Eighth annual INTERMACS report: Special focus on framing the impact of adverse events

Kirklin, James K.; Pagani, Francis D.; Kormos, Robert L.; Stevenson, Lynne Warner; Blume, Elizabeth D.; Myers, Susan; Miller, Marissa A.; Baldwin, J. Timothy; Young, James B.; Naftel, David C.

doi:10.1016/j.healun.2017.07.005

Cited by 1,105 publications

(1,014 citation statements)

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“…Nearly half the cohort underwent post‐cardiotomy implantation, which generally has higher mortality, and in our cohort had 77% higher mortality risk than primary implantation, although this did not reach statistical significance in multivariable analysis. We found that males had much lower mortality risk than females after VAD implantation, a pattern previously reported in non‐CKD LVAD cohorts 27. The hemodynamic instability and clinical status at time of implantation, as reflected by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, is an important determinant of mortality,27 and is unknown in our cohort.…”

Section: Discussionsupporting

confidence: 64%

“…We found that males had much lower mortality risk than females after VAD implantation, a pattern previously reported in non‐CKD LVAD cohorts 27. The hemodynamic instability and clinical status at time of implantation, as reflected by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, is an important determinant of mortality,27 and is unknown in our cohort. It is likely, however, that the severe chronic kidney disease and associated comorbidities are major contributors to the high mortality.…”

Section: Discussionsupporting

confidence: 64%

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Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

Walther

Niu

Winkelmayer

et al. 2018

JAHA

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BackgroundPeople with end‐stage renal disease (ESRD) are at risk for advanced heart failure, but little is known about use and outcomes of durable mechanical circulatory support in this setting. We examined use and outcomes of implantable ventricular assist devices (VADs) in a national ESRD cohort.Methods and ResultsWe performed a retrospective cohort study of Medicare beneficiaries with ESRD who underwent implantable VAD placement from 2006 to 2014. We examined in‐hospital and 1‐year mortality, all‐cause and cause‐specific hospitalizations, and heart/kidney transplantation outcomes. We investigated as predictors demographic factors, time‐period of VAD implantation, primary or post‐cardiotomy implantation, and duration of ESRD before VAD implantation. We identified 96 people with ESRD who underwent implantable VAD placement. At time of VAD implantation, 74 (77.1%) were receiving hemodialysis, 10 (10.4%) were receiving peritoneal dialysis and 12 (12.5%) had renal transplant. Time from incident ESRD to VAD implantation was median 4.0 (interquartile range 1.1, 8.2) years. Mortality during the implantation hospitalization was 40.6%. Within 1 year of implantation 61.5% of people had died. On multivariable analysis, males had half the mortality risk of females. Lower mortality risk was also seen with VAD implantation in a primary setting, and with more recent year of implantation, but these results did not reach statistical significance.ConclusionsMedicare beneficiaries with ESRD are undergoing durable VAD implantation, often several years after incident ESRD, although in low numbers. Mortality is high among these patients, highlighting the need for investigations to improve treatment selection and management.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionsupporting

confidence: 64%

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

Walther

Niu

Winkelmayer

et al. 2018

JAHA

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“…MCS devices, originally used for patients with AdHF as a bridge-to-transplant or bridge-to-recovery, now increasingly used as destination (lifelong) therapy, have the potential to outnumber HTx by a factor of 1:10 [26]. Because of this success, destination MCS is increasingly being offered to patients with challenging clinical profiles.…”

Section: Outcomes In Adhf Patients Undergoing Mcs/htx Adhf Patients Umentioning

confidence: 99%

A Peripheral Blood Transcriptome Biomarker Test to Diagnose Functional Recovery Potential in Advanced Heart Failure

Deng

2018

Biomark. Med.

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Heart failure (HF) is a complex clinical syndrome that causes systemic hypoperfusion and failure to meet the body's metabolic demands. In an attempt to compensate, chronic upregulation of the sympathetic nervous system and renin-angiotensin-aldosterone leads to further myocardial injury, HF progression and reduced O 2 delivery. This triggers progressive organ dysfunction, immune system activation and profound metabolic derangements, creating a milieu similar to other chronic systemic diseases and presenting as advanced HF with severely limited prognosis. We hypothesize that 1-year survival in advanced HF is linked to functional recovery potential (FRP), a novel clinical composite parameter that includes HF severity, secondary organ dysfunction, co-morbidities, frailty, disabilities as well as chronological age and that can be diagnosed by a molecular biomarker.

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“…За этот период времени клиниче-ская практика применения имплантируемых систем с непульсирующим потоком насчитывала более 20 000 случаев в 180 различных клиниках мира [6].…”

Section: Introductionunclassified

Special Aspects of Implantation of a Heart Pump Support System Avk-N as a «bridge» to Heart Transplantation

Халилулин

Захаревич

Попцов

et al. 2018

RJTAO

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1 ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский университет), Москва, Российская Федерация 3 Московский физико-технический институт (государственный университет), кафедра физики живых систем, Москва, Российская Федерация 4 ГБОУ ВПО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России, кафедра кардиологии, Москва, Российская Федерация Целью исследования явилась разработка оптимальной хирургической тактики имплантации систем АВК-Н в качестве «моста» к трансплантации сердца. Материалы и методы. В исследование были включены 17 пациентов, оперированных в период с 2012-го по октябрь 2017 г. в ФГБУ «Националь-ный медицинский исследовательский центр трансплантологии и искусственных органов имени акаде-мика В.И. Шумакова». С целью замещения насосной функции ЛЖ сердца использовалась миниатюрная имплантируемая система вспомогательного кровообращения «Аппарат вспомогательного кровообра-щения -носимый» (АВК-Н) (Россия). До имплантации системы длительной механической поддержки кровообращения все пациенты были обследованы по программе потенциальных реципиентов на транс-плантацию сердца. Среди оперированных пациентов было 16 (94,1%) мужчин и 1 (5,9%) женщина, сред-ний возраст составил 52,64 ± 10,56 (от 33 до 67 лет). Все пациенты имели застойную сердечную недо-статочность III-IV функционального класса по NYHA, рефрактерную к оптимальной медикаментозной терапии. Причиной развития сердечной недостаточности в 12 (70,58%) случаях явилась дилатационная кардиомиопатия, а в 5 (29,42%) -постинфарктная систолическая дисфункция левого желудочка. Имп-лантация системы АВК-Н проводилась потенциальным реципиентам донорского сердца с терминаль-ной стадией ХСН со снижением фракции выброса ЛЖ до 10%. Результаты. В результате настоящего исследования был разработан ряд технологических аспектов имплантации системы, облегчающих по-следующее выполнение ТС. Заключение. Наш опыт оптимизации хирургической тактики импланта-ции системы АВК-Н в качестве «моста» к трансплантации сердца продемонстрировал возможность и безопасность ее активного применения у пациентов с терминальной сердечной недостаточностью, как находящихся в листе ожидания трансплантации сердца, так и имеющих временные противопоказания к ее выполнению.Ключевые слова: критическая сердечная недостаточность, трансплантация сердца, механическая поддержка кровообращения.

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Eighth annual INTERMACS report: Special focus on framing the impact of adverse events

Abstract: Greater application of durable devices to patients with ambulatory heart failure will mandate more effective neutralization or prevention of major adverse events.

Cited by 1,105 publications

References 4 publications

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

A Peripheral Blood Transcriptome Biomarker Test to Diagnose Functional Recovery Potential in Advanced Heart Failure

Special Aspects of Implantation of a Heart Pump Support System Avk-N as a «bridge» to Heart Transplantation

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