Building a Bridge to Save a Failing Ventricle: Radiologic Evaluation of Short- and Long-term Cardiac Assist Devices

Mohamed, Inas Elkhedr; Lau, Charles T.; Bolen, Michael A.; El-Sherief, Ahmed H.; Azok, Joseph; Karimov, Jamshid H.; Moazami, Nader; Renapurkar, Rahul D.

doi:10.1148/rg.352140149

Cited by 20 publications

(8 citation statements)

References 68 publications

(92 reference statements)

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“…Imaging modalities, such as CT and echocardiogram, are often used to help identify thrombosis [9], [10]. The efficiency of these modalities to visualize the interior aspect of the pump is limited hence the entire clinical picture needs to be used to arrive at the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Thrombolytics in VAD management — A single-center experience

Nair

Schmitt

Rau

et al. 2016

IJC Heart & Vasculature

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BackgroundWith continued increase in the use of mechanical circulatory support, the incidence of device thrombus remains a challenge. This study is a retrospective analysis of data at a single center to assess the safety and efficacy of thrombolytic use in durable mechanical assist devices.MethodsData was analyzed retrospectively from 154 patients who underwent left ventricular assist device (LVAD) implantation from 1/1/2005 to 6/30/2014. The HMII device was implanted in 131 patients while 23 received the HVAD. LVAD thrombus was diagnosed when lactate dehydrogenase levels exceeded 1000 units/l accompanied by clinical signs of hemolysis and heart failure, echocardiographic data and surges in pump power. TPA (tissue plasminogen activator) protocol consisted of a 5 mg intravenous bolus followed by 3 mg/h infusion in normal saline for 10 h. If symptoms persisted another cycle of TPA at 1 mg/h was continued up to 48 h.ResultsThe TPA group had a 70% success rate. Success was defined as complete resolution of hemolysis and clinical symptoms with no requirement for LVAD exchange at 30 days. 95% survival was noted at 30 days and 90% were free of a hemorrhagic stroke in the TPA group. The rates of hemorrhagic strokes in the TPA group and the control group were not different (OR = 0.92).ConclusionThe TPA protocol described here was successful consistently. Though this study is limited by its size and retrospective nature it leads the way for larger studies to generate more robust comparisons between different types of mechanical assist devices as well as the tailored use of thrombolytics in this patient population.

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Section: Introductionmentioning

confidence: 99%

“…There is limited data on the best therapy for pump thrombosis at present. Recommendations for management vary widely ranging from medical management to catheter-directed thrombolysis and/or pump exchange as the first option [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20].…”

Section: Introductionmentioning

confidence: 99%

Thrombolytics in VAD management — A single-center experience

Nair

Schmitt

Rau

et al. 2016

IJC Heart & Vasculature

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“…catheter-related [perforation, tear and incorrect positioning] infection and neurological sequelae). 3,4,5…”

Section: Ventricular Assist Devicesmentioning

confidence: 99%

“…Avalon Elite) is inserted through the right IJV into the RA, with the tip in the IVC (Figures 2 and 3). Cannulation sites for VA ECMO cannulas depend on the device configuration, with femoral-femoral being the commonest 3,6 (Figure 4). A change in the position of the cannula with reference to an adjacent bony landmark on subsequent radiographs should prompt the radiologist to check for ECMO malfunction.…”

Section: Ventricular Assist Devicesmentioning

confidence: 99%

Chest radiographs of cardiac devices (Part 2): Ventricular assist devices

et al. 2019

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Heart failure is considered a worldwide pandemic affecting 26 million people globally. Patients who are unfit or waiting for cardiac transplantation may benefit from alternate mechanical support therapies using ventricular assist devices. It is not uncommon for radiologists, especially those working in institutions with a high volume of cardiac transplantations, to be presented with radiographs containing these devices. The role of the radiologist is not only to accurately identify these devices, but also to evaluate for any complications.

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“…vvECMO cannula tips are usually positioned with the Binflow^catheter in the SVC, through a right internal jugular vein access, and Boutflow^or drainage catheter in the intraventricular catheter (IVC) [37] (Fig. 1) via femoral vein access.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

2015

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The purpose of this article is to review the spectrum of severe traumatic injuries treatable with ECMO and their imaging features, considerations for cannula placement, and complications that may arise in polytraumatized patients on extracorporeal life support. Recent major advances in miniaturization and biocompatibility of ECMO devices have dramatically increased their safety profile and expanded the application of ECMO to patients with severe polytrauma.

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Building a Bridge to Save a Failing Ventricle: Radiologic Evaluation of Short- and Long-term Cardiac Assist Devices

Cited by 20 publications

References 68 publications

Thrombolytics in VAD management — A single-center experience

Thrombolytics in VAD management — A single-center experience

Chest radiographs of cardiac devices (Part 2): Ventricular assist devices

Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

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