Heart Transplantation - Part II: Aspects of Procedure and Medical Management

2020 ◽  
Author(s):  
Michael M. Givertz
Keyword(s):  
Ventricular Assist Devices ◽  
Close Collaboration ◽  
Ventricular Assist ◽  
Ischemic Time ◽  
Bridge To Transplant ◽  
Key Words Heart ◽  
Transplant Center ◽  
Allograft Function ◽  
Surgical Teams ◽  
Time Required

Ischemic time, defined as the period from donor procurement to surgical implantation and restoration of intrinsic allograft function, is an independent risk factor for post-transplant mortality. In general, the ischemic time should be less than 4 hours.  Most programs will accept donor hearts from within their own UNOS region or within a radius of 500 to 1000 miles to minimize ischemic time.  Given the prevalent use of ventricular assist devices (VAD) as bridge to transplant and the increased time required to explant both the native heart and VAD hardware, patients must live within 2-3 hours (by car or air) of the transplant center.  Coordinating the donor harvest and recipient preparation requires close collaboration between multiple surgeons, surgical teams and coordinators. This review contains 11 figures, 7 tables, and 52 references. Key words: heart transplant, immunosuppression, allograft rejection, infection, hypertension, hyperlipidemia, diabetes, malignancy, cardiac allograft vasculopathy, survival 

Heart Transplantation - Part II: Aspects of Procedure and Medical Management

2020 ◽  
Author(s):  
Michael M. Givertz
Keyword(s):  
Ventricular Assist Devices ◽  
Close Collaboration ◽  
Ventricular Assist ◽  
Ischemic Time ◽  
Bridge To Transplant ◽  
Key Words Heart ◽  
Transplant Center ◽  
Allograft Function ◽  
Surgical Teams ◽  
Time Required

Ischemic time, defined as the period from donor procurement to surgical implantation and restoration of intrinsic allograft function, is an independent risk factor for post-transplant mortality. In general, the ischemic time should be less than 4 hours.  Most programs will accept donor hearts from within their own UNOS region or within a radius of 500 to 1000 miles to minimize ischemic time.  Given the prevalent use of ventricular assist devices (VAD) as bridge to transplant and the increased time required to explant both the native heart and VAD hardware, patients must live within 2-3 hours (by car or air) of the transplant center.  Coordinating the donor harvest and recipient preparation requires close collaboration between multiple surgeons, surgical teams and coordinators. This review contains 11 figures, 7 tables, and 52 references. Key words: heart transplant, immunosuppression, allograft rejection, infection, hypertension, hyperlipidemia, diabetes, malignancy, cardiac allograft vasculopathy, survival 

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.

Cost‐utility of continuous‐flow ventricular assist devices as bridge to transplant in pediatrics

2019 ◽  
Vol 23 (8) ◽  
Author(s):  
Patrick D. Evers ◽  
Chet Villa ◽  
Samuel G. Wittekind ◽  
Rebecca Hobing ◽  
David L. S. Morales ◽  
...  
Keyword(s):  
Continuous Flow ◽  
Cost Utility ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Bridge To Transplant

Impact of Outlet Valve Orientation on Fluid Dynamics of the 12 cc Penn State Pediatric Ventricular Assist Device

2008 ◽  
Author(s):  
Isabella E. Valenti ◽  
Breigh N. Roszelle ◽  
Michael V. Perone ◽  
Steven Deutsch ◽  
Keefe B. Manning
Keyword(s):  
Heart Valves ◽  
Thrombus Formation ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Bridge To Transplant ◽  
Penn State ◽  
Outlet Valve ◽  
Cardiovascular Defects ◽  
Interior Walls ◽  
Arteries And Veins

Congenital cardiovascular defects are the leading cause of death among live births [1]. These defects involve the interior walls of the heart, valves, arteries, and veins and change the normal flow of blood through the heart and into the systemic system. Fortunately, several options exist for the more than 35,000 children born with congenital heart disease. Ventricular assist devices (VADs) currently hold the most promise for bridge-to-transplant treatment; however, a major problem for these devices is thrombus formation and deposition.

scholarly journals Driveline Infection in Ventricular Assist Devices and Its Implication in the Present Era of Destination Therapy

2017 ◽  
Vol 9 ◽  
pp. 117906521771421 ◽  
Author(s):  
Gabriel A Hernandez ◽  
Jonatan D Nunez Breton ◽  
Sandra V Chaparro
Keyword(s):  
Treatment Options ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Destination Therapy ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Bridge To Transplant ◽  
Innovative Therapy

Advances in mechanical circulatory support devices provided the technology to develop long-term, implantable left ventricular assist devices as bridge to transplant, destination therapy, and in a lesser group of patients, as bridge to recovery. Despite the benefits from this innovative therapy, with their increased use, many complications have been encountered, one of the most common being infections. With the driveline acting as a portal to the exterior environment, an infection involving this structure is the most frequent one. Because patients with destination therapy are expected to receive circulatory support for a longer period of time, we will focus this review on the risk factors, prevention, and treatment options for driveline infections.

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