A Computational Hemodynamics Approach to Left Ventricular Assist Device (LVAD) Optimization Validated in a Large Patient Cohort
With increasing use of left ventricular assist devices (LVAD) it is critical to devise strategies to optimize LVAD speed while controlling mean arterial pressure (MAP) and flow according to patient physiology. The complex interdependency between LVAD speed, MAP, and flow frequently makes optimization difficult under clinical conditions. We propose a method to guide this procedure in silico, narrowing the conditions to test clinically. A computational model of the circulatory network that simulates HF and LVAD support, incorporating LVAD pressure–flow curves was applied retrospectively to anonymized patient hemodynamics d...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Biomedical Engineering Source Type: research
Arterial Compliance and Continuous-Flow Left Ventricular Assist Device Pump Function
This study assessed the impact of alterations in arterial compliance, preload, and afterload on continuous-flow pump function and measured hemodynamics using an in-vitro pulsatile mock circulatory loop. Decreased arterial compliance was associated with a significant increase in arterial pressure pulsatility which was not evident in the flow pulsatility, as displayed in pump flow waveforms. There were marked changes in the pump flow waveforms due to the significant alteration in the aortoventricular gradient during diastole according to the changes in compliance. This study demonstrates that changes in systemic blood pressu...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Adult Circulatory Support Source Type: research
Comparison of Bivalirudin Versus Unfractionated Heparin for Anticoagulation in Adult Patients on Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation (ECMO) contributes to coagulopathy, necessitating systemic anticoagulation to prevent thrombosis. Traditionally, unfractionated heparin (UFH) has been the anticoagulant of choice, however, due to many inadequacies new evidence suggests benefit with the use of direct thrombin inhibitors. This retrospective cohort sought to evaluate the safety and efficacy of bivalirudin compared to UFH in ECMO patients. Primary endpoints included incidence of bleeding and thrombosis. Percent time in therapeutic range (TR), time to achieve TR and number of dose titrations required to maintain TR were calcu...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Adult Circulatory Support Source Type: research
Post Heart Transplantation Outcomes of Patients Supported on Biventricular Mechanical Support
With the implementation of the new heart transplant (HT) allocation system, patients requiring biventricular support systems have the highest priority, a shorter waitlist time, and a higher frequency of HT. However, the short-term and long-term outcomes of such patients are often disputed. Hence, we examined the outcomes of these patients who underwent HT before change in allocation scheme. Additionally, we compared post-HT outcomes of extracorporeal membrane oxygenation (ECMO) with other nondischargeable biventricular (BiVAD) supported patients. We identified adult ECMO or BiVAD supported HT recipients between 2000 and 20...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Adult Circulatory Support Source Type: research
Venoarterial Extracorporeal Membrane Oxygenation in Severe Drug Intoxication: A Retrospective Comparison of Survivors and Nonsurvivors
This study reported short-term survival outcomes and factors associated with mortality in V-A ECMO-treated patients for poisoning. Twenty-two patients placed on V-A ECMO after drug intoxication from January 2014 to December 2020 were retrospectively analyzed. The primary endpoint of this study was survival at hospital discharge. Univariate descriptive analysis was performed to compare survivors and nonsurvivors during hospitalization. The overall survival at hospital discharge was 45.4% (n = 10/22). Survival rate tended to be higher in patients treated for refractory shock (n = 7/10) compared with those treated for refract...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Adult Circulatory Support Source Type: research
Prevalence of Iron Deficiency and Iron Administration in Left Ventricular Assist Device and Heart Transplantation Patients
Iron deficiency (ID) is a common comorbidity in heart failure (HF). In these patients, intravenous iron administration can improve clinical outcomes and quality of life (QoL). However, data on ID are lacking in patients who have transitioned toward left ventricular assist device (LVAD) or heart transplantation (HTx). All patients who underwent LVAD (n = 84) surgery or HTx (n = 67) at our center between 2012 and 2019, aged ≥18 years with a follow-up of ≥3 months, were included. Retrospectively, the prevalence of ID up to 1 year preoperatively, and up to February 2020 postoperatively, as well as all iron administrations ...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Adult Circulatory Support Source Type: research
Durable Left Ventricular Assist Device as a Bridge to Heart Transplantation Under the New Donor Heart Allocation System
The new donor heart allocation system prioritizes candidates supported by temporary devices. However, waitlist and posttransplant outcomes in candidates with durable left ventricular assist device (LVAD) remain to be elucidated. The United Network for Organ Sharing database was queried for adults listed from October 2015 to March 2020 for a single-organ, first-time heart transplant (HTx) with a durable LVAD. Waitlist removal within 1 year because of death or clinical deterioration and HTx was analyzed using competing risks regression. Candidates who underwent HTx within 1 year of listing were identified for examination of ...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Adult Circulatory Support Source Type: research
The Disconnect Between Extracorporeal Circulation and the Microcirculation: A Review
Extracorporeal circulation (ECC) procedures, such as cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), take over the function of one or more organs, providing clinicians time to treat underlying pathophysiological conditions. ECMO and CPB carry significant mortality rates for patients, despite prior decades of research focused on the resulting failure of critical organs. Since the focus of these procedures is to support blood flow and provide oxygen-rich blood to tissues, a shift in research toward the effects of ECMO and CPB on the microcirculation is warranted. Along with provoking systemic res...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Review Source Type: research
Extracorporeal Life Support Organization Guidelines for the Provision and Assessment of Nutritional Support in the Neonatal and Pediatric ECMO Patient
Disclaimer: This guideline is intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultim...
Source: ASAIO Journal - June 30, 2022 Category: Medical Devices Tags: Guidelines Source Type: research
Reply Letter to the Editor Regarding the ELSO Interim Guidelines for Veno-Arterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients
No abstract available (Source: ASAIO Journal)
Source: ASAIO Journal - June 1, 2022 Category: Medical Devices Tags: Letters to the Editor Source Type: research
Weaning from Veno Arterial Extracorporeal Membrane Oxygenation
No abstract available (Source: ASAIO Journal)
Source: ASAIO Journal - June 1, 2022 Category: Medical Devices Tags: Letters to the Editor Source Type: research
Severe Pulmonary Hemorrhage in a Neonate With Hypoxic Ischemic Encephalopathy and Sepsis Managed on Extracorporeal Membrane Oxygenation
We describe the therapeutic strategies used on veno-arterial ECMO to successfully manage this infant, including clamping the endotracheal tube, aggressive correction of coagulopathy, and use of dornase alfa, as well as elaborate on the subtle changes in ECMO parameters during the run that preceded worsening pneumonia with sepsis. (Source: ASAIO Journal)
Source: ASAIO Journal - June 1, 2022 Category: Medical Devices Tags: Case Reports Source Type: research
Toxicity-induced Cardiomyopathy in a Patient with Femoral Sarcoma: Heart Transplantation After Support with Ventricular Assist Device as Bridge to Transplantability
This case report exemplifies how a ventricular assist device successfully supported a 15 year old tumor patient with anthracycline-induced cardiomyopathy for 419 days until she was confirmed free from tumor recurrence to undergo heart transplantation, presently with an 18 year follow up without any malignancy. (Source: ASAIO Journal)
Source: ASAIO Journal - June 1, 2022 Category: Medical Devices Tags: Case Reports Source Type: research
First-in-Man Use of the Percutaneous 10F Reitan Catheter Pump for Cardiorenal Syndrome
Cardiorenal syndrome worsens outcome in patients with decompensated chronic heart failure, and complicates recompensation by medical therapy. Mechanical circulatory support has the potential to improve renal function, and likely mitigates diuretic resistance in patients with severe cardiorenal syndrome. The Reitan catheter pump (RCP) is a novel temporary percutaneous circulatory support system for reducing cardiac afterload and increasing renal preload. Here, we report on the first-in-man use of the 10F-version of the RCP device, which was associated with favorable effects on hemodynamics and diuresis. Further investigatio...
Source: ASAIO Journal - June 1, 2022 Category: Medical Devices Tags: Case Reports Source Type: research
Pediatric Extracorporeal Membrane Oxygenation (ECMO) Transport in a Developing Nation: A Single Center Experience
No abstract available (Source: ASAIO Journal)
Source: ASAIO Journal - June 1, 2022 Category: Medical Devices Tags: Brief Communication Source Type: research
