Mechanical circulatory support as a bridge to cardiac transplantation: toward the 21st century

1999 ◽  
Vol 8 (5) ◽  
pp. 324-337 ◽  
Author(s):  
K Scherr ◽  
L Jensen ◽  
A Koshal
Keyword(s):  
Risk Factors ◽  
21St Century ◽  
Cardiac Transplantation ◽  
Mechanical Circulatory Support ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Donor Organ ◽  
Ventricular Assist ◽  
Selection Of

Mechanical circulatory support is used to sustain the lives of patients awaiting cardiac transplantation who would otherwise die before a donor organ became available. Currently available ventricular assist devices used for mechanical circulatory support, risk factors and complications associated with use of these devices, and selection of candidates for treatment with mechanical support as a bridge to cardiac transplantation are reviewed. The importance of early insertion of the devices before end-organ dysfunction occurs is examined.

Mechanical Circulatory Support in Patients with Pulmonary Hypertension

2019 ◽  
pp. 47-53
Author(s):  
David Ishizawar
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Cardiac Transplantation ◽  
Mechanical Circulatory Support ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Pulmonary Vascular Disease ◽  
Ventricular Assist

Pulmonary hypertension (PH) is a heterogeneous group of diagnoses including pulmonary vascular disease, left-sided heart failure, lung disease, and thromboembolic disease. Regardless of the cause, PH is often associated with increased morbidity and mortality. In systolic heart failure, the development of irreversible PH precludes cardiac transplantation because the risk of allograft right-ventricular failure and death is increased. In these cases, left ventricular assist devices (LVADs) can provide circulatory support and the potential to reverse PH. This chapter discusses the WHO classifications of PH and the associated diagnoses, mechanisms, and medical and surgical treatments for PH. It also discusses the strategies for reversing PH, the indications for selecting patients with PH for heart transplantation, and how exposure of the donor heart to elevated pulmonary pressures can affect the recipient. In many of these challenging patients, mechanical circulatory support as a bridge to candidacy has permitted successful cardiac transplantation.

Mechanical Circulatory Support: A Clinical Reality

2008 ◽  
Vol 16 (5) ◽  
pp. 419-431 ◽  
Author(s):  
Daniel Loisance
Keyword(s):  
Cardiac Failure ◽  
Cardiac Transplantation ◽  
Mechanical Circulatory Support ◽  
Therapeutic Option ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Recent Experience ◽  
Ventricular Assist ◽  
Prospective Trials ◽  
Maximal Medical Therapy

Mechanical circulatory support is becoming an alternative therapeutic option for patients in cardiogenic shock or advanced cardiac failure who cannot be improved by maximal medical therapy. More than 30 years of engineering development and clinical research have led to a level of efficacy and reliability of ventricular assist devices, which allows promotion of this approach for the most difficult patients. Uses include a gaining-time strategy as a bridge to cardiac transplantation or recovery of native cardiac function, as well as permanent support with the device. The large variety of devices permits every cardiac surgical unit, even those not used to cardiac transplantation, to propose this option to the patient. Recent experience with small silent implantable pumps suggests that the pioneering period of mechanical circulatory support is probably over, and the time has come for precise prospective trials to optimize both patient selection and the timing for utilization. In countries where cardiac transplantation has not developed, there is now an easily accessible technique for management of patients with cardiac failure.

scholarly journals Temporary Mechanical Circulatory Support: A Review of the Options, Indications, and Outcomes

2014 ◽  
Vol 8s1 ◽  
pp. CMC.S15718 ◽  
Author(s):  
Nisha A. Gilotra ◽  
Gerin R. Stevens
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Circulatory Support ◽  
Clinical Applications ◽  
Ventricular Assist Devices ◽  
Blood Pump ◽  
Circulatory Support ◽  
Disease Entity ◽  
Significant Morbidity ◽  
Ventricular Assist ◽  
Acute Setting

Cardiogenic shock remains a challenging disease entity and is associated with significant morbidity and mortality. Temporary mechanical circulatory support (MCS) can be implemented in an acute setting to stabilize acutely ill patients with cardiomyopathy in a variety of clinical situations. Currently, several options exist for temporary MCS. We review the indications, contraindications, clinical applications, and evidences for a variety of temporary circulatory support options, including the intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), CentriMag blood pump, and percutaneous ventricular assist devices (pVADs), specifically the TandemHeart and Impella.

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.

Cerebrovascular Events in Patients with Centrifugal-Flow Left Ventricular Assist Devices: A Propensity Score Matched Analysis from the Intermacs Registry

Circulation ◽  
2021 ◽  
Author(s):  
Sung-Min Cho ◽  
J. Hunter Mehaffey ◽  
Susan L. Myers ◽  
Ryan S. Cantor ◽  
Randall C. Starling ◽  
...  
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
Secondary Analysis ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Background: Ischemic and hemorrhagic cerebrovascular accidents (ICVA and HCVA, respectively) remain common among patients with centrifugal-flow left ventricular assist devices (CF-LVADs), despite improvements in survival and device longevity. Therefore, the incidence of neurological adverse events (NAEs) associated with two contemporary CF-LVADs, the Abbott HeartMate3 ® (HM3) and the Medtronic HeartWare ™ HVAD ® (HVAD), were compared. Methods: Using the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs), we collected data on adult patients who received a CF-LVAD as a primary isolated implant between 1/1/2017 and 9/30/2019. Major NAEs were defined as transient ischemic attack (TIA), ICVA, and HCVA. The association of HVAD with risk of NAE in the first year post implant was evaluated using propensity score matching to balance for pre-implant risk factors. After matching, freedom from first major NAE in the HM3 and HVAD cohorts was compared with Kaplan-Meier curves. A secondary analysis using multivariable multiphase hazard models was used to identify predictors of NAE, which uses a data driven parametric fit of the early declining and constant phase hazards and the associations of risk factor with either phase. Results: Of 6,205 included patients, 3,076 (49.6%) received the HM3 and 3,129 (50.4%) received the HVAD. Median follow-up was 9 and 12 months (HM3 and HVAD). HVAD patients had more major NAEs (16.4% vs. 6.4%, p <0.001), as well as each subtype (TIA: 3.3% vs. 1.0%, p <0.001; ICVA: 7.7% vs. 3.4%, p <0.001; and HCVA: 7.2% vs. 2.0%, p <0.001), than did HM3 patients. A propensity-matched cohort balanced for pre-implant risk factors showed that HVAD was associated with higher probabilities of major NAEs (% freedom from NAE: 82% vs. 92%, p <0.001). Device type was not significantly associated with NAEs in the early hazard phase, but HVAD was associated with higher incidence of major NAEs during the constant hazard phase (hazard ratio: 5.71, confidence interval: 3.90-8.36). Conclusions: HM3 is associated with lower hazard of major NAEs than is HVAD beyond the early post-implantation period and during the constant hazard phase. Defining the explanation for this observation will inform device selection for individual patients.

Providing Mechanical Support to Children Size and Anatomical Considerations

2019 ◽  
pp. 246-254
Author(s):  
Kyle W. Riggs ◽  
David L. S. Morales
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Management Strategies ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Ventricular Assist ◽  
Small Children

Mechanical circulatory support (MCS) in children has changed greatly during the past two decades. Historically, extracorporeal membranous oxygenation was the only mechanical support option for children. The introduction and widespread use of the Berlin Heart EXCOR pump—a pulsatile, pneumatic compression device still commonly used in small children—allowed the use of ventricular assist devices (VAD). This chapter describes the leading MCS options in small children with complex pathology and reviews the evolution of cannulation strategies for long-term support. It describes an advanced imaging technique that allows devices to be “virtually fit” to patients before implantation, a technology that may increase the number of eligible patients receiving devices thought to be too large by body surface area alone. Although body imaging is required, virtual fit will supplant the antiquated use of weight and body surface area in planning complicated implantations. Finally, the chapter presents MCS management strategies for different congenital anomalies, such as single-ventricle pathology and arterial transpositions.

scholarly journals Haemolysis induced by mechanical circulatory support devices: unsolved problems

Perfusion ◽  
2020 ◽  
Vol 35 (6) ◽  
pp. 474-483
Author(s):  
Inge Köhne
Keyword(s):  
Shear Stress ◽  
Continuous Flow ◽  
Mechanical Circulatory Support ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Theoretical Approaches ◽  
Blood Pumps ◽  
Mechanical Circulatory Support Devices ◽  
Support Devices

Since the use of continuous flow blood pumps as ventricular assist devices is standard, the problems with haemolysis have increased. It is mainly induced by shear stress affecting the erythrocyte membrane. There are many investigations about haemolysis in laminar and turbulent blood flow. The results defined as threshold levels for the damage of erythrocytes depend on the exposure time of the shear stress, but they are very different, depending on the used experimental methods or the calculation strategy. Here, the results are resumed and shown in curves. Different models for the calculation of the strengths of erythrocytes are discussed. There are few results reported about tests of haemolysis in blood pumps, but some theoretical approaches for the design of continuous flow blood pumps according to low haemolysis have been investigated within the last years.

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