Sternal sparing bilateral symmetrical thoracotomy for implantation of left ventricular assist device

Heart Transplant ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Reopening the chest in patients with left ventricular assist devices at the time of a heart transplant is challenging due to adhesions and the possibility of injury to vital structures. The sternal sparing bilateral thoracotomy approach utilized to implant a left ventricular assist device minimizes the chances of such injuries and offers a cosmetically better outcome. We demonstrate a procedure for implanting a left ventricular assist device in a 54-year-old man diagnosed with dilated cardiomyopathy who suffered rapid decompensation despite maximum medical therapy.

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

The International Journal of Artificial Organs ◽

10.1177/0391398818806162 ◽

2018 ◽

Vol 42 (3) ◽

pp. 113-124 ◽

Cited By ~ 6

Author(s):

Matteo Selmi ◽

Wei-Che Chiu ◽

Venkat Keshav Chivukula ◽

Giulio Melisurgo ◽

Jennifer Ann Beckman ◽

...

Keyword(s):

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Assist Devices ◽

Pump Thrombosis ◽

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.

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

Texas Heart Institute Journal ◽

10.14503/thij-14-4654 ◽

2015 ◽

Vol 42 (6) ◽

pp. 572-574

Author(s):

Heidi J. Reich ◽

Aamir Shah ◽

Babak Azarbal ◽

Jon Kobashigawa ◽

Jaime Moriguchi ◽

...

Keyword(s):

Left Ventricular ◽

Bridge To Transplantation ◽

Assist Device ◽

Ventricular Assist ◽

Device Malfunction ◽

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.

Management of a Pediatric Patient With a Left Ventricular Assist Device and Symptomatic Acquired von Willebrand Syndrome Presenting for Orthotopic Heart Transplant

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253220949386 ◽

2020 ◽

Vol 24 (4) ◽

pp. 355-359

Author(s):

Kaitlin M Flannery ◽

Komal Kamra ◽

Katsuhide Maeda ◽

Paul Shuttleworth ◽

Christopher Almond ◽

...

Keyword(s):

Heart Transplant ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Acquired Von Willebrand Syndrome ◽

Left Ventricular Assist ◽

Von Willebrand

We present the successful perioperative management of an 11-year-old patient presenting for heart transplant with a left ventricular assist device, symptomatic acquired von Willebrand syndrome, and recent preoperative intracranial hemorrhage. A brief review of the pathophysiology of acquired von Willebrand syndrome is included. As the number of pediatric patients supported with ventricular assist devices continues to increase, the management of symptomatic acquired von Willebrand syndrome during the perioperative period is an important consideration for anesthesiologists.

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

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa307 ◽

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 ◽

Assist Devices ◽

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.

Gender difference with the use of percutaneous left ventricular assist device in patients undergoing complex high-risk percutaneous coronary intervention: From pVAD Working Group

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617745790 ◽

2018 ◽

Vol 8 (4) ◽

pp. 369-378 ◽

Cited By ~ 4

Author(s):

Rajkumar Doshi ◽

Avneet Singh ◽

Rajiv Jauhar ◽

Perwaiz M Meraj

Keyword(s):

High Risk ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Left Ventricular Assist ◽

Males And Females

Background: The interventional treatment of complex high-risk indicated patients is technically difficult and can result in poor outcomes. Thus, percutaneous left ventricular assist devices are being increasingly used to provide hemodynamic support. No data is available comparing male and female for Complex High-risk Indicated Patients treated with percutaneous left ventricular assist devices. Our goal was to evaluate in-hospital as well as short term outcomes comparing males and females. Methods: There were 160 complex high-risk indicated patients with percutaneous left ventricular assist device use who were not in cardiogenic shock. A total of 132 male and 28 female patients were included. Ejection fraction below 35% with one additional criterion such as use of atherectomy device or treatment on unprotected left main disease or multi-vessel disease were our inclusion criteria. An Impella 2.5 or Impella CP (Abiomed Inc.) device was used as a left ventricular support device. Results: There was no difference in in-hospital mortality between the genders after performing a propensity score matched analysis (8.3% vs. 12.5%, p=0.54). Secondary outcomes of myocardial infarction, cardiogenic shock, congestive heart failure, dysrhythmia, major adverse cardiac events and composite of all complications were higher in males. Furthermore, 30-day survival was similar in males and females (88.9% vs. 87.5%, p=0.31). In addition, worse complications rates and survival were noted in patients with incomplete revascularization compared with those patients with complete revascularization in both gender. Conclusion: This study demonstrated no gender difference in clinical outcomes when using percutaneous left ventricular assist device support for the treatment of complex high-risk indicated patients. Overall, males had higher secondary outcomes compared with females with no difference in in-hospital mortality or 30-day survival rates.

Kinking of the Outflow Graft, Consequent Ventricular Tachycardia, and the Need for Reoperation in a Patient with Left Ventricular Assist Device

The Heart Surgery Forum ◽

10.1532/hsf.1848 ◽

2017 ◽

Vol 20 (4) ◽

pp. 139

Author(s):

Dusko Terzic ◽

Emilija Nestorovic ◽

Svetozar Putnik ◽

Dejan Markovic ◽

Miljko Ristic

Keyword(s):

Ventricular Tachycardia ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Left Ventricular Assist ◽

Outflow Graft

Background: Left ventricular assist devices (LVAD) have become a lifesaving solution for patients awaiting heart transplantation as well as an option to support the failing hearts of non-transplant candidates as a lifelong, or destination therapy (DT). Improvements in LVAD design have enabled greater durability and broader patient applicability, but not without complications. Ventricular arrhythmias in LVAD patients were considered benign in the early days of LVADs, but today are increasingly recognized for their harmful impact on morbidity and quality of life.Case presentation: We describe a 53-year-old male who underwent HeartWare left ventricular assist device (HVAD) implantation. During the postoperative period, the patient experienced ventricular tachycardia (VT) during a coughing episode, later found on CT to be due to significant angulation of the outflow graft. Following reoperation to shorten the outflow graft, the patient returned to hemodynamic stability, without VT or other arrhythmias.Conclusions: Innovative strategies in VT prevention and improved clinical outcomes in LVAD patients may be the result of better understanding of characteristics that predispose these patients to VT. This case report showed that an excessively long outflow graft with considerable kinking created significant VT, but reoperation to correct the length of the graft mitigated further VT complications.

Implication of Hemodynamic Assessment during Durable Left Ventricular Assist Device Support

Medicina ◽

10.3390/medicina56080413 ◽

2020 ◽

Vol 56 (8) ◽

pp. 413

Author(s):

Teruhiko Imamura ◽

Nikhil Narang

Keyword(s):

Heart Failure ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Hemodynamic Assessment ◽

Durable left ventricular assist device therapy has improved survival in patients with advanced heart failure refractory to conventional medical therapy, although the readmission rates due to device-related comorbidities remain high. Left ventricular assist devices are designed to support a failing left ventricle through relief of congestion and improvement of cardiac output. However, many patients still have abnormal hemodynamics even though they may appear to be clinically stable. Furthermore, such abnormal hemodynamics are associated with an increased risk of future adverse events including recurrent heart failure, gastrointestinal bleeding, stroke, and pump thrombosis. Correction of residual hemodynamic derangements post-implantation may be a target in improving longitudinal clinical outcomes during left ventricular assist device support. Automatic and timely device speed adjustments considering a patients’ hemodynamic status (i.e., with a smart pump) are potential improvements in forthcoming devices.

Biomarkers in Advanced Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.119.006840 ◽

2020 ◽

Vol 13 (7) ◽

Author(s):

Rahul S. Loungani ◽

Robert J. Mentz ◽

Richa Agarwal ◽

Adam D. DeVore ◽

Chetan B. Patel ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Assist Device ◽

Ventricular Assist ◽

Biomarkers have a well-defined role in the diagnosis and management of chronic heart failure, but their role in patients with left ventricular assist devices and cardiac transplant is uncertain. In this review, we summarize the available literature in this patient population, with a focus on clinical application. Some ubiquitous biomarkers, for example, natriuretic peptides and cardiac troponin, may assist in the diagnosis of left ventricular assist device complications and transplant rejection. Novel biomarkers focused on specific pathological processes, such as left ventricular assist device thrombosis and profiling of leukocyte activation, continue to be developed and show promise in altering the management of the advanced heart failure patient. Few biomarkers at this time have been assessed with sufficient scrutiny to warrant broad, universal application, but encouraging limited data and large potential for impact should prompt ongoing investigation.

Giant arteriovenous fistula after implantation of a percutaneous left ventricular assist device

VASA ◽

10.1024/0301-1526.38.2.190 ◽

2009 ◽

Vol 38 (2) ◽

pp. 190-192 ◽

Cited By ~ 1

Author(s):

Baldi ◽

Wolff ◽

Aschwanden ◽

Thalhammer ◽

Jaeger

Keyword(s):

Arteriovenous Fistula ◽

Vascular Complications ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Introduction: Percutaneous left ventricular assist devices are an important tool in the management of patients with severe cardiogenic shock. Limited experiences concerning vascular complications after long term implantation of these devices exist. We report on a large arteriovenous fistula after placement of a left ventricular assist device, which has not been described in the literature. The arteriovenous fistula was of clinical relevance because it represented a supplementary cardiac burden in a patient with impaired left ventricular function after a severe myocardial infarction.

Influence of left ventricular assist device pressure-flow characteristic on exercise physiology: Assessment with a verified numerical model

The International Journal of Artificial Organs ◽

10.1177/0391398819846126 ◽

2019 ◽

Vol 42 (9) ◽

pp. 490-499 ◽

Cited By ~ 5

Author(s):

Roland Graefe ◽

Andreas Henseler ◽

Reiner Körfer ◽

Bart Meyns ◽

Libera Fresiello

Keyword(s):

Flow Characteristic ◽

Left Ventricular ◽

Assist Device ◽

Pressure Flow ◽

Ventricular Assist ◽

Current left ventricular assist devices are designed to reestablish patient’s hemodynamics at rest but they lack the suitability to sustain the heart adequately during physical exercise. Aim of this work is to assess the performance during exercise of a left ventricular assist device with flatter pump pressure-flow characteristic and increased pressure sensitivity (left ventricular assist device 1) and to compare it to the performance of a left ventricular assist device with a steeper characteristic (left ventricular assist device 2). The two left ventricular assist devices were tested at constant rotational speed with a verified computational cardiorespiratory simulator reproducing an average left ventricular assist device patient response to exercise (EXE↑) and a left ventricular assist device patient with no chronotropic and inotropic response (EXE→). According to the results, left ventricular assist device 1 pumps a higher flow than left ventricular assist device 2 both at EXE↑ (6.3 vs 5.6 L/min) and at EXE→ (6.7 vs 6.1 L/min), thus it better unloads the left ventricle. Left ventricular assist device 1 increases the power delivered to the circulation from 0.63 W at rest to 0.67 W at EXE↑ and 0.82 W at EXE→, while left ventricular assist device 2 power shows even a minimal decrease. Left ventricular assist device 1 better sustains exercise hemodynamics and can provide benefits in terms of exercise performance, especially for patients with a poor residual left ventricular function, for whom the heart can hardly accommodate an increase of cardiac output.