Cavo-pulmonary anastomosis associated with left ventricular in comparison with biventricular circulatory support in acute heart failure

Santos, Luis Alberto Saraiva; Benício, Anderson; Júnior, Ewaldo de Mattos; Benvenutti, Luiz Alberto; Cestari, Idágene Aparecida; Stolf, Noedir Antônio Groppo; Moreira, Luíz Felipe Pinho

doi:10.5935/1678-9741.20120097

Cited by 5 publications

(8 citation statements)

References 18 publications

(34 reference statements)

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“…In fact, one of the major complications in LVAD patients is the right ventricular (RV) failure with an incidence among 13–44% in adults and an incidence of 42% in children (Chen et al, 1996; Kukucka et al, 2011; Saraiva Santos et al, 2012; Karimova et al, 2014). Different explanations about the increased risk of the RV failure in LVAD patients were proposed:…”

Section: Introductionmentioning

confidence: 99%

“…). In literature, there are different opinions and several authors performed also animal experiments to study the interventricular interaction during LVAD assistance (Kawai et al, 1992; Mandarino et al, 1992; Morita et al, 1992; Hendry et al, 1994; Chen et al, 1996; Barbone et al, 2001; Omoto et al, 2002; de Jonge et al, 2005; Kukucka et al, 2011; Saraiva Santos et al, 2012; Umeki et al, 2012; Arakawa et al, 2014; Karimova et al, 2014). …”

Section: Introductionmentioning

confidence: 99%

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The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg: A Single Center Experience

et al. 2016

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Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single center experience in using BHE in children with a body weight under 10 kg.Methods: Data of all pediatric patients under 10 kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed.Results: Of the 30 patients enrolled in the study, 53% were male, 87% were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75 ± 2.16 Kg and 11.57 ± 10.12 months, respectively. Three patients (10%) required a BIVAD implantation. After the implantation, 7 patients (23%) required re-intervention for bleeding and 9 patients (30%) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8 ± 94.4 days. Twenty patients (67%) were successfully transplanted and 10 patients (33%) died: 7 for major neurological complication and 3 for sepsis.Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg: A Single Center Experience

et al. 2016

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“…Several alternative strategies to avoid RVAD implantation have been proposed to partially bypass the right ventricle and restore an adequate left ventricular preload. Alternatives include the creation of an ASD, a CPC, a CAS (1–4, 8–9). In this paper, a numerical model of the cardiovascular system was used to simulate the baseline hemodynamics of 5 pediatric patients undergoing LVAD implantation and then to simulate the acute hemodynamic effects of LVAD implantation, the effects of RVF and, finally, the hemodynamic effects of the different surgical strategies (ASD, CPC, CAS, RVAD).…”

Section: Discussionmentioning

confidence: 99%

“…Despite the use of appropriate drug therapy, such as nitric oxide and phosphodiesterase inhibitor, right ventricular failure (RVF) remains one of the major complications that can occur both in the adult and pediatric populations during left ventricular assist device (LVAD) implantation, with an incidence of 13% to 44% (1–3). In addition, a number of patients are affected by different degrees of right ventricular dysfunction before the LVAD implantation and the LVAD implantation itself can deteriorate RVF due to right ventricular overload after LVAD (4).…”

Section: Introductionmentioning

confidence: 99%

“…Starting from this consideration, several alternative approaches have been experimentally tested to partially exclude the right ventricle and to improve left ventricular diastolic function and CO. Alternative approaches include the creation of an atrial septal defect (ASD), a cavo-aortic shunt (CAS) including the LVAD (9) and a cavo-pulmonary connection (CPC) (1–4, 8). Due to the complex physiopathology, a numerical model could be helpful to evaluate the hemodynamic changes caused by the different surgical strategies.…”

Section: Introductionmentioning

confidence: 99%

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Simulation of Acute Haemodynamic Outcomes of the Surgical Strategies for the Right Ventricular Failure Treatment in Pediatric LVAD

et al. 2015

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Acute Biventricular Interaction in Pediatric Patients Implanted with Continuous Flow and Pulsatile Flow LVAD: A Simulation Study

et al. 2016

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Left ventricular assist devices (LVADs) are used to bridge pediatric patients till transplantation. However, the LVADs effects on right ventricular (RV) function are controversial. This work aims at studying the ventricular interdependency in the presence of continuous (c-) and pulsatile (p-) flow LVAD in pediatric patients using a lumped parameter model including the representation of the septum. Five pediatric patients' data were used to simulate patients' baseline. The effects on LV and RV functions, energetics, preloads and afterloads of different c-LVAD speeds, p-LVAD rate, p-LVAD systole duration, p-LVAD filling and ejection pressures were simulated. c-LVAD and p-LVAD unload the LV decreasing the LV external work and improving the LV ventriculo-arterial coupling and these effects are more evident increasing the c-LVAD speed and the p-LVAD rate. Continuous-LVAD and p-LVAD decrease the RV afterload, increase the RV ejection fraction and improve the RV ventriculo-arterial coupling. The changes in RV function are inversely proportional to the degree of the interventricular septum leftward shift that increased by increasing the LVAD contribution. The study of the interventricular interaction could lead to the development of a dedicated algorithm to optimize LVAD setting in pediatric population.

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Cavo-pulmonary anastomosis associated with left ventricular in comparison with biventricular circulatory support in acute heart failure

Cited by 5 publications

References 18 publications

The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg: A Single Center Experience

The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg: A Single Center Experience

Simulation of Acute Haemodynamic Outcomes of the Surgical Strategies for the Right Ventricular Failure Treatment in Pediatric LVAD

Acute Biventricular Interaction in Pediatric Patients Implanted with Continuous Flow and Pulsatile Flow LVAD: A Simulation Study

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