Mechanical Circulatory Support in Women

Dayanand, Sandeep; Martinez, J.; Figueredo, Vincent M.; Gupta, Shuchita

doi:10.1016/j.jjcc.2020.07.012

Cited by 12 publications

(18 citation statements)

References 87 publications

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“…The overrepresentation of male participants in this study (33/38 participants) is in line with other reports, where women were less likely to receive a LVAD, since they appear to have poorer outcomes and more frequent adverse events ( Joyce et al, 2009 ; Magnussen et al, 2018 ; Dayanand et al, 2021 ). The high prevalence of obesity (over 30% of participants) in the sample should spark action towards weight management strategies in this population.…”

Section: Discussionsupporting

confidence: 92%

Muscle strength, aerobic capacity, and exercise tolerance are impaired in left ventricular assist devices recipients: A pilot study

et al. 2022

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Background: Left ventricular assist devices (LVAD) are increasingly being used as a therapy for advanced heart failure, both as a bridge to heart transplant and, given the rapid advances in the LVAD’s functionality and safety, and constant lack in availability of donor organs, as long-term destination therapy. With the diffusion of such therapy, it is crucial to assess patients’ muscle strength, aerobic capacity and exercise tolerance, to improve their functional capacity.Methods: 38 LVAD recipients (33 men and five women) were included. Exercise testing including a maximal cardiopulmonary exercise test (CPET), handgrip, isometric and isokinetic strength testing of knee and ankle flexion/extension, and Romberg balance test in three conditions (eyes open, eyes closed, double task). Given the small and heterogeneous final sample size, a mostly descriptive statistical approach was chosen.Results: 12 participants were classified as “Obese” (BMI>29.9). The most common comorbidities were type II diabetes and chronic kidney disease. Only 12 participants were able to successfully complete all the assessments. CPET and isokinetic strength trials were the least tolerated tests, and the handgrip test the best tolerated. Mean VO2 peak was 12.38 ± 3.43 ml/kg/min, with 15 participants below 50% of predicted VO2 max, of which 6 below 30% VO2max. Mean handgrip strength was 30.05 ± 10.61 Kg; 25 participants were below the 25° percentile of their population’s normative reference values for handgrip strength, 10 of which were below the 5° percentile. Issues with the management of the external pack of the LVAD and its influence on the test limited the validity of the balance tests data, therefore, no solid conclusions could be drawn from them. VO2 peak did not correlate with handgrip strength or with any of the lower limb strength measures.Conclusion: LVAD recipients show greatly reduced functional capacity and tolerance to exercise and exercise testing, with low overall strength levels. As strength variables appear to be independent from VO2 peak, different lower limbs strength tests should be explored to find a tolerable alternative in this population, which is subjected to muscle wasting due to old age, reduced tissue perfusion, side effects from the pharmacological therapies, and prolonged periods of bedrest.

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Section: Discussionsupporting

confidence: 92%

Muscle strength, aerobic capacity, and exercise tolerance are impaired in left ventricular assist devices recipients: A pilot study

et al. 2022

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“…The factors that underlie gender differences in thromboembolic risk and responses to anticoagulation could similarly explain gender disparities in stroke risk after LVAD implantation and should be explored in future studies. Right ventricular failure is also more common in women than men after LVAD implantation, with some evidence supporting later presentation and higher prevalence of non-ischemic cardiomyopathy as contributing factors ( 44 ).…”

Section: Life Sustaining Therapies For Women With Advanced Heart Failurementioning

confidence: 99%

“…It is unclear how gender biases in selection arising from differences in clinical severity or psychosocial issues could influence LVAD outcomes. To further address conflicting data, more sex-specific LVAD research is needed, especially limited to contemporary LVADSs like HeartMate 3 which has a lower rate of adverse events ( 44 ).…”

Section: Life Sustaining Therapies For Women With Advanced Heart Failurementioning

confidence: 99%

“…Current trends show a decrease in intra-aortic balloon pump use and increases in micro-axial LVADs and extracorporeal membrane oxygenation use in both sexes ( 48 ). Despite being sicker at presentation ( 44 ), TMCS is underutilized in women ( 49 ) and is associated with greater complication rates, including vascular complications that sometimes require surgical interventions ( 50 ). Women experience greater mortality from cardiogenic shock than men despite TMCS use ( 49 ).…”

Section: Life Sustaining Therapies For Women With Advanced Heart Failurementioning

confidence: 99%

“…Women experience greater mortality from cardiogenic shock than men despite TMCS use ( 49 ). In acute myocardial infarction related-cardiogenic shock, women received TMCS support less frequently ( 48 ) even though Impella support prior to percutaneous coronary intervention is associated with greater survival benefits in women than men ( 44 ). Further research is required to explore sex-based differences, hormonal influences and potential anatomical considerations in TMCS utilization and outcomes.…”

Section: Life Sustaining Therapies For Women With Advanced Heart Failurementioning

confidence: 99%

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Special Considerations in the Care of Women With Advanced Heart Failure

Ebong

DeFilippis

Hamad

et al. 2022

Front. Cardiovasc. Med.

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Advanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.

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