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Role of Doppler Echocardiography for Cardiac Output Assessment in Fontan Patients
Conclusion Doppler SVI correlated with CMRI SVI in patients with systemic LV and systemic RV. The association between output measures (SVI and CI) and FAD were seen only in single LV patients (single RV patients not assessed for this outcome due to small numbers). An association between low Doppler CI and Fontan failure was suggested in a small number of single LV patients.
Source: American Heart Journal - September 22, 2017 Category: Cardiology Source Type: research

Ischemic Stroke and Subsequent Thrombosis within a HeartMate 3 Left Ventricular Assist System: A Cautionary Tale
Introduction of the centrifugal continuous flow-pump, the Heartmate 3 Left Ventricular Assist System (LVAS) has been heralded with the unique observation that de-novo pump thrombosis has not been reported to occur with this device in the pivotal clinical trials.1,2 While engineering principles inherent in this LVAS obviate the initial development of thrombosis within the pump, they cannot protect against ingestion of thrombus or other circulating materials. Similarly, if such ingested material (or thrombus) remains trapped within the device and materially influences its function, it may set-up a nidus for propagation of th...
Source: The Journal of Heart and Lung Transplantation - November 6, 2017 Category: Transplant Surgery Authors: Ivan Netuka, Mandeep R. Mehra Source Type: research

Experimental Investigation of Left Ventricular Flow Patterns After Percutaneous Edge ‐to‐Edge Mitral Valve Repair
Abstract Mitral valve percutaneous edge‐to‐edge repair (PEtER) is a viable solution in high‐risk patients with severe symptomatic mitral regurgitation. However, the generated double‐orifice configuration poses challenges for the evaluation of the hemodynamic performance of the mitral valve and may alter flow patterns in the left ventricle (LV) during diastole. This in vitro study aims to evaluate the hemodynamic modifications following a simulated PEtER. A custom‐made mitral valve was developed, and two configurations were tested: (i) a single‐orifice valve with mitral regurgitation and (ii) a double‐orifice ...
Source: Artificial Organs - November 1, 2017 Category: Transplant Surgery Authors: Morteza Jeyhani, Shahrokh Shahriari, Michel Labrosse Tags: Main Text Source Type: research

Anticoagulation with VADs and ECMO: walking the tightrope.
Authors: Raffini L Abstract The evolution of devices for mechanical circulatory support (MCS), including ventricular assist devices (VADs) for patients with heart failure and extracorporeal membrane oxygenation (ECMO) for patients with acute cardiac or respiratory failure, has improved survival for subsets of critically ill children and adults. The devices are intricate and complex, allowing blood to bypass the heart or lungs (or both). As blood flows through these artificial devices, normal hemostasis is disrupted, coagulation is promoted, and in the absence of anticoagulation, a thrombus may form in the device, r...
Source: Hematology ASH Education Program - December 10, 2017 Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research

A Co-Rhythmic, Isolable, Self-Maintenance, Assist (CoRISMA) Device for Class III Heart Failure
Mechanical circulatory support for class III heart failure will be acceptable if it is devoid of any adverse events associated with current LVAD devices. Long blood paths, lack of regular maintainence in a pump bathed in blood and tethered operation may account for some of the adverse events witnessed in current LVADs such as stroke, pump thrombosis and infections. An intra-cardiac device with ability to isolate and clean the interior of the pump, powered without driveline is presented.
Source: The Journal of Heart and Lung Transplantation - March 31, 2018 Category: Transplant Surgery Authors: J. Park, P. Bonde Source Type: research

Prognostic Implications of Intermediate Hemolysis in Continuous Flow Left Ventricular Assist Device Patients
Hemolysis is an early marker of device thrombosis in pts on continuous flow left ventricular assist device (CF-LVAD). For pts with high levels of hemolysis (LDH>700 U/L) treatment with device exchange rather than medical therapy leads to improvement in stroke free survival. We aimed to investigate outcomes and optimal treatment (tx) strategies for outpts on CF-LVAD demonstrating intermediate levels of hemolysis (LDH 500-700 U/L).
Source: The Journal of Heart and Lung Transplantation - March 31, 2018 Category: Transplant Surgery Authors: H. Rosenblum, A. Pinsino, M. Gavalas, A. Zuver, K. Parikh, G. Parkis, M. Flannery, M. Mabasa, E.A. Royzman, A. Gaudig, A.R. Garan, V.K. Topkara, H. Takayama, K. Takeda, Y. Naka, M. Yuzefpolskaya, P.C. Colombo Source Type: research

Systolic Blood Pressure and Outcomes in Patients on Continuous Flow LVAD Support: An INTERMACS Analysis
High mean arterial pressures in continuous flow (cf) LVAD patients are associated with increased stroke and pump thrombosis risks. Optimal thresholds for systolic blood pressure are unknown.
Source: The Journal of Heart and Lung Transplantation - March 31, 2018 Category: Transplant Surgery Authors: J.A. Cowger, T. Chamogeorgakis, J. Borgi, G. Grafton, Y. Selektor, H. Nemeh, C. Williams, C. Tita, D. Lanfear Source Type: research

A Review of the Use of Direct Oral Anticoagulant Use in Orthotopic Heart Transplantation Recipients
Over 60 years ago, the vitamin K antagonist (VKA) warfarin was approved and remained the only oral anticoagulation agent until recently [1]. Currently, within North America and Europe there are four DOACs available. Dabigatran, first approved in Europe and Canada in 2008, then in the United States of America in 2010, followed by rivaroxaban, apixaban, and most recently edoxaban. The introduction of direct oral anticoagulants (DOACs) has been a major advancement and these agents are the preferred to VKAs for many indications [2 –5], including stroke prevention in nonvalvular atrial fibrillation (NVAF), acute treatment and...
Source: Transplantation Reviews - April 16, 2018 Category: Transplant Surgery Authors: Rosaleen Boswell, Glen J. Pearson Tags: Review article Source Type: research

First-in-Man Use of the MVAD Axial-Flow Pump: Long Term Outcome
The use of durable continuous-flow mechanical assist devices provides selected heart failure patients with both symptomatic and functional benefits; however, they are not without potential complications. Infection, thrombosis, stroke and GI bleeding are amongst the most commonly reported problems of left ventricular assist device (LVAD) therapy.1 –3 In addition, LVAD peripherals can be bulky and heavy for the patient to carry, causing joint stress, discomfort and reduced quality of life. Device miniaturization is one design trend that has enabled device implantation in patients with a broader range of body sizes, and whe...
Source: The Journal of Heart and Lung Transplantation - April 24, 2018 Category: Transplant Surgery Authors: Marian Urban, Anfrew Woods, Nicola Robinson-Smith, Guy MacGowan, Chandrika Roysam, Stephan Schueler Source Type: research

A Review of the Use of Direct Oral Anticoagulant Use in Orthotopic Heart Transplantation Recipients
Over 60 years ago, the vitamin K antagonist (VKA) warfarin was approved and remained the only oral anticoagulation agent until recently [1]. Currently, within North America and Europe there are four DOACs available. Dabigatran, first approved in Europe and Canada in 2008, then in the United States of America in 2010, followed by rivaroxaban, apixaban, and most recently edoxaban. The introduction of direct oral anticoagulants (DOACs) has been a major advancement and these agents are the preferred to VKAs for many indications [2 –5], including stroke prevention in nonvalvular atrial fibrillation (NVAF), acute treatment and...
Source: Transplantation Reviews - April 16, 2018 Category: Transplant Surgery Authors: Rosaleen Boswell, Glen J. Pearson Tags: Review article Source Type: research

First-in-man use of the MVAD axial-flow pump: Long-term outcome
The use of durable continuous-flow mechanical assist devices provides selected heart failure patients with both symptomatic and functional benefits; however, they are not without potential complications. Infection, thrombosis, stroke, and gastrointesinal bleeding are among the most commonly reported problems of left ventricular assist device (LVAD) therapy.1 –3 In addition, LVAD peripherals can be bulky and heavy for the patient to carry, causing joint stress, discomfort, and reduced quality of life.
Source: The Journal of Heart and Lung Transplantation - April 24, 2018 Category: Transplant Surgery Authors: Marian Urban, Anfrew Woods, Nicola Robinson-Smith, Guy MacGowan, Chandrika Roysam, Stephan Schueler Tags: Case Anecdotes, Comments and Opinions Source Type: research

Living Without a Pulse: The Vascular Implications of Continuous-Flow Left Ventricular Assist Devices Advances in Mechanical Circulatory Support
Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure compared with lower ordered animals. Yet despite years of such natural selection, the modern generation of continuous-flow left ventricular assist devices (CF-LVADs) that have been increasingly used for the last decade have created a unique physiology characterized by a nonpulsatile, nonlaminar blood flow profile with the absence of the usual large elastic artery Windkessel effect during diastole. Although outcomes and durability h...
Source: Circulation: Heart Failure - June 14, 2018 Category: Cardiology Authors: Purohit, S. N., Cornwell, W. K., Pal, J. D., Lindenfeld, J., Ambardekar, A. V. Tags: Translational Studies, Vascular Biology, Heart Failure, Cardiovascular Surgery, Transplantation Advances in Mechanical Circulatory Support Source Type: research

A Tale of the Twist in the Outflow Graft: An Analysis from the MOMENTUM 3 Trial
Heralded as a significant step forward in the evolution of left ventricular assist systems (LVAS), the HeartMate 3 device (Abbott, Abbott Park, Il, USA) has demonstrated improved outcomes by averting de-novo intra-pump thrombosis leading to pump related malfunction, and in reducing the incidence of stroke events when compared with the axial flow HeartMate II LVAS.1,2,3,4 Moreover, the HeartMate 3 LVAS experience has reduced the vexing incidence of hemocompatibility related adverse outcomes.5,6,7 On the heels of these advances, intriguing reports began to surface of a twist within the outflow graft that caused disruption in...
Source: The Journal of Heart and Lung Transplantation - August 24, 2018 Category: Transplant Surgery Authors: Mandeep R. Mehra, Christopher Salerno, Yoshifumi Naka, Nir Uriel, Joseph C. Cleveland, Douglas Horstmanshof, Daniel J. Goldstein, for the MOMENTUM 3 Investigators Tags: Editorial Source Type: research

Unusual Techniques for Preserving Surgical and Oncologic Safety in Hepatectomy of Advanced Adrenal Malignancy with Vena Cava and Liver Invasion
We report herein three cases of major hepatectomy with IVC invasion and discuss several surgical tips.Patients and MethodsFrom March 2011 to February 2014, we retrospectively reviewed three cases of adrenal malignancy with liver and IVC invasion. Based on the severity of the malignant tumor, each case illustrates a different method to address surgical complications and maintain oncologic safety. Case 1: A 34-year-old woman was diagnosed with adrenocortical tumor during medical examination. Tumor invaded the right lobe of the liver and very close to the IVC. Fortunately, there was little thrombosis inside the IVC; we perfor...
Source: Annals of Surgical Oncology - September 6, 2018 Category: Cancer & Oncology Source Type: research

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