scholarly journals The use of enoxaparin as bridge to therapeutic INR after LVAD implantation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zubair Shah ◽  
Ioannis Mastoris ◽  
Prakash Acharya ◽  
Aniket S. Rali ◽  
Moghni Mohammed ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Index Admission ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Bleeding Events ◽  
Ventricular Assist ◽  
Safety Outcome

Abstract Background Left ventricular assist devices (LVAD) have been increasingly used in the treatment of end-stage heart failure. While warfarin has been uniformly recommended in the long-term as anticoagulation strategy, no clear recommendation exists for the post-operative period. We sought to evaluate the feasibility of enoxaparin in the immediate and early postoperative period after LVAD implantation. Methods This is a two-center, retrospective analysis of 250 consecutive patients undergoing LVAD implantation between January 2017 and December 2018. Patients were bridged postoperatively to therapeutic INR by either receiving unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were followed while inpatient and for 3 months after LVAD implantation. The efficacy outcome was occurrence of first and subsequent cerebrovascular accident while safety outcome was the occurrence of bleeding events. Length of stay (LOS) was also assessed. Results Two hundred fifty and 246 patients were analyzed for index admission and 3-month follow up respectively. No statistically significant differences were found between the two groups in CVA (OR = 0.67; CI = 0.07–6.39, P = 0.73) or bleeding events (OR = 0.91; CI = 0.27–3.04, P = 0.88) during index admission. Similarly, there were no differences at 3 months in either CVAs or bleeding events (OR = 0.85; 0.31–2.34; p = 0.76). No fatal events occurred during the study follow-up period. Median LOS was significantly lower (4 days; p = 0.03) in the LMWH group. Conclusions LMWH in the immediate and early postoperative period after LVAD implantation appears to be a concurrently safe and efficacious option allowing earlier postoperative discharge and avoidance of recurrent hospitalizations due to sub-therapeutic INR.

scholarly journals Retrospective 1-year outcome follow-up in 200 patients supported with HeartMate 3 and HeartWare left ventricular assist devices in a single centre

2020 ◽  
Vol 57 (6) ◽  
pp. 1160-1165 ◽  
Author(s):  
Marcus Mueller ◽  
Christoph Hoermandinger ◽  
Gregor Richter ◽  
Johanna Mulzer ◽  
Dmytro Tsyganenko ◽  
...  
Keyword(s):  
Group Versus ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Systematic Bias ◽  
Left Ventricular Assist Devices ◽  
Single Centre ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Abstract OBJECTIVES Various trials have assessed the outcome and reliability of the HeartWare HVAD (HW) and HeartMate 3 (HM3) left ventricular assist devices. A direct comparison of clinical outcomes and of the complication profile of these 2 left ventricular assist devices is lacking. We present a retrospective analysis of patients supported with HM3 and HW as a left ventricular assist device. METHODS Preoperative data, complications and outcomes including a 1-year follow-up of patients supported with the HM3 and HW in a single centre were retrospectively analysed. Both pumps were implanted on- or off-pump, employing standard and minimally invasive techniques. For logistic reasons, the 2 device types were implanted in an alternating manner, thereby reducing the systematic bias for pump selection. We considered this to be an appropriate approach, as no differences in respect of survival or the complication profile of the two device types have been demonstrated. Anticoagulation was similar in patients with both pumps according to our anticoagulation protocol, with a target international normalized ratio of 2.5–3.0, a home monitoring system and blood pressure management with a mean arterial target pressure of 70–80 mmHg. RESULTS Between October 2015 and April 2017, 100 patients underwent implantation of the HW and 100 patients underwent implantation of the HM3. The median time on the device was 0.98 years (range 0–2.23 years). The median age was 58.5 (51–65) versus 57 (49–64) years (P = 0.456); the number of male patients was 87 versus 88 (P = 0.831). Of the HW patients, 73% were rated as having an INTERMACS level I or II, compared to 57% of the HM3 patients (P = 0.018). There were no further differences in preoperative data. A total of 14 patients had pre-, intra- or post-pump blood flow obstruction in the HW group versus 4 in the HM3 group [hazard ratio (HR) 2.5 (0.7–8.8), P = 0.103]. There were no differences regarding gastrointestinal bleeding [HR 1.25 (0.56–2.64), P = 0.624] or driveline infection (0.68 vs 0.8 events per patient-year, P = 0.0789). The incidence of ischaemic stroke was similar in both groups [HR 0.72 (0.25–2.09), P = 0.550]. Cerebral bleeding was more frequent in patients supported with HW [HR 6.79 (1.43–32.20), P = 0.016]. The incidence of cerebrovascular accidents, on the other hand, was similar in both groups [HR 1.85 (0.83–4.19), P = 0.13]. The incidence of haemocompatibility-related adverse events, however, was significantly higher in the HW group (113 points corresponding to 1.28 events per patient-year versus 69 points corresponding to 0.7 events per patient-year, P < 0.001). The 1-year survival was similar in both groups [62.2%, 95% confidence interval (CI) (0.53–0.73) vs 66.7%, 95% CI (0.58–0.767), P = 0.372]. CONCLUSIONS Our data show that the complication profile differs between the 2 pumps, but that early survival is comparable.

Non-pulsatile circulation with axial-flow left ventricular assist device preserves neurocognitive function

Perfusion ◽  
2010 ◽  
Vol 25 (4) ◽  
pp. 225-228 ◽  
Author(s):  
Helena Argiriadou ◽  
Kalliopi Megari ◽  
Polychronis Antonitsis ◽  
Mary H. Kosmidis ◽  
Christos Papakonstantinou ◽  
...  
Keyword(s):  
Axial Flow ◽  
Circulation Pattern ◽  
Neurocognitive Function ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
New Generation

Concerns about the potential impact of the non-pulsatile circulation pattern generated by the new generation axial-flow left ventricular assist devices on neurocognitive function led us to evaluate a patient in whom a Jarvik 2000 pump was implanted. We assessed the patient’s baseline neurocognitive function preoperatively as well as at 1-month and 6-month follow-up, using a comprehensive battery of neuropsychological tests. A slight improvement in circumscribed neurocognitive domains was noted, with no evidence of further decline at the end of a 6-month follow-up period.

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.

Sign in / Sign up

Export Citation Format

Share Document