First human use of the Hemopump, a catheter-mounted ventricular assist device

Frazier, O.H.; Wampler, Richard K.; Duncan, James M.; Dear, Wayne E.; Macris, Michael P.; Parnis, Steven M.; Fuqua, John M.

doi:10.1016/0003-4975(90)90155-y

Cited by 106 publications

(25 citation statements)

References 10 publications

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“…The first continuous-flow LVAD-the Hemopump-was subsequently implanted in 1988. 3 It was followed by successful implantations of the HeartMate XVE in 1991, 4 the Jarvick 2000 in 2000, 5 and the HeartMate2 (Figure 1) in 2003 by O. H. Frazier and his colleagues at St. Luke's Hospital in Houston, Texas. 6 Continuousflow LVADs are designed to provide blood flow of up to 10 L/min by generating a continuous blood flow from the inlet through the revolving impeller to the outlet.…”

Section: A Brief History and Clinical Applications Of Lvadmentioning

confidence: 99%

“…Fourth, while it facilitates VWF cleavage by ADAMTS-13, 72,73,82 a high fluid shear stress or a tensile force also unfolds VWF to bind and activate platelets, 74,81,[124][125][126] potentially leading to a consumptive deficiency in large VWF multimers, similar to patients with type 2B VWD. This shearinduced platelet aggregation depends on the attachment of large VWF multimers to GP Iba and the activation of integrin aIIbb 3 . 125,127,128 This gain-of-function VWF phenotype can not only remove large VWF multimers from the circulation, but also occlude cerebral and GI microvessels, producing punctate injury, bleeding, and AVM.…”

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confidence: 99%

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Acquired von Willebrand syndrome associated with left ventricular assist device

Nascimbene

Neelamegham

Frazier

et al. 2016

Blood

187

150

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Left ventricular assist devices (LVAD) provide cardiac support for patients with end-stage heart disease as either bridge or destination therapy, and have significantly improved the survival of these patients. Whereas earlier models were designed to mimic the human heart by producing a pulsatile flow in parallel with the patient’s heart, newer devices, which are smaller and more durable, provide continuous blood flow along an axial path using an internal rotor in the blood. However, device-related hemostatic complications remain common and have negatively affected patients’ recovery and quality of life. In most patients, the von Willebrand factor (VWF) rapidly loses large multimers and binds poorly to platelets and subendothelial collagen upon LVAD implantation, leading to the term acquired von Willebrand syndrome (AVWS). These changes in VWF structure and adhesive activity recover quickly upon LVAD explantation and are not observed in patients with heart transplant. The VWF defects are believed to be caused by excessive cleavage of large VWF multimers by the metalloprotease ADAMTS-13 in an LVAD-driven circulation. However, evidence that this mechanism could be the primary cause for the loss of large VWF multimers and LVAD-associated bleeding remains circumstantial. This review discusses changes in VWF reactivity found in patients on LVAD support. It specifically focuses on impacts of LVAD-related mechanical stress on VWF structural stability and adhesive reactivity in exploring multiple causes of AVWS and LVAD-associated hemostatic complications.

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Section: A Brief History and Clinical Applications Of Lvadmentioning

confidence: 99%

mentioning

confidence: 99%

Acquired von Willebrand syndrome associated with left ventricular assist device

Nascimbene

Neelamegham

Frazier

et al. 2016

Blood

187

150

View full text Add to dashboard Cite

show abstract

“…5 Ultrasonographic studies at our institution have revealed thrombus formation along the aortic cusps and carotid bulb in LVAD patients with nonpulsatile flow. 6,7 Thus, intermittent pulsatility may reduce the risk of thromboembolic events by enabling arterial washout in areas susceptible to stasis. Investigators have also suggested an increased incidence of aortic insufficiency 8 and gastrointestinal bleeding 9 in patients with continuous-flow devices; however, the mechanisms by which these effects occur is not yet fully understood.…”

Section: Discussionmentioning

confidence: 99%

Tolerance of Sustained Ventricular Fibrillation During Continuous-Flow Left Ventricular Assist Device Support

Baldwin¹,

Gemmato²,

Sandoval³

et al. 2017

Texas Heart Institute Journal

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The widespread use of continuous-flow left ventricular assist devices for mechanical circulatory support has shown that long-term hemodynamic support is possible, even when a clinical “pulse” cannot be detected. We present the incidental discovery of ventricular fibrillation in 6 alert, hemodynamically stable patients supported only by a continuous-flow device (HeartMate II, n=5; Jarvik 2000, n=1). Ventricular fibrillation was found in 3 patients during routine outpatient follow-up visits and in 3 awaiting discharge from the hospital after device placement. Diagnosis was confirmed by electrocardiographic and echocardiographic studies. The average duration of mechanical circulatory support before ventricular fibrillation occurred was 221 ± 362 days (range, 5–864 d). All patients were conscious and ambulatory at the time of the arrhythmia. Three patients reported symptoms—primarily fatigue, nausea, and exertional dyspnea—that prompted evaluation. Serum chemistry analysis of blood drawn immediately after diagnosis showed no changes that suggested end-organ dysfunction. Three patients died of unrelated complications an average of 3.9 yr (range, 360–2,270 d) after the event. Two of the remaining 3 patients eventually underwent successful pump explantation, and one is on ongoing support. Our experience shows that it is possible for patients with continuous-flow left ventricular assist devices to remain hemodynamically stable while in ventricular fibrillation. Additional investigation is needed to determine whether defibrillator settings for these patients should be adjusted to limit delivery of shock therapy.

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“…The concept of continuous left ventricular unloading with an axial flow pump was introduced 25 years ago [10]. The first concept was realized with the Hemopump™ which was driven by an external motor sucking blood through a pump cannula from the left ventricle into the ascending aorta with a small impeller in the distal part of the cannula.…”

Section: Axial Flow Pumpsmentioning

confidence: 99%

Coronary Interventions with Mechanical Circulatory Support

Ferrari¹

2011

Coronary Angiography - The Need for Improvement in Medical and Interventional Therapy

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First human use of the Hemopump, a catheter-mounted ventricular assist device

Cited by 106 publications

References 10 publications

Acquired von Willebrand syndrome associated with left ventricular assist device

Acquired von Willebrand syndrome associated with left ventricular assist device

Tolerance of Sustained Ventricular Fibrillation During Continuous-Flow Left Ventricular Assist Device Support

Coronary Interventions with Mechanical Circulatory Support

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