Home Inotropes in Patients Supported with Left Ventricular Assist Devices

There is little data outlining the use of outpatient inotropic medications in patients with existing left ventricular assist devices (LVADs). This case series explores this patient population and seeks to define the indications, complications, and safety of dual support. A retrospective chart review was conducted for all patients on LVAD and then subsequently started on home inotropes post device implant. Eight patients met inclusion criteria. The indications for inotropes were right ventricular failure, aortic insufficiency with biventricular failure, LVAD thrombosis with contraindication to device exchange, and cannula malposition with elevated pulmonary vascular resistance. Mean duration of combined support was 273 ± 170 days. Cardiac index improved from 1.96 ± 0.24 to 2.31 ± 0.35 L/min/m2 after inotropes (p = 0.02). There was no change in hospital admissions. The most common reason for readmission was heart failure symptoms, followed by bleeding. Five patients died during the study period, one underwent heart transplant, and two remain on inotropic support. Home inotropes may be indicated in selected continuous flow left ventricular assist device (CF-LVAD) patients with refractory right ventricular failure or impaired LVAD function. Inotropes can improve hemodynamics and provide palliation of symptoms. However, long-term inotrope use does not reduce hospital readmissions and is associated with multiple ...
Source: ASAIO Journal - Category: Medical Devices Tags: Case Reports Source Type: research

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Source: Johnson and Johnson - Category: Pharmaceuticals Source Type: news
ConclusionsHVAD cannula coronal angle was associated with reduced right ventricular function and HRAE. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on HRAEs are warranted.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
CONCLUSIONS: HVAD cannula coronal angle was associated with reduced right ventricular function and HRAE. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on HRAEs are warranted. PMID: 32035046 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
ConclusionsThe overall VTE rate after CABG has been low. However, the condition has been associated with worse 30-day postoperative outcomes and complications. The independent predictors of VTE development included a history of bleeding disorders, congestive heart failure in the 30 days before surgery, and operative time of ≥310 minutes. Understanding these risk factors should aid physicians in the decisions regarding prophylaxis and treatment.
Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research
CONCLUSION: I-PE and DVT/PE have important differences. Older age, female sex, heart failure and cancer, were risk factors for I-PE; thrombophilic alterations were associated with DVT/PE. HC use was more frequent in the I-PE group. The prevalence of arterial complications was higher in patients with I-PE. Further studies, specifically designed on this issue, are warranted. PMID: 31500936 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
ConclusionsOutpatient management for iPE in cancer patients appears to be feasible and safe in selected cancer patients.
Source: Clinical and Translational Oncology - Category: Cancer & Oncology Source Type: research
Conclusion: Our findings describe the most reported risk factors for preventability of oral anticoagulant-induced bleedings. These factors may be useful for targeting interventions to improve pharmacovigilance activities in our regional territory and to reduce the burden of medication errors and inappropriate prescription. Introduction Oral anticoagulant therapy is widely used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, or for the prevention and treatment of deep vein thrombosis and pulmonary embolism (Raj et al., 1994; Monaco et al., 2017). Oral anticoagulants can be di...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
l;ger K Abstract A 46-year-old woman on oral contraceptives developed an intrahepatic hematoma due to a benign hepatic tumor. As an incidental finding, a computed tomography showed a pulmonary embolism. Unfractionated heparin was given in a prophylactic dosing in an attempt to balance the risk of further intrahepatic bleeding with that of thrombosis. Ten days later, the patient developed a second pulmonary embolism along with acute right heart failure requiring cardiopulmonary resuscitation. As a sufficient circulation and oxygenation could not be reestablished, a veno-arterial extracorporeal membrane oxygenation ...
Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS - Category: Intensive Care Authors: Tags: Anasthesiol Intensivmed Notfallmed Schmerzther Source Type: research
This study aimed to assess HRAEs in patients with optimized haemodynamics.Methods and resultsEighty ‐three outpatients [aged 61 (53–67) years, 50 male] underwent a haemodynamic ramp test at 253 (95–652) days after LVAD implantation, and 51 (61%) had optimized haemodynamics (defined as central venous pressure
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
AbstractBackgroundVenous thromboembolism (VTE) occurs frequently in critically ill patients without heparin prophylaxis. Although heparin prevents VTE, VTEs occur frequently despite prophylaxis. Higher heparin dosage may be more effective for preventing VTE.MethodsA retrospective study was conducted utilizing the Premier Incorporated Perspective Database to comparatively evaluate the effects of different heparin prophylaxis dosing strategies in the critically ill patient. Critically ill adult patients who were mechanically ventilated for at least 1 day and had an Intensive Care Unit (ICU) length of stay of at least 2 days ...
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - Category: Drugs & Pharmacology Authors: Tags: SI on Prevention Strategies in the Critically Ill Source Type: research
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