ventricular Assist ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Mitral Valve Replacement ◽  
Pacemaker Leads

AbstractAs the number of, and the indications for, structural heart interventions are increasing worldwide, the optimal secondary prevention to reduce device thrombosis is becoming more important. To date, most of the recommendations are empiric. The current review discusses mechanisms behind device-related thrombosis, the available evidence with regard to antithrombotic regimen after cardiac device implantation, as well as providing an algorithm for identification of risk factors for device thrombogenicity and for management of device thrombosis after implantation of patent foramen ovale and left atrial appendage occluders, MitraClips/transcatheter mitral valve replacement, pacemaker leads, and left ventricular assist devices. Of note, the topic of antithrombotic therapy and thrombogenicity of prostheses in aortic position (transcatheter aortic valve replacement, surgical, mechanical, and bioprostheses) is not part of the present article and is discussed in detail in other contemporary focused articles.

Defibrillator-Heart Pump: An Implantable Ventricular Assist Device With Integrated Defibrillator Component—The First In Vitro Testing

2019 ◽  
Vol 26 (6) ◽  
pp. 720-724
Author(s):  
Anas Aboud ◽  
Kai Liebing ◽  
Charlie Abraham ◽  
Jan-Christian Reil ◽  
Yara Turkistani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Therapeutic Option ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
In Vitro Testing ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Heart Pump ◽  
Increased Risk

Left ventricular assist devices (LVADs) are an important therapeutic option for patients with end-stage heart failure waiting for heart transplantation or in older patients as definite therapy for heart failure. Interestingly, about 62% of patients receiving LVADs do not have an automatic implantable cardioverter-defibrillator (AICD) at the time of implantation, although these patients have increased risk of being confronted with dangerous arrhythmia. Therefore, an LVAD system including AICD function is a reasonable alternative for such heart failure patients thereby avoiding a second surgical intervention for AICD implantation. In this article, a newly developed system including LVAD and AICD function is introduced, and we also report its first in vitro testing.

scholarly journals Cardiovascular biomarkers as predictors of adverse outcomes in chronic Chagas cardiomyopathy

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258622
Author(s):  
Luis E. Echeverría ◽  
Lyda Z. Rojas ◽  
Sergio Alejandro Gómez-Ochoa ◽  
Oscar L. Rueda-Ochoa ◽  
Cristian David Sosa-Vesga ◽  
...  
Keyword(s):  
Troponin T ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Cardiac Biomarkers ◽  
Ventricular Assist Devices ◽  
Composite Outcome ◽  
Left Ventricular Assist Devices ◽  
Chagas Cardiomyopathy ◽  
Amino Terminal ◽  
Increased Risk

Background Chronic Chagas Cardiomyopathy (CCM) is a unique form of cardiomyopathy compared to other etiologies of heart failure. In CCM, risk prediction based on biomarkers has not been well-studied. We assessed the prognostic value of a biomarker panel to predict a composite outcome (CO), including the need for heart transplantation, use of left ventricular assist devices, and mortality. Methods Prospective cohort study of 100 adults with different stages of CCM. Serum concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL), high sensitivity troponin T (hs-cTnT), soluble (sST2), and cystatin-C (Cys-c) were measured. Survival analyses were performed using Cox proportional hazard models. Results During a median follow-up of 52 months, the mortality rate was 20%, while the CO was observed in 25% of the patients. Four biomarkers (NT-proBNP, hs-cTnT, sST2, and Cys-C) were associated with the CO; concentrations of NT-proBNP and hs-cTnT were associated with the highest AUC (85.1 and 85.8, respectively). Combining these two biomarkers above their selected cut-off values significantly increased risk for the CO (HR 3.18; 95%CI 1.31–7.79). No events were reported in the patients in whom the two biomarkers were under the cut-off values, and when both levels were above cut-off values, the CO was observed in 60.71%. Conclusion The combination of NT-proBNP and hs-TnT above their selected cut-off values is associated with a 3-fold increase in the risk of the composite outcome among CCM patients. The use of cardiac biomarkers may improve prognostic evaluation of patients with CCM.

scholarly journals 1251. Determinants of Infection at a Nontransplanting Cardiothoracic LVAD Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S450-S450
Author(s):  
Alexander Milgrom ◽  
Amanda Collins ◽  
J Aaron Grubbs ◽  
Caroline Derrick ◽  
Kristin Logan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Destination Therapy ◽  
Left Ventricular Assist Devices ◽  
Heartmate Ii ◽  
Bridge To Transplant ◽  
Increased Risk ◽  
The Impact

Abstract Background Left ventricular assist devices (LVADs) are a treatment option for end-stage heart failure, traditionally used as a bridge to a transplant. However, LVADs as a destination therapy is an option for individuals with contraindications for transplant. Infections are a common and devastating complication with significant morbidity and mortality. The purpose of this study was to assess the impact of risk factors for LVAD-associated infections in a nontransplant LVAD center. Methods All patients with implanted LVADs from 2013–2018 at Prisma Health were screened for inclusion. LVAD-associated infection was defined using INTERMACS criteria. Patient characteristics and device characteristics were evaluated for infection risk. Time to infection and associated mortality were also analyzed. Results Fifty-four of 138 (39.1%) patients developed an LVAD infection (driveline infection, or bacteremia). Mean time to infection among those who experienced infections was 7.78 months, with a standard deviation of 9.58 months. Table 1 summarizes baseline patient characteristics. HeartWare devices, compared with HeartMate II, were at an increased risk of infections and had a shorter time to infection (Figure 1) (HeartWare vs. HeartMate II, HR 2.12, P = 0.01). Those with a BMI of ≥35 kg/m2 were found on average to have a number of infections 0.729 greater than those with a BMI < 35 kg/m2 (P = 0.01). Prealbumin, A1C, and chronic kidney disease (any stage) were not found to be associated with infection. Staphylococcus aureus (21, 18.26%), Pseudomonas aeruginosa (24, 20.87%), and Staphylococcus epidermidis (22, 19.13%) were the most common organisms identified. Conclusion In an LVAD center where the majority of patients received LVAD as destination therapy, infection rates were similar as those receiving LVAD as a bridge to transplant. Modifiable risk factors for infection are areas for future interventions and prevention efforts. Disclosures All authors: No reported disclosures.

Abstract 12518: Ventricular Arrhythmias and Mortality After Left Ventricular Assist Devices Implantation: A Meta-Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nader Makki ◽  
Olurotimi Mesubi ◽  
Curtis Steyers ◽  
Brian Olshansky
Keyword(s):  
Ventricular Arrhythmias ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Increased Risk ◽  
Left Ventricular Assist ◽  
All Cause Mortality

Background: Ventricular arrhythmias (VAs) are among the most commonly reported adverse effects associated with left ventricular assist devices (LVADs). However, prevalence of VAs post-LVAD implantation, and their relation to all-cause mortality, remains to be elucidated. We conducted a meta-analysis and systematic review of observational studies with the primary objective of evaluating the risk of VAs after LVAD implantation and the risk of all-cause mortality in patients with LVADs who had VAs. Methods: We searched Medline, Embase and Cochrane Central from 2001 to 2014. Two reviewers independently searched,selected and assessed quality of included studies with differences resolved by consensus. Data were collected and analyzed using random and fixed-effect model, as appropriate, with inverse variance weighting. Results: Of 2,393 studies identified, 15 observational studies were eligible including 1,517 patients with a mean follow up of 201 days. An LVAD was associated with an increased risk of VA after implantation (OR = 2.21, 95% confidence interval [CI] 1.37-3.59, p<0.001).There was an increased risk of all-cause mortality in LVAD patients who had post-LVAD VA (OR = 1.91, 95% CI 1.18-3.11, p<0.001). Using meta-regression and sensitivity analyses to account for risk factors such as etiology of cardiomyopathy, duration of follow-up, destination LVAD versus bridge therapy and presence of an implantable cardioverter defibrillator at time of LVAD implantation did not change the results of our main analysis. Conclusions: LVADs are associated with an increased risk of VA and presence of VAs post LVAD implantation is associated with increased risk of all-cause mortality.

Awake and aware with ongoing ventricular fibrillation during LVAD treatment: is it possible?

2020 ◽  
Vol 13 (4) ◽  
pp. e234527
Author(s):  
Ingrid Hell Mott ◽  
Steen Hvitfeldt Poulsen ◽  
Brian Bridal Løgstrup
Keyword(s):  
Ventricular Fibrillation ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Randomised Trials ◽  
Ventricular Assist ◽  
Increased Risk ◽  
Left Ventricular Assist ◽  
Shed Light

Left ventricular assist devices (LVADs) are currently used as destination therapy or bridge to heart transplantation in patients with advanced chronic heart failure (CHF). It has been proved to reduce mortality and symptoms in these patients. Patients with advanced CHF are known to have increased risk of ventricular arrhythmias (ventricular tachycardia or ventricular fibrillation (VF)) despite the presence of LVAD. We report the case of patients with ongoing VF during LVAD treatment while being awake and aware. We discuss the challenges introduced along with the increasing use of LVAD treatment. The decision whether a patient with LVAD automatically should have an implantable cardioverter-defibrillator is challenging. Randomised trials are warranted to shed light on these challenging decisions.

scholarly journals Current Desensitization Strategies in Heart Transplantation

2021 ◽  
Vol 12 ◽  
Author(s):  
Marlena V. Habal
Keyword(s):  
Immune Response ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Therapeutic Potential ◽  
Hla Antigens ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Hla Antibodies ◽  
Increased Risk

Heart transplant candidates sensitized to HLA antigens wait longer for transplant, are at increased risk of dying while waiting, and may not be listed at all. The increasing prevalence of HLA sensitization and limitations of current desensitization strategies underscore the urgent need for a more effective approach. In addition to pregnancy, prior transplant, and transfusions, patients with end-stage heart failure are burdened with unique factors placing them at risk for HLA sensitization. These include homograft material used for congenital heart disease repair and left ventricular assist devices (LVADs). Moreover, these risks are often stacked, forming a seemingly insurmountable barrier in some cases. While desensitization protocols are typically implemented uniformly, irrespective of the mode of sensitization, the heterogeneity in success and post-transplant outcomes argues for a more tailored approach. Achieving this will require progress in our understanding of the immunobiology underlying the innate and adaptive immune response to these varied allosensitizing exposures. Further attention to B cell activation, memory, and plasma cell differentiation is required to establish methods that durably abrogate the anti-HLA antibody response before and after transplant. The contribution of non-HLA antibodies to the net state of sensitization and the potential implications for graft longevity also remain to be comprehensively defined. The aim of this review is to first bring forth select issues unique to the sensitized heart transplant candidate. The current literature on desensitization in heart transplantation will then be summarized providing context within the immune response. Building on this, newer approaches with therapeutic potential will be discussed emphasizing the importance of not only addressing the short-term pathogenic consequences of circulating HLA antibodies, but also the need to modulate alloimmune memory.

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