Myocardial Gene Expression of Regulators of Myocyte Apoptosis and Myocyte Calcium Homeostasis During Hemodynamic Unloading by Ventricular Assist Devices in Patients With End-Stage Heart Failure

Circulation ◽  
1999 ◽  
Vol 100 (Supplement 2) ◽  
pp. II-216-II-223 ◽  
Author(s):  
B. Bartling ◽  
H. Milting ◽  
H. Schumann ◽  
D. Darmer ◽  
L. Arusoglu ◽  
...  
Keyword(s):  
Gene Expression ◽  
Heart Failure ◽  
Calcium Homeostasis ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
End Stage Heart Failure ◽  
Myocyte Apoptosis ◽  
End Stage ◽  
Myocardial Gene Expression

Myocardial Gene Expression of Regulators of Myocyte Apoptosis and Myocyte Calcium Homeostasis During Hemodynamic Unloading by Ventricular Assist Devices in Patients With End-Stage Heart Failure

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Babett Bartling ◽  
Hendrik Milting ◽  
Heike Schumann ◽  
Dorothea Darmer ◽  
Lativ Arusoglu ◽  
...  
Keyword(s):  
Gene Expression ◽  
Heart Failure ◽  
Sarcoplasmic Reticulum ◽  
Calcium Homeostasis ◽  
Cardiac Transplantation ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage ◽  
Myocardial Gene Expression

Background —In patients with end-stage heart failure, characterized by an increased susceptibility to cardiomyocyte apoptosis and a labile cardiomyocyte calcium homeostasis, a ventricular assist device (VAD) is implanted for bridging to cardiac transplantation and results in myocardial unloading. Although phenotype changes in the failing heart are assumed to result from hemodynamic overload, the reversibility of these changes under unloading is unknown. Methods and Results —By use of quantitative reverse-transcription polymerase chain reaction, mRNA expression analyses were performed on left ventricular specimens obtained from 10 nonfailing donor hearts (from 8 patients with dilated cardiomyopathy and 2 patients with coronary heart disease) at the time of VAD implantation and 36 to 169 days later during VAD removal with subsequent cardiac transplantation. In terminally failing hearts before VAD support, left ventricular mRNA analyses revealed increased Pro-ANP, reduced antiapoptotic Bcl-x L and antiapoptotic Fas isoform FasExo6Del, and a decreased ratio of sarcoplasmic reticulum Ca 2+ -ATPase per sarcolemmal Na + -Ca 2+ exchanger in comparison with nonfailing ventricles. After VAD unloading, ventricular transcription of Pro-ANP was immediately normalized, and apoptotic DNA fragmentation was attenuated. In patients with dilated cardiomyopathy, mRNAs of Bcl-x L and FasExo6Del/Fas were enhanced depending on time on VAD. The Bcl-x L mRNA level correlated positively with that of the Bcl-x L protein. Transcription of sarcoplasmic reticulum Ca 2+ -ATPase/Na + -Ca 2+ exchanger demonstrated recovery in only 4 of 10 patients. Conclusions —Mechanical support of the failing heart induces a time-dependent change in myocardial gene expression compatible with a decreased susceptibility to apoptosis.

scholarly journals Sex Differences in Patients Receiving Left Ventricular Assist Devices for End-Stage Heart Failure

2020 ◽  
Vol 8 (9) ◽  
pp. 770-779
Author(s):  
Jadry Gruen ◽  
Cesar Caraballo ◽  
P. Elliott Miller ◽  
Megan McCullough ◽  
Catherine Mezzacappa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sex Differences ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage

Innovations in Ventricular Assist Devices for End-Stage Heart Failure

2019 ◽  
Vol 70 (1) ◽  
pp. 33-44 ◽  
Author(s):  
Robert J.H. Miller ◽  
Jeffrey J. Teuteberg ◽  
Sharon A. Hunt
Keyword(s):  
Heart Failure ◽  
Patient Management ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Number Of Patients ◽  
End Stage Heart Failure ◽  
End Stage

The number of patients with end-stage heart failure (HF) continues to increase over time, but there has been little change in the availability of organs for cardiac transplantation, intensifying the demand for left ventricular assist devices (LVADs) as a bridge to transplantation. There is also a growing number of patients with end-stage HF who are not transplant candidates but may be eligible for long-term support with an LVAD, known as destination therapy. Due to this increasing demand, LVAD technology has evolved, resulting in transformative improvements in outcomes. Additionally, with growing clinical experience patient management continues to be refined, leading to iterative improvements in outcomes. With outcomes continuing to improve, the potential benefit from LVAD therapy is being considered for patients earlier in their course of advanced HF. We review recent changes in technology, patient management, and implant decision making in LVAD therapy.

Rise of the Machines: In an Era of Ventricular Assist Devices, Prolonging Life or Death?

2017 ◽  
Vol 10 (2) ◽  
pp. 96-107
Author(s):  
Oliver Diaz
Keyword(s):  
Heart Failure ◽  
Lung Function ◽  
Venous Blood ◽  
Alternative Therapy ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
End Stage Heart Failure ◽  
End Stage ◽  
Organ Replacement

The past few decades witnessed the unprecedented “rise of the machines”; life-prolonging devices to support failing organs or as a form of organ replacement. Sophisticated machines provide us clinical milieu to intervene on sicker, dying patients, support the failing organ, prevent downward trajectory to multi-organ failure, and avert death. Hemodialysis has been in existence for several decades and has become the standard therapy for acute renal failure. Extracorporeal liver assist device replaces the detoxification function of the failing liver. Extracorporeal membrane oxygenator in cases of profound respiratory failure can replace the native lung function in the oxygenation of the venous blood and removal of carbon dioxide. The technology can also be used as a short-term heart–lung machine to keep the patient alive in the event of profound refractory cardiopulmonary collapse until the native heart and lung function returns. Ventricular assist devices (VADs) can completely replace the cardiac function in patients with end-stage heart failure and provide systemic flow. These innovative machines were developed under the assumption that they will improve survival, functional capacity, and quality of life in this cohort of patients. This case study focuses on the appropriate use of VADs as an alternative therapy for end-stage heart failure. This will explicate the ethical dilemma that concomitantly may arise with the use of these sophisticated organ replacement strategies when the goals of their placement are not met and just merely prolonging the dying process.

Left Ventricular Assist Devices in Patients With End-Stage Heart Failure

Angiology ◽  
2014 ◽  
Vol 65 (10) ◽  
pp. 861-868 ◽  
Author(s):  
Panayotis Fantidis ◽  
Eladio Sánchez ◽  
Ibrahim Tarhini ◽  
Ijaz Khan ◽  
Tomas Pineda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage
Sign in / Sign up

Export Citation Format

Share Document