ASAIO Journal最新文献

Right heart failure (RHF) is a major cause of mortality in patients using left ventricular assist devices (LVADs). Vericiguat, an oral soluble guanylate cyclase stimulator, has recently been used to treat chronic heart failure (HF) with a reduced ejection fraction (EF) and is expected to improve RHF owing to its pulmonary vasodilatory and inotropic properties in patients with an LVAD. A 62 year old woman with advanced HF due to cardiac sarcoidosis was transferred to our center with HF recurrence and left ventricular (LV) thrombosis. Since her status became inotropic-dependent post-thrombectomy, an LVAD was implanted. Right heart catheterization before LVAD implantation suggested combined pre- and post-capillary pulmonary hypertension. Postoperative RHF requiring a temporary right VAD (RVAD) was noted. Despite the administration of oral inotropes and pulmonary artery vasodilators, including pimobendan and sildenafil, the low cardiac output associated with RHF persisted post-RVAD withdrawal. Upon the addition of vericiguat, her cardiac output increased and RHF improved; moreover, the interventricular septal position was optimized. Treatment strategies for RHF after LVAD implantation are limited; therefore, vericiguat may be an additional therapeutic option for RHF in patients with an LVAD.

The Abiomed Impella 5.5 (Danvers, MA) is a temporary left ventricular assist device (LVAD) used to support patients during acute cardiogenic shock. It is a catheter-based micro-axial blood pump that is surgically implanted to provide up to 5.5 liters per minute (LPM) of cardiac augmentation. The pump is most frequently inserted through a right subclavicular incision to the axillary artery. Anticoagulation is used during the implant procedure and then maintained at a lower concentration during the duration of support. Inadequate anticoagulation can result in pump thrombosis with subsequent thromboembolization. Excess anticoagulation can result in surgical site bleeding and potential hematoma formation. This case series details three patients with a low-dose anticoagulation strategy. There were no adverse embolic or hemorrhagic events in the peri- or postoperative period.

Digital ischemia following extracorporeal membrane oxygenation (ECMO) therapy is a known complication with potential devastating long-term sequela. Onabotulinum toxin type A (BTX-A) has been demonstrated to be effective for digital ischemia in adults with Raynaud's phenomenon. The objective of this study is to describe the use of BTX-A in pediatric and neonatal patients with digital ischemia following ECMO therapy. Three consecutive patients with digital ischemia after ECMO therapy were included. Patient ages ranged from 3 days to 13 months. Twenty-five to 50 units of BTX-A were injected to each affected extremity targeting the areas around the known arterial anatomy of the hands and feet. On post-injection day one, all patients demonstrated improvement in ischemic discoloration. Complete resolution was noted by treatment day 3 in one case and near complete resolution by day 16 in the second. Case 3 expired on hospital day four from an unrelated intracranial hemorrhage. No complications or digital loss were observed. Onabotulinum toxin type A as an off-label treatment for digital ischemia was demonstrated to be safe and effective in pediatric and neonatal patients. Clinical improvement was noted in all patients by post-procedure day one, with two patients demonstrating near to complete resolution within 3 weeks.

Heart transplantation practices have evolved significantly following the 2018 heart allocation policy changes and the introduction of donation after circulatory death (DCD) heart transplantation in 2019. Under the new system, candidates supported with durable left ventricular assist devices (DLVADs) experience longer waitlist times with worse outcomes. This study evaluates the impact of DCD heart utilization on waitlist outcomes among DLVAD candidates using the United Network for Organ Sharing (UNOS) registry. Adult candidates with DLVADs listed for isolated heart transplantation from December 1, 2019, to March 31, 2023, with a 2 year follow-up period extending to March 31, 2025. Candidates were stratified by approval status to accept DCD donor offers. The outcomes were 2 year cumulative incidences of transplantation, delisting due to death or clinical deterioration, and all-cause survival from the time of initial waitlisting. Among 2,993 candidates, 487 (16.3%) were approved to accept DCD donor offers. Approval for DCD donor offers was associated with a significantly lower risk of delisting, a higher likelihood of transplantation, and improved all-cause survival. Moreover, this survival improvement persisted in the multivariable Cox regression. These findings highlight the growing use and clinical value of DCD heart utilization in expanding access to transplantation and improving outcomes in DLVAD candidates awaiting transplantation.

ProtekDuo dual-lumen cannula implantation provides effective percutaneous right ventricular support in acute right heart failure. This retrospective study analyzed 60 patients who received ProtekDuo support for a mean of 14.9 ± 9.7 days. Hemodynamic improvements included reduced central venous pressure (17.8 ± 5.6-11.8 ± 5.0 mmHg, p < 0.001) and increased central venous oxygen saturation (60.6 ± 15.2-74.6% ± 7.8%, p < 0.001). End-organ function improved, with lower creatinine (2.9 ± 5.0-1.6 ± 0.8 mg/dl, p = 0.046) and lactate levels (26.0 ± 23.3-14.1 ± 10.4 mg/dl, p < 0.001). Bilirubin levels increased post-implantation (2.9 ± 3.2 to 5.7 ± 6.0 mg/dl, p < 0.001) but returned to baseline within 13.5 ± 19 days in weaned patients. Independent mortality risk factors were female sex (hazard ratio [HR] = 6.47, p < 0.001), older age (HR = 1.035, p = 0.036), and higher body mass index (BMI) (HR = 1.124, p = 0.003). These findings highlight the benefits of percutaneous ProtekDuo implantation in acute right heart failure, although patient selection remains critical. Further studies are needed to refine selection criteria and optimize outcomes.

Heart failure (HF) remains a progressive condition even with optimal medical therapy, often requiring advanced interventions like left ventricular assist devices (LVAD). Recent advancements in HF treatment, including sodium-glucose co-transporter 2 inhibitors (SGLT2i), have demonstrated benefits such as reduced mortality, symptom improvement, and renal protection. Their effects in LVAD patients remain unexplored. This study aims to evaluate the safety and therapeutic potential of SGLT2i in LVAD recipients, addressing a critical gap in current knowledge. A retrospective analysis of 176 consecutive patients who underwent LVAD implantation at two major academic centers in Germany (2018-2023) was conducted. In 139 LVAD patients (58 SGLT2i vs. 81 controls), we compared clinical and laboratory parameters at 6 and 12 months. In an additional group of 37 SGLT2i naïve patients who were already established on LVAD support the clinical course was compared to the pre-SGLT2i era. Renal function and cardiac biomarkers were not negatively affected during the first year of SGLT2i use. Complication rates (eg, infections, hypovolemic events, acute kidney injury) were comparable to both the control group and pre-SGLT2i era. Sodium-glucose co-transporter 2 inhibitors as part of contemporary HF medication appear to be safe for LVAD patients. Further research and longer follow-up periods are necessary to draw robust conclusions on cardiovascular and renal outcomes.

Severe right heart failure is typically managed using external right ventricular assist devices (RVADs) or inotropic agents while awaiting heart transplantation. Here, we report a successful case using an implantable RVAD to treat end-stage right-sided heart failure caused by arrhythmogenic right ventricular cardiomyopathy.

Severe right ventricular failure (RVF) is a morbid complication of left ventricular assist device insertion. The optimal timing of right ventricular assist device (RVAD) support remains controversial. We sought to evaluate outcomes associated with preemptive versus delayed RVAD insertion at the time of HeartMate 3 (HM3) implantation. We retrospectively reviewed 293 patients who underwent HM3 implantation between November 2014 and December 2022. A preemptive RVAD strategy was applied to select patients. Outcomes were compared to patients who did not require an RVAD and who required an RVAD after HM3 insertion (reactive RVAD). Thirty-three patients (11.3%) underwent preemptive RVAD insertion, whereas 229 (78.2%) had no RVAD, and 31 (10.5%) had a reactive RVAD. Reasons for preemptive RVADs were cardiogenic shock (n = 22, 66.7%), severe biventricular failure (n = 7, 21.2%), or refractory ventricular tachycardia (n = 4, 12.1%). In-hospital mortality was highest in the reactive group (None: 2.2 versus Preemptive: 3.0 versus Reactive: 25.8%, p < 0.001). Kaplan-Meier analysis showed the lowest 3 year survival in the reactive group, whereas the preemptive and non-RVAD groups had comparable survival rates (83.5% vs. 85.5% vs. 46.6%, p < 0.001). In multivariable Cox analysis, reactive RVAD was an independent risk factor for mortality (hazard ratio [HR]: 2.7, p < 0.001). In our study, preemptive RVAD insertion was associated with improved outcomes.