Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report

Abstract Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah’s Witness patient with catecholamine-induced acutely decompensated heart failure required dependable afterload reduction for a cardio-protective strategy. This was emphasized due to the relative contraindication to perioperative anticoagulation required for mechanical circulatory support. A phenylephrine challenge clearly demonstrated adequate alpha blockade after only 24 hours of phenoxybenzamine treatment. This resulted in advancement of the surgery date. This case also highlights management of beta blockade, volume and salt loading, autologous blood transfusion, and profound post-operative vasoplegia in the setting of cardiogenic shock. Careful attention to hemodynamic optimization and cardio-protective strategies ultimately resulted in positive outcome for this challenging clinical scenario.

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Perioperative management including dual cell salvage in a Jehovah's Witness patient undergoing major urological surgery

Clinical Case Reports ◽

10.1002/ccr3.5098 ◽

2021 ◽

Vol 9 (11) ◽

Author(s):

Thomas G. Smith ◽

Irina Anastasescu ◽

James M. Wight ◽

Anicee Danaee ◽

Rajesh Nair ◽

...

Keyword(s):

Perioperative Management ◽

Cell Salvage ◽

Jehovah’S Witness ◽

Jehovah's Witness ◽

Urological Surgery ◽

Witness Patient

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Plasma galectin 3 is increased in terminal heart failure patients and is elevated in patients not surviving mechanical circulatory support

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269295 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

G Erkilet ◽

S Schulte-Eistrup ◽

M Morshuis ◽

B Bohms ◽

D Röfe ◽

...

Keyword(s):

Heart Failure ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Heart Failure Patients ◽

Galectin 3 ◽

Terminal Heart Failure

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Chronic Mechanical Circulatory Support for Patients with End-stage Heart Failure as a Definitive Treatment Option

European Cardiology Review ◽

10.15420/ecr.2010.8.2.22 ◽

2010 ◽

Vol 6 (4) ◽

pp. 22

Author(s):

Patrycja Ganslmeier ◽

Christof Schmid ◽

◽

Keyword(s):

Heart Failure ◽

Mechanical Circulatory Support ◽

Definitive Treatment ◽

Circulatory Support ◽

Randomized Evaluation ◽

Fda Approval ◽

Cerebrovascular Events ◽

Device Placement ◽

End Stage Heart Failure ◽

End Stage

Mechanical circulatory support for end-stage heart failure has become routine and is now increasingly used as definitive treatment. Several small devices qualify for this purpose, but only a few have gained US Food and Drug Administration (FDA) approval as yet. Several studies, including the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) study, the Investigation of Non-transplant-Eligible Patients Who Are Inotrope Dependent (INTrEPID) and the HeartMate (HM) II trial have confirmed a significantly improved quality of life and functional capacity after device placement. However, cerebrovascular events, infection and device malfunction still pose a considerable risk to patients and hinder widespread use.

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Pediatric Palliative Care in the Heart Failure, Ventricular Assist Device and Transplant Populations: Supporting Patients, Families and Their Clinical Teams

Children ◽

10.3390/children8060468 ◽

2021 ◽

Vol 8 (6) ◽

pp. 468

Author(s):

Kyle D. Hope ◽

Priya N. Bhat ◽

William J. Dreyer ◽

Barbara A. Elias ◽

Jaime L. Jump ◽

...

Keyword(s):

Heart Failure ◽

Palliative Care ◽

Heart Transplantation ◽

Ventricular Assist Device ◽

Mechanical Circulatory Support ◽

Pediatric Palliative Care ◽

Circulatory Support ◽

Assist Device ◽

Ventricular Assist ◽

Patients With Heart Failure

Heart failure is a life-changing diagnosis for a child and their family. Pediatric patients with heart failure experience significant morbidity and frequent hospitalizations, and many require advanced therapies such as mechanical circulatory support and/or heart transplantation. Pediatric palliative care is an integral resource for the care of patients with heart failure along its continuum. This includes support during the grief of a new diagnosis in a child critically ill with decompensated heart failure, discussion of goals of care and the complexities of mechanical circulatory support, the pensive wait for heart transplantation, and symptom management and psychosocial support throughout the journey. In this article, we discuss the scope of pediatric palliative care in the realm of pediatric heart failure, ventricular assist device (VAD) support, and heart transplantation. We review the limited, albeit growing, literature in this field, with an added focus on difficult conversation and decision support surrounding re-transplantation, HF in young adults with congenital heart disease, the possibility of destination therapy VAD, and the grimmest decision of VAD de-activation.

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Can mechanical circulatory support be an effective treatment for HFpEF patients?

Heart Failure Reviews ◽

10.1007/s10741-021-10154-1 ◽

2021 ◽

Author(s):

Einar Gude ◽

Arnt E. Fiane

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Mechanical Circulatory Support ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Cavity ◽

Circulatory Support ◽

Left Ventricular Assist Devices ◽

Mechanical Pressure ◽

Entry Points

AbstractHeart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and represents approximately 50% of all heart failure (HF) patients. Patients with this complex clinical scenario, characterized by high filling pressures, and reduced cardiac output (CO) associated with progressive multi-organ involvement, have so far not experienced any significant improvement in quality of life or survival with traditional HF treatment. Left ventricular assist devices (LVAD) have offered a new treatment alternative in terminal heart failure patients with reduced ejection fraction (HFrEF), providing a unique combination of significant pressure and volume unloading together with an increase in CO. The small left ventricular cavity in HFpEF patients challenges left-sided pressure unloading, and new anatomical entry points need to be explored for mechanical pressure and volume unloading. Optimized and pressure/volume-adjusted mechanical circulatory support (MCS) devices for HFrEF patients may conceivably be customized for HFpEF anatomy and hemodynamics. We have developed a long-term MCS device for HFpEF patients with atrial unloading in a pulsed algorithm, leading to a significant reduction of filling pressure, maintenance of pulse pressure, and increase in CO demonstrated in animal testing. In this article, we will discuss HFpEF pathology, hemodynamics, and the principles behind our novel MCS device that may improve symptoms and prognosis in HFpEF patients. Data from mock-loop hemolysis studies, acute, and chronic animal studies will be presented.

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