Less invasive off-pump implantation of axial flow pumps in chronic ischemic heart failure: Survival effects

Ghodsizad, Ali; Kar, B.; Layolka, P; Okur, Abdullah; Gonzales, Jose; Bara, Christoph; Ungerer, Matthias; Kretzler, Matthias; Gregorič, Igor D.; Ruhparwar, Arjang

doi:10.1016/j.healun.2011.03.012

Cited by 31 publications

(26 citation statements)

References 17 publications

(14 reference statements)

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“…The investigation of this interaction is usually performed in silico, in vitro, and in vivo with acute and chronic animal models (1)(2)(3)(4)(5). The investigation of this interaction is usually performed in silico, in vitro, and in vivo with acute and chronic animal models (1)(2)(3)(4)(5).…”

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confidence: 99%

Interaction of a Transapical Miniaturized Ventricular Assist Device With the Left Ventricle: Hemodynamic Evaluation and Visualization in an Isolated Heart Setup

et al. 2016

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New left ventricular assist devices (LVADs) offer both important advantages and potential hazards. VAD development requires better and expeditious ways to identify these advantages and hazards. We validated in an isolated working heart the hemodynamic performance of an intraventricular LVAD and investigated how its outflow cannula interacted with the aortic valve. Hearts from six pigs were explanted and connected to an isolated working heart setup. A miniaturized LVAD was implanted within the left ventricle (tMVAD, HeartWare Inc., Miami Lakes, FL, USA). In four experiments blood was used to investigate hemodynamics under various loading conditions. In two experiments crystalloid perfusate was used, allowing visualization of the outflow cannula within the aortic valve. In all hearts the transapical miniaturized ventricular assist device (tMVAD) implantation was successful. In the blood experiments hemodynamics similar to those observed clinically were achieved. Pump speeds ranged from 9 to 22 krpm with a maximum of 7.6 L/min against a pressure difference between ventricle and aorta of ∼50 mm Hg. With crystalloid perfusate, central positioning of the outflow cannula in the aortic root was observed during full and partial support. With decreasing aortic pressures the cannula tended to drift toward the aortic root wall. The tMVAD could unload the ventricle similarly to LVADs under conventional cannulation. Aortic pressure influenced central positioning of the outflow cannula in the aortic root. The isolated heart is a simple, accessible evaluation platform unaffected by complex reactions within a whole, living animal. This platform allowed detection and visualization of potential hazards.

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confidence: 99%

Interaction of a Transapical Miniaturized Ventricular Assist Device With the Left Ventricle: Hemodynamic Evaluation and Visualization in an Isolated Heart Setup

et al. 2016

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“…Moreover, this strategy is particularly suitable for patients in extremis whose neurologic status is questionable and thus candidacy for cardiac transplantation or long-term support is uncertain. The novel technique described is best suited to centers with established ECLS infrastructure and activity levels, which maintain competency [21-28], [29]. For this reason, regionalization is recommended to ensure that adequate volumes are present at each ECMO center.…”

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confidence: 99%

Central extracorporeal life support with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure

Weymann

Schmack

Sabashnikov

et al. 2014

J Cardiothorac Surg

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BackgroundThe purpose of this prospective study was to evaluate the effects and functional outcome of central extracorporeal life support (ECLS) with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure.MethodsBetween August 2010 and August 2013, 12 consecutive patients (2 female) with a mean age of 31.6 ± 15.1 years received central ECLS with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure. Underlying disease was acute cardiac decompensation due to dilated cardiomyopathy (n = 3, 25%), coronary artery disease with acute myocardial infarction (AMI) (n = 3, 25%), and acute myocarditis (n = 6, 50%). We routinely implemented ECLS by cannulating the ascending aorta, right atrium and inserting a left ventricular decompression cannula vent via the right superior pulmonary vein.ResultsAll patients were successfully bridged to either recovery (n = 3, 25%), long-term biventricular support (n = 6, 50%) or cardiac transplantation (n = 3, 25%). Seven patients (58.3%) were discharged after a mean hospital stay of 42 ± 11.9 days. The overall survival from ECLS implantation to the end of the study was 58.3%. The cumulative ICU stay was 23.1 ± 9.6 days. The length of support was 8.0 ± 4.3 days (range 3-17 days).ConclusionsWe strongly recommend left ventricular decompression in refractory cardiogenic shock and lung failure to avoid pulmonary edema, left heart distension and facilitate myocardial recovery.

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“…All initial LVAD implantations were performed using median sternotomy, whereas most of the LVAD exchange was performed through a less‐invasive subcostal approach. Future innovations in less invasive device implantation techniques including off‐pump extraperitoneal subcostal surgical approach might further improve the postoperative outcomes …”

Section: Discussionmentioning

confidence: 99%

Outcomes following left ventricular assist device exchange

et al. 2020

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Introduction Left ventricular assist device (LVAD) exchange has been historically associated with a significant risk of morbidity and mortality. It is unknown, however, whether these outcomes have improved. We aimed to compare clinical outcomes following LVAD exchange to those following initial LVAD implant in a contemporary patient cohort. Methods A total of 115 LVAD patients were enrolled between 2014 and 2017 and followed for 1 year. Of these, 15 patients (54.5 ± 13.3 years old, 87% male) underwent LVAD exchange at 277 (IQR 191‐597) days following LVAD implantation and 100 patients (57.5 ± 12.3 years old, 76% male) did not undergo an LVAD exchange (non‐exchange group). Results One‐year survival rate following LVAD exchange tended to be higher than the non‐exchange patients (93% vs 76%, P = .15). Readmission rates for each comorbidity did not significantly differ between the two groups (P > .05 for all) except for the higher rate of pump thrombosis in the LVAD exchange group (P < .05). Discussion LVAD exchange cohorts seem to have comparable clinical outcome with the non‐exchange cohorts. Conclusion LVAD exchange might be an increasingly appropriate therapeutic option for the management of pump thrombosis, although careful monitoring for recurrent pump thrombosis is required.

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Less invasive off-pump implantation of axial flow pumps in chronic ischemic heart failure: Survival effects

Cited by 31 publications

References 17 publications

Interaction of a Transapical Miniaturized Ventricular Assist Device With the Left Ventricle: Hemodynamic Evaluation and Visualization in an Isolated Heart Setup

Interaction of a Transapical Miniaturized Ventricular Assist Device With the Left Ventricle: Hemodynamic Evaluation and Visualization in an Isolated Heart Setup

Central extracorporeal life support with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure

Outcomes following left ventricular assist device exchange

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