Destination LVAD therapy in the current era of the heart transplant allocation system

Toro, Saleem; Patel, Kelsey; Guha, Ashrith

doi:10.1097/hco.0000000000001043

Cited by 3 publications

(1 citation statement)

References 35 publications

(36 reference statements)

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“…In advanced HFrEF, a left ventricle assist device (LVAD) is a therapeutic option as a bridge to transplantation, bridge to candidacy or as a destination therapy [ 121 ]. Owing to the unloading of the LV, one may expect LVAD implantation to be followed by a significant decrease or normalization in PAP.…”

Section: Therapeutic Management Of Ph-lhdmentioning

confidence: 99%

Pulmonary Hypertension in Left Heart Diseases: Pathophysiology, Hemodynamic Assessment and Therapeutic Management

Ltaief¹,

Yerly²,

Liaudet³

2023

IJMS

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Pulmonary hypertension (PH) associated with left heart diseases (PH-LHD), also termed group 2 PH, represents the most common form of PH. It develops through the passive backward transmission of elevated left heart pressures in the setting of heart failure, either with preserved (HFpEF) or reduced (HFrEF) ejection fraction, which increases the pulsatile afterload of the right ventricle (RV) by reducing pulmonary artery (PA) compliance. In a subset of patients, progressive remodeling of the pulmonary circulation resulted in a pre-capillary phenotype of PH, with elevated pulmonary vascular resistance (PVR) further increasing the RV afterload, eventually leading to RV-PA uncoupling and RV failure. The primary therapeutic objective in PH-LHD is to reduce left-sided pressures through the appropriate use of diuretics and guideline-directed medical therapies for heart failure. When pulmonary vascular remodeling is established, targeted therapies aiming to reduce PVR are theoretically appealing. So far, such targeted therapies have mostly failed to show significant positive effects in patients with PH-LHD, in contrast to their proven efficacy in other forms of pre-capillary PH. Whether such therapies may benefit some specific subgroups of patients (HFrEF, HFpEF) with specific hemodynamic phenotypes (post- or pre-capillary PH) and various degrees of RV dysfunction still needs to be addressed.

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Section: Therapeutic Management Of Ph-lhdmentioning

confidence: 99%

Pulmonary Hypertension in Left Heart Diseases: Pathophysiology, Hemodynamic Assessment and Therapeutic Management

Ltaief¹,

Yerly²,

Liaudet³

2023

IJMS

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Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study

Ondrusek,

Artemiou,

Bezak

et al. 2024

Thorac Cardiovasc Surg

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Background Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation of mechanical support devices contributed to this change. In this single-center study, we focused on two time periods that are characterized by the use of different types of mechanical support devices, different patient characteristics, and change in the indications. Methods The data were processed from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). We retrospectively defined two time intervals to reflect changes in ventricular assist device technology (period 1: 2007–2015; period 2: 2016–20222). A total of 181 patients underwent left ventricular assist device implantation. Device utilization was the following: HeartMate II = 52 (76.4%) and HeartWare = 16 (23.6%) in period 1 and HeartMate II = 2 (1.8%), HeartMate 3 = 70 (61:9%), HeartWare = 29 (25.7%), SynCardia TAH = 10 (8.8%), and BerlinHeart EXCOR = 2 (1.8%) in period 2. The outcomes of the time intervals were analyzed and evaluated. Results Survival was significantly higher during the second time period. Multivariate analysis revealed that age and bypass pump time are independent predictors of mortality. Idiopathic cardiomyopathy, bypass time, and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score are independent predictors of adverse events. Furthermore, the first period was noted to be at an increased risk of the following adverse events: pump thrombosis, gastrointestinal bleeding, and bleeding events. Conclusion Despite the higher risk profile of the patients and persistent challenges, during the second period, there was a significant decrease in mortality and morbidity. The use of the HeartMate 3 device may have contributed to this result.

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Contact Dermatitis With Associated Exuberant Granulation Tissue at the Site of Left Ventricular Assist Device

Surapaneni,

de la Feld,

Cheeley

2023

Dermatitis®

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Destination LVAD therapy in the current era of the heart transplant allocation system

Cited by 3 publications

References 35 publications

Pulmonary Hypertension in Left Heart Diseases: Pathophysiology, Hemodynamic Assessment and Therapeutic Management

Pulmonary Hypertension in Left Heart Diseases: Pathophysiology, Hemodynamic Assessment and Therapeutic Management

Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study

Contact Dermatitis With Associated Exuberant Granulation Tissue at the Site of Left Ventricular Assist Device

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