Comparison of feasibility and results of frailty assessment methods prior to left ventricular assist device implantation

Roehrich, Luise; Sündermann, Simon H.; Just, Isabell Anna; Fernandes, Laurenz Kopp; Stein, Julia; Solowjowa, Natalia; Mulzer, Johanna; Mueller, Marcus; Hummel, Manfred; Knierim, Jan; Potapov, Evgenij; Falk, Volkmar; Schoenrath, Felix

doi:10.1002/ehf2.13764

Cited by 13 publications

(17 citation statements)

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“…Another limitation is that only 14.3% of our cohort were female, which is, however, in line with the reported implantation prevalence. 1,27,28 In conclusion, an acute outflow graft occlusion after lysis therapy for intra-pump thrombosis is a severe complication in patients on HVAD support. Despite a lack of the pathophysiological understanding, we are able to identify patients at risk and consequently initiate an effective treatment rapidly.…”

Section: Discussionmentioning

confidence: 94%

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Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

et al. 2023

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Christoph hoermandinger,* nadine riedler,* Julia stein,* philipp stawowy, † ‡ evgeniJ potapov,* † Felix sChoenrath,* † § and isabell a. Just* † Lysis therapy is an established treatment option for intrapump thrombosis of left ventricular assist devices (LVADs). In clinical routine, we observed repeated cases of acute outflow graft occlusions (OGO) associated with lysis therapy with need for urgent intervention. The aim of this investigation was to gain understanding of this observation. We screened data of 962 HeartWare ventricular assist device (HVAD) patients. One hundred twenty (13.8%) had intra-pump thromboses; 58 were treated with recombinant tissue-type plasminogen activator (rtPA). Mean age was 53.0 ± 11.1 years; 84.9% were male. In 13 (24.5%) patients, OGO occurred following rtPA-lysis. These patients showed an increase in left ventricular function (18.45% ± 12.62% to 27.73% ± 10.57%; p = 0.056), more frequent 1:1 aortic valve opening (OGO+: +36.4%; OGO−: +7.4%; p = 0.026), a decrease in LVAD pulsatility within 12 months prior intrapump thrombosis (OGO+: -0.8 L/min [interquartile range {IQR}, -1.4 to -0.4 L/min]; OGO−: -0.3 L/min [IQR, -0.9 to 0.1 L/min]; p = 0.038) and lower HVAD flows at admission (OGO+: 6.7 L/min [IQR, 6.1-7.4 L/min]; OGO−: 8.3 L/ min [IQR, 6.9-9.3 L/min]; p = 0.013), indicating a subclinical OGO prior intra-pump thrombosis. There were no differences in implantation techniques, blood parameters, and lysis strategy. Subclinical OGO represented a major risk factor for acute OGO following rtPA lysis therapy. We here propose an algorithm for risk stratification and dealing with patients presenting this first-described complication. Further research is required to confirm our results and decipher the underlying pathomechanism.

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Section: Discussionmentioning

confidence: 94%

“…Another limitation is that only 14.3% of our cohort were female, which is, however, in line with the reported implantation prevalence. 1,27,28…”

Section: Discussionmentioning

confidence: 99%

Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

et al. 2023

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“…However, in order to include patients in the list of subjects awaiting heart transplantation, survivors of anticancer treatments must be free from recurrence of cancer for a lag time which may vary among centers [ 76 ]. Of note, survivors of anticancer treatments may show a specific profile of frailty, which is a relevant predictor of untoward events after LVAD implantation as well as after heart transplantation [ 77 , 78 , 79 ]. In fact, in survivors of anticancer treatments, post-heart transplantation prognosis is proportional to the length of the period free of cancer disease prior to heart transplantation [ 80 , 81 ].…”

Section: Resultsmentioning

confidence: 99%

Cardiotoxicity, Cardioprotection, and Prognosis in Survivors of Anticancer Treatment Undergoing Cardiac Surgery: Unmet Needs

Palmieri

Vietri

Montalto

et al. 2023

Cancers

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Background: Anticancer treatments are improving the prognosis of patients fighting cancer. However, anticancer treatments may also increase the cardiovascular (CV) risk by increasing metabolic disorders. Atherosclerosis and atherothrombosis related to anticancer treatments may lead to ischemic heart disease (IHD), while direct cardiac toxicity may induce non-ischemic heart disease. Moreover, valvular heart disease (VHD), aortic syndromes (AoS), and advanced heart failure (HF) associated with CV risk factors and preclinical CV disease as well as with chronic inflammation and endothelial dysfunction may also occur in survivors of anti-carcer treatments. Methods: Public electronic libraries have been searched systematically looking at cardiotoxicity, cardioprotection, CV risk and disease, and prognosis after cardiac surgery in survivors of anticancer treatments. Results: CV risk factors and disease may not be infrequent among survivors of anticancer treatments. As cardiotoxicity of established anticancer treatments has been investigated and is frequently irreversible, cardiotoxicity associated with novel treatments appears to be more frequently reversible, but also potentially synergic. Small reports suggest that drugs preventing HF in the general population may be effective also among survivors of anticancer treatments, so that CV risk factors and disease, and chronic inflammation, may lead to indication to cardiac surgery in survivors of anticancer treatments. There is a lack of substantial data on whether current risk scores are efficient to predict prognosis after cardiac surgery in survivors of anticancer treatments, and to guide tailored decision-making. IHD is the most common condition requiring cardiac surgery among survivors of anticancer treatments. Primary VHD is mostly related to a history of radiation therapy. No specific reports exist on AoS in survivors of anticancer treatments. Conclusions: It is unclear whether interventions to dominate cancer- and anticancer treatment-related metabolic syndromes, chronic inflammation, and endothelial dysfunction, leading to IHD, nonIHD, VHD, HF, and AoS, are as effective in survivors of anticancer treatments as in the general population. When CV diseases require cardiac surgery, survivors of anticancer treatments may be a population at specifically elevated risk, rather than affected by a specific risk factor.

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“…The phase angle is a reflection of cellular health, and as such, a low phase angle has been found to be predictive of morbidity and mortality in patients undergoing cardiac surgery. [8][9][10][11] To date, no studies have evaluated the utility of BIS in patients following heart transplantation. Herein, we describe a prospective single-center evaluation of BIS and clinical outcomes in heart transplant recipients during the first year posttransplant.…”

Section: Introductionmentioning

confidence: 99%

Bioimpedance Spectroscopy in Heart Transplantation: Posttransplant Changes in Body Composition and Effects in Outcomes

et al. 2023

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Background. Bioimpedance spectroscopy yields measurements of fat-free mass, fat mass, phase angle, and other measures. Bioimpedance spectroscopy has been validated as a preoperative assessment tool in cardiac surgical studies, in which low phase angle predicted morbidity and mortality. No studies have evaluated bioimpedance spectroscopy following heart transplantation. Methods. We evaluated body composition, nutrition status (Subjective Global Assessment, body mass index, midarm muscle circumference, and triceps skinfolds), and functional status (handgrip strength and 6-min walk test) in 60 adults. Body composition measurements via a 256-frequency bioimpedance spectroscopy device included fat and fat-free mass as well as phase angle calculated at 50 kHz. Testing was completed at baseline and 1, 3, 6, and 12 mo following heart transplantation. Mortality and hospital readmissions were analyzed. Results. Phase angle and fat mass increased while fat-free mass decreased; grip strength and 6-min walk test improved after transplantation (all P < 0.001). Improvement in phase angle in the first month postoperatively was associated with reduced risk of readmission. Low perioperative and 1-mo phase angles were associated with prolonged posttransplant length of stay (median: 13 versus 10 d, P = 0.03), increased infection-related readmissions (40% versus 5%, P = 0.001), and increased 4-y mortality (30% versus 5%, P = 0.01). Conclusions. Phase angle, grip strength, and 6-min walk test distance improved after heart transplantation. Low phase angle appears to be associated with suboptimal outcomes and may be a feasible and affordable method to predict outcomes. Further research should ascertain whether preoperative phase angle can predict outcomes.

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Comparison of feasibility and results of frailty assessment methods prior to left ventricular assist device implantation

Cited by 13 publications

References 50 publications

Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

Cardiotoxicity, Cardioprotection, and Prognosis in Survivors of Anticancer Treatment Undergoing Cardiac Surgery: Unmet Needs

Bioimpedance Spectroscopy in Heart Transplantation: Posttransplant Changes in Body Composition and Effects in Outcomes

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