Effects of the <scp>H</scp>eart<scp>M</scp>ate II Left Ventricular Assist Device as Observed by Serial Echocardiography

Chapman, Carrie B.; Allana, Salman; Sweitzer, Nancy K.; Kohmoto, Takushi; Murray, Margaret; Murray, David R.; Johnson, Maryl R.; Rahko, Peter S.

doi:10.1111/echo.12100

Cited by 20 publications

(20 citation statements)

References 22 publications

(52 reference statements)

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“…Significant preoperative mitral regurgitation (MR) is thought to decrease after LVAD implantation and for this reason correction of MR is not indicated if ventricular recovery is not expected . Speed optimization—with the target mean arterial pressure 65–85 mm Hg, parallel positioning along the interventricular septum, intermittent opening of aortic valve, and less than moderate MR—should be done for appropriate ventricular unloading before discharge .…”

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confidence: 99%

Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation

et al. 2016

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Significant mitral regurgitation (MR) is thought to decrease after left ventricular assist device (LVAD) implantation, and therefore repair of mitral valve is not indicated in current practice. However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in right ventricular (RV) dysfunction during follow-up. We examined the impact of residual MR on systolic function of the right ventricle by echocardiography after LVAD implantation. This study included 90 patients (mean age: 51.7 ± 10.9 years, 14.4% female) who underwent LVAD implantation (HeartMate II = 21, HeartWare = 69) in a single center between December 2010 and June 2014. Echocardiograms obtained at 3-6 months and over after implantation were analyzed retrospectively. RV systolic function was graded as normal, mild, moderate, and severely depressed. MR (≥moderate) was observed in 43 and 44% of patients at early and late period, respectively. Systolic function of the RV was severely depressed in 16 and 9% of all patients. Initial analysis (mean duration of support 174.3 ± 42.5 days) showed a statistically significant correlation between less MR and improved systolic function of RV (P = 0.01). Secondary echocardiographic analysis (following a mean duration of support of 435.1 ± 203 days) was also statistically significant for MR degree and RV systolic dysfunction (P = 0.008). Residual MR after LVAD implantation may cause deterioration of RV systolic function and cause right-sided heart failure symptoms. Repair of severe MR, in selected patients such as those with severe pulmonary hypertension and depressed RV, may be considered to improve the patient's clinical course during pump support.

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confidence: 99%

Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation

et al. 2016

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“…Nine transoesophageal echocardiograms (TEE) were done in the operating room under general anaesthesia during the LVAD implantation to evaluate inflow cannula and septum position, and to monitor the de-airing process while weaning from cardiopulmonary bypass. The specific protocol used for these echocardiographic studies included standard TTE parasternal, apical, subcostal and suprasternal notch views 12345678910111213…”

Section: Methodsmentioning

confidence: 99%

Fine-tuning management of the Heart Assist 5 left ventricular assist device with two- and three-dimensional echocardiography

Demirozu

Arat

Küçükaksu

2016

CVJA

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SummaryIntroduction:Left ventricular assist device (LVAD) implantation is a viable therapy for patients with severe end-stage heart failure, providing effective haemodynamic support and improved quality of life. The Heart Assist 5 (Micromed Cardiovascular Inc, Houston, TX) continuous-flow LVAD has been on the market in Europe since May 2009.Methods:We evaluated nine Heart Assist 5 LVAD patients with two- and three-dimensional transthoracic echocardiographic (TTE) and transoesophageal echocardiographic (TEE) parameters between December 2011 and December 2013. The pre-operative TTE LVAD evaluations included left ventricular (LV) function and structure, quantification of right ventricular (RV) function and tricuspid regurgitation (TR), assessment of aortic and mitral regurgitation, and presence of patent foramen ovale and intra-cardiac clots. Peri-operative TEE determined the inflow cannula and septum position, and assessed the de-airing process while weaning from cardiopulmonary bypass. Post-operative serial follow-up TTE showed the surgical results of LVAD implantation, determined the overall structure and function of the LV, RV and TR, and observed the inflow and outflow cannula position.Results:Nine patients who had undergone Heart Assist 5 LVAD implantation and had been followed up for more than 30 days were included in this study. Eight patients had ischaemic cardiomyopathy and one had adriamycin-induced cardiomyopathy. Pre-implantation data: the mean age of the patients was 52 ± 13 (34–64) years, mean body surface area (BSA) was 1.8 ± 0.2 (1.6–2.0) m2, mean cardiac index (CI) was 2.04 ± 0.4 (1.5–2.6) l/min/m2, mean cardiac output (CO) was 3.7 ± 0.7 (2.6–4.2) l/min, mean ejection fraction (EF) was 23 ± 5 (18–28)%, and right ventricular fractional area contraction (RVFAC) was 43 ± 9 (35–55)%. One patient had aortic valve replacement (AVR) during the LVAD implantation, and excess current alarms and increased power were suspected to be caused by a possible thrombus. Close follow up with TTE studies were carried out to clear the LV of thrombus formation, and the inflow cannula position was checked to maintain the septum in the midline, so preventing the suction cascade. Four patients were followed up for more than two years, and two were followed up for more than a year. Three patients died due to multi-organ failure. Follow-up speed-change TTE studies of six patients showed that the mean speed was 9 800 ± 600 (9 500–10 400) rpm, and mean CO was 4.7 ± 0.3 (4.3– 5.0) l/min during the three-month post-implant period.Conclusion:We believe that TTE can play a major role in managing LVAD patients to achieve optimal settings for each patient. A large series is mandatory for assessment of echocardiographic studies on Heart Assist 5 LVAD.

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“…In addition to documenting baseline cardiac structure and function, pre-operative echocardiography is vital for surgical planning ( Table 2). Aortic insufficiency (AI) tends to worsen after LVAD implantation (7)(8)(9), and the presence of moderate or greater AI is typically an indication for valve replacement or oversewing at the time of surgery (6). Although tricuspid regurgitation (TR) might be expected to improve with reduction in pulmonary vascular resistance after LVAD placement, the increase in RV preload and subsequent distortion of RV and septal geometry may actually worsen tricuspid regurgitant flow (4).…”

Section: Pre-operative Evaluationmentioning

confidence: 99%

Echocardiography and Continuous-Flow Left Ventricular Assist Devices

Cohen

Thomas

Freed

et al. 2015

JACC: Heart Failure

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Echocardiography is the most used imaging modality in the growing population of patients with advanced heart failure undergoing continuous-flow, durable mechanical circulatory support. However, no guidelines for the use of echocardiography in this population exist, evidence for core applications is limited and conflicting, and newer centrifugal-flow devices have been subject to minimal study. As a first step toward addressing these deficits, this review summarizes the evidence and expert opinion for the use of echocardiography in pre-operative planning and perioperative management, prediction of post-operative right ventricular failure, the use of echocardiographic surrogates for invasive hemodynamic measurements, and the performance of speed ramp studies for the diagnosis of thrombosis and optimization of device settings.

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Effects of the HeartMate II Left Ventricular Assist Device as Observed by Serial Echocardiography

Cited by 20 publications

References 22 publications

Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation

Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation

Fine-tuning management of the Heart Assist 5 left ventricular assist device with two- and three-dimensional echocardiography

Echocardiography and Continuous-Flow Left Ventricular Assist Devices

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