scholarly journals Anticoagulation Monitoring in Left Ventricular Assist Device (LVAD) Patients

2017 ◽  
Author(s):  
Adam C. Sieg ◽  
Jennifer A. Gass ◽  
Phillip Weeks ◽  
Indranee Rajapreyar ◽  
Igor Gregoric
Keyword(s):  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Bridge To Transplant ◽  
Complex Patients ◽  
Therapeutic Anticoagulation ◽  
Left Ventricular Assist ◽  
Ongoing Assessment

The use of left ventricular assist devices (LVAD) provides a treatment strategy for advanced heart failure patients to prolong life and serve as a mediator (bridge to transplant) until an organ becomes available in patients considered suitable candidates for heart transplantation. The use of LVAD therapy is complicated by the constant risk of bleeding and thrombotic events. We reviewed and analyzed the effectiveness of our current heparin protocol with respect to overall anticoagulation and time in therapeutic range (TTR). Our analysis demonstrated that patients did not achieve therapeutic anticoagulation for at least 24 hours following initiation of heparin and that only 40% of the time patients were considered therapeutic. Even after patients achieved a therapeutic activated plasma thromboplastin time (aPTT) TTR was only approximately 50% with less than 50% of tests resulting within range. Individual centers should perform ongoing assessment of effectiveness of individual heparin protocol for LVAD patients to ensure anticoagulation is optimized in these highly complex patients.

Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices

2019 ◽  
pp. 277-280
Author(s):  
Shivtej Kaushal ◽  
Nunzio Gaglianello
Keyword(s):  
Gastrointestinal Bleeding ◽  
Continuous Flow ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Complex Patients ◽  
Therapeutic Anticoagulation ◽  
Left Ventricular Assist

Continuous-flow, left ventricular assist devices (CF-LVADs) offer multiple advantages over older, pulsatile left ventricular assist devices (PF-LVADs). However, the reported rate of gastrointestinal bleeding (GIB) for CF-LVADs is between 18% and 40%, which is two to four times higher than the GIB rate for PF-LVADs. Proposed pathophysiological mechanisms include the mechanics of continuous flow, abnormal platelet aggregation, and the need for therapeutic anticoagulation. Treatment can be challenging in these patients but should always be systematic and mainly involves endoscopic and medical therapy. Over the past decade, advances in both of these areas have allowed practioners to stabilize and treat these patients effectively. Given the advances in these therapies, GIB has become a manageable condition in these otherwise complex patients.

Abstract 225: Frequency and Assessment of Poor Global Outcome in Patients with Left Ventricular Assist Devices

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Timothy J Fendler ◽  
Michael E Nassif ◽  
Kevin F Kennedy ◽  
John A Spertus ◽  
Shane J LaRue ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Bridge To Transplant ◽  
Patient Reported ◽  
Left Ventricular Assist

Background: Left ventricular assist device (LVAD) therapy can improve survival and quality of life in advanced heart failure (HF), but some patients may still do poorly after LVAD. Understanding the likelihood of experiencing poorer outcomes after LVAD can better inform patients and calibrate their expectations. Methods: We analyzed patients receiving LVAD therapy from January 2012 to October 2013 at a single, high-volume, high-acuity center. We defined a poor global outcome at 1 year after LVAD as the occurrence of death, disabling stroke (precluding transplant), poor patient-reported health status (most recent KCCQ at 3, 6, or 12 months < 45, corresponding to NYHA class IV), or recurrent HF (≥2 HF readmissions post-implant). We compared characteristics of those with and without poor global outcome. Results: Among 164 LVAD recipients who had 1-year outcomes data, mean age was 56, 76.7% were white, 20.9% were female, and 85.9% were INTERMACS Profile 1 or 2 (cardiogenic shock or declining despite inotropes). Poor global outcome occurred in 58 (35.4%) patients at 1 year, of whom 37 (63.8%) died, 17 (29.3%) had a most recent KCCQ score < 45, 3 (5.2%) had ≥2 HF readmissions, and 1 (1.7%) had a disabling stroke (Figure). Eight of the patients who died also experienced one of the three other poor outcomes prior to death. Patients who experienced a poor global outcome were more likely to be designated for destination therapy (46.4% vs. 23.6%, p=0.01) than bridge to transplant, have longer index admissions (median [IQR]: 39 [24, 57] days vs. 25 [18, 35] days, p=0.003), and have major GI bleeding (44.2% vs. 27.7%, p=0.056), and were less likely to undergo LVAD exchange (0% vs. 12.3%, p=0.004). Conclusion: In this large, single-center study assessing global outcome after LVAD implantation, we found that about a third of all patients had experienced a poor global outcome at 1 year. While LVAD therapy remains life-saving and the standard of care for many patients with advanced heart failure, these findings could help guide discussions with eligible patients and families. Future work should compare patients’ pre-LVAD expectations with likely outcomes and create risk models to estimate the probability of poorer outcomes for individual patients using pre-procedural factors.

Computationally Sizing a Left Ventricular Assist Device Graft: A Pre-Procedural Tool to Improve Surgical Outcomes

2020 ◽  
Author(s):  
David A. Ramirez ◽  
Mikayle A. Holm ◽  
Andrew Shaffer ◽  
Paul A. Iaizzo
Keyword(s):  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Life Saving ◽  
Improve Life Expectancy ◽  
Left Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage

Abstract Implanting Left ventricular assist devices (LVADs) can be life saving therapies that improve life expectancy for the patients that receive it. The target patient population suffer from end-stage heart failure and are therefore susceptible to morbidities arising from a less than ideal surgical implantation. Importantly, the graft that carries the blood from the LVAD pump to the aorta needs to be sized accordingly so as to not cause any compounding complications. The current typical surgical method, is to perform a visual estimation at the time of implantation. This present study proposes a computational tool that utilizes pre-procedural imaging to better calculate the personalized, ideal, LVAD graft length.

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 Left Ventricular Assist Devices 101: Shared Care for General Cardiologists and Primary Care

2019 ◽  
Vol 8 (10) ◽  
pp. 1720 ◽  
Author(s):  
Aditi Singhvi ◽  
Barry Trachtenberg
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Left Ventricular ◽  
Urgent Care ◽  
Ventricular Assist Devices ◽  
Care Providers ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Complex Patients ◽  
Left Ventricular Assist

Ambulatory patients with a left ventricular assist device (LVAD) are increasing in number, and so is their life expectancy. Thus, there is an increasing need for care of these patients by non-LVAD specialists, such as providers in the emergency department, urgent care centers, community-based hospitals, outpatient clinics, etc. Non-LVAD specialists will increasingly come across LVAD patients and should be equipped with the knowledge and skills to provide initial assessment and management for these complex patients. These encounters may be for LVAD-related or unrelated issues. However, there are limited data and guidelines to assist non-LVAD specialists in caring for these complex patients. The aim of our review, targeting primary care providers (both inpatient and outpatient), general cardiologists, and other providers is to describe the current status of durable LVAD therapy in adults, patient selection, management strategies, complications and to summarize current outcome data.

scholarly journals Microaxial Flow Left Ventricular Assist Device as a Bridge to Transplantation after LVAD Malfunction

2015 ◽  
Vol 42 (6) ◽  
pp. 572-574
Author(s):  
Heidi J. Reich ◽  
Aamir Shah ◽  
Babak Azarbal ◽  
Jon Kobashigawa ◽  
Jaime Moriguchi ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Bridge To Transplantation ◽  
Assist Device ◽  
Ventricular Assist ◽  
Device Malfunction ◽  
Left Ventricular Assist

Evolving technology and improvements in the design of modern, continuous-flow left ventricular assist devices have substantially reduced the rate of device malfunction. As the number of implanted devices increases and as survival prospects for patients with a device continue to improve, device malfunction is an increasingly common clinical challenge. Here, we present our initial experience with an endovascular microaxial flow left ventricular assist device as a successful bridge to transplantation in a 54-year-old man who experienced left ventricular assist device malfunction.

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