Complications of Minimally Invasive Left Ventricular Assistance Device Implantation

Indication of Ventricular assistance is advanced cardiac failure with maximal medical and surgical treatment has been used. The ventricular assistance has two main purposes: first, to maintain circulation by discharging the ventricle (s) untill to recovery, or to ensure patient survival by replacing cardiac function permanently or transitionally for patients waiting for heart Transplantation. The encouraging results of the partial or total artificial heart and the miniaturization of these devices allow their use in permanent implantation for patients with heart failure that is not eligible for heart transplantation. In left mono-ventricular assistance, blood is taken from the apex of the left ventricle (LV) and reinjected in the ascending aorta. The classic surgical approach is a total median sternotomy. Other minimally invasive approaches for the implantation or explanation of left ventricular assist devices have been published and have shown encouraging results. These alternatives currently play an important role in certain indications and in patients with heavy medical history. Nevertheless, the complications of the ventricular assistance even by minimally invasive approaches might be serious and represent a turning point in the life of the patients. In this chapter, we describe the implantation technique of left ventricular assistance device (LVAD) and we discuss its advantages and disadvantages including possible complications.

Numerical study of shear-based hemolysis in aorta with left ventricular assistance device

Ventricular assistance devices (VADs) for heart failure treatment have been paid high attention among researchers for decades. However, the follow-up complications such as hemolysis and thrombosis require further optimization for this technique. Shear stress has been demonstrated to be significantly related to the hemolysis because of the rupture of red blood cells membrane with a leaking of hemoglobin in the plasma. This issue has already been investigated inside the pump of VAD, but estimations are still lacking regarding hemolysis generation in the aorta itself after VAD implantaion. Thus, the present study aims to evaluate the hemolysis in aorta through establishing the 3D numerical model of aorta with left ventricular assistance device (LVAD). Non-Newtonian Carreau model has been adopted. Comparisons of hemolysis evaluation have been made with two different mathematical models existing in literature. Moreover, the flow topology and hemodynamic variations have been studied. Different working conditions of LVAD have been considered corresponding to different heart failure severities. The results reveal a relatively low level of hemolysis risks in aorta. The thrombosis is more prone to occur in the case of severe heart failure condition.

Sequential use of povidone-iodine and chlorhexidine for cutaneous antisepsis: A systematic review

Cutaneous antisepsis with chlorhexidine or povidone-iodine, usually with alcohol, has been extensively studied. This review of published studies reveals that sequential use of povidone-iodine and chlorhexidine leads to a greater reduction in the bioburden of aerobic and anaerobic bacteria on the skin, lower risk of intravascular catheter colonization, and lower risk of surgical site infection compared to use of either agent alone. As such, sequential use of cutaneous antiseptic agents may further reduce risk of surgical site infections, as well as infections associated with insertion of transdermal devices such as nephrostomy tubes, left-ventricular assistance devices, and intravascular catheters.