Center Variability in Patient Outcomes Following HeartMate 3 Implantation: An Analysis of the MOMENTUM 3 Trial

Kanwar, Manreet; Pagani, Francis D.; Mehra, Mandeep R.; Estep, Jerry D.; Pinney, S.; Silvestry, Scott C.; Uriel, Nir; Goldstein, Daniel J.; Long, James W.; Cleveland, Joseph C.; Kormos, Robert L.; Wang, AiJia; Chuang, Joyce; Cowger, Jennifer

doi:10.1016/j.cardfail.2022.04.006

Cited by 15 publications

(5 citation statements)

References 17 publications

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“…The literature research and consultation of nine international VAD implanting centers revealed that a great number of different adhesive anchoring devices are used in clinical practice, potentially reflecting the center variability 13 in DLI rates. In addition, VAD centers often use multiple products in their clinical practice (Supplementary Material 2, Supplemental Digital Content, http://links.lww.com/ASAIO/B170).…”

Section: Discussionmentioning

confidence: 99%

“…11,12 This lack of best practice is reflected in the wide variability in DL infection rates between VAD centers. 13 The most beneficial care protocols appear to be those that include chlorhexidine, a silver-based dressing, and an adhesive anchoring device to immobilize the DL. 12 The use of an anchoring device to immobilize the DL is also recommended by the International Society for Heart and Lung Transplantation 8,14 and serves the dual purpose of securing the DL and reducing tension and trauma to the DLES.…”

mentioning

confidence: 99%

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Mechanical Characterization of Anchoring Devices for the Prevention of Driveline Infection in Left Ventricular Assist Device Patients

Schachl,

Stoiber,

Socha

et al. 2023

ASAIO Journal

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Driveline infection (DLI) is associated with increased mortality and morbidity in left ventricular assist device (LVAD) patients. Because trauma to the driveline exit-site (DLES) is a risk factor for DLI, adhesive anchoring devices are used to immobilize the DL. In this study, commonly used products (identified through literature review and contact with nine international VAD implantation centers) were mechanically characterized to evaluate their effectiveness in preventing DLES trauma. Eight devices were tested in an in vitro abdominal model of the DLES, where a tensile force (10 N) was applied to a HeartMate 3 DL, whereas the resulting force (F Total) on the DLES was recorded using a three-axis load cell. Four devices (CathGrip: F Total = 2.1 ± 0.4 N, Secutape: F Total = 2.6 ± 0.3 N, Hollister: F Total = 2.7 ± 0.5 N, Tubimed: F Total = 2.9 ± 0.2 N) were significantly (p < 0.05) better at preventing tensile forces at the DLES compared to the other four devices (Main-Lock: F Total = 3.7 [0.7] N, Secutape sensitive: F Total = 3.9 ± 0.4 N, Foley Anchor: F Total = 4.3 ± 0.5 N, Grip-Lok: F Total = 5.4 ± 0.8 N). Immobilization of the DL with each anchoring device resulted in lower tensile force on the DLES than without an anchor (F Total = 8.2 ± 0.3 N). In conclusion, the appropriate selection of anchoring devices plays a critical role in reducing the risk of DLI, whereas the CathGrip, Secutape, Hollister, or Tubimed were superior in preventing trauma to the DLES in this study.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Mechanical Characterization of Anchoring Devices for the Prevention of Driveline Infection in Left Ventricular Assist Device Patients

Schachl,

Stoiber,

Socha

et al. 2023

ASAIO Journal

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“…In this context, impaired hemocompatibility results from increased shear stress, low pulsatility and the complex interaction of patient’s blood components with the artificial interface of LVAD pumps, thereby triggering coagulation abnormalities [ 8 , 15 , 16 , 17 ]. Many studies have focused on the clinical characteristics associated with bleeding complications after LVAD implantation, identifying age, history of prior bleeding, low platelet count and comorbidities such as renal insufficiency or hypertension as risk factors for post-LVAD bleeding complications [ 1 , 5 , 18 , 19 , 20 , 21 ]. In our study, age, pre-implant bleeding rate, platelet count and recorded comorbidities were comparable in patients with and without NSB.…”

Section: Discussionmentioning

confidence: 99%

Decreased Platelet Specific Receptor Expression of P-Selectin and GPIIb/IIIa Predict Future Non-Surgical Bleeding in Patients after Left Ventricular Assist Device Implantation

Klaeske

Meyer

Saeed

et al. 2022

IJMS

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Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. The increased shear stress leads to an altered platelet receptor composition. Whether these changes increase the risk for NSB is unclear. Thus, we compared the platelet receptor composition of patients with (bleeder group, n = 18) and without NSB (non-bleeder group, n = 18) prior to LVAD implantation. Blood samples were obtained prior to LVAD implantation and after bleeding complications in the post-implant period. Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Bleeders and non-bleeders were comparable regarding clinical characteristics, von Willebrand factor diagnostics and the aggregation capacity before and after LVAD implantation (p > 0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (33%; n = 6), epistaxis (22%; n = 4), hematuria or hematoma (17%; n = 3, respectively) and cerebral bleeding (11%; n = 2). Prior to LVAD implantation, a restricted surface expression of the platelet receptors P-selectin and GPIIb/IIIa was observed in the bleeder group (P-selectin: 7.2 ± 2.6%; GPIIb/IIIa: 26,900 ± 13,608 U) compared to non-bleeders (P-selectin: 12.4 ± 8.1%, p = 0.02; GPIIb/IIIa: 36,259 ± 9914 U; p = 0.02). We hypothesized that the reduced platelet receptor expression of P-selectin and GPIIb/IIIa prior to LVAD implantation may be linked to LVAD-related NSB.

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“…22 There is significant heterogeneity in the rate of infection by center, which may be due to local center factors, including infection prophylaxis protocols, patient demographics, or environmental factors. 24,25…”

Section: Epidemiologymentioning

confidence: 99%

Infections in Patients With Left Ventricular Assist Devices: Current State and Future Perspectives

et al. 2023

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Mechanical circulatory support is increasingly being used as bridge-to-transplant and destination therapy in patients with advanced heart failure. Technologic improvements have led to increased patient survival and quality of life, but infection remains one of the leading adverse events following ventricular assist device (VAD) implantation. Infections can be classified as VAD-specific, VAD-related, and non-VAD infections. Risk of VAD-specific infections, such as driveline, pump pocket, and pump infections, remains for the duration of implantation. While adverse events are typically most common early (within 90 days of implantation), device-specific infection (primarily driveline) is a notable exception. No diminishment over time is seen, with event rates of 0.16 events per patient-year in both the early and late periods postimplantation. Management of VAD-specific infections requires aggressive treatment and chronic suppressive antimicrobial therapy is indicated when there is concern for seeding of the device. While surgical intervention/hardware removal is often necessary in prosthesis-related infections, this is not so easily accomplished with VADs. This review outlines the current state of infections in patients supported with VAD therapy and discusses future directions, including possibilities with fully implantable devices and novel approaches to treatment.

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Center Variability in Patient Outcomes Following HeartMate 3 Implantation: An Analysis of the MOMENTUM 3 Trial

Cited by 15 publications

References 17 publications

Mechanical Characterization of Anchoring Devices for the Prevention of Driveline Infection in Left Ventricular Assist Device Patients

Mechanical Characterization of Anchoring Devices for the Prevention of Driveline Infection in Left Ventricular Assist Device Patients

Decreased Platelet Specific Receptor Expression of P-Selectin and GPIIb/IIIa Predict Future Non-Surgical Bleeding in Patients after Left Ventricular Assist Device Implantation

Infections in Patients With Left Ventricular Assist Devices: Current State and Future Perspectives

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