Background: Current treatment options for end-stage heart failure, such as transplantation, can be limited by obesity guidelines. Mechanical devices such as Left Ventricular Assistive Devices (LVAD) can bridge heart failure patients to transplantation, however, after implantation; some patients may experience weight gain that precludes them from transplantation. Therefore, the objective of this study was to evaluate weight changes after the implantation of an LVAD. Methods: A retrospective review of 130 patients receiving an LVAD were divided into two groups based on BMI at the time of implantation: obese (>30 kg/m2) and non-obese (/m2). Patients were evaluated at three time points post LVAD implantation: 3, 6, and 12 months for changes in weight and BMI. Results: The mean BMI of the overall cohort at the time of LVAD implantation was 30.3 kg/m2. Patients who were not classified as obese at the time of LVAD implementation had a significant increase in BMI (2.1 kg/m2, p<0.001). Conclusion: Weight gain after LVAD implementation is more likely in patients who are non-obese at the time of LVAD evaluation; however, obese subjects remained unlikely to lose weight one year post implantation.
{"title":"Exploring Body Mass Index Changes in Left Ventricular Assist Device Patients","authors":"R. E. Thomas, C. Hanson, G. Woscyna, B. Lowes","doi":"10.13023/VAD.2016.13","DOIUrl":"https://doi.org/10.13023/VAD.2016.13","url":null,"abstract":"\u0000 \u0000 \u0000Background: Current treatment options for end-stage heart failure, such as transplantation, can be limited by obesity guidelines. Mechanical devices such as Left Ventricular Assistive Devices (LVAD) can bridge heart failure patients to transplantation, however, after implantation; some patients may experience weight gain that precludes them from transplantation. Therefore, the objective of this study was to evaluate weight changes after the implantation of an LVAD. \u0000Methods: A retrospective review of 130 patients receiving an LVAD were divided into two groups based on BMI at the time of implantation: obese (>30 kg/m2) and non-obese (/m2). Patients were evaluated at three time points post LVAD implantation: 3, 6, and 12 months for changes in weight and BMI. \u0000Results: The mean BMI of the overall cohort at the time of LVAD implantation was 30.3 kg/m2. Patients who were not classified as obese at the time of LVAD implementation had a significant increase in BMI (2.1 kg/m2, p<0.001). \u0000Conclusion: Weight gain after LVAD implementation is more likely in patients who are non-obese at the time of LVAD evaluation; however, obese subjects remained unlikely to lose weight one year post implantation. \u0000 \u0000 \u0000","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88062248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
How to use inotropes is one of the most controversial topics in the management of heart failure. While most clinicians use these drugs, and recognize the state of inotrope dependency, current guidelines recommend them onlu as a bridge or palliation. Thus, inotropes are considered either neutral or detrimental in terms of outcomes. Meanwhile, properly designed randomized clinical trials testing the outcomes on inotropes, have never been performed and it is unlikely that they will ever be attempted. These trials would require randomizing patients with advanced heart failure, low output syndrome, and impaired end-organ perfusion into groups that received or not received inotropes, or received inotropes or placebo. Many physicians would consider this design unethical so the trials would be challenging to implement. But if it is unethical to deny inotropes to this subset of patients, we have to admit that inotropes do not only improve quality of life, but prolong it, or decrease mortality. Otherwise, we consider it unethical to deny the medication which increases mortality. In this review, we analyze the current evidence relating to inotropes and outcomes. We demonstrate that the original trials were performed with agents that are no longer in use, or on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. We conclude that current guidelines for inotropes are misleading in their interpretation of outcomes in patients with advanced heart failure. The guidelines should be revised to adequately reflect the evidence.
{"title":"Inotropes Are Not Linked to Increased Mortality in Heart Failure","authors":"M. Guglin","doi":"10.13023/VAD.2015.09","DOIUrl":"https://doi.org/10.13023/VAD.2015.09","url":null,"abstract":"How to use inotropes is one of the most controversial topics in the management of heart failure. While most clinicians use these drugs, and recognize the state of inotrope dependency, current guidelines recommend them onlu as a bridge or palliation. Thus, inotropes are considered either neutral or detrimental in terms of outcomes. Meanwhile, properly designed randomized clinical trials testing the outcomes on inotropes, have never been performed and it is unlikely that they will ever be attempted. These trials would require randomizing patients with advanced heart failure, low output syndrome, and impaired end-organ perfusion into groups that received or not received inotropes, or received inotropes or placebo. Many physicians would consider this design unethical so the trials would be challenging to implement. But if it is unethical to deny inotropes to this subset of patients, we have to admit that inotropes do not only improve quality of life, but prolong it, or decrease mortality. Otherwise, we consider it unethical to deny the medication which increases mortality. In this review, we analyze the current evidence relating to inotropes and outcomes. We demonstrate that the original trials were performed with agents that are no longer in use, or on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. We conclude that current guidelines for inotropes are misleading in their interpretation of outcomes in patients with advanced heart failure. The guidelines should be revised to adequately reflect the evidence.","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"136 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86434219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background While intracranial hemorrhage (ICH) is a known complication of left ventricular assist device (LVAD) support, and is associated with high morbidity and mortality, optimal care pathways have neither been elucidated nor reported. We describe management of LVAD patients following ICH, with a focus on anticoagulation, operative interventions, care team designation, complications, and outcomes. Methods We retrospectively reviewed all durable continuous-flow LVAD implantations at our academic medical center from January 2007 to July 2018. Patients who experienced ICH after LVAD were identified. We defined baseline and ICH characteristics, medical and surgical interventions, care teams, and outcomes including death, device thrombosis, ischemic stroke, and hemorrhage expansion. Results A total of 321 patients underwent LVAD implantation during the study period, and 27 (8%) developed ICH (17 intraparenchymal, 7 subdural, 2 subarachnoid, 1 intraventricular) while on support. Twenty-five were anticoagulated at onset of bleed. Of those, 13 were managed with immediate cessation of anticoagulation and administration of reversal products (Group A). Group A had a median of 6 days off anticoagulation and 60 days of follow up with 1 patient (8%) developing device thrombosis at day 8, 1 (8%) developing subsequent ischemic stroke at day 14, and 4 (31%) with ICH expansion. Seven patients had anticoagulation stopped at onset of bleed without administration of reversal products (Group B). With a median of 2 days off anticoagulation and 2 days of follow up, no patients in Group B developed ischemic stroke or device thrombosis while 1 (14%) had ICH expansion. Five patients had anticoagulation continued at onset of bleed (Group C) with a median follow up of 330 days. One (20%) developed device thrombosis at day 5 while 2 (40%) developed ICH expansion. Four patients with subdural hemorrhage underwent Burr hole drainage with all 4 surviving to discharge. Two patients with intraparenchymal hemorrhage underwent open craniotomy with neither surviving to discharge. An interdisciplinary discussion occurred in all cases. Following ICH, only one-third of patients in the study survived to 6 months. Conclusion LVAD patients who experience an ICH have variable outcomes. Their care is multidisciplinary and can involve operative intervention. The discontinuation and reversal of anticoagulation is generally well-tolerated, with a low risk for early device thrombosis. Like for many hemorrhagic complications of LVADs, ICH often persists or worsens. Additional investigation is needed to elucidate the most optimal management strategies.
{"title":"Managing Intracranial Hemorrhage in Patients with a Durable Continuous Flow Left Ventricular Assist Device","authors":"Godly Jack, Phil Barker, R. Searcy, J. Katz","doi":"10.14434/VAD.V5I0.28077","DOIUrl":"https://doi.org/10.14434/VAD.V5I0.28077","url":null,"abstract":"Background \u0000While intracranial hemorrhage (ICH) is a known complication of left ventricular assist device (LVAD) support, and is associated with high morbidity and mortality, optimal care pathways have neither been elucidated nor reported. We describe management of LVAD patients following ICH, with a focus on anticoagulation, operative interventions, care team designation, complications, and outcomes. \u0000Methods \u0000We retrospectively reviewed all durable continuous-flow LVAD implantations at our academic medical center from January 2007 to July 2018. Patients who experienced ICH after LVAD were identified. We defined baseline and ICH characteristics, medical and surgical interventions, care teams, and outcomes including death, device thrombosis, ischemic stroke, and hemorrhage expansion. \u0000Results \u0000A total of 321 patients underwent LVAD implantation during the study period, and 27 (8%) developed ICH (17 intraparenchymal, 7 subdural, 2 subarachnoid, 1 intraventricular) while on support. Twenty-five were anticoagulated at onset of bleed. Of those, 13 were managed with immediate cessation of anticoagulation and administration of reversal products (Group A). Group A had a median of 6 days off anticoagulation and 60 days of follow up with 1 patient (8%) developing device thrombosis at day 8, 1 (8%) developing subsequent ischemic stroke at day 14, and 4 (31%) with ICH expansion. Seven patients had anticoagulation stopped at onset of bleed without administration of reversal products (Group B). With a median of 2 days off anticoagulation and 2 days of follow up, no patients in Group B developed ischemic stroke or device thrombosis while 1 (14%) had ICH expansion. Five patients had anticoagulation continued at onset of bleed (Group C) with a median follow up of 330 days. One (20%) developed device thrombosis at day 5 while 2 (40%) developed ICH expansion. Four patients with subdural hemorrhage underwent Burr hole drainage with all 4 surviving to discharge. Two patients with intraparenchymal hemorrhage underwent open craniotomy with neither surviving to discharge. An interdisciplinary discussion occurred in all cases. Following ICH, only one-third of patients in the study survived to 6 months. \u0000Conclusion \u0000LVAD patients who experience an ICH have variable outcomes. Their care is multidisciplinary and can involve operative intervention. The discontinuation and reversal of anticoagulation is generally well-tolerated, with a low risk for early device thrombosis. Like for many hemorrhagic complications of LVADs, ICH often persists or worsens. Additional investigation is needed to elucidate the most optimal management strategies.","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82235324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karolina Viquez, Peggy Hardesty, K. Fahmy, A. El-Husseini, Mohamed Elyamny, M. Guglin
In patients with chronic kidney disease (CKD) and heart failure (HF), volume overload is a major problem. Removal of fluid during the dialysis treatment is the cornerstone management in these conditions, but assessing the amount of volume that should be removed is a challenge since physical exam findings are not accurate. Ambulatory pulmonary artery (PA) pressure measurement is a promising tool in HF that potentially could be used as well in CKD population, monitoring volume status changes and allowing a prompt intervention such as increasing or decreasing the volume of ultrafiltration. We presented two cases of patients with CKD, HF and CardioMEMS.
{"title":"The Use of CardioMEMS in Dialysis Patients with Heart Failure","authors":"Karolina Viquez, Peggy Hardesty, K. Fahmy, A. El-Husseini, Mohamed Elyamny, M. Guglin","doi":"10.14434/VAD.V5I0.28087","DOIUrl":"https://doi.org/10.14434/VAD.V5I0.28087","url":null,"abstract":"In patients with chronic kidney disease (CKD) and heart failure (HF), volume overload is a major problem. Removal of fluid during the dialysis treatment is the cornerstone management in these conditions, but assessing the amount of volume that should be removed is a challenge since physical exam findings are not accurate. Ambulatory pulmonary artery (PA) pressure measurement is a promising tool in HF that potentially could be used as well in CKD population, monitoring volume status changes and allowing a prompt intervention such as increasing or decreasing the volume of ultrafiltration. We presented two cases of patients with CKD, HF and CardioMEMS.","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82878012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There have been over 15,000 continuous flow left ventricular assist devices (LVADs) implanted in the United States1 . As the care of these patients expands into the general community, it is important for providers at all levels to be familiar with the sound of a normal LVAD. The sound generated is normally described as an “LVAD hum”. That non-descriptive term may be misunderstood as all LVADs or “hums” are the same, when in fact the sound produced is unique to each device. Another common misconception held by some providers, is the absence of heart sounds in a normally functioning LVAD. Using apex phonocardiography we were able to better visualize these unique characteristics (Figures 1-4, phonocardiograms of three United States Food and Drug Administration approved durable LVADs), and suggest a refined description of each device sound. The recordings were made on normal functioning LVADs using the EKO Core stethoscope attachment (EKO, Berkeley, CA).
{"title":"Refining Auscultation of Left Ventricular Assist Devices: Insights From Phonocardiography","authors":"F. Araj, A. Amin, J. Cox, P. Mammen","doi":"10.14434/VAD.V5I0.28088","DOIUrl":"https://doi.org/10.14434/VAD.V5I0.28088","url":null,"abstract":"There have been over 15,000 continuous flow left ventricular assist devices (LVADs) implanted in the United States1 . As the care of these patients expands into the general community, it is important for providers at all levels to be familiar with the sound of a normal LVAD. The sound generated is normally described as an “LVAD hum”. That non-descriptive term may be misunderstood as all LVADs or “hums” are the same, when in fact the sound produced is unique to each device. Another common misconception held by some providers, is the absence of heart sounds in a normally functioning LVAD. Using apex phonocardiography we were able to better visualize these unique characteristics (Figures 1-4, phonocardiograms of three United States Food and Drug Administration approved durable LVADs), and suggest a refined description of each device sound. The recordings were made on normal functioning LVADs using the EKO Core stethoscope attachment (EKO, Berkeley, CA).","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87497133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Carroll, Meghan Tooman, M. Bochan, C. Salerno, A. Ravichandran
Left ventricular assist device (LVAD) therapy remains a vital therapeutic option for patients with end-stage heart failure. Unfortunately, adverse events can occur and progress to require consideration for device exchange once the failure of medical management becomes evident, especially when heart transplantation is not possible in a timely manner. The aim of this analysis is to describe the incidence and outcomes of LVAD exchanges at our institution. Between April 2008 and May 2017, 397 patients underwent LVAD implantation, with 32 of those patients subsequently receiving exchange upon the recommendation of our multidisciplinary team due to refractory infection (n=12), device malfunction (n=5), hemolysis (n=9) and pump thrombosis (n=6). The average time from index implant to exchange was 580.6 days, with an average length of stay of 18.2 days. Survival at 3 months was 84.4%, 75.0% at 1 year and median at 8.3 years after exchange. The most common adverse events, occurring in less than 1/3 of the population, included bleeding, infection and stroke. This study suggests that LVAD exchange can be an effective and definitive mechanism for the treatment of otherwise potential fatal pump complications in highly select patients.
{"title":"Favorable Outcomes with Ventricular Assist Device Exchange","authors":"M. Carroll, Meghan Tooman, M. Bochan, C. Salerno, A. Ravichandran","doi":"10.14434/VAD.V5I0.28076","DOIUrl":"https://doi.org/10.14434/VAD.V5I0.28076","url":null,"abstract":"Left ventricular assist device (LVAD) therapy remains a vital therapeutic option for patients with end-stage heart failure. Unfortunately, adverse events can occur and progress to require consideration for device exchange once the failure of medical management becomes evident, especially when heart transplantation is not possible in a timely manner. The aim of this analysis is to describe the incidence and outcomes of LVAD exchanges at our institution. Between April 2008 and May 2017, 397 patients underwent LVAD implantation, with 32 of those patients subsequently receiving exchange upon the recommendation of our multidisciplinary team due to refractory infection (n=12), device malfunction (n=5), hemolysis (n=9) and pump thrombosis (n=6). The average time from index implant to exchange was 580.6 days, with an average length of stay of 18.2 days. Survival at 3 months was 84.4%, 75.0% at 1 year and median at 8.3 years after exchange. The most common adverse events, occurring in less than 1/3 of the population, included bleeding, infection and stroke. This study suggests that LVAD exchange can be an effective and definitive mechanism for the treatment of otherwise potential fatal pump complications in highly select patients.","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77208421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sumon Roy, Nishit Biniwale, V. Pendela, Patricia Oates, Katrina F. Wojciechowski, S. Feitell
Amniotic fluid embolism (AFE) is one of the most devastating complications of pregnancy that typically manifests as acute cardiopulmonary collapse during delivery or in the postpartum period. The potential role of extracorporeal membrane oxygenation (ECMO) as a management technique in severe cases of AFE remains largely unknown. In this report, we present the first case, to our knowledge, of successful implementation of ECMO as a life-saving measure in a case of hemorrhagic shock due to postpartum bleeding complicated by severe AFE leading to acute respiratory distress syndrome (ARDS) ultimately requiring tracheostomy. Hemodynamic decompensation is often rapid but transient in cases of severe AFE, and we recommend early consideration of ECMO implementation given its vital utility in these critical moments.
{"title":"Successful Extracorporeal Membrane Oxygenation in the Management of Acute Respiratory Distress Syndrome and Cardiopulmonary Collapse Secondary to Amniotic Fluid Embolism","authors":"Sumon Roy, Nishit Biniwale, V. Pendela, Patricia Oates, Katrina F. Wojciechowski, S. Feitell","doi":"10.14434/VAD.V5I0.28086","DOIUrl":"https://doi.org/10.14434/VAD.V5I0.28086","url":null,"abstract":"Amniotic fluid embolism (AFE) is one of the most devastating complications of pregnancy that typically manifests as acute cardiopulmonary collapse during delivery or in the postpartum period. The potential role of extracorporeal membrane oxygenation (ECMO) as a management technique in severe cases of AFE remains largely unknown. In this report, we present the first case, to our knowledge, of successful implementation of ECMO as a life-saving measure in a case of hemorrhagic shock due to postpartum bleeding complicated by severe AFE leading to acute respiratory distress syndrome (ARDS) ultimately requiring tracheostomy. Hemodynamic decompensation is often rapid but transient in cases of severe AFE, and we recommend early consideration of ECMO implementation given its vital utility in these critical moments.","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89591199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this paper, we summarized the most interesting and important, from our standpoint, publications from 2018. There may be some slight overlapping with the end of 2017 because some papers were published online first. For the second time this year, we added a section on extracorporeal membrane oxygenation (ECMO) which primarily addresses new developments in veno-arterial (VA) ECMO.
{"title":"What Did We Learn about VADs in 2018?","authors":"M. Guglin","doi":"10.14434/VAD.V5I0.28084","DOIUrl":"https://doi.org/10.14434/VAD.V5I0.28084","url":null,"abstract":"In this paper, we summarized the most interesting and important, from our standpoint, publications from 2018. There may be some slight overlapping with the end of 2017 because some papers were published online first. For the second time this year, we added a section on extracorporeal membrane oxygenation (ECMO) which primarily addresses new developments in veno-arterial (VA) ECMO.","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83671963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. S. Armas, M. Akay, J. Patel, Chandni Patel, M. Patel, B. Akkanti, B. Kar, I. Gregoric
A heavily calcified ventricular apex represents a challenging, rare and unique situation in LVAD implantation. A 44-year-old male was admitted with myocardial infarction. Left heart catheterization was complicated by episodes of ventricular fibrillation. After an acute stabilization with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), an LVAD implantation was approved. Pre-operative work-up had shown a heavily calcified ventricular apex and an intraventricular thrombus, which was confirmed intraoperatively. To retain a viable ventricular geometry, the decision was made to preserve the calcified apex rather than to excise the entire calcified left ventricular aneurysm. Sutures for the inlet cannula were placed around the calcific apex (Apex Preserving) away from the core site, parachuting the inflow sewing ring into an intramyocardial position (Telescope) and assuring hemostasis by placing a felt strip on the epicardial tissue in a purse string fashion (Cerclage). The HeartMate II LVAD inflow cannula was secured into the sawing ring, and the rest of the procedure was conducted in the standardized fashion. The patient was discharged into a rehabilitation center eight weeks after LVAD implantation. Thus, if the calcific area is maintained by coring just the inflow site, the spherical shape of the ventricle is maintained to all for better positioning of the inlet cannula. The second suture line enhances hemostasis around the inflow insertion site and stays away from the calcium, which sits in a deeper layer. This procedure, the apex preserving cerclage technique (APCT), does not increase surgical time and reinforces the tissue around the inlet site.
在LVAD植入中，严重钙化的心室顶点是一种具有挑战性、罕见和独特的情况。44岁男性，因心肌梗死入院。左心导管术并发心室颤动发作。经静脉-动脉体外膜氧合(VA-ECMO)急性稳定后，批准LVAD植入。术前检查显示严重钙化的心室尖和心室内血栓，这在术中得到证实。为了保留可行的心室几何结构，我们决定保留钙化顶点，而不是切除整个钙化的左心室动脉瘤。将入口插管的缝合线置于远离核心部位的钙化尖端(保留尖端)周围，将流入缝合线空降至心内位置(望远镜)，并将毛毡条以钱包线的方式放置在心外膜组织上(环扣)以确保止血。将HeartMate II LVAD流入套管固定在锯环中，其余操作以标准化方式进行。患者在LVAD植入8周后出院进入康复中心。因此，如果仅通过取心来维持钙化区域，则可以保持心室的球形，从而更好地定位入口插管。第二条缝合线加强了流入插入部位周围的止血，并远离位于更深一层的钙。这一过程，即保留尖端环扎技术(APCT)，不会增加手术时间，并加强了入口部位周围的组织。
{"title":"Implantation of Left Ventricular Assist Device in the setting of heavily calcified left ventricular apex using an apex preserving technique","authors":"I. S. Armas, M. Akay, J. Patel, Chandni Patel, M. Patel, B. Akkanti, B. Kar, I. Gregoric","doi":"10.14434/VAD.V5I0.28085","DOIUrl":"https://doi.org/10.14434/VAD.V5I0.28085","url":null,"abstract":"A heavily calcified ventricular apex represents a challenging, rare and unique situation in LVAD implantation. A 44-year-old male was admitted with myocardial infarction. Left heart catheterization was complicated by episodes of ventricular fibrillation. After an acute stabilization with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), an LVAD implantation was approved. Pre-operative work-up had shown a heavily calcified ventricular apex and an intraventricular thrombus, which was confirmed intraoperatively. To retain a viable ventricular geometry, the decision was made to preserve the calcified apex rather than to excise the entire calcified left ventricular aneurysm. Sutures for the inlet cannula were placed around the calcific apex (Apex Preserving) away from the core site, parachuting the inflow sewing ring into an intramyocardial position (Telescope) and assuring hemostasis by placing a felt strip on the epicardial tissue in a purse string fashion (Cerclage). The HeartMate II LVAD inflow cannula was secured into the sawing ring, and the rest of the procedure was conducted in the standardized fashion. The patient was discharged into a rehabilitation center eight weeks after LVAD implantation. Thus, if the calcific area is maintained by coring just the inflow site, the spherical shape of the ventricle is maintained to all for better positioning of the inlet cannula. The second suture line enhances hemostasis around the inflow insertion site and stays away from the calcium, which sits in a deeper layer. This procedure, the apex preserving cerclage technique (APCT), does not increase surgical time and reinforces the tissue around the inlet site.","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89702097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin S. Yei, Casey Kaisi, R. Mohan, A. Srivastava, J. Heywood
In the left ventricular assist device (LVAD) population, right ventricular (RV) failure represents a significant cause of morbidity and mortality. It is unclear whether hemodynamic monitoring with the implantable CardioMEMS system can improve outcomes within this population. This case report highlights two patients in our clinic who had CardioMEMS implanted after LVAD, enabling us to modify their medical regimens remotely and more frequently in the management of their RV failure.
{"title":"Implanted Hemodynamic Monitoring in Management of Significant Right Heart Failure before and after Left Ventricular Assist Device Implantation: Creation and Maintenance of Fontan Physiology in Severe Right Ventricular Dysfunction","authors":"Kevin S. Yei, Casey Kaisi, R. Mohan, A. Srivastava, J. Heywood","doi":"10.14434/vad.v4i0.28051","DOIUrl":"https://doi.org/10.14434/vad.v4i0.28051","url":null,"abstract":"In the left ventricular assist device (LVAD) population, right ventricular (RV) failure represents a significant cause of morbidity and mortality. It is unclear whether hemodynamic monitoring with the implantable CardioMEMS system can improve outcomes within this population. This case report highlights two patients in our clinic who had CardioMEMS implanted after LVAD, enabling us to modify their medical regimens remotely and more frequently in the management of their RV failure.","PeriodicalId":91822,"journal":{"name":"The VAD journal : the journal of mechanical assisted circulation and heart failure","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82068554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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