scholarly journals Eradication of Ventricular Assist Device Driveline Infection in Paediatric Patients with Taurolidine

2022 ◽  
Vol 9 (1) ◽  
pp. 18
Author(s):  
Johannes Weichsel ◽  
Benito Baldauf ◽  
Hendrik Bonnemeier ◽  
Ernest W. Lau ◽  
Sven Dittrich ◽  
...  
Keyword(s):  
Skin Barrier ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
The Novel ◽  
Ventricular Assist ◽  
Cardiac Implantable Electronic Devices ◽  
External Power Source ◽  
Driveline Infection ◽  
External Power ◽  
End Stage

Ventricular assist devices (VADs) are used to provide mechanical circulatory support to patients with end-stage heart failure. The driveline connecting the external power source to the pump(s) of the intra-corporal VAD breaches the protective skin barrier and provides a track for microbes to invade the interior of the patient’s body. Driveline infection constitutes a major and potentially fatal vulnerability of VAD therapy. Driveline infection cannot traditionally be salvaged and requires the extraction of the entire VAD system. We report here the successful eradication of a VAD driveline infection with a taurolidine-containing antimicrobial solution used for preventing the infection of cardiac implantable electronic devices. If replicated in more cases, the novel treatment concept described here may provide a valuable alternative management strategy of salvage rather than explantation for VAD driveline infection.

scholarly journals In Full Flow: Left Ventricular Assist Device Infections in the Modern Era

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Radoslav Zinoviev ◽  
Christopher K Lippincott ◽  
Sara C Keller ◽  
Nisha A Gilotra
Keyword(s):  
The United States ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
External Power Source ◽  
Left Ventricular Assist ◽  
Improved Design ◽  
End Stage

Abstract With the rising prevalence of heart disease in the United States, there is increasing reliance on durable mechanical circulatory support (MCS) to treat patients with end-stage heart failure. Left ventricular assist devices (LVADs), the most common form of durable MCS, are implanted mechanical pumps that connect to an external power source through a transcutaneous driveline. First-generation LVADs were bulky, pulsatile pumps that were frequently complicated by infection. Second-generation LVADs have an improved design, though infection remains a common and serious complication due to the inherent nature of implanted MCS. Infections can affect any component of the LVAD, with driveline infections being the most common. LVAD infections carry significant morbidity and mortality for LVAD patients. Therefore, it is paramount for the multidisciplinary team of clinicians caring for these patients to be familiar with this complication. We review the epidemiology, prevention, diagnosis, treatment, and outcomes of LVAD infections.

Differences in Shear Stress, Residence Time and Estimates of Hemolysis Between Different Ventricular Assist Devices

2011 ◽  
Author(s):  
Katharine H. Fraser ◽  
Tao Zhang ◽  
Bartley P. Griffith ◽  
Zhongjun J. Wu
Keyword(s):  
Cardiovascular Disease ◽  
Mechanical Circulatory Support ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
The Past ◽  
The Us ◽  
Mechanical Circulatory Support Devices ◽  
End Stage ◽  
Support Devices

Cardiovascular disease is the leading cause of mortality globally. Among various forms of cardiovascular disease, heart failure (HF) affects 5.7 million patients in the United States1. Despite optimal treatment, some patients still do not improve and the available therapies fail to control their symptoms; for them, cardiac transplantation may be the only option. However, only around 2200 transplants are performed in the US each year1, or only about 6% of the estimated 35,000 US patients who would benefit actually receive a heart. To address the need to support the circulation in patients with end-stage HF a wide variety of mechanical circulatory support devices (MCSDs) have been developed over the past four decades.

The Pharmacotherapy Implications of Ventricular Assist Device in the Patient With End-Stage Heart Failure

2012 ◽  
Vol 25 (2) ◽  
pp. 232-249 ◽  
Author(s):  
Serena A. S. Von Ruden ◽  
Margaret A. Murray ◽  
Jennifer L. Grice ◽  
Amy K. Proebstle ◽  
Karen J. Kopacek
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Association ◽  
Functional Class ◽  
Neurological Dysfunction ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage

Advances in mechanical circulatory support, such as the use of ventricular assist devices (VADs), have become a means for prolonging survival in end-stage heart failure (HF). VADs decrease the symptoms of HF and improve quality of life by replacing some of the work of a failing heart. They unload the ventricle to provide improved cardiac output and end-organ perfusion, resulting in improvement in cardiorenal syndromes and New York Heart Association functional class rating. VADs are currently used as a bridge to heart transplantation, a bridge to recovery of cardiac function, or as destination therapy. Complications of VAD include bleeding, infections, arrhythmias, multiple organ failure, right ventricular failure, and neurological dysfunction. Patients with VAD have unique pharmacotherapeutic requirements in terms of anticoagulation, appropriate antibiotic selection, and continuation of HF medications. Pharmacists in acute care and community settings are well prepared to care for the patient with VAD. These patients require thorough counseling and follow-up with regard to prevention and treatment of infections, appropriate levels of anticoagulation, and maintenance of fluid balance. A basic understanding of this unique therapy can assist pharmacists in attending to the needs of patients with VAD.

scholarly journals First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

Cardiology ◽  
2017 ◽  
Vol 138 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Corstiaan A. den Uil ◽  
Giorgia Galli ◽  
Lucia S. Jewbali ◽  
Kadir Caliskan ◽  
Olivier C. Manintveld ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
First Line ◽  
Ventricular Assist ◽  
Intra Aortic Balloon Pump ◽  
Coronary Syndrome ◽  
Iabp Support ◽  
End Stage

Objectives: Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients. Methods: A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016. Results: At 24 h, lactate decreased from 3.2 (2.1-6.8) to 1.8 (1.2-2.2) mmol/L (p < 0.001). Eighteen patients (67%) defined as IABP responders were successfully bridged to either recovery (n = 7), left ventricular assist device (n = 5), or heart transplantation (n = 6). IABP failed in 9 patients (non-responders, 33%) who either died (n = 7) or needed support by extracorporeal membrane oxygenation (n = 2). At 24 h of IABP support, urinary output was higher (2,660 [1,835-4,440] vs. 1,200 [649-2,385] mL; p = 0.02) and fluid balance more negative (-1,564 [-2,673 to -1,086] vs. -500 [-930 to +240] mL; p < 0.001) in responders than non-responders. Overall survival at 1 year was 63%. Conclusion: In most patients, first-line support by IABP in end-stage cardiomyopathy is associated with improvement in organ perfusion and clinical stabilisation for at least 24 h allowing time for decision making on next therapies.

scholarly journals Left Ventricular Assist Devices in the Management of Heart Failure

2015 ◽  
Vol 1 (1) ◽  
pp. 25 ◽  
Author(s):  
Edo Y Birati ◽  
Mariell Jessup ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Reduced Ejection Fraction ◽  
Device Implantation ◽  
Clinical Presentations ◽  
End Stage

Mechanical circulatory support has emerged as an important therapy for advanced heart failure, with more than 18,000 continuous flow devices implanted worldwide to date. These devices significantly improve survival and quality of life and should be considered in every patient with end-stage heart failure with reduced ejection fraction who has no other life-limiting diseases. All candidates for device implantation should undergo a thorough evaluation in order to identify those who could benefit from device implantation. Long-term management of ventricular assist device patients is challenging and requires knowledge of the characteristic complications with their unique clinical presentations.

scholarly journals HeartMate II Post-marketing Clinical Studies to Further Establish and Expand LVAD Therapy

2015 ◽  
Author(s):  
Faouzi Kallel
Keyword(s):  
Adverse Events ◽  
Survival Rates ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Actuarial Survival ◽  
Ventricular Assist ◽  
Number Of Patients ◽  
Post Marketing ◽  
Life Improvement ◽  
End Stage

The number of patients with end-stage heart failure (HF) benefiting from mechanical circulatory support based therapy is rapidly growing. Over the last 2 decades the therapy has been rapidly evolving particularly since the introduction of continuous flow ventricular assist devices (CF-LVAD) which addressed several limitations of the first generation pulsatile devices. According to the sixth INTERMACS registry annual report, the 12 and 24 months overall actuarial survival of CF-LVAD was 80% and 70% respectively.1 Survival rates remained unchanged over the past 6 years. The adverse events associated with CF-LVAD have been dramatically reduced when compared to rates associated with the previous generation pulsatile flow devices. The burden of adverse events associated with CF-LVAD decreased over the last 6 years and quality of life improvement at 12 and 24 months remained consistent. According to the report, while the proportion of patients implanted while stable on inotropic support has significantly increased in the last era (2011-2013), the expansion into INTERMACS levels 4 and higher remains limited to 20%.

Engineering a Brighter Future: The Evolving Role of the Pharmacist in the Era of the HeartMate 3

2018 ◽  
Vol 53 (4) ◽  
pp. 430-433
Author(s):  
Alana M. Ciolek ◽  
Audrey J. Littlefield ◽  
Douglas L. Jennings
Keyword(s):  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
End Stage ◽  
Brighter Future

Continuous-flow left-ventricular assist devices (CF-LVADs) are an option for patients with end-stage heart failure requiring durable mechanical circulatory support. Two of the older-generation CF-LVADs have been associated with multiple device-related complications, including bleeding and thrombosis. The newest generation CF-LVAD, the HeartMate 3, was engineered specifically to prevent device-related thrombosis. As more data enhance our understanding of the burden of bleeding and thrombotic adverse events, patients with durable mechanical circulatory support may require less-aggressive antithrombotic therapy.

In Vitro Evaluation of Shear-Induced Platelet Activation in the MicroMed DeBakey Ventricular Assist Device With Antiplatelet Therapy

2013 ◽  
Author(s):  
Jawaad Sheriff ◽  
Gaurav Girdhar ◽  
Sheela George ◽  
Wei-Che Chiu ◽  
Bryan E. Lynch ◽  
...  
Keyword(s):  
Platelet Activation ◽  
Thrombus Formation ◽  
Optimization Techniques ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Bridge To Transplant ◽  
Thrombotic Complications ◽  
End Stage

Mechanical circulatory support (MCS) devices, which include ventricular assist devices (VADs), offer an attractive solution to approximately 35,000 end-stage heart failure patients eligible for transplants, of which only 2,000–2,300 are performed annually [1]. These devices are employed to augment the function of the ailing left and/or right ventricle and serve as bridge-to-transplant or destination therapy, but are often accompanied by thrombotic complications. Pathologic flow patterns are characteristic of VADs and increase susceptibility to shear-induced platelet activation, which leads to thrombus formation [2]. Patients implanted with such devices are routinely prescribed antiplatelets to tackle these complications. Despite this concurrent therapy, thromboembolic incident rates of 0.9–13% are reported for the widely-implanted Thoratec HeartMate II and MicroMed DeBakey VADs [3, 4]. This has spurred the development of design optimization techniques to lower or eliminate the incidence of thrombosis and reduce the dependence on pharmacotherapy management.

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