Management issues during HeartWare left ventricular assist device implantation and the role of transesophageal echocardiography

Patangi, Sanjay Orathi; George, Anthony; Pauli, Henning; O'Leary, D.; Roysam, Chandrika; Butt, Tanveer; Schueler, Stephan; Prabhu, Mahesh; MacGowan, Guy A.

doi:10.4103/0971-9784.119173

Cited by 28 publications

(3 citation statements)

References 68 publications

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“…LVAD initiation can create a pressure gradient from the RA to the LA, with right-to-left shunting in the presence of a PFO. Intraoperative TEE is therefore mandatory because PFO needs to be closed during VAD surgery [ 148 , 163 ]. To improve the visualization of that shunting by TEE it is useful to induce a short-term shifting of the atrial septum to the left by increasing the LVAD flow [ 148 ].…”

Section: Usefulness Of Echo During Vad Implantationmentioning

confidence: 99%

“…To improve the visualization of that shunting by TEE it is useful to induce a short-term shifting of the atrial septum to the left by increasing the LVAD flow [ 148 ]. After starting the LVAD, TEE is also necessary for guiding pump speed adjustment for optimizing LV unloading without any septum shift and, if possible, with maintaining a systolic AV opening at least once every 3 heart cycles [ 57 , 163 , 164 ]. Even if a maximum attainable LVAD support could be more advantageous for promoting LV reverse remodeling and increasing patient exercise capacity, sub-maximal support in order to keep a near physiologic AV function should be preferred in outpatients, because a full support enhances the risk of AV leaflet fusion, suction alarms, aortic rood thrombosis and also the emergence and/or aggravation of AR by increasing the

P over the closed AV [ 164 ].…”

Section: Usefulness Of Echo During Vad Implantationmentioning

confidence: 99%

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Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Dandel¹

2022

Rev. Cardiovasc. Med.

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Echocardiography (ECHO) is indispensable for evaluation of patients with terminal chronic heart failure (HF) who require transplantation or mechanical circulatory support by a left- or biventricular assist device (LVAD or BiVAD, respectively). In LVAD candidates, ECHO represents the first-line investigation necessary for a timely discovery of heart-related risk factors for potentially life-threatening post-operative adverse events, including identification of patients who necessitate a biventricular support. ECHO is also required for intra-operative guiding of VAD implantation and finding of the most appropriate setting of the device for an optimal ventricular unloading, postoperative surveillance of the VAD support, and monitoring of the RV changes in LVAD recipients. Thanks to the ECHO, which has decisively contributed to the proof that prolonged VAD support can facilitate cardiac reverse remodeling and functional improvement to levels which allow successful weaning of carefully selected patients from LVAD or BiVAD, the previous opinion that chronic non-ischemic cardiomyopathy (NICMP) is irreversible could be refuted. In patients with normalized and stable right heart catheter-derived hemodynamic parameters obtained at short-term interruptions of VAD support, ECHO has proved able to predict post-weaning long-term freedom from HF recurrence in patients with pre-implant terminal chronic NICMP. The purpose of this article is to offer an actualized theoretical and practical support for clinicians engaged in this particularly challenging and topical issue especially due to the new practical aspects which have emerged in conjunction with the growing use of long-term ventricular assist devices as bridge-to-transplantation or as destination therapy, as well as the increasing evidence that, in some patients, such VAD can become a bridge-to-recovery, allowing the removal of the device after a longer support time.

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Section: Usefulness Of Echo During Vad Implantationmentioning

confidence: 99%

P over the closed AV [ 164 ].…”

Section: Usefulness Of Echo During Vad Implantationmentioning

confidence: 99%

Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Dandel¹

2022

Rev. Cardiovasc. Med.

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“…The aortic valve should be interrogated and any evidence of aortic insufficiency should be reported [ 57 ].…”

Section: Echocardiography In the Management Of Patients With A Left ...mentioning

confidence: 99%

Echocardiography in Cardiac Assist Devices

Anand¹,

Barry²,

Arsanjani³

et al. 2022

Rev. Cardiovasc. Med.

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In patients with medically refractory heart failure or cardiogenic shock, both temporary and durable mechanical circulatory support devices can be used to support cardiac circulation. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are widely available, relatively noninvasive, and avoid radiation exposure. Thus, echocardiography is an invaluable tool that provides vital information aiding in preprocedure evaluation, placement, management, and weaning of cardiac assist devices. The purpose of this article is to review the utility of both TTE and TEE in managing patients with cardiac assist devices.

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Echocardiography in Mechanical Circulatory Support

Pérez

Grimm

2016

Intraprocedural Imaging of Cardiovascular Interventions

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Management issues during HeartWare left ventricular assist device implantation and the role of transesophageal echocardiography

Cited by 28 publications

References 68 publications

Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Echocardiography in Cardiac Assist Devices

Echocardiography in Mechanical Circulatory Support

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