Enhanced Recovery After Surgery in Patients Implanted with Left Ventricular Assist Device

Lindenmuth, Danielle M.; Chase, Karin; Cheyne, C.; Wyrobek, Julie; Bjelic, Milica; Ayers, Brian; Barrus, Bryan; Vanvoorhis, Timothy; McKinley, Elizabeth D.; Falvey, Jennifer; Barney, Bethany; Fingerut, Liubov; Sitler, Brianna; Kumar, Neil G.; Akwaa, Frank; Paić, Frane; Vidula, Himabindu; Alexis, Jeffrey D.; Gošev, Igor

doi:10.1016/j.cardfail.2021.05.006

Cited by 10 publications

(6 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Merging two complementary sets of ideas, ERAS and LVAD evidence‐based best practices, we have created a novel comprehensive ERAS for LVAD protocol. Our previous publications have covered details of the protocol 12 . In August 2019, we began the implementation of the ERAS protocol.…”

Section: Methodsmentioning

confidence: 99%

“…Preoperative characteristics, intraoperative data, and postoperative characteristics were obtained from the UR LVAD Database and the electronic medical record. Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) definitions were used for postoperative complications 12 …”

Section: Methodsmentioning

confidence: 99%

“…Our previous publications have covered details of the protocol. 12 In August 2019, we began the implementation of the ERAS protocol. The overarching goal of the protocol was the standardization of clinical pathways that ensure the use of best practices and decreased variation in perioperative care.…”

Section: Enhanced Recovery After Surgery (Eras) Protocolmentioning

confidence: 99%

See 2 more Smart Citations

Impact of surgical approach for left ventricular assist device implantation on postoperative invasive hemodynamics and right ventricular failure

Bjelic

Vidula

et al. 2022

Journal of Cardiac Surgery

Self Cite

View full text Add to dashboard Cite

Background: Right ventricular failure (RVF) remains one of the major causes of morbidity and mortality after left ventricular assist device (LVAD) implantation. We sought to compare immediate postoperative invasive hemodynamics and the risk of RVF following two different surgical approaches: less invasive surgery (LIS) versus full sternotomy (FS). Methods:The study population comprised all 231 patients who underwent implantation of a HeartMate 3 (Abbott) LVAD at our institution from 2015 to 2020, utilizing an LIS (n = 161; 70%) versus FS (n = 70; 30%) surgical approach.Outcomes included postoperative invasive hemodynamic parameters, vasoactiveinotropic score (VIS), RVF during index hospitalization, and 6-month mortality.Results: Baseline clinical characteristics of the two groups were similar. Multivariate analysis showed that LIS, compared with FS, was associated with the improved cardiac index (CI) at the sixth postoperative hour (p = .036) and similar CI at 24 h, maintained by lower VIS at both timepoints (p = .002). The LIS versus FS approach was also associated with a three-fold lower incidence of in-hospital severe RVF (8.7% vs. 28.6%, p < .001) and need for RVAD support (5.0% vs. 17.1%, p = .003), and with 68% reduction in the risk of 6-month mortality after LVAD implantation (Hazard ratio, 0.32; CI, 0.13-0.78; p = .012). Conclusion:Our findings suggest that LIS, compared with FS, is associated with a more favorable hemodynamic profile, as indicated by similar hemodynamic parameters maintained by lower vasoactive-inotropic support during the acute postoperative period. These findings were followed by a reduction in the risk of severe RVF and 6-month mortality in the LIS group.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Impact of surgical approach for left ventricular assist device implantation on postoperative invasive hemodynamics and right ventricular failure

Bjelic

Vidula

et al. 2022

Journal of Cardiac Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Our institution developed and incorporated a novel comprehensive ERAS for LVAD protocol, described in detail in our previous publication 16 . The protocol's main goal was the standardization of clinical pathways to ensure the use of best practices and decrease variation in perioperative care.…”

Section: Methodsmentioning

confidence: 99%

“…Our institution developed and incorporated a novel comprehensive ERAS for LVAD protocol, described in detail in our previous publication. 16 The protocol's main goal was the standardization of clinical pathways to ensure the use of best practices and decrease variation in perioperative care. Since August 2019, different initiatives have been incorporated, from prerehabilitation, intraoperative opioid reduction and anesthesia standardization, to postoperative patient optimization and education.…”

Section: Enhanced Recovery After Surgery (Eras) Protocolmentioning

confidence: 99%

Left atrial appendage exclusion with less invasive left ventricular assist device implantation

Bjelic

Wood

Simon

et al. 2022

Journal of Cardiac Surgery

Self Cite

View full text Add to dashboard Cite

Objectives The objective of this single‐center, pilot, prospective, and historical control study is to evaluate safety and feasibility outcomes associated with left atrial appendage exclusion (LAAE) concomitant with left ventricular assist device (LVAD) implantation via less invasive surgery (LIS) as a stroke prevention strategy. Methods A predefined number of 30 eligible subjects scheduled for LIS LVAD with LAAE were enrolled in the prospective arm between January 2020 and February 2021. Eligible retrospective LIS LVAD patients without LAAE were propensity‐matched in a 1:1 ratio with the prospective arm subjects. The primary study objectives were to evaluate the safety, feasibility, and efficacy of the LAAE concomitant with LIS LVAD. Results Preoperative characteristics of patients in the Non‐LAAE and LAAE groups were similar. LAAE was successfully excluded in all prospective patients (100%). Primary safety endpoints of chest tube output within the first 24 postoperative hours, Reoperation for bleeding within 48 h, and index hospitalization mortality demonstrated comparable safety of LAAE versus Non‐LAAE with LIS LVAD. Cox proportional hazard regression demonstrated that LAAE with LIS LVAD was associated with 37% and 49% reduction in the risk of stroke and disabling stroke, respectively (p > .05). Conclusion Results from our pilot study demonstrated the safety and feasibility of LAAE concomitant with LIS LVAD as a stroke prevention strategy. This is the first prospective study describing LAAE performed concomitantly to less invasive LVAD implantation. The efficacy of LAAE in long‐term stroke prevention needs to be confirmed in future prospective randomized clinical trials.

show abstract

Enhanced Recovery After Surgery (ERAS®) in der Kardioanästhesie

Kubitz

Schubert²,

Schulte‐Uentrop³

2022

Anaesthesiologie

View full text Add to dashboard Cite

Enhanced Recovery After Surgery in Patients Implanted with Left Ventricular Assist Device

Cited by 10 publications

References 22 publications

Impact of surgical approach for left ventricular assist device implantation on postoperative invasive hemodynamics and right ventricular failure

Impact of surgical approach for left ventricular assist device implantation on postoperative invasive hemodynamics and right ventricular failure

Left atrial appendage exclusion with less invasive left ventricular assist device implantation

Enhanced Recovery After Surgery (ERAS®) in der Kardioanästhesie

Contact Info

Product

Resources

About