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M Turina - One of the best experts on this subject based on the ideXlab platform.
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left Ventricular Assist Device lvad enables survival during 7 h of sustained Ventricular fibrillation
European Journal of Cardio-Thoracic Surgery, 2004Co-Authors: Sacha P Salzberg, Mario Lachat, Gregor Zund, M TurinaAbstract:We describe the case of a patient implanted with a DeBakey left Ventricular Assist Device (LVAD) as bridge to transplant who survived 7 h of Ventricular fibrillation. He was successfully converted into a stable sinus rhythm.
John V Conte - One of the best experts on this subject based on the ideXlab platform.
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left Ventricular Assist Device driveline infections
Cardiology Clinics, 2011Co-Authors: Daniel Pereda, John V ConteAbstract:: This article reviews some important aspects of driveline infection in patients under left Ventricular Assist Device (LVAD) support, including epidemiology, causes, diagnosis, and treatment options, both medical and surgical. Focus is placed on prevention along every aspect of the process of LVAD therapy, as the authors believe this is the most efficient measure to fight driveline infections. Once driveline infection is present, early recognition and adequate treatment, including surgical measures, play a central role management, and are key to achieving the goals of LVAD support.
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right heart dysfunction after left Ventricular Assist Device implantation a comparison of the pulsatile heartmate i and axial flow heartmate ii Devices
The Annals of Thoracic Surgery, 2008Co-Authors: Nishant D Patel, Susan Ullrich, Eric S Weiss, Justin M Schaffer, Dennis C Rivard, Ashish S Shah, Stuart D Russell, John V ConteAbstract:Background Right heart dysfunction confers significant morbidity and mortality after left Ventricular Assist Device implantation and historically occurs in as many as a third of patients. It is unknown whether newer axial flow pumps have a different impact on postimplant right heart dysfunction. We compared the incidence of right heart dysfunction after implantation of the pulsatile HeartMate I (XVE) and the continuous flow HeartMate II left Ventricular Assist Device. Methods We retrospectively reviewed patients who underwent HeartMate I or HeartMate II implantation between June 2000 and March 2007. Right heart dysfunction was defined as inotropic/vasodilator support for 14 or more consecutive days or the need for a right Ventricular Assist Device, or both. Results Seventy-seven patients underwent HeartMate implantation; 43 received a HeartMate I and 34 received a HeartMate II, for a mean left Ventricular Assist Device support time of 202 and 160 days, respectively. Operative mortality was lower for HeartMate II patients (28% versus 15%; p = 0.26). The HeartMate II patients had lower preoperative right Ventricular stroke work index. Pulmonary vascular resistance index, right Ventricular stroke work index, and pulmonary and right atrial pressures improved and were similar between groups postoperatively. Overall, right heart dysfunction developed in 35% of HeartMate I patients (15 of 43) and 41% of HeartMate II patients (14 of 34; p = 0.63). Fewer HeartMate II patients (2) than HeartMate I patients (5) required 7 or more days of epinephrine, whereas more HeartMate II patients (7) than HeartMate I patients (5) required 7 or more days of milrinone. Six HeartMate I and 3 HeartMate II patients required right Ventricular Assist Device implantation for right heart failure. Survival was similar ( p = 0.7) between groups at, respectively, 3 (63% versus 62%), 6 (58% versus 58%), and 12 months (49% versus 48%). Conclusions Right heart dysfunction is a persistent clinical problem after left Ventricular Assist Device placement. We report the first study comparing the incidence of right heart dysfunction after HeartMate I versus HeartMate II implantation. Although the incidence of right heart dysfunction was similar, fewer HeartMate II patients required right Ventricular Assist Device placement and fewer required pure inotropic support for right heart failure.
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treatment of Ventricular Assist Device driveline infection with vacuum Assisted closure system
The Annals of Thoracic Surgery, 2005Co-Authors: Maryann Albaugh, Susan Ullrich, John V ConteAbstract:Deep driveline infection is a serious complication after left Ventricular Assist Device implantation. Current treatment strategies are associated with significant morbidity related to healing or relocation of the driveline tract. We present a case of deep driveline infection successfully treated with a vacuum-Assisted closure system as a potentially improved alternative therapy.
Ulrich P. Jorde - One of the best experts on this subject based on the ideXlab platform.
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outcome of unplanned right Ventricular Assist Device support for severe right heart failure after implantable left Ventricular Assist Device insertion
Journal of Heart and Lung Transplantation, 2014Co-Authors: K Takeda, Yoshifumi Naka, Ulrich P. Jorde, Nir Uriel, Jonathan Yang, P C Colombo, Hiroo TakayamaAbstract:Background The use of a right Ventricular Assist Device (RVAD) becomes necessary for severe right Ventricular (RV) failure after left Ventricular Assist Device (LVAD) insertion. Although temporary support could lead to successful RVAD weaning in certain patients, the data remain scarce. Methods We retrospectively reviewed 398 patients who underwent implantable LVAD insertion between January 2000 and December 2012. Of these patients, 44 (11%) required unplanned RVAD support due to severe RV failure after LVAD insertion. For comparison, 37 patients who underwent planned biVentricular Assist Device (BiVAD) insertion were identified during the same study period. We analyzed the early and late outcomes in these patients. Results The mean duration of RVAD support was 21 ± 23 days. Of the 44 patients, 21 (49%) were weaned from the RVAD (weaning group), whereas 23 (51%) required continued biVentricular support (failure group). The failure group had ongoing end-organ dysfunction after RVAD insertion. Hospital mortality was significantly lower in the weaning group (24%) and in the planned BiVAD group (30%) as compared to the failure group (74%, p = 0.0009). The 6-month actuarial survival rate was 75% in the weaning group, 62% in the planned BiVAD group and 13% in the failure group ( p p = 0.03). On multivariate logistic regression analyses, pre-operative white blood cell (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.04 to 1.50, p = 0.016) and creatinine (OR 0.26, 95% CI 0.079 to 0.88, p = 0.03) levels were significant predictors for RVAD removal. Conclusions Among patients who developed acute RV failure after LVAD insertion, only half could be weaned from the temporary RVAD support. An alternative strategy is necessary in patients who require continuous RVAD support.
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prevalence significance and management of aortic insufficiency in continuous flow left Ventricular Assist Device recipients
Circulation-heart Failure, 2014Co-Authors: Ulrich P. Jorde, Nir Uriel, Nadav Nahumi, David Bejar, Jose Gonzalezcostello, Sunu S Thomas, Kerry A Morrison, Sophie Jones, Susheel Kodali, Rebecca T HahnAbstract:Background—Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left Ventricular Assist Device support; however, its long-term prevalence, clinical significance, and efficacy of potential interventions are not well known. Methods and Results—We studied the prevalence and management of AI in 232 patients with continuous flow left Ventricular Assist Device at our institution. Patients with aortic valve (AV) surgery before left Ventricular Assist Device implantation were excluded from analysis. To examine the prevalence of de novo AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant, and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan–Meier analysis revealed that freedom from greater th...
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Ventricular Assist Device therapy.
Cardiovascular therapeutics, 2009Co-Authors: Gabriel Sayer, Yoshifumi Naka, Ulrich P. JordeAbstract:Ventricular Assist Devices are an important therapeutic option for advanced congestive heart failure. A left Ventricular Assist Device (LVAD) can be implanted as a bridge to transplantation or for the purpose of destination therapy. LVADs improve end-organ function and reduce morbidity and mortality in appropriately selected patients. The development of axial flow pumps has overcome many of the limitations of the first-generation pulsatile flow LVADs. However, many complications of LVAD therapy remain. Treating these complications requires an understanding of LVAD physiology. Ongoing research is directed at reducing the incidence of many of these complications and may allow for wider use of LVADs.
Yoshifumi Naka - One of the best experts on this subject based on the ideXlab platform.
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a fully magnetically levitated left Ventricular Assist Device final report
The New England Journal of Medicine, 2019Co-Authors: Mandeep R Mehra, Yoshifumi Naka, Nir Uriel, Joseph C Cleveland, M Yuzefpolskaya, Christopher T Salerno, Mary Norine Walsh, Carmelo A Milano, Chetan B Patel, Steven W HutchinsAbstract:Abstract Background In two interim analyses of this trial, patients with advanced heart failure who were treated with a fully magnetically levitated centrifugal-flow left Ventricular Assist Device ...
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Bridge to durable left Ventricular Assist Device for refractory cardiogenic shock.
The Journal of thoracic and cardiovascular surgery, 2016Co-Authors: Daisuke Yoshioka, Hiroo Takayama, Arthur R. Garan, Veli K. Topkara, Jiho Han, Paul Kurlansky, Melana Yuzefpolskaya, Paolo C. Colombo, Yoshifumi NakaAbstract:Abstract Objective The role of short-term mechanical circulatory support has increased in patients with refractory cardiogenic shock. However, limited data exist on the outcomes of a bridge to a durable left Ventricular Assist Device strategy using short-term mechanical circulatory support. Methods We retrospectively reviewed 382 patients who underwent continuous-flow left Ventricular Assist Device insertion between 2004 and 2014. Of these, 45 (12%) were bridged with short-term mechanical circulatory support Devices for refractory cardiogenic shock. We analyzed early and midterm outcomes in this bridged cohort. Multivariate Cox proportional hazards modeling was performed to evaluate the predictor of overall death in the entire cohort. Results The mean age of the bridged cohort was 53 ± 10 years, and 87% were male. The types of initial support included percutaneous Devices in 24 patients (53%) and external continuous-flow Ventricular Assist Device in 21 patients (47%). The median duration of short-term mechanical circulatory support was 14.0 (interquartile range, 7.5-29.5) days. The short-term mechanical circulatory support significantly improved end-organ function and hemodynamics. After conversion to durable left Ventricular Assist Device insertion, in-hospital mortality was 18%. The incidence of right Ventricular Assist Device use was high at 27%. The overall survival was 70% and 62% at 1 and 2 years, respectively. Cox multivariate hazard analysis in the entire cohort demonstrated that the use of a postoperative right Ventricular Assist Device was a significant predictor of overall death (hazard ratio, 4.04; P P = .937). Conclusions Short-term mechanical circulatory support can optimize patients in refractory cardiogenic shock and serve as a bridge to implantation of a durable left Ventricular Assist Device. However, the early mortality rate after durable left Ventricular Assist Device implantation is high because of unrecognized right Ventricular failure.
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outcome of unplanned right Ventricular Assist Device support for severe right heart failure after implantable left Ventricular Assist Device insertion
Journal of Heart and Lung Transplantation, 2014Co-Authors: K Takeda, Yoshifumi Naka, Ulrich P. Jorde, Nir Uriel, Jonathan Yang, P C Colombo, Hiroo TakayamaAbstract:Background The use of a right Ventricular Assist Device (RVAD) becomes necessary for severe right Ventricular (RV) failure after left Ventricular Assist Device (LVAD) insertion. Although temporary support could lead to successful RVAD weaning in certain patients, the data remain scarce. Methods We retrospectively reviewed 398 patients who underwent implantable LVAD insertion between January 2000 and December 2012. Of these patients, 44 (11%) required unplanned RVAD support due to severe RV failure after LVAD insertion. For comparison, 37 patients who underwent planned biVentricular Assist Device (BiVAD) insertion were identified during the same study period. We analyzed the early and late outcomes in these patients. Results The mean duration of RVAD support was 21 ± 23 days. Of the 44 patients, 21 (49%) were weaned from the RVAD (weaning group), whereas 23 (51%) required continued biVentricular support (failure group). The failure group had ongoing end-organ dysfunction after RVAD insertion. Hospital mortality was significantly lower in the weaning group (24%) and in the planned BiVAD group (30%) as compared to the failure group (74%, p = 0.0009). The 6-month actuarial survival rate was 75% in the weaning group, 62% in the planned BiVAD group and 13% in the failure group ( p p = 0.03). On multivariate logistic regression analyses, pre-operative white blood cell (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.04 to 1.50, p = 0.016) and creatinine (OR 0.26, 95% CI 0.079 to 0.88, p = 0.03) levels were significant predictors for RVAD removal. Conclusions Among patients who developed acute RV failure after LVAD insertion, only half could be weaned from the temporary RVAD support. An alternative strategy is necessary in patients who require continuous RVAD support.
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Ventricular Assist Device therapy.
Cardiovascular therapeutics, 2009Co-Authors: Gabriel Sayer, Yoshifumi Naka, Ulrich P. JordeAbstract:Ventricular Assist Devices are an important therapeutic option for advanced congestive heart failure. A left Ventricular Assist Device (LVAD) can be implanted as a bridge to transplantation or for the purpose of destination therapy. LVADs improve end-organ function and reduce morbidity and mortality in appropriately selected patients. The development of axial flow pumps has overcome many of the limitations of the first-generation pulsatile flow LVADs. However, many complications of LVAD therapy remain. Treating these complications requires an understanding of LVAD physiology. Ongoing research is directed at reducing the incidence of many of these complications and may allow for wider use of LVADs.
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circulatory resuscitation with left Ventricular Assist Device support reduces interleukins 6 and 8 levels
The Annals of Thoracic Surgery, 1997Co-Authors: Daniel J Goldstein, Yoshifumi Naka, Nader Moazami, Alex J Seldomridge, Hui Laio, Robert C Ashton, David J Pinsky, Mehmet C OzAbstract:Abstract Background. Elevated tumor necrosis factor serum levels have been reported in patients with severe congestive heart failure. This study was designed to characterize the cytokine profile in patients with acute circulatory collapse. Methods. Blood drawn from 14 consecutive patients within 24 hours before undergoing left Ventricular Assist Device placement and after at least 30 days of mechanical Assistance or before transplantation was assayed for levels of interleukin 6, interleukin 8, and tumor necrosis factor-α. Results. Interleukin 6 level was elevated in 11 (79%), interleukin 8 in 10 (71%), and tumor necrosis factor in 2 (14%) of the 14 patients. After hemodynamic recovery, interleukin 6 levels decreased from 33.6 ± 9 pg/mL to 11.3 ± 4 pg/mL ( p = 0.05) and interleukin 8 levels decreased from 122 ± 34 pg/mL to 19.7 ± 8 pg/mL ( p = 0.005). Tumor necrosis factor-α levels did not vary significantly; they were associated with infection in 2 left Ventricular Assist Device recipients and normalized after left Ventricular Assist Device support. All patients had resolution of circulatory shock after mechanical support and had improvement in parameters of end-organ function. Conclusions. Circulatory shock treated with left Ventricular Assist Device placement is associated with a proinflammatory response similar to that seen in septic shock. The decrease in cytokine serum levels that follows hemodynamic recovery suggests that these cytokines may be markers of tissue damage and may modulate cardiac dysfunction. (Ann Thorac Surg 1997;63:971–4)
Carmelo A Milano - One of the best experts on this subject based on the ideXlab platform.
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a fully magnetically levitated left Ventricular Assist Device final report
The New England Journal of Medicine, 2019Co-Authors: Mandeep R Mehra, Yoshifumi Naka, Nir Uriel, Joseph C Cleveland, M Yuzefpolskaya, Christopher T Salerno, Mary Norine Walsh, Carmelo A Milano, Chetan B Patel, Steven W HutchinsAbstract:Abstract Background In two interim analyses of this trial, patients with advanced heart failure who were treated with a fully magnetically levitated centrifugal-flow left Ventricular Assist Device ...
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clinical outcomes after implantation of a centrifugal flow left Ventricular Assist Device and concurrent cardiac valve procedures
Circulation, 2014Co-Authors: Carmelo A Milano, Duc Thinh Pham, Mark S Slaughter, Francis D Pagani, David R Hathaway, Mary V Jacoski, Kevin B Najarian, Keith D AaronsonAbstract:Background—Cardiac valve procedures are commonly performed concurrently during implantation of left Ventricular Assist Devices, but the added procedural risk has not been studied in detail. Methods and Results—Data from patients receiving the HeartWare Ventricular Assist Device in the ADVANCE bridge to transplant (BTT) trial and continued access protocol were reviewed. Of 382 consecutive patients who completed follow-up between August 2008 and June 2013 (mean time on support 389 days, median 271 days), 262 (68.6%) underwent isolated HeartWare Ventricular Assist Device implantation, 75 (19.6%) a concurrent valve procedure, and 45 (11.8%) concurrent nonvalvular procedures. Of the concurrent valve procedures, 56 were tricuspid, 13 aortic, and 6 mitral. Survival was similar between groups (79% for concurrent valve procedures and 85% for HeartWare Ventricular Assist Device only at 1 year; P=0.33). Concurrent valve procedures were also associated with increased unadjusted early right heart failure (RHF). A mult...
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unexpected abrupt increase in left Ventricular Assist Device thrombosis
The New England Journal of Medicine, 2014Co-Authors: Randall C. Starling, Michael A Acker, Scott C Silvestry, Carmelo A Milano, Joseph G Rogers, Gregory A. Ewald, Nader Moazami, Eduardo J Rame, Eugene H Blackstone, John EhrlingerAbstract:BACKGROUND We observed an apparent increase in the rate of Device thrombosis among patients who received the HeartMate II left Ventricular Assist Device, as compared with preapproval clinical-trial results and initial experience. We investigated the occurrence of pump thrombosis and elevated lactate dehydrogenase (LDH) levels, LDH levels presaging thrombosis (and associated hemolysis), and outcomes of different management strategies in a multi-institutional study. METHODS
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endovascular stent grafting of a left Ventricular Assist Device outflow graft pseudoaneurysm
Circulation-heart Failure, 2013Co-Authors: Asvin M Ganapathi, Carmelo A Milano, Nicholas D Andersen, Deyanira J Prastein, Zubair A Hashmi, Joseph G Rogers, Richard L Mccann, Chad G HughesAbstract:A 61-year-old female underwent implantation of a Heartmate II left Ventricular Assist Device (LVAD; Thoratec Corporation, Pleasanton, CA) for end-stage nonischemic cardiomyopathy. Six months later, she presented with chest pain and worsening heart failure symptoms. Computed tomography angiography revealed a large subxiphoid pseudoaneurysm with peripheral thrombus exerting a mass effect on the heart (Figures 1 and 2). Further evaluation by ultrasonography with anterior chest transducer placement confirmed a 13-cm pseudoaneurysm with multiple connections to the LVAD outflow Dacron graft (Figure 3). She was afebrile and had no physical or laboratory evidence of infection. Because of extensive comorbidities, including morbid obesity, restrictive lung disease, and chronic renal insufficiency, open repair via repeat sternotomy was considered risk-prohibitive, and an endovascular repair was pursued. Figure 1. Axial computed tomography angiography image demonstrating the large subxiphoid pseudoaneurysm ( red arrow ) with area of communication to the outflow graft of the left Ventricular Assist Device (LVAD; yellow arrow ). Figure 2. Three-dimensional computed tomography angiography reconstruction demonstrating pseudoaneurysm ( yellow arrow ) arising from the outflow graft ( blue arrow ) of the left Ventricular Assist Device (LVAD; red arrow ). Figure 3. A , Sagittal ultrasonographic view of the anterior chest demonstrating a 13×9 cm fluid collection (demarcated by + symbols) surrounding the outflow tract ( red arrow ) from the left Ventricular apex ( yellow arrow ) to the left Ventricular Assist Device (LVAD). B , Sagittal Doppler view demonstrating swirling flow within the fluid collection consistent with pseudoaneurysm. Off-label use of a Gore …
