Partial Support with a Centrifugal Left Ventricular Assist Device Reduces Myocardial Oxygen Consumption in Chronic, Ischemic Heart Failure

Goldstein, Andrew H.; Monreal, Gretel; Kambara, Atsushi; Spiwak, Allison J.; Schlossberg, Matthew L.; Abrishamchian, A. Reza; Gerhardt, Mark A.

doi:10.1016/j.cardfail.2004.07.005

Cited by 28 publications

(21 citation statements)

References 27 publications

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“…We developed an ovine model of small-vessel model HF (Monreal et al, 2004;Goldstein et al, 2005). Sheep underwent selective microembolization of the circumflex coronary artery (LCx) to induce HF.…”

Section: Methodsmentioning

confidence: 99%

Cytoskeletal remodeling of desmin is a more accurate measure of cardiac dysfunction than fibrosis or myocyte hypertrophy

et al. 2008

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Section: Methodsmentioning

confidence: 99%

Cytoskeletal remodeling of desmin is a more accurate measure of cardiac dysfunction than fibrosis or myocyte hypertrophy

et al. 2008

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“…The myocardium maintains considerable energy demands in healthy systems. Indices such as intramyocardial pressure and tension-time index are costly in terms of energy requirements and are well-characterized in the LV [9], however the energy requirements of the RV, especially in rVSD, are unclear. Increases in mitochondrial energetic proteins, either via increased protein upregulation or by increased mitochondrial biosynthesis, may reflect a boost in energy production essential for fulfilling enhanced demands by the RV [2,28].…”

Section: Discussionmentioning

confidence: 99%

“…A pulmonary artery thermodilution catheter (7.5 Fr, Edwards Lifesciences; Irvine, CA) was passed into the RV and pulmonary artery for obtaining right heart hemodynamics and cardiac outputs. A dual-pressure micromanometer-tipped conductance catheter (Millar Instruments; Houston, TX) was passed into the aorta and LV for pressure–volume measurements [8,9]. Blood resistivity was measured to determine volume conductance.…”

Section: Methodsmentioning

confidence: 99%

Right ventricular remodeling in restrictive ventricular septal defect

Monreal

Youtz

Phillips

et al. 2010

Journal of Molecular and Cellular Cardiology

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Restrictive ventricular septal defect (rVSD) presents with little/no hemodynamic aberrations despite a patent septal defect. Clinically, these patients are observed with the hope that the defect will functionally close over time without the need for surgical repair and development of heart failure. Without evidence supporting a definitive therapeutic strategy, rVSD patients may have increased risk of a poor outcome. We tested the hypothesis that rVSD results in subclinical RV diastolic dysfunction and molecular remodeling. Five pigs underwent surgical rVSD creation. Echocardiography, hemodynamics, myocyte contractility experiments, and proteomics/Western blot were performed 6-weeks post-rVSD and in controls. *p < 0.05. LV and RV hemodynamics in rVSD were comparable to controls. The tricuspid valve early/late diastolic inflow velocity ratio (TV E/A ratio) decreased from 1.6 ± 0.05 in controls to 1.0 ± 0.08* in rVSD, indicating RV diastolic dysfunction. rVSD RV myocytes showed abnormalities in contraction (departure velocity (Vd) − 51%*, Vd time +55%*) and relaxation (return velocity (Vr) −50%*, Vr time +62%*). Mitochondrial proteins (fatty acid, TCA cycle) increased 2-fold*, indicating heightened RV work. Desmin protein upregulated 285%* in rVSD RV myocardium, suggesting cytoskeletal remodeling. rVSD causes RV diastolic dysfunction, myocyte functional impairment, and mitochondrial/cytoskeletal protein upregulation in our model. Desmin upregulation may hinder sarcomeric organization/relaxation, representing a key subclinical early marker for future RV dysfunction. TV E/A measurements are a non-invasive modality to assess rVSD patients for diastolic dysfunction. Translational research applications may lead to fundamental changes in the clinical management of rVSD by providing evidence for early repair of the defect.

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“…The concept has been studied by goldstein et al 24 using short-term devices and has been proven to be effective in reducing myocardial oxygen consumption in chronic ischemic heart failure. In addition, improvement in renal function has been shown to improve with both partial support and complete support techniques in heart failure patients within 3 months of implantation.…”

Section: A New Implant Strategy For Bridged Patientsmentioning

confidence: 98%

Can an Alternative Outflow Strategy be Utilized for High-Risk Bridged Patients with Previous Cardiac Surgery?

Danish

Davis

et al. 2016

ASAIO Journal

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The HeartWare ventricular assist device (HVAD) is an implantable continuous-flow centrifugal pump that has allowed the development of sternal-sparing techniques, with the use of alternative outflow strategies. We compared early outcomes for patients bridged with the conventional versus alternative outflow graft strategy. From January 2013 to October 2014, 89 patients with HVAD implantation were identified. Survival was analyzed with Kaplan-Meier methods, and a log-rank test was used to compare outcomes between groups. Thirty patients (34%) had ≥1 previous sternotomy before HVAD implantation. Eight patients (27%) were approached using an alternative outflow graft technique with outflow graft connection to the descending aorta (n = 4, 50%) or left subclavian artery (n = 4, 50%), whereas 22 (73%) were implanted via a conventional sternotomy approach with the outflow graft to the ascending aorta. Preoperative characteristics (age, Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS], and Lietz-Miller score) were comparable between groups (all p > 0.05). Median follow-up was 4.7 (2.8-9.3) months of support. Outcomes were comparable between conventional and alternative outflow groups; survival at 6 months was 74% for the conventional group and 83% in the alternative outflow group. An alternative outflow graft strategy can be utilized to support bridged patients with a history of prior sternotomy.

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Partial Support with a Centrifugal Left Ventricular Assist Device Reduces Myocardial Oxygen Consumption in Chronic, Ischemic Heart Failure

Cited by 28 publications

References 27 publications

Cytoskeletal remodeling of desmin is a more accurate measure of cardiac dysfunction than fibrosis or myocyte hypertrophy

Cytoskeletal remodeling of desmin is a more accurate measure of cardiac dysfunction than fibrosis or myocyte hypertrophy

Right ventricular remodeling in restrictive ventricular septal defect

Can an Alternative Outflow Strategy be Utilized for High-Risk Bridged Patients with Previous Cardiac Surgery?

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