Development of Mechanical Circulatory Support Devices: 55 Years and Counting

2021 ◽  
Vol 32 (4) ◽  
pp. 424-433
Author(s):  
Emalie Petersen
Keyword(s):  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
Mechanical Circulatory Support Devices ◽  
Support Devices

Heart failure is a leading cause of morbidity and mortality in the United States. Treatment of this condition increasingly involves mechanical circulatory support devices. Even with optimal medical therapy and use of simple cardiac devices, heart failure often leads to reduced quality of life and a shortened life span, prompting exploration of more advanced treatment approaches. Left ventricular assist devices constitute an effective alternative to cardiac transplantation. These devices are not without complications, however, and their use requires careful cooperative management by the patient’s cardiology team and primary care provider. Left ventricular assist devices have undergone many technological advancements since they were first introduced, and they will continue to evolve. This article reviews the history of different types of left ventricular assist devices, appropriate patient selection, and common complications in order to increase health professionals’ familiarity with these treatment options.

scholarly journals Fatal Flaw – Driveline Fracture as a Rare But Serious Complication Of Mechanical Circulatory Support With Left Ventricular Assist Devices

2017 ◽  
Author(s):  
Yuri Boyechko ◽  
Thomas Tribble ◽  
Maya Guglin
Keyword(s):  
Heart Transplant ◽  
Mechanical Circulatory Support ◽  
Rare Complication ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Background Patients with advanced heart failure have seen decreased mortality and improved quality of life due to mechanical circulatory support with left ventricular assist devices (LVAD). Regardless of such outcomes, many complications still exist and remain a significant cause of morbidity and mortality. Our purpose is to study the prevalence, clinical course, and outcomes specifically of patients with LVAD driveline (DL) fractures. Methods This single-center, retrospective review included all patients at our institution who had continuous flow LVADs and experienced DL fracture/injury from January 2012 - December 2015. Results Thirteen of 110 LVAD patients (11.8%) had DL fractures (Table 1). Time from implant to time of fracture was 23+/-16.5 months. The majority of fractures were external (62%), due to trauma (i.e. cut during dressing change). Internal injury, proximal to the cutaneous exit site, occurred in 38% of patients, usually due to unknown causes. Only one patient (7.6%) survived on LVAD support. One survived LVAD explant, two underwent pump exchange, and four others underwent heart transplantation. The remaining 5 expired. All patients with untreated internal fractures died (60%). Conclusions Driveline fracture is a rare complication of LVAD and is often lethal when it occurs. Only one patient in our cohort survived without the need for heart transplant, LVAD exchange, or explant. Internal driveline fractures portend a very high mortality. Driveline fracture, especially one that cannot be promptly repaired or if internal fracture is suspected, requires immediate pump exchange or listing for heart transplant.

scholarly journals Tolerance of Sustained Ventricular Fibrillation During Continuous-Flow Left Ventricular Assist Device Support

2017 ◽  
Vol 44 (5) ◽  
pp. 357-360 ◽  
Author(s):  
Andrew C.W. Baldwin ◽  
Courtney J. Gemmato ◽  
Elena Sandoval ◽  
William E. Cohn ◽  
Jeffrey A. Morgan ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Continuous Flow ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

The widespread use of continuous-flow left ventricular assist devices for mechanical circulatory support has shown that long-term hemodynamic support is possible, even when a clinical “pulse” cannot be detected. We present the incidental discovery of ventricular fibrillation in 6 alert, hemodynamically stable patients supported only by a continuous-flow device (HeartMate II, n=5; Jarvik 2000, n=1). Ventricular fibrillation was found in 3 patients during routine outpatient follow-up visits and in 3 awaiting discharge from the hospital after device placement. Diagnosis was confirmed by electrocardiographic and echocardiographic studies. The average duration of mechanical circulatory support before ventricular fibrillation occurred was 221 ± 362 days (range, 5–864 d). All patients were conscious and ambulatory at the time of the arrhythmia. Three patients reported symptoms—primarily fatigue, nausea, and exertional dyspnea—that prompted evaluation. Serum chemistry analysis of blood drawn immediately after diagnosis showed no changes that suggested end-organ dysfunction. Three patients died of unrelated complications an average of 3.9 yr (range, 360–2,270 d) after the event. Two of the remaining 3 patients eventually underwent successful pump explantation, and one is on ongoing support. Our experience shows that it is possible for patients with continuous-flow left ventricular assist devices to remain hemodynamically stable while in ventricular fibrillation. Additional investigation is needed to determine whether defibrillator settings for these patients should be adjusted to limit delivery of shock therapy.

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