scholarly journals Durable Mechanical Circulatory Support in Patients With Amyloid Cardiomyopathy

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Katherine C. Michelis ◽  
Lin Zhong ◽  
W.H. Wilson Tang ◽  
James B. Young ◽  
Matthias Peltz ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Artificial Heart ◽  
Mechanical Circulatory Support ◽  
Restrictive Cardiomyopathy ◽  
Interquartile Range ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Device Implantation ◽  
Included Patient ◽  
Amyloid Cardiomyopathy

Background: Many patients with amyloid cardiomyopathy (ACM) develop advanced heart failure, and durable mechanical circulatory support (MCS) may be a consideration. However, data describing clinical outcomes after MCS in this population are limited. Methods: Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support with dilated cardiomyopathy (DCM, n=19 921), nonamyloid restrictive cardiomyopathy (RCM, n=248), or ACM (n=46) between 2005 and 2017 were included. Patient and device characteristics were compared between cardiomyopathy groups. The primary end point was the cumulative incidence of death with heart transplantation as a competing risk. Results: Patients with ACM (n=46) were older (61 years [interquartile range, 55–69 years] versus 58 years [interquartile range, 49–66 years] for DCM and 55 years [interquartile range, 46–62 years] for nonamyloid RCM, P <0.001) and were more commonly Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30.4% versus 17.9% for DCM and 21.0% for nonamyloid RCM, P =0.04) at device implantation. Use of biventricular support (biventricular assist device or total artificial heart) was the highest for patients with ACM (41.3% versus 6.7% and 19.4% for patients with DCM and nonamyloid RCM, respectively, P =0.014). The cumulative incidence of death was highest for patients with ACM relative to those with DCM or nonamyloid RCM ( P <0.001) but did not differ significantly between groups for those who required biventricular MCS. Conclusions: Compared with patients with DCM or nonamyloid RCM who received durable MCS, those with ACM experienced the highest use of biventricular support and the worst survival. These data highlight concerns with the use of durable MCS for patients with ACM.

Abstract 15821: Patients With Amyloid Cardiomyopathy Who Receive Durable Mechanical Circulatory Support Are at Increased Risk for Mortality and Early Adverse Events

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Katherine C Michelis ◽  
Lin Zhong ◽  
Wai Hong W Tang ◽  
James B Young ◽  
Mark H Drazner ◽  
...  
Keyword(s):  
Adverse Events ◽  
Mechanical Circulatory Support ◽  
Restrictive Cardiomyopathy ◽  
Total Artificial Heart ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Risk Of Death ◽  
Increased Risk ◽  
Amyloid Cardiomyopathy

Introduction: Amyloid cardiomyopathy (ACM) is recognized increasingly as a cause of advanced heart failure. There are limited data describing clinical outcomes for ACM patients who receive durable mechanical circulatory support (MCS). Methods: This analysis included adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) with a primary diagnosis of dilated cardiomyopathy (DCM, N=19,921), non-amyloid restrictive cardiomyopathy (RCM, N=248), or ACM (N=48) who received durable MCS of any type or strategy from 2005-2017. We compared baseline characteristics and adverse events for the 3 groups. The primary endpoint was death with heart transplantation as a competing risk with follow-up censored at device explantation. Results: Patients with ACM (N=48) were older (61 y [IQR 55-69] versus 58 y [IQR 49-66] for DCM and 55 y [IQR 46-62] for non-amyloid RCM, P<0.001), and more likely to be male (85% versus 79% for DCM and 63% for non-amyloid RCM, P<0.001) and INTERMACS profile 1 (30% versus 18% for DCM and 21% for non-amyloid RCM, P=0.04) at implant. Use of biventricular support (concomitant left and right ventricular assist devices or total artificial heart) was highest in the ACM group (41% versus 7% and 19% for DCM and non-amyloid RCM groups, respectively, P<0.001). ACM patients experienced a higher frequency of major bleeding (48% versus 29% for DCM and 34% for non-amyloid RCM, P=0.005), neurologic dysfunction (22% versus 10% for DCM and 14% for non-amyloid RCM, P=0.006), and renal dysfunction (20% versus 10% for DCM and 17% for non-amyloid RCM, P<0.001) within 3 months. Risk of death at a median follow-up of 1 year was highest for the ACM group compared to DCM and non-amyloid RCM (Log-rank, P=0.014). Conclusion: Compared to DCM or non-amyloid RCM patients, those with durable MCS for ACM have the highest risk of early adverse events and lowest survival. These data highlight concerns with durable MCS for ACM.

Caring for Pediatric Heart Failure Patients With Long-Term Mechanical Circulatory Support

2018 ◽  
Vol 38 (5) ◽  
pp. 44-56
Author(s):  
Kari Hyotala
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Congenital Defects ◽  
Specific Information ◽  
Device Implantation ◽  
Assessment Skills ◽  
Pediatric Heart Failure

Pediatric cardiac failure is a significant problem that may be caused by cardiomyopathy, myocarditis, or congenital defects that cannot be surgically repaired. Long-term mechanical circulatory support (LTMCS) devices provide hemodynamic support for patients in heart failure as a bridge to heart transplant and, sometimes, cardiac recovery or destination therapy. Critical care nurses must have a comprehensive understanding of LTMCS device function and keen assessment skills to detect signs of impaired perfusion and device failure. Nurses should anticipate postoperative interventions, prevent adverse events, and be prepared to respond during emergencies. Patient care should be family centered and nurses must strive to maximize patients’ quality of life throughout device implantation. This article provides a basic guide to caring for pediatric patients receiving LTMCS, including specific information regarding 4 devices that are often used for pediatric heart failure: Berlin Heart EXCOR, SynCardia Total Artificial Heart, HeartWare HVAD, and HeartMate II.

Abstract WMP66: Cerebrovascular Hemodynamics of Mechanical Circulatory Support Device Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kara R Melmed ◽  
Konrad H Shlick ◽  
Brenda Rinsky ◽  
Shlee S Song ◽  
Patrick D Lyden
Keyword(s):  
Continuous Flow ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Total Artificial Heart ◽  
Circulatory Support ◽  
Normative Values ◽  
Mean Flow ◽  
Mean Velocity ◽  
Ventricular Assist ◽  
Cerebrovascular Hemodynamics

Background: Multiple types of mechanical circulatory support (MCS) devices are commonly used in heart failure patients. These devices carry risk for neurologic complications, specifically cardioembolic stroke. Alterations in blood flow play a role in the pathophysiology, however there is limited data regarding cerebrovascular hemodynamics in MCS patients. We used transcranial Doppler (TCD) to define hemodynamics of commonly used MCS devices. Methods: We retrospectively examined charts from 2/2013 through 6/2016 for patients with MCS who underwent TCD, and obtained the following: peak systolic,end-diastolic velocities, mean flow velocities, pulsatility indices (PI) and number of high-intensity transient signals (HITS). Waveform morphologies were compared between devices. Results: Of 1,796 TCDs studies screened, 62 TCD studies were from 32 MCS patients. Of these, 21 were on extracorporeal membrane oxygenation (ECMO), 15 had a left ventricular assist device (LVAD), 18 had total artificial heart (TAH), and 2 had intra-aortic balloon pumps (IABP). Waveforms in patients supported by ECMO demonstrated continuous flow without clear systolic peaks. The averaged mean MCA velocity was 57.57 (SD= 21.00) cm/sec and mean PI is 0.35 (0.17). LVAD averaged mean MCA velocity was 57.57 (14.38) cm/sec and mean PI of 0.45 (0.28). PIs were low in patients with continuous-flow LVADs. Impella patients had morphologically distinct pulsatile waveforms compared to other types of VADs. IABP had averaged mean velocity of 56.21 (14.78) cm/sec and mean PI of 0.77 (0.15). These waveforms demonstrated pronounced diastolic upstrokes not present in other devices. In TAH patients, mean MCA velocity was 73.69 (33.00) cm/sec and PI of 0.86 (0.40). Emboli detection was performed in 46 studies, and HITS were detected in 29 (63%). Of these 15 (51%) were administered 100% oxygen which suppressed >50% HITS in 10 (67%) patients. Conclusion: Patients supported by MCS devices produce unique and characteristic waveforms on TCD studies. Further studies will describe normative values in this special population. HITS were not universally present and intermittently suppressible by oxygen, suggesting some may be gaseous in nature. Risk of stroke in patients with MCS and HITS is under study.

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