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Preoperative higher right ventricular stroke work index increases the risk of de novo aortic insufficiency after continuous-flow left ventricular assist device implantation
This study investigated the influence of preoperative hemodynamic parameters on de novo AI in CF-LVAD recipients. We reviewed 125 patients who underwent CF-LVAD implantation without concomitant AV surgery between 2005 and 2018. De novo AI was defined as moderate or severe AI in those with none or trivial preoperative AI. During mean 30  ± 16 months of CF-LVAD support, de novo AI-free rate was 86% and 67% at 1 and 2 years, respectively. Multivariable analysis showed that higher right ventricular stroke work index (RVSWI) (hazard ratio, 1.12 /g/m2/beat; 95% confidence interval, 1.00 –1.20;p = 0.047) and trivial ...
Source: Journal of Artificial Organs - July 19, 2023 Category: Transplant Surgery Source Type: research

Huge thrombus formation in the left ventricle during bilateral CentriMag ventricular assist device with successful bridging to heart transplantation: a case report and review of the literature
AbstractOwing to shortage of donor hearts, the ventricular assist device is used as a bridging therapy to heart transplantation. However, thrombus formation is a critical complication during ventricular assist device circulatory support that might result in ischemic infarction of end organs. Here, we report a patient diagnosed with decompensated dilated cardiomyopathy and cardiogenic shock who underwent emergent extracorporeal life support, and subsequent temporary bilateral ventricular assistance with the CentriMag device (Levitronix LLC, Waltham, MA). Daily transthoracic echocardiography did not detect any thrombus forma...
Source: Journal of Artificial Organs - July 13, 2020 Category: Transplant Surgery Source Type: research

Mid-term results of 17-mm St. Jude Medical Regent prosthetic valves in elder patients with small aortic annuli: comparison with 19-mm bioprosthetic valves
This study was designed to compare the mid-term outcomes after aortic valve replacement (AVR) between 17-mm mechanical heart valves (MV) and 19-mm bioprosthetic valves (BV) in elderly patients with small aortic annuli. Between 2000 and 2011, 127 consecutive patients (mean age 79 years; 87 % female) underwent AVR for aortic valve stenosis with a small aortic annulus. 19-mm BV (n = 67) was implanted. When the 19-mm BV did not fit the annulus, 17-mm St. Jude Medical Regent prosthetic mechanical valve (n = 60) was used instead of an aortic root-enlargement procedure. The follow-up rate was 94.0 % in the BV group, and 98...
Source: Journal of Artificial Organs - September 1, 2014 Category: Transplant Surgery Source Type: research

Biventricular failure with low pulmonary vascular resistance was managed by left ventricular assist device alone without right-sided mechanical support
Abstract How to manage preoperative right ventricular dysfunction (RVD) in heart failure patients without cardiogenic shock remains as a matter to be debated because implantable biventricular assist device treatment has not been established thus far. We here presented a patient with significant RVD indicated by low RV stroke work index (0.3 g/m) and RV dilatation as well as low pulmonary vascular resistance (PVR, 0.8 Wood Unit), who was managed by the introduction of pimobendan and sildenafil after the implantation of DuraHeart and tricuspid annuloplasty without right VAD, although his New York Heart Association ...
Source: Journal of Artificial Organs - March 13, 2015 Category: Transplant Surgery Source Type: research

Shifting the pulsatility by increasing the change in rotational speed for a rotary LVAD using a native heart load control system
In this study, we assessed the effects of different levels of increase in RS on pulsatility and LV load in the chronic awake phase. We implanted the EVAHEART via left thoracotomy in 7 normal goats (59.3 ± 4.6 kg). Two weeks after implantation, we examined the effects of co-pulse mode (increased RS in the systolic phase) and counter-pulse mode (increased RS in the diastolic phase), as well as shifting the change in RS from 250 to 500 rpm, and 750 rpm in both modes on pulsatility and LV load. Pulsatility was assessed using pulse pressure and mean dP/dt max of aortic pressure. LV load was assessed using stroke work and ...
Source: Journal of Artificial Organs - May 13, 2016 Category: Transplant Surgery Source Type: research

Anticoagulation therapy for a LVAD patient with acquired warfarin resistance
AbstractAnticoagulation therapy with warfarin is essential for postoperative management in patients with left ventricular assist device (LVAD). In this manuscript, we report the case of a patient who developed warfarin resistance after LVAD implantation. Although we administered a novel anticoagulant drug in addition to warfarin and aspirin therapy, the patient developed a major stroke. The patient needed continuous intravenous heparinization until heart transplantation for approximately 2  years. Meticulous management of anticoagulation therapy is essential for a LVAD with warfarin resistance. To our best knowledge, our ...
Source: Journal of Artificial Organs - March 27, 2017 Category: Transplant Surgery Source Type: research

Readmissions after continuous flow left ventricular assist device implantation
AbstractContinuous flow left ventricular assist device (CF-LVAD) therapy has improved the survival of patients with advanced heart failure. However, the readmission rate of CF-LVAD patients is still relatively high. A total of 90 patients who received CF-LVADs between April 2011 and March 2016 at our institute and were discharged home were analyzed retrospectively. They were followed up through March 2017. Clinical data, including frequency, length and etiology of readmission, were obtained from medical records. The mean observation period after initial discharge was 713  ± 322 days. In total, 73 patients (81%) had 236...
Source: Journal of Artificial Organs - July 27, 2017 Category: Transplant Surgery Source Type: research

Role of percutaneous veno-arterial extracorporeal membrane oxygenation as bridge to left ventricular assist device
AbstractPercutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides emergency circulatory support for cardiogenic shock patients and is used as a bridge to a left ventricular assist device (LVAD). The purpose of this study was to determine risk factors for LVAD implantation in patients who required percutaneous VA-ECMO as a bridge to long-term LVAD. We retrospectively investigated 32 consecutive LVAD patients who required percutaneous VA-ECMO as a bridge to long-term LVAD. Twenty-nine patients (91%) were intubated, and their serum creatinine and total bilirubin levels before LVAD implantation were 2.1...
Source: Journal of Artificial Organs - September 4, 2017 Category: Transplant Surgery Source Type: research

Single-center experience of the bridge-to-bridge strategy using the Nipro paracorporeal ventricular assist device
AbstractCurrently, we use the Nipro paracorporeal VAD (p-VAD) for initial short-term ventricular support, as a bridge to decision (BTD) or a bridge to candidacy (BTC) treatment, in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels 1 and 2 patients. However, it is possible that compared to patients with primary implantable-VADs (P-iVAD), the bridge-to-bridge (BTB) patients are more likely to develop complications. This retrospective study used data from 24 consecutive BTB patients who were initially implanted with Nipro p-VAD as BTD or BTC treatments between April 2011 and March 2016, and...
Source: Journal of Artificial Organs - June 25, 2018 Category: Transplant Surgery Source Type: research

Quantification of interventricular dyssynchrony during continuous-flow left ventricular assist device support
In this study, we evaluated seven goats (body weight 44.5  ± 6.5 kg) with normal hearts. A centrifugal LVAD was implanted under general anesthesia. We inserted the conductance catheters into the left ventricle (LV) and right ventricle (RV) to assess the volume signal simultaneously. We defined the interventricular dyssynchrony as a signal (increase o r decrease) of LV volume (LVV) change opposite to that of RV volume (RVV) (i.e., (dLVV/dt)  × (dRVV/dt)  <  0). The duration of interventricular dyssynchrony (DYS) was reported as the percentage of time that a heart was in a dyssynchronous state within a card...
Source: Journal of Artificial Organs - June 14, 2019 Category: Transplant Surgery Source Type: research

Identification of characteristics, risk factors, and predictors of recurrent LVAD thrombosis: conditions in HeartWare devices
ConclusionRecurrent HVAD thrombosis mostly appears within 12  months after first thrombosis. Systemic t-PA therapy for recurrent pump thrombosis seems safe, achieving comparable effectiveness rates to initial t-PA therapy. Survival does not differ between patients with or without recurrent HVAD thrombosis.
Source: Journal of Artificial Organs - December 18, 2020 Category: Transplant Surgery Source Type: research

Can the intermittent low-speed function of left ventricular assist device prevent aortic insufficiency?
In this study, the Jarvik 2000 device, which is programmed to reduce the pump speed each minute for 8  s, was chosen to examine this potential effect. Prospectively collected data of 85 heart transplant-eligible Jarvik 2000 recipients who met the study criteria (no pre-existing AI and aortic valve surgery) were retrospectively analyzed for the incidence, correlating factors, and clinical outcomes o f de novo AI. All data were provided by the Japanese Registry for Mechanically Assisted Circulatory Support. De novo AI occurred in 58 patients, 23 of whom developed at least moderate AI during a median support duration of 23.5...
Source: Journal of Artificial Organs - January 9, 2021 Category: Transplant Surgery Source Type: research

Left thoracotomy vs full sternotomy for centrifugal durable LVAD implantation: 1-year outcome comparison post-LVAD and post-heart transplantation
This study sought to compare the outcomes of FS and LT patients post-primary LVAD implantation and post-subsequent heart transplant (HT). This was a single-center retrospective study. 83 patients who underwent primary centrifugal durable LVAD implantation from January 2014 to June 2018 were included (FS,n = 41; LT,n = 42). 41 patients had a subsequent HT (FS,n = 19; LT,n = 22). Pre-operative patient demographics, intraoperative variables, post-operative 1-year survival, length of hospital stay, complications, and outcomes for LVAD implantation and following HT were analyzed. Intraoperative data showed that ...
Source: Journal of Artificial Organs - March 19, 2021 Category: Transplant Surgery Source Type: research

Three-year experience of catheter-based micro-axial left ventricular assist device, Impella, in Japanese patients: the first interim analysis of Japan registry for percutaneous ventricular assist device (J-PVAD)
AbstractCatheter-based micro-axial ventricular assist device Impella ® (Abiomed, Danvers, MA) has been used in Japanese patients with drug-refractory acute heart failure (AHF) since 2017. This is the first interim analysis of the ongoing Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD) to investigate the safety and efficacy of Impella support. Betw een October 2017 and January 2020, 823 Japanese patients, who were treated with the Impella 2.5, CP, or 5.0 pump, were enrolled. The primary endpoints were safety profiles and cumulative 30-day survival. Among them, 44.8% of patients were acute myocardial infa...
Source: Journal of Artificial Organs - April 25, 2022 Category: Transplant Surgery Source Type: research

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