Management of left ventricular assist devices after surgery: bridge, destination, and recovery

Mountis, Maria; Starling, Randall C.

doi:10.1097/hco.0b013e32832c7c09

Cited by 18 publications

(19 citation statements)

References 27 publications

(17 reference statements)

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“…Current problems include strokes, unwieldy power connections, anticoagulation, and increased risk of potentially fatal infections. Interestingly, implantation of LVADs actually restored native heart function in some cases where a transplantable heart was not identified (reviewed by Mountis and Starling 163 ). Problems of integration of artificial biomaterials with biological systems are likely to be solved by hybrid approaches.…”

Section: Bioengineered Mechanical Organsmentioning

confidence: 99%

Applied Healthspan Engineering

Larrick

Mendelsohn

2010

Rejuvenation Research

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According to the Homeric Hymn to Aphrodite, when Eos asked Zeus for Tithonus to be granted immortality, she forgot to ask for eternal youth. Applied Healthspan Engineering (AHE) seeks to address this problem. All organisms have a minimal level of functional reserve required to sustain life that eventually declines to a point incompatible with survival at death. AHE seeks to maintain or restore optimal functional reserve of critical tissues and organs. Tissue reserve correlates with well being. Diet, physical exercise, and currently available smallmolecule-based therapeutics may attenuate the rate of decline of specific organs or organ systems, but are unlikely to restore lost reserve. Inherent evolutionary-derived limitations in tissue homeostasis and cell maintenance necessitate the development of therapies to enhance regenerative processes and possibly replace whole organs or tissues. AHE supports the study of cell, tissue, and organ homeostatic mechanisms to derive new regenerative and tissue replacement therapies to extend the period of human health.

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Section: Bioengineered Mechanical Organsmentioning

confidence: 99%

Applied Healthspan Engineering

Larrick

Mendelsohn

2010

Rejuvenation Research

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“…Efforts to improve outcomes have focused on enhancements in VAD technology (6,7), refinements in patient selection (8–11), organization of care around multidisciplinary teams (12), and patient-centered instruction (13). In addition, Joint Commission standards require surgeons to perform a minimum of 10 VAD placements within 3 years to achieve certification to use VADs as permanent therapy (14).…”

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confidence: 99%

Trends in the Use and Outcomes of Ventricular Assist Devices Among Medicare Beneficiaries, 2006 Through 2011

Khazanie

Hammill

Patel

et al. 2014

Journal of the American College of Cardiology

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Objectives This study sought to examine trends in mortality, readmission, and costs among Medicare beneficiaries receiving ventricular assist devices (VADs) and associations between hospital-level procedure volume and outcomes. Background VADs are an option for patients with advanced heart failure, but temporal changes in outcomes and associations between facility-level volume and outcomes are poorly understood. Methods This is a population-based, retrospective cohort study of all fee-for-service Medicare beneficiaries with heart failure who received an implantable VAD between 2006 and 2011. We used Cox proportional hazards models to examine temporal changes in mortality, readmission, and hospital-level procedure volume. Results Among 2,507 patients who received a VAD at 103 centers during the study period, the in-hospital mortality decreased from 30% to 10% (p < 0.001), the 1-year mortality decreased from 42% to 26% (p < 0.001), and the all-cause readmission was frequent (82% and 81%; p = 0.70). After covariate adjustment, in-hospital and 1-year mortality decreased (p < 0.001 for both), but the all-cause readmission did not change (p = 0.82). Hospitals with a low procedure volume had higher risks of in-hospital mortality (risk ratio: 1.72; 95% confidence interval [CI]: 1.28 to 2.33) and 1-year mortality (risk ratio: 1.55; 95% CI: 1.24 to 1.93) than high-volume hospitals. Procedure volume was not associated with risk of readmission. The greatest cost was from the index hospitalization and remained unchanged ($204,020 in 2006 and $201,026 in 2011; p = 0.21). Conclusions Short- and long-term mortality after VAD implantation among Medicare beneficiaries improved, but readmission remained similar over time. A higher volume of VAD implants was associated with lower risk of mortality but not readmission. Costs to Medicare have not changed in recent years.

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“…A question that remains, however, is whether or not lower-volume community centers should be performing implantation of LVADs as a destination therapy [19]. Regardless, it is obvious that patients instrumented with an LVAD as destination need intensive follow-up with a multidisciplinary team approach to optimize their medical therapy, reduce the risk of device-related morbidity and improve survival [20][21][22]. Moreover, a point of concern with continuous-flow devices -especially as destination therapy grows -has been the long-term effects of non-pulsatile flow on end-organ function.…”

Section: Destination Therapymentioning

confidence: 97%

Left ventricular assist devices in heart failure

Kilic

Ailawadi

2012

Expert Review of Cardiovascular Therapy

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End-stage heart failure is an ever-growing and devastating disease. The median survival for patients with heart failure on ionotropic support alone is a meager 6 months. Historically, the only option for these patients was to be listed for heart transplantation. Out of medical necessity, the idea of left ventricular assist device (LVAD) as a bridge to transplantation was born. Since their approval by the US FDA, LVADs have quadrupled the survival in patients with heart failure. The increase in survival has also been accompanied by decreased perioperative morbidity, better biocompatibility and longer device life over first-generation LVADs. Undoubtedly, LVADs have changed the landscape of heart failure treatment and will continue to do so in the foreseeable future. In this review, we will highlight the landmark studies that have established LVADs as a therapeutic option for heart failure, as well as reviewing the current LVADs available and speculating on the advancements that will be made in the upcoming years.

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Management of left ventricular assist devices after surgery: bridge, destination, and recovery

Abstract: Care for the MCS patient provided in a multidisciplinary team approach is imperative to allow for a seamless transition from the hospital and into the community and successful long-term outcomes.

Cited by 18 publications

References 27 publications

Applied Healthspan Engineering

Applied Healthspan Engineering

Trends in the Use and Outcomes of Ventricular Assist Devices Among Medicare Beneficiaries, 2006 Through 2011

Left ventricular assist devices in heart failure

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