ISHLT issues new guidelines for care of mechanical circulatory support device patients
(Elsevier Health Sciences) The International Society for Heart and Lung Transplantation convened an international panel of experts in all aspects of mechanical circulatory support care (MCS), a rapidly growing technology to treat advanced heart failure. They developed practice guidelines to provide a common framework for the care and treatment of MCS patients. The Executive Summary of these guidelines is published in the February issue of The Journal of Heart and Lung Transplantation and is freely available.
ConclusionsTranscatheter LA decompression is an age-independent, effective palliation treating patients with HFpEF.
Heart transplantation (HTx) remains the ultimate treatment for selected end-stage heart failure patients. Over time, patient selection and pre- and post-operative management have improved along with immunosuppressive therapy. However, these efforts have failed to improve outcome following the first post-transplant year. Analysis of International Society for Heart and Lung Transplantation registry data shows that cardiac allograft vasculopathy (CAV) and graft failure are the major heart-related late mortality causes following HTx .
We reported that compared to Primary Reperfusion (PR), first reducing myocardial oxygen demand by activating a trans-valvular pump while delaying coronary reperfusion (Primary Unloading; PU) reduces myocardial damage and increases myocardial levels of stromal derived factor 1 alpha (SDF-1a) in models of acute myocardial infarction (AMI). We hypothesize that SDF1a mediates the acute and chronic cardioprotective effects of PU.
Long-term survival after left ventricular assist device (LVAD) implantation in heart failure patients is mainly determined by a sophisticated after-care. Ambulatory visits only take place every 12 weeks. In case of life-threatening complications like pump thrombosis this might lead to delayed diagnosis and delayed intervention. It was the intention of the present study to develop new algorithms by analysis of LVAD log files for early detection of pump thrombosis.
Neurocognitive impairment is not uncommon in patients with established heart failure. Less is known of neurocognitive function (NCF) in patients living with left ventricular assist devices (LVADs) and of the factors that influence NCF. We investigated the NCF profile of a cohort of ambulatory patients with LVADs
Strokes (S) during continuous flow (CF) left ventricular assist device (LVAD) support are a major barrier to extension of the therapy to less ill ambulatory heart failure (HF) patients. We analyzed the incidence, outcome, and impact of major S in the INTERMACS database.
Palliative care (PC) has gained rising attention in a holistic treatment approach to chronic heart failure (CHF). However, the need after LVAD implantation or HTX is unclear.
The thoracotomy approach for implanting the HeartWareTM Ventricular Assist System (HVADTM) is an increasingly commonly used alternative implant procedure in select patients with advanced heart failure. Additionally, certain patient physiologies or co-morbidities allow alternative outflow graft placement locations when the ascending aorta is not a viable option. Multicenter data on the outcomes of these alternative outflow procedures has not previously been studied.
Despite considerable improvements in heart failure symptoms, exercise capacity as measured by maximal oxygen uptake (VO2max) remains low in patients treated with a left ventricular assist device (LVAD). We hypothesized that an inadequate increase in heart rate (HR) during exercise is associated with a low VO2max in LVAD recipients. We further aimed to analyse the potential relation between HR and VO2max and use of drugs with negative chronotropic effect.
In patients affected by chronic heart failure (HF) an inappropriate tissues O2 extraction is one of the major determinants of patients ’ fatigue during exercise. We tested the hypothesis that an increase of CO through pump speed change in LVAD patients, might be associated with a better O2 muscle metabolism in both rest and exercise conditions.