scholarly journals Novel Risk Model to Predict Emergency Department Associated Mortality for Patients Supported With a Ventricular Assist Device: The Emergency Department–Ventricular Assist Device Risk Score

2022 ◽  
Author(s):  
Jonathan B. Edelson ◽  
Jonathan J. Edwards ◽  
Hannah Katcoff ◽  
Antara Mondal ◽  
Feiyan Chen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Score ◽  
Ventricular Assist Device ◽  
Risk Model ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Predictors Of Mortality ◽  
Risk Of Death

Background The past decade has seen tremendous growth in patients with ambulatory ventricular assist devices. We sought to identify patients that present to the emergency department (ED) at the highest risk of death. Methods and Results This retrospective analysis of ED encounters from the Nationwide Emergency Department Sample includes 2010 to 2017. Using a random sampling of patient encounters, 80% were assigned to development and 20% to validation cohorts. A risk model was derived from independent predictors of mortality. Each patient encounter was assigned to 1 of 3 groups based on risk score. A total of 44 042 ED ventricular assist device patient encounters were included. The majority of patients were male (73.6%), <65 years old (60.1%), and 29% presented with bleeding, stroke, or device complication. Independent predictors of mortality during the ED visit or subsequent admission included age ≥65 years (odds ratio [OR], 1.8; 95% CI, 1.3–4.6), primary diagnoses (stroke [OR, 19.4; 95% CI, 13.1–28.8], device complication [OR, 10.1; 95% CI, 6.5–16.7], cardiac [OR, 4.0; 95% CI, 2.7–6.1], infection [OR, 5.8; 95% CI, 3.5–8.9]), and blood transfusion (OR, 2.6; 95% CI, 1.8–4.0), whereas history of hypertension was protective (OR, 0.69; 95% CI, 0.5–0.9). The risk score predicted mortality areas under the curve of 0.78 and 0.71 for development and validation. Encounters in the highest risk score strata had a 16‐fold higher mortality compared with the lowest risk group (15.8% versus 1.0%). Conclusions We present a novel risk score and its validation for predicting mortality of patients with ED ventricular assist devices, a high‐risk, and growing, population.

Abstract 13530: A Novel Risk Model to Predict Emergency Department Associated Mortality for Patients Supported With a Ventricular Assist Device: The Ed-vad Risk Score

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan B Edelson ◽  
Jonathan J Edwards ◽  
Hannah Katcoff ◽  
Antara Mondal ◽  
Feiyan Chen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Score ◽  
Ventricular Assist Device ◽  
Risk Model ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Assist Device ◽  
Ventricular Assist ◽  
Predictors Of Mortality ◽  
Risk Of Death

Introduction: The past decade has seen tremendous growth in ambulatory ventricular assist device (VAD) patients. We sought to identify patients that present to the emergency department (ED) who are at the highest risk of death. Methods: We performed a retrospective analysis of ED encounters of VAD patients using data from the Nationwide Emergency Department Sample (NEDS) from 2010-2017. Demographic and clinical variables significantly associated with mortality (p < 0.2) in a univariate analysis were evaluated in a multivariate model. Using a random sampling of patient encounters, 80% were assigned to development and 20% to validation cohorts. A risk model was derived from independent predictors of mortality, which were weighted using integer-normalized beta coefficients. Each patient encounter was assigned to one of three groups based on risk score. Results: A total of 44,042 ED encounters of VAD patients were included in the study. The majority of patients were male (73.6%), <65 years old (60.1%), and 29% presented with bleeding, ischemic/hemorrhagic stroke, or device complication. Independent predictors of mortality during the ED visit or subsequent admission included age ≥65 years (OR 1.8, 95% CI 1.3, 4.6), primary diagnoses [stroke (OR 19.4, 95% CI 13.1, 28.8), device complication (OR 10.1, 95% CI 6.5, 16.7), cardiac (OR 4.0 95% CI 2.7, 6.1), infection (OR 5.8, 95% CI 3.5, 8.9)], and blood transfusion (OR 2.6, 95% CI 1.8, 4.0), while history of hypertension was protective (OR 0.69, 95% CI 0.5, 0.9)]. The risk score predicted mortality with an area under the curve of 0.78 and 0.71 for development and validation, respectively. Encounters in the highest risk score strata tertile had a 16-fold higher mortality compared to lowest risk tertile (15.8% vs 1.0%). Conclusions: We present a novel risk score and its validation for predicting mortality of VAD patients who present to the ED, which can serve as useful tool for clinicians caring for this high-risk, and growing, population.

Arrhythmias in children with ventricular assist devices

2013 ◽  
Vol 25 (2) ◽  
pp. 255-260
Author(s):  
W. Buck Kyle ◽  
Jamie Decker ◽  
Scott L. Macicek ◽  
Santiago O. Valdes ◽  
David Morales ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Assist Device ◽  
Transplant Rejection ◽  
Decompensated Heart Failure ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Risk Of Death ◽  
The Impact

AbstractBackground: Children with decompensated heart failure are at high risk for arrhythmias, and ventricular assist device placement is becoming a more common treatment strategy. The impact of ventricular assist devices on arrhythmias and how arrhythmias affect the clinical course of this population are not well described. Methods and results: A single-centre retrospective analysis of children receiving a ventricular assist device between 1998 and 2011 was performed. In all, 45 patients received 56 ventricular assist devices. The median age at initial placement was 13 years (interquartile range 6–15). The median duration of support was 10 days (range 2–260). The aetiology of heart failure included cardiomyopathy, transplant rejection, myocarditis, and congenital heart disease. In all, 32 patients (71%) had an arrhythmia; 19 patients (42%) had an arrhythmia before ventricular assist device and eight patients (18%) developed new arrhythmias on ventricular assist device. Ventricular tachycardia was most common (25/32, 78%). There was no correlation between arrhythmia and risk of death or transplantation (p=0.14). Of the 15 patients who weaned from ventricular assist device, post-ventricular assist device arrhythmias occurred in nine (60%), with five (33%) having their first arrhythmia after weaning. Patients with ventricular dysfunction after ventricular assist device were more likely to have arrhythmias (p<0.02). Conclusions: Arrhythmias, especially ventricular, are common in children requiring ventricular assist device. They frequently persist for those able to wean from ventricular assist device.

Blood damage in Left Ventricular Assist Devices: Pump thrombosis or system thrombosis?

2018 ◽  
Vol 42 (3) ◽  
pp. 113-124 ◽  
Author(s):  
Matteo Selmi ◽  
Wei-Che Chiu ◽  
Venkat Keshav Chivukula ◽  
Giulio Melisurgo ◽  
Jennifer Ann Beckman ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Pump Thrombosis ◽  
Left Ventricular Assist

Introduction: Despite significant technical advancements in the design and manufacture of Left Ventricular Assist Devices, post-implant thrombotic and thromboembolic complications continue to affect long-term outcomes. Previous efforts, aimed at optimizing pump design as a means of reducing supraphysiologic shear stresses generated within the pump and associated prothrombotic shear-mediated platelet injury, have only partially altered the device hemocompatibility. Methods: We examined hemodynamic mechanisms that synergize with hypershear within the pump to contribute to the thrombogenic potential of the overall Left Ventricular Assist Device system. Results: Numerical simulations of blood flow in differing regions of the Left Ventricular Assist Device system, that is the diseased native left ventricle, the pump inflow cannula, the impeller, the outflow graft and the anastomosed downstream aorta, reveal that prothrombotic hemodynamic conditions might occur at these specific sites. Furthermore, we show that beyond hypershear, additional hemodynamic abnormalities exist within the pump, which may elicit platelet activation, such as recirculation zones and stagnant platelet trajectories. We also provide evidences that particular Left Ventricular Assist Device implantation configurations and specific post-implant patient management strategies, such as those allowing aortic valve opening, are more hemodynamically favorable and reduce the thrombotic risk. Conclusion: We extend the perspective of pump thrombosis secondary to the supraphysiologic shear stress environment of the pump to one of Left Ventricular Assist Device system thrombosis, raising the importance of comprehensive characterization of the different prothrombotic risk factors of the total system as the target to achieve enhanced hemocompatibility and improved clinical outcomes.

scholarly journals 1180. Colonization with Multidrug-Resistant Organisms Is Associated with Subsequent Infection in the Ventricular Assist Device Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S423-S423
Author(s):  
Scott C Roberts ◽  
Jonathan D Rich ◽  
Duc T Pham ◽  
Rebecca Harap ◽  
Valentina Stosor
Keyword(s):  
Ventricular Assist Device ◽  
Retrospective Cohort ◽  
Multidrug Resistant ◽  
Ventricular Assist Devices ◽  
Resistant Organism ◽  
Subsequent Infection ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Multidrug Resistant Organisms

Abstract Background Infection is a leading cause of morbidity and mortality in the ventricular assist device (VAD) population. We performed a retrospective cohort study outlining the epidemiology of multidrug-resistant organism (MDRO) colonization and infection rates in this population. Methods We performed a longitudinal retrospective cohort of all patients receiving continuous-flow (axial and centrifugal) ventricular assist devices from July 2008 to September 2018 at Northwestern Memorial Hospital. Peri-operative prophylaxis from July 2008 to June 2013 was vancomycin, rifampin, ciprofloxacin, and fluconazole, and vancomycin plus cefuroxime from June 2013 to September 2018. VAD-specific and VAD-related Infections were classified according to ISHLT 2013 definitions. Patients were screened for methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis or Enterococcus faecium, or extended-spectrum β-lactamase producing Gram-negative rods. Statistics were performed using IBM® SPSS Statistics version 25.0. Comparative statistics were performed using two-sided Fisher’s exact test with a P-value of <0.05 deemed significant. Results A total of 89 patients with ventricular assist devices developed either VAD-specific or VAD-related infections and were included in the analysis. 77% of patients (n = 66) were colonized with an MDRO; 29% (n = 25) with MRSA, 73% (n = 63) with VRE, and 24% (n = 21) with an ESBL organism. 17.9% (n = 16) of patients who went on to develop infection was secondary to MDROs. Colonization with an MDRO was associated with subsequent infection secondary to these organisms (P = 0.018). Conclusion Colonization rates of multidrug-resistant organisms in the VAD population are high. VRE rates were significantly higher than MRSA or ESBL, possible as a result of peri-implantation utilization of vancomycin as surgical site prophylaxis. MDRO colonization was associated with progression to VAD-specific or VAD-related Infection. Disclosures All authors: No reported disclosures.

Poor outcomes resulting from ventricular assist devices implanted in hospitals without dedicated ventricular assist device programs

2011 ◽  
Vol 2 (1) ◽  
pp. 11826574 ◽  
Author(s):  
Anelechi C. Anyanwu ◽  
Sean Pinney ◽  
Kimmarie Hammond ◽  
Kimberly Ashley ◽  
David H. Adams
Keyword(s):  
Ventricular Assist Device ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Poor Outcomes

scholarly journals Extended right posterior liver sectionectomy for HCC in a patient with left ventricular assist device—a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Lea Timmermann ◽  
Moritz Schmelzle ◽  
Evgenij Potapov ◽  
Marcus Müller ◽  
Christian Lojewski ◽  
...  
Keyword(s):  
Case Report ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Abstract Successful implementation of left ventricular assist devices lead to a prolonged survival in patients with chronic terminal heart failure. Thus, patients with pre-existing left ventricular assist devices with abdominal comorbidities requiring abdominal surgery, e.g. for malignancy, are upcoming issues. We carried out a major liver resection for hepatocellular carcinoma in a patient with pre-existing left ventricular assist device. The importance of this case report is that it outlines the significance of oncologic resections in patients with left ventricular assist devices as an upcoming issue and provides an interdisciplinary approach.

scholarly journals Endovascular treatment of stroke in children under 2 years with heart failure and ventricular assist device

2019 ◽  
Vol 25 (5) ◽  
pp. 516-520
Author(s):  
Elvira Jiménez Gómez ◽  
Isabel Bravo Rey ◽  
Rafael Oteros Fernández ◽  
Fernando Delgado Acosta
Keyword(s):  
Endovascular Treatment ◽  
Left Hemisphere ◽  
Ventricular Assist Device ◽  
Clinical Results ◽  
Ventricular Assist Devices ◽  
Cardiac Transplant ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Hemisphere Stroke

Introduction Strokes in children are characterised by a high mortality rate while, at the same time, the low number of cases makes it difficult to gain practical experience. As heart disease is the most common risk factor, and as more and more cardiological interventions are being carried out, an increase in the incidence of paediatric stroke is expected. In some cases a transplant is required. While waiting for a donor, the use of ventricular assist devices may be necessary. These present with a high rate of neurological complications. We present two cases of children under 2 years of age awaiting heart transplantation supported by ventricular assist devices who had a stroke which was treated by endovascular techniques. Case 1: A 16-month-old boy with restrictive cardiomyopathy who was listed for a cardiac transplant. At 20 months he required an implantation of an external biventricular support device (Berlin Heart) and had a left hemisphere stroke at 23 months. An intra-arterial approach was used and produced good clinical results. One month later, a heart transplant was performed successfully. Case 2: An 18-month-old girl with non-compacted dilated cardiomyopathy included in the cardiac transplant programme and in need of a Levitronix Centrimag ventricular assist device presented with an acute left hemisphere stroke at 23 months. An intra-arterial procedure was carried out leading to positive clinical results except for residual right hypertonia. Seven months later she received her transplant. Conclusion As a result of the difficulty in performing arterial puncture, the small vessel calibre and the limitation in the use of iodated contrast, there are certain limitations to endovascular treatment of strokes in children that can lead to complications. A multidisciplinary approach to managing such cases would be helpful.

A simplified Cardiopulmonary Bypass Technique for Animal Experiments on Implantable Ventricular Assist Devices

2002 ◽  
Vol 25 (2) ◽  
pp. 147-150
Author(s):  
W.G. Kim ◽  
W.Y. Lee ◽  
B.H. Lee ◽  
H.S. Cho
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Assist Device ◽  
Animal Experiments ◽  
Venous Drainage ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Descending Aorta ◽  
Assist Devices ◽  
Bypass Technique

We have developed and report on a simplified cardiopulmonary bypass technique for experiments on implantable ventricular assist devices in calves. We used an electromechanical implantable ventricular assist device with a double cylindrical cam in three calves. Cannulas for the ventricular assist system were designed to be inserted between the left atrium and the descending aorta. We used the outflow cannula of the ventricular assist device, anastomosed to the descending aorta, as a temporary arterial return route for the cardiopulmonary bypass. A cannula for venous drainage was iserted into the right ventricle through the pulmonary artery. There were no problems related to the procedure and the cardiopulmonary bypass was succesful. In conclusion, this simplified cardiopulmonary bypass technique without neck incision in calves, as used in developmental work involving implantable ventricular assist devices, can be reliably performed.

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