Concomitant Repair For Mild Aortic Insufficiency And Implantation Of Left Ventricle Mechanical Support

Aortic valve regurgitation in patients undergoing LVAD implantation is a significant complication which occurs in up to 10% of patients in the INTERMACS database. Patients who have aortic valve regurgitation at the time of implant have been handled by several methods, including aortic valve leaflets approximation, to aortic valve replacement or even valve closure. We report a case where we used HAART Ring to repair a regurgitant aortic valve during LAVD implant for destination therapy.

ELECTIVE MECHANICAL SUB PULMONARY SUPPORT - THE FINAL FRONTIER OF SINGLE VENTRICLE PALLIATION

Sophisticated technology advances are fast taking taking shape to provide long term destination therapy mechanical circulatory assistance. Sai Spandan total articial heart with hybrid BSRM core with dual motor and controls, virtual t technology is one such over the horizon. The promise is of better quality of life and longevity. Transcutaneous charging of fully implantable models would very soon revolutionize cardiac surgical treatment modalities. The nal frontier in a failing Fontan is sub pulmonary mechanical assistance. We take a short look into the issues and possibilities. The research gap exists for the innovator in this eld.

Peritoneal dialysis improves quality-of-life in an LVAD destination therapy patient – a case report

Background Progressive renal insufficiency is frequent in heart failure patients with a left ventricular assist device (LVAD). The optimal strategy for long-term dialysis in LVAD patients and its effect on quality-of-life in these patients remain to be determined. Case summary Our 55-year-old patient with pre-existing renal insufficiency received an LVAD as destination therapy because of advanced ischemic heart failure. Six years after implantation, he developed end-stage renal disease for which peritoneal dialysis (PD) was initiated. LVAD flow alterations during ultrafiltration did not cause clinical or technical problems. The patient’s exercise capacity increased and quality-of-life improved. Over 7.5 years after LVAD implantation and 16 months after PD initiation, he died from encephalitis. Discussion Despite initial improvement, renal function often gradually decreases after LVAD implantation. Data on long-term renal replacement therapy in LVAD patients are limited. Haemodialysis is most commonly applied. Conceptually, however, PD has advantages over haemodialysis including less blood stream infections, less haemodynamic shifts and the comfort of the ambulant setting. This case illustrates that PD in an LVAD patient is feasible and improves quality-of-life. Key factors contributing to successful PD in LVAD patients may be a good right ventricular function and close cardiology-nephrology collaboration.

Perceptions of Bereaved Caregivers and Clinicians About End‐of‐Life Care for Patients With Destination Therapy Left Ventricular Assist Devices

Background Patients with left ventricular assist devices (LVADs) implanted as destination therapy may receive suboptimal preparation for and care at the end of life, but there is limited understanding of the reasons for these shortcomings. Exploring perceptions of individuals (caregivers and clinicians) who are closely involved in the end‐of‐life experience with patients with destination therapy LVADs can help identify key opportunities for improving care. Methods and Results We conducted semistructured qualitative interviews with 7 bereaved caregivers of patients with destination therapy LVADs and 10 interdisciplinary LVAD clinicians. Interviews explored perceptions of preparing for end of life, communicating about end of life, and providing and receiving end‐of‐life care, and were analyzed using a 2‐step team‐based inductive approach to coding and analysis. Six themes pertaining to end‐of‐life experiences were derived: (1) timing end‐of‐life discussions in the setting of unpredictable illness trajectories, (2) prioritizing end‐of‐life preparation and decision‐making, (3) communicating uncertainty while providing support and hope, (4) lack of consensus on responsibility for end‐of‐life discussions, (5) perception of the LVAD team as invincible, and (6) divergent perceptions of LVAD withdrawal. Conclusions This study revealed 6 unique aspects of end‐of‐life care for patients with destination therapy LVADs as reported by clinicians and caregivers. Themes coalesced around communication, team‐based care, and challenges unique to patients with LVADs at end of life. Programmatic changes may address some aspects, including training clinicians in LVAD‐specific communication skills. Other aspects, such as standardizing the role of the palliative care team and developing practical interventions that enable timely advance care planning during LVAD care, will require multifaceted interventions.

SARS-CoV-2 infection in a patient with destination left ventricular assist device

Recipients of LVAD for destination therapy may represent a challenge in the treatment of COVID-19. We present a case of a 58 year-old male with LVAD support complicated with SARS-CoV-2 who declines for hospital admission despite interstitial pneumonia and lower O2 saturation. The patient recieved ambulatory support and treatment with anticoagulation, supplementary O2, steroids, antibiotics, ivermectin with succesful evolution and recovery.