Abstract 16583: Beta Blocker Administration Within 30 Days Post-Left Ventricular Assist Device Significantly Decreases 1-Year Mortality in a Multi-institutional Retrospective Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mohamed H Derbala ◽  
Mercedes Rivas-Lasarte ◽  
Salil Kumar ◽  
Joel Ferrall ◽  
Matthew Cefalu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Medical Center ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Ohio State University ◽  
State University ◽  
Ventricular Assist ◽  
Medical Centers ◽  
Left Ventricular Assist ◽  
Mortality Table

Introduction: The utilization of beta blockers (BB) post LVAD implantation is controversial, especially in the setting of right ventricular failure. There is limited evidence-based data regarding the survival benefits of BB post LVAD implantation Hypothesis: We hypothesized that BB use would not be associated with increased mortality Methods: We performed a dual-center retrospective study of 487 patients from Ohio State University & Montefiore Medical Center who received a continuous-flow durable LVAD bet. Jan 2006 through Dec 2016. A survival analysis was done to determine if patients had increased 1 year mortality depending on whether they received BB within 30 days post LVAD, after 30 days & up to 1 year post LVAD, or did not receive BB. Multivariate analysis of predictors of post LVAD mortality was conducted. Results: Overall the baseline characteristics bet. the 3 groups were similar (Table 1). BB utilization within 30 days post LVAD was associated with a drastic decrease in 1 year mortality (p <0.001; Fig.1). Multivariate analysis shows that no BB use (HR 3.36, p <0.001), age ≥70 (HR 2.73, p = 0.005) & pre LVAD creatinine ≥1.5 mg/dl (HR 1.86, p = 0.022) were significant independent predictors of mortality (Table 2). Conclusions: The early use of BB significantly improves 1 year survival post LVAD. Notably these results are from Midwest and East Coast Medical Centers to improve generalizability.

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 Effects of Beta Blockers and ACE Inhibitors after Left Ventricular Assist Device Implantation

2018 ◽  
Author(s):  
Gaurang Vaidya ◽  
Emma Birks ◽  
Jessica Pillarella ◽  
Benjamin Salgado ◽  
Rajakrishnan Vijayakrishnan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Right Atrial ◽  
Assist Device ◽  
Ventricular Assist ◽  
Significant Difference ◽  
Left Ventricular Assist

Background While Beta blockers(BB) and Angiotensin system blockers(ACEinh/ARB) are important components in advanced heart failure therapy, their use after left ventricular assist device (LVAD) implantation remains controversial. Concern has been raised about possible adverse effects of BB on right ventricular(RV) function while tolerance and efficacy/outcome data for ACEinh are lacking. This study aimed to characterize the use of medical therapy post-LVAD implantation and to evaluate its safety and efficacy. Methods Demographic, clinical and echocardiographic variables of patients implanted with a continuous-flow LVAD between 2012 and 2015 at a single center were retrospectively reviewed. Mortality and heart failure(CHF) hospitalizations were followed from 6-18 months’ post-implant. Results Of a total of 98 patients, the mean age was 57 years, 81% were men and 61% had ischemic disease. While the use of diuretics decreased considerably post LVAD, over 50% continued to require diuretics. At 6th month post-implantation, 73% of patients were on BB, and these patients had significantly lower proBNP at 6 and 12 months follow up. Despite significant prevalence of RV dysfunction in the cohort (>75% at 6 months), there was no significant difference in CHF hospitalizations based on BB use (14% vs 15%) and instead a trend towards less deaths in those on BB (6% vs 15%). ACEinh/ARB use was likewise common at 6 month (61%) and these patients had lower proBNP at 6 and 12 months, lower right atrial(RA) pressures (9 vs 12 mmHg, p=0.03), and a significantly lower mortality—a finding which remained on multivariate analysis. Conclusion The use of ACEinh/ARB appeared to be associated with subsequent improved survival, lower proBNP and RA pressures. The use of BB post-LVAD appears safe and was associated with a lower proBNP, even in a patient population with a significant prevalence of RV dysfunction.

Abstract WP230: Stroke Characteristics and Outcomes in Patients With Current Generation Centrifugal Flow Left Ventricular Assist Devices

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ovais Inamullah ◽  
Yuting Chiang ◽  
Martin Weiss ◽  
Michael Lutz ◽  
Carmelo Milano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Medical Center ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
The Difference ◽  
New Generation

Introduction: Stroke is a devastating complication of left ventricular assist device (LVAD) therapy and a leading cause of mortality in this group. The newer HeartMate (HVAD, 2012) and HeartMate 3 (HM3, 2017) devices use a continuous flow centrifugal pump with a magnetically levitated rotor that may cause less thrombosis and stroke. We aim to compare the rate and severity of strokes in the setting of the new generation LVADs. Methods: This was a single-center retrospective cohort study at a single US academic medical center. The cohort includes all subjects at Duke University Medical Center who received either an HM3 or HVAD LVAD between September 2009 through February 2018 and had a cerebrovascular accident while the LVAD was in place. Descriptive statistics were calculated to compare the clinical variables for individuals receiving either the HVAD or HM3 device. 95% confidence intervals were calculated when appropriate. Results: A total of 163 HVAD patients and 84 HM3 patients were included in the analysis. Strokes occurred more commonly among those with HVAD (14.7%, 9.7%-21.1%) compared to those with HM3 (6.0%, 2.0%-13.3%). About 62.1% of strokes were ischemic. Patients with HM3 were older and had a higher rate of cardiovascular risk factors. The initial mean NIHSS was higher in HM3 patients (24.6, 11.9-37.3) compared to those with HVADs (16, 10.9-21.1). Mortality within 30 days was higher in HM3 patients (60.0%, 14.7%-94.7%) compared to HVAD patients (45.8%, 25.6%-67.2%). Patients were more likely to be disabled (mRs> 3) at 3 months if they had an HM3 (80%, 28.4%-99.5%) compared to those who had an HVAD (54.2%, 32.8%-74.4%). Conclusion: Strokes occurred more commonly among those with HVAD compared to HM3, but the strokes in those with HM3 tended to be more severe at onset compared to HVAD with a higher 30 days mortality and more disability at 3 months. The difference in stroke frequency may suggest that the HM3 is less prone to thrombosis. The difference in mortality may have been secondary to patients with HM3 being older and with more cardiovascular risk factors or could be related to a reduction in minor strokes causing a shift to worse outcomes. Additional studies are needed to understand the predictors of stroke in the setting of the new generation LVADs.

P1667Comparison of post-implant anticoagulation agents in left ventricular assist devices

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bigeh ◽  
J Keuth ◽  
R Gerkin ◽  
R Gopalan
Keyword(s):  
Adverse Events ◽  
Medical Center ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Heparin Group ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Anticoagulation Agents ◽  
Left Ventricular Assist

Abstract Background Left ventricular assist devices (LVADs) improve survival in patients with end-stage heart failure. Despite technological advancements, there is still a high risk of bleeding and thromboembolic events. To minimise device clotting, anticoagulation is usually started three days after implant. Unfractionated heparin (UFH) is the standard as a bridge to coumadin, however, current guidelines lack comparative evidence and do not delineate between anticoagulation agents (such as enoxaparin). Purpose To evaluate the safety of post-implant anticoagulation in LVAD patients using UFH and low molecular weight heparin enoxaparin (LMWH). Methods From October 2007 to October 2018, 83 patients underwent LVAD implantation (Heartmate II, III or HVAD) at Banner University Medical Center-Phoenix. Retrospective analysis was performed on 68 patients who received post-implant anticoagulation with a goal INR 1.8–2.5. Patients were bridged with either UFH (n=46) or LMWH (n=22). Results Demographics and patient characteristics were comparable between groups. We analysed adverse events, survival, and time to adverse events. The heparin group had a nonsignificant longer event-free period after implant compared with LMWH, median 9.4 and 1.8 months, respectively (p=0.428). The LMWH group had a significantly increased proportion of adverse events across all categories (p=0.021). Bleeding was the most common event for both groups, although substantially more for those receiving LMWH. Most notably 14 heparin patients (30.4%) had no adverse events compared to zero in the LMWH group. Types of Adverse Events Post-Implant Bleeding Hemorrhagic Stroke Ischemic Stroke Pump Thrombus None Total Bridging Agent Heparin Count 18 3 8 3 14 46 % 39.1% 6.5% 17.4% 6.5% 30.4% 100% Enoxaparin Count 14 2 4 2 0 22 % 63.6% 9.1% 18.2% 9.1% 0% 100% Total Count 32 5 12 5 14 68 % 47.1% 7.4% 17.6% 7.4% 20.6% 100% p=0.021. Post-Implant Event-Free Survival Conclusions Minimising bleeding and clotting are a persistent challenge in LVAD patients. Use of LMWH was associated with significantly more adverse events compared to UFH, with bleeding constituting the majority of events. Establishing institutional protocols and standards are necessary to improve patient outcomes; therefore, larger prospective studies are needed.

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 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

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