scholarly journals Test Procedure for a New Type of a Ventricular Assist Device Based on a Viscous Friction Pump

2020 ◽  
Vol 13 (3) ◽  
pp. 256-261
Author(s):  
Maksim Zhulkov ◽  
Alexander Golovin ◽  
Alexander Grenaderov ◽  
Vitaliy Tsirikhov ◽  
Azat Sabetov ◽  
...  
Keyword(s):  
Ventricular Assist Device ◽  
Test Procedure ◽  
Viscous Friction ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Laboratory Animals ◽  
Implantation Technique ◽  
Assist Device ◽  
Ventricular Assist ◽  
Mini Pigs

Introduction. Currently, the possibility of effective correction of multiple organ failure and increasing the life expectancy of patients with critical heart failure using the ventricular assist devices (VAD) is absolutely evidenced. The development of alternative analogues of such devices produced within the country has been an urgent problem for many decades. The design of this machine requires the development of a protocol for carrying out complex biomedical studies on the biocompatibility and safety of the new device.The aim of the study was to develop a protocol for testing and conducting comprehensive biomedical biocompatibility studies of a new ventricular assist device in an acute animal experiment.Materials and methods. The study to develop a technique for implanting a left-ventricular assist device (LVAD) in an acute experiment included female mini-pigs, weighed 40-60 kg. In a series of acute experiments, 5 implantations of a disk pump as a LVAD were performed with a maximum observation period equal 6 hours.Results. In the series of acute experiments, an implantation technique was developed and the fundamental possibility of a viscous friction pump application as a ventricular assist device was evidenced. In all experiments (n = 5), the average level of free hemoglobin did not exceed 2.6 mg%, which supports safety of performance of the viscous friction pump regarding blood erythrocytes. None of the experiments recorded episodes of pump shut-off or breakdown.Conclusions. The series of acute experiments on mini-pigs helped reveal a number of anatomical and physiological features of this animal species that significantly complicated implementation of persistent observation. However, the developed experimental LVAD test methodology can be recommended for use in further chronic experiments on large laboratory animals (calves).

scholarly journals Optimization with levosimendan improves outcomes after left ventricular assist device implantation

2019 ◽  
Vol 57 (1) ◽  
pp. 176-182
Author(s):  
Sinan Sabit Kocabeyoglu ◽  
Umit Kervan ◽  
Dogan Emre Sert ◽  
Mehmet Karahan ◽  
Emre Aygun ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Left Ventricular Assist ◽  
Right Ventricular Assist Device

Abstract OBJECTIVES The aim of this study was to examine the haemodynamic effects of preoperative levosimendan infusion in patients who underwent left ventricular assist device implantation and evaluate the prognoses. METHODS Between May 2013 and October 2018, 85 adult patients who underwent left ventricular assist device implantation were included; 44 and 41 patients suffered from dilated cardiomyopathy and ischaemic cardiomyopathy, respectively. Patients were divided into 2 groups: group A (58 patients) included those who received levosimendan infusion in addition to other inotropes and group B (27 patients) included those who received inotropic agents other than levosimendan. Levosimendan infusion was started at a dose of 0.1 µg⋅kg−1⋅min−1 for a maximum of 48 h without a bolus. The primary outcome was early right ventricular failure (RVF). The secondary outcomes were in-hospital mortality, need for right ventricular assist device, late RVF and recovery of end-organ functions. The safety end points of levosimendan included hypotension, atrial fibrillation, ventricular tachycardia or fibrillation and resuscitated cardiac arrest. RESULTS Patient characteristics were similar in both groups. No significant differences between groups were observed in the rates of early mortality, RVF, need for right ventricular assist device, cardiopulmonary bypass time and intensive care unit stay. Survival rates at 30 days, 1 year and 3 years and freedom from late RVF were similar between the groups. Administration of levosimendan was safe, generally well-tolerated and not interrupted because of side effects. CONCLUSIONS Levosimendan therapy was well-tolerated in patients who received permanent left ventricular assist devices. Combined preoperative therapy with inotropes and levosimendan significantly improves end-organ functions.

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 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.

scholarly journals Širdies nepakankamumo gydymas implantuojant dirbtinį skilvelį INCOR

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Kęstutis Ručinskas ◽  
Saulius Miniauskas ◽  
Gintaras Rasimavičius ◽  
Rimantas Bubulis ◽  
Stanislovas Stankevič ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
University Hospital ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Key Words Heart ◽  
Key Words Heart Failure ◽  
Vilnius University

Kęstutis Ručinskas1, Saulius Miniauskas1, Gintaras Rasimavičius1, Rimantas Bubulis2, Stanislovas Stankevič2, Vaclovas Jurkuvėnas2, Gitana Žemaitytė3, Vytė Valerija Maneikienė3, Vytautas Sirvydis1, Aleksandras Taucevičius41 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Anesteziologijos,intensyviosios terapijos ir skausmo gydymo centras, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius4 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Dirbtinis implantuojamas pastovios tėkmės kairysis skilvelis INCOR Vilniaus universiteto Širdies chirurgijos centre naudojamas nuo 2003 metų. Pacientams, kuriems nustatytas kraštutinis širdies nepakankamumas, implantuota 14 dirbtinių skilvelių. Po prijungimo 9 pacientai buvo išrašyti į namus, 4 iš jų sulaukė širdies persodinimo operacijos. Šiuo metu ambulatoriškai stebimi 4 pacientai, kuriems implantuotas INCOR skilvelis. Bendras pacientų stebėjimo laikas yra daugiau kaip 8,5 metų. Dirbtinio skilvelio INCOR implantacija yra labai efektyvus atrinktos grupės pacientų širdies nepakankamumo gydymo būdas. Pagrindiniai žodžiai: širdies nepakankamumas, dirbtinis skilvelis, širdies persodinimas Treatment of heart failure by implanting an INCOR left ventricular assist device Kęstutis Ručinskas1, Saulius Miniauskas1, Gintaras Rasimavičius1, Rimantas Bubulis2, Stanislovas Stankevič2, Vaclovas Jurkuvėnas2, Gitana Žemaitytė3, Vytė Valerija Maneikienė3, Vytautas Sirvydis1, Aleksandras Taucevičius41 Cardial Surgery Centre, Vilnius University, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“, Anesthesiology,Intensive Care and Pain Management Center, Santariškių str. 2, LT-08661 Vilnius, Lithuania 3 Cardial Surgery Centre of Vilnius University Hospital „Santariškių klinikos“,Santariškių str. 2, LT-08661 Vilnius, Lithuania4 Vilnius University, Clinic of Cardiovascular Diseases,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Continuous blood flow ventricular assist devices, INCOR, are used at Vilnius University Cardial Surgery Centre since 2003. Fourteen of them were implanted to terminal heart failure patients. After the procedure, 9 patients were discharged home and 4 received heart transplant. At the present time, four patients with INCOR are being observed at home. The cumulative time of the patients with the INCOR assist device is 8.5 years. Effective treatment for a selected group of patients with heart failure is ventricular assist device INCOR implantation. Key words: heart failure, assist device, heart transplantation

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

2020 ◽  
Vol 24 (4) ◽  
pp. 355-359
Author(s):  
Kaitlin M Flannery ◽  
Komal Kamra ◽  
Katsuhide Maeda ◽  
Paul Shuttleworth ◽  
Christopher Almond ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Heart Transplant ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
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.

Noncardiac surgery in patients with a left ventricular assist device

2019 ◽  
Vol 28 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Archana Puri ◽  
Raj Tobin ◽  
Shameek Bhattacharjee ◽  
Mukul Chandra Kapoor
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Noncardiac Surgery ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Anesthetic Care ◽  
Ventricular Assist ◽  
Left Heart Failure ◽  
Left Ventricular Assist

Left ventricular assist devices are implanted in patients with chronic left heart failure refractory to maximal medical therapy. These devices were initially meant as bridge-to-transplant therapy, but with technological advances they are now also used as destination therapy. With improved survival, many patients with implanted devices need noncardiac surgery. We present three representative cases of noncardiac surgery in such patients to highlight the issues involved in their management. We also review the contemporary literature on various aspects of perioperative management. Anesthesia for noncardiac surgery in these patients was initially the domain of cardiac anesthesiologists, but with an increasing number of such patients needing surgery, general anesthesiologists are frequently tasked to provide anesthetic care. An understanding of left ventricular assist device physiology and issues unique to these patients is essential for safe management of these cases.

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.

Impact of Previous Sternotomy on Outcome after Left Ventricular Assist Device Implantation

2019 ◽  
Vol 67 (03) ◽  
pp. 183-190 ◽  
Author(s):  
Konstantin Zhigalov ◽  
Marcin Szczechowicz ◽  
Ahmed Mashhour ◽  
Sabreen Mkalaluh ◽  
Maxim Isaev ◽  
...  
Keyword(s):  
Ventricular Assist Device ◽  
Study Groups ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Mortality And Morbidity ◽  
Left Ventricular Assist ◽  
The Impact

Background The main purpose of this article is to investigate the impact of previous sternotomy (PS) on the outcome of three different left ventricular assist devices (LVAD). Methods Between June 2007 and February 2018, a total of 121 patients received HeartMate II (60.3%), HeartWare (12.4%), or HeartMate III (27.3%), with or without previous sternotomy (PS and non-PS groups, respectively). Propensity matching resulted in 44 patient pairs. The primary end point was overall survival at 30 days, 1 year, 2, and 5 years, postoperatively. Secondary end points were adverse events. Results The overall cumulative survival rates for the two study groups were significantly different (77, 63, 54, and 38% for non-PS group vs 64, 39, 27, and 24% for PS group, p = 0.036). In the PS group, there was a higher need for intraoperative implantation of short-term right ventricular assist device (22.7 vs 6.8%, p = 0.034) and a higher incidence of hepatic dysfunction (20.5 vs 4.5%, p = 0.025) and acute kidney dysfunction (40.9 vs 20.5%, p = 0.032). Conclusion PS is a reliable predictor of mortality and morbidity after LVAD implantation.

Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation – A Single-Center Experience

2018 ◽  
Vol 67 (03) ◽  
pp. 170-175 ◽  
Author(s):  
D. Reichart ◽  
C.F. Brand ◽  
A.M. Bernhardt ◽  
S. Schmidt ◽  
A. Schaefer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Ventricular Assist Device ◽  
Median Sternotomy ◽  
Left Ventricular ◽  
Implantation Technique ◽  
Assist Device ◽  
Ventricular Assist ◽  
Invasive Approach ◽  
Left Thoracotomy ◽  
Bridge To Transplant

Background Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group). Methods HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n = 22, 52 ± 15 years old; STX group n = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed. Results No survival differences were observed between the LT and STX group (p = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation (p = 0.02), which could not be demonstrated in the STX group (p = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections (n = 4 LT group vs n = 20 STX group, p = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group (p = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups (p = 0.48). Conclusion The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.

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