scholarly journals The role of Heart Failure Team in managing Mechanical Circulatory Support in a Swiss low-volume institution

2018 ◽  
Vol 21 (4) ◽  
pp. E257-E262 ◽  
Author(s):  
Piergiorgio Tozzi ◽  
Anna Nowacka ◽  
Roger Hullin ◽  
Patrick Yerly ◽  
Matthias Kirsch
Keyword(s):  
Heart Failure ◽  
High Volume ◽  
Clinical Results ◽  
Circulatory Support ◽  
Heart Team ◽  
Kaplan Meier ◽  
Procedural Volume ◽  
Low Volume ◽  
Ongoing Support

Background. Outcomes after VAD implantation may be dependent on institutional procedural volume. Specifically, it is claimed that high volumes are associated to better clinical results. This study aims to determine if this procedure is safe even in low‐volume center. Methods. Single center, retrospective cohort study, including Heart Failure consecutive patients who received long-term VAD from 2007 to 2017. Primary outcome was survival to transplant or ongoing MCS at 1-year. Survival analysis was performed using Kaplan-Meier method. Results. Data concerning 50 adult patients were examined; 35 male (70%), mean age 49+/- 8 years. VAD was implanted as BTT in 48 and DT in 2. Devices implanted were: HeartMate II in 18 (36%), HeartWare in 20 (40%), HeartMate III in 12 (24%). Outcomes were: Death in 16 (32%), heart transplant in 24 (48%), uneventful ongoing support 10 (20%). Data were analysed according to pre and post-heart team creation and 2 groups of 25 patients were identified: 2007-2013 (mean INTERMACS level 3.1) and 2014-2017 (mean INTERMACS level 3.9) showing 1-year survival of 56% and 80% respectively. According to the type of device implanted, 3 groups were identified: HMII = 18 (mean INT. level 2.7), HW=20 (mean INT. level 3.3) and HMIII=12 (mean INT. level 3.7), showing survival of 52%, 78% and 91% respectively. Conclusions. Long term MCS can be implanted at low-volume centers with survival rate not inferior to high volume centers. A Heart team specifically trained in heart failure is probably more important than institutional volume in determining outcomes after VAD implantation.

Institutional volume affects long-term survival following lung transplantation in the USA

2019 ◽  
Vol 56 (2) ◽  
pp. 271-276 ◽  
Author(s):  
Arman Kilic ◽  
Thomas G Gleason ◽  
Hiroshi Kagawa ◽  
Ahmet Kilic ◽  
Ibrahim Sultan
Keyword(s):  
Lung Transplantation ◽  
High Volume ◽  
Term Survival ◽  
Long Term Survival ◽  
Kaplan Meier ◽  
The Usa ◽  
Institutional Volume ◽  
Low Volume ◽  
The Impact

Abstract OBJECTIVES The aim of this study was to evaluate the impact of institutional volume on long-term outcomes following lung transplantation (LTx) in the USA. METHODS Adults undergoing LTx were identified in the United Network for Organ Sharing registry. Patients were divided into equal size tertiles according to the institutional volume. All-cause mortality following LTx was evaluated using the risk-adjusted multivariable Cox regression and the Kaplan–Meier analyses, and compared between these volume cohorts at 3 points: 90 days, 1 year (excluding 90-day deaths) and 10 years (excluding 1-year deaths). Lowess smoothing plots and receiver-operating characteristic analyses were performed to identify optimal volume thresholds associated with long-term survival. RESULTS A total of 13 370 adult LTx recipients were identified. The mean annual centre volume was 33.6 ± 20.1. After risk adjustment, low-volume centres were found to be at increased risk for 90-day mortality, [hazard ratio (HR) 1.56, P < 0.001], 1-year mortality excluding 90-day deaths (HR 1.46, P < 0.001) and 10-year mortality excluding 1-year deaths (HR 1.22, P < 0.001). These findings persisted when the centre volume was modelled as a continuous variable. The Kaplan–Meier analysis also demonstrated significant reductions in survival at each of these time points for low-volume centres (each P < 0.001). The 10-year survival conditional on 1-year survival was 37.4% in high-volume centres vs 28.0% in low-volume centres (P < 0.001). The optimal annual volume threshold for long-term survival was 26 LTx/year. CONCLUSIONS The institutional volume impacts long-term survival following LTx, even after excluding deaths within the first post-transplant year. Identifying the processes of care that lead to longer survival in high-volume centres is prudent.

Design of a Muscle-Powered Extra-Aortic Counterpulsation Device for Long-Term Circulatory Support

2017 ◽  
Author(s):  
Edgar Aranda-Michel ◽  
Jooli Han ◽  
Dennis R. Trumble
Keyword(s):  
Heart Failure ◽  
Ventricular Assist Devices ◽  
Blood Pump ◽  
Circulatory Support ◽  
Pump Design ◽  
Persistent Problem ◽  
Therapeutic Benefits ◽  
Increased Risk ◽  
Low Volume

While great strides continue to be made in the treatment of congestive heart failure using mechanical ventricular assist devices (VADs), several longstanding difficulties associated with pumping blood continue to limit their long-term use. Among the most troublesome has been the persistent risk of clot formation at the blood-device interface, which generally requires VAD recipients to undergo costly — and potentially dangerous — anticoagulation therapy for the duration of the implant. Another serious and persistent problem with long-term use of these pumps is the increased risk of infection associated with the use of percutaneous drivelines. To address these issues we are currently exploring a new approach to blood pump design that aims to solve both these problems by avoiding them altogether. Toward that end, we propose to harness the body’s own endogenous energy stores in order to eliminate the need to transmit energy across the skin. Further, we intend to transfer the energy from this internal power source to the circulation without contacting the blood to obviate the thrombogenic risks imposed by devices placed directly into the bloodstream. To power the implant we will employ a device developed previously by our group called a muscle energy converter (MEC), shown in Figure 1. The MEC is, in essence, an implantable hydraulic actuator powered by the latissimus dorsi (LD) muscle with the capacity to transmit up to 1.37 joules of contractile work per stroke [1]. By training the muscle to express fatigue-resistant oxidative fibers and stimulating the LD to contract in coordination with the cardiac cycle, the MEC captures and transmits this contractile energy as a high-pressure low-volume (5 cc) hydraulic pulse that can be used, in principle, to actuate an implanted pulsatile blood pump. The goal of this research is to use the low-volume output of the MEC to drive a polymer-based aortic compression device for long-term circulatory support. In this context it is important to note that the idea of applying a counterpulsation device around the ascending aorta is not new. Indeed, this approach has been validated by clinical trials recently completed by Sunshine Heart Inc. showing that displacing 20 cc of blood at the aortic root has significant therapeutic benefits [2]. Unfortunately, while the pneumatic ‘C-Pulse’ device solves the blood-contacting problem, it suffers from the same limitations as traditional VADs — i.e., driveline infections. The device described here achieves the same volumetric displacement as the SSH device via geometric amplification of MEC outputs. Thus, through this mechanism we believe the low-volume power output of the MEC can be used to support heart failure patients while addressing the major limitations associated with long-term VAD use.

scholarly journals Complications and outcome of the long-term use of the intra-aortic balloon pump in patients with end-stage heart failure

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Stratinaki ◽  
E Bousoula ◽  
I Malakos ◽  
M Zymatoura ◽  
E Fountas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pharmacological Therapy ◽  
Circulatory Support ◽  
Intra Aortic Balloon Pump ◽  
Funding Sources ◽  
Iabp Support ◽  
End Stage Heart Failure ◽  
The Mean ◽  
End Stage

Abstract Funding Acknowledgements Type of funding sources: None. Background Intra-aortic balloon pump (IABP) can be used as circulatory support in order to stabilize haemodynamically compromised patients as either a bridge to therapy or to further mechanical support. Based on the current literature its use should be limited to up to two weeks and there are not enough data regarding its long term use’s efficacy and possible complications. Purpose To review the possible complications of the long-term use of IABP Methods We restrospectively analysed the data from 24 consecutive patients with end-stage heart failure (ESHF) who received long-term IABP support and recorded the complications during their hospitalization as well as their outcome. Results 24 patients (14 male and 10 female) were included. In 5 of them ESHF was attributed to ischemic cardiomyopathy and the in 19 to dilated cardiomyopathy. Their mean age was 45.6+/-14 years. The mean duration of IABP support was 70.2 days (minimum 30days maximum 192 days). The mean ejection fraction (EF) was 20%. Regarding the pharmacological therapy, 12/24 patients were on dobutamine, 4/24 on dobutamine and milrinone and 8/24 on dobutamine and noradrenaline. Regarding the clinical course of these patients, 7/24 underwent heart transplantation, 2/24 managed to wean from IABP, 5/24 received left lentrivular assist device (LVAD), 6/24 received biventricular assist veice (BiVAD) and 4/24 died. In terms of complications they were recorded as following : infection 7/24, bleeding 3/24, thrombosis 4/24, heparin-induced thrombocytopenia(HIT) 5/24, hematoma 4/24, ischemia 0/24 and rupture 1/24. Conclusions   Although not indicated by the current guidelines, long term IABP can be used as a relatively safe  circulatory support method.

Reinforcement Rings for Deficient Acetabular Bone in Revision Surgery: Long-Term Results

1997 ◽  
Vol 7 (2) ◽  
pp. 57-64 ◽  
Author(s):  
E. Garcia-Cimbrelo ◽  
J. Alonso-Biarge ◽  
J. Cordero-Ampuero
Keyword(s):  
Revision Surgery ◽  
Clinical Results ◽  
Long Term Results ◽  
Cumulative Probability ◽  
Metal Ring ◽  
Kaplan Meier ◽  
Medial Migration ◽  
Cemented Cup

This study analyzes the long-term results of 23 metal ring supports used in revision surgery since 1979. Only a metallic ring and a cemented cup were used in this series. Bone grafts and cementless cups were excluded from this study. One deep infection was excluded from the follow-up study. In the 22 cases analyzed, the mean follow-up period was 10 years for all cases and 12.2 years for unrevised cases. Bone defects according to the AAOS classification were: Grade 1, 1 case, Grade 2, 1 case, Grade 3, 10 cases, and Grade 4, 10 cases. A Müller ring was indicated in an anterior or medial wall defect (12 cases) and a Burch-Schneider ring was indicated in an anterior or posterior column defect or in pelvic discontinuity (10 cases). The clinical results were good in 8 cases, fair in 8 cases, and poor in 6 cases. Six cases were rerevised or removed, resulting in a total cumulative probability of rerevison or removal of 23.8% after 10 years according to the Kaplan-Meier analysis. Postoperatively, 18 cases had neutral rings, 2 cases had horizontal rings, and 2 cases had vertical rings. Radiological cup migration was found in 12 cases, resulting in a total cumulative probability of migration of 56.8% after 13 years according to the Kaplan-Meier analysis. Changes in the acetabular angle were present in 2 cases, vertical migration in 12 cases, and medial migration in 10 cases. Our data suggest that the metal ring and cemented cup alone could be used for salvage surgery in elderly patients and in low-demand patients. Possibly, adding bone graft could improve these results.

Ventricular assist devices in the ICU

2016 ◽  
Author(s):  
Alain Combes
Keyword(s):  
Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Short And Long Term ◽  
Alternative Approaches ◽  
The Subject

Despite major advances in pharmacological therapies for heart failure with left ventricular pump dysfunction, the number of hospitalizations for decompensated heart failure is increasing, with most patients ultimately dying of disease complications. Heart transplantation remains the only treatment providing substantial individual benefit for patients with advanced disease. However, fewer than 3000 organ donors are available worldwide per year, limiting its overall impact. Therefore, alternative approaches, such as mechanical circulatory support have been the subject of intense research over recent decades. The development of mechanical circulatory devices parallels that of cardiac surgery and cardiac transplantation. Current practice and the development of economically affordable short-term devices have resulted in updated indications for mechanical circulatory assistance for both short- and long-term support.

scholarly journals The role of long-term mechanical circulatory support in patients with advanced heart failure

2020 ◽  
Vol 28 (S1) ◽  
pp. 115-121
Author(s):  
S. E. A. Felix ◽  
N. de Jonge ◽  
K. Caliskan ◽  
O. Birim ◽  
K. Damman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Advanced Heart Failure ◽  
Circulatory Support

scholarly journals Neurological Events During Long-Term Mechanical Circulatory Support for Heart Failure

Circulation ◽  
2004 ◽  
Vol 109 (20) ◽  
pp. 2423-2427 ◽  
Author(s):  
Ronald M. Lazar ◽  
Peter A. Shapiro ◽  
Brian E. Jaski ◽  
Michael K. Parides ◽  
Robert C. Bourge ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Circulatory Support

scholarly journals Mortality and Survival Rates after Elective Hepatic Surgery in a Low-Volume Centre Are Comparable to Those of High-Volume Centres

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
I. E. Nygård ◽  
K. Lassen ◽  
J. Kjæve ◽  
A. Revhaug
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Survival Rates ◽  
Disease Free Survival ◽  
High Volume ◽  
Colorectal Metastases ◽  
Rank Test ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Low Volume

Background. Over the last decades, liver resection has become a frequently performed procedure in western countries because of its acceptance as the most effective treatment for patients with selected cases of metastatic tumours. The purpose of this study was to evaluate the results after hepatic resections performed electively in our centre since 1979 and compare the results to those of larger high-volume centres. Methods. Medical records of all patients who underwent liver resection from January 1979 to December 2011 were reviewed. Disease-free survival and overall survival were determined by Kaplan-Meier analysis. Risk factors for complications were tested with the log-rank test and the Cox proportional hazard model. Complications were classified according to the modified Clavien classification system. Results. 290 elective liver resections were performed between January 1979 and December 2011. There were 171 males (59.0%) and 119 females (41.0%). Median age was 63 years, range 1–87. Overall survival ranged from 0 to 383 months, with a median of 31 months. Five-year survival rate for patients who underwent liver resection for colorectal metastases was 35.8% (34/95). Discussion. Hepatic resections are safely performed at a low-volume centre, with regard to perioperative- and in-house mortality and 5-year survival rates.

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