Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

Cook, Jennifer; Colvin, Monica; Francis, Gary S.; Grady, Kathleen L.; Hoffman, Timothy M.; Jessup, Mariell; John, Ranjit; Kiernan, Michael S.; Mitchell, Judith E.; Pagani, Francis D.; Petty, Michael; Ravichandran, Pasala; Rogers, Joseph G.; Semigran, Marc J.; O’Toole, John M.

doi:10.1161/cir.0000000000000507

Cited by 87 publications

(56 citation statements)

References 64 publications

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“…AI in patients with LVAD support contributes to higher baseline central venous pressure, peek capillary wedge pressure, and lower pulmonary artery pulsatility index. [9].…”

Section: Discussionmentioning

confidence: 99%

“…Significant AI was associated with higher rates of rehospitalization (32.1% vs. 26.6%, respectively, at two years; p = 0.015) and mortality (77.2% vs. 71.4%, respectively, at two years; p = 0.005), conditional upon survival to one year. [12,9].…”

Section: Discussionmentioning

confidence: 99%

“…Understanding of the AI after MCS is evolving; however, continuous closure of the aortic valve is thought to be the main cause. Careful attention to outflow cannula orientation in order to prevent direct flow towards the aortic valve can minimize the stress on the valve [9].…”

Section: Discussionmentioning

confidence: 99%

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Left ventricular assist device implantation and concomitant aortic valve replacement

et al. 2019

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Introduction The implantable device for mechanical support of the left ventricular circulation (LVAD) is widely applied as a therapeutic option for survival and improvement of the quality of life in patients with the end-stage heart failure. The objective of our paper was to present the implantation of the aforementioned device together with the aortic valve replacement in the same procedure. Case outline The patient was admitted to the hospital during his terminal stage of heart failure, with ejection fraction of 18%. The ergospirometry test showed that the maximum VO 2 was 10.1 ml/kg/min. Because the medicament therapy hadn't provided adequate results, the LVAD device was implanted as a bridge until transplantation. Due to severe aortic insufficiency, the aortic valve was concomitantly replaced with bioprosthesis in order to prevent the negative effect of this valvular disease on pump work and clinical outcome. Conclusion This case report confirms that LVAD implantation with the correction of a significant aortic insufficiency is a procedure with satisfactory short-term and long-term results.

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“…AI in patients with LVAD support contributes to higher baseline central venous pressure, peek capillary wedge pressure, and lower pulmonary artery pulsatility index. [9].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Left ventricular assist device implantation and concomitant aortic valve replacement

et al. 2019

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“…11,12 Other studies have also suggested that maintaining the mean arterial pressure (MAP) below 90 mm Hg in patients on LVADs reduces the incidence of hemorrhagic strokes. 13 It is also possible that previously existing chronic hypertension can be exacerbated after LVAD implantation if the blood pressure in patients on LVADs is not actively maintained at lower levels. 14 Studies have shown that MAPs over 100 mm Hg during the 48 h prior to hospital discharge are associated with a higher incidence of subsequent ischemic and hemorrhagic strokes 16 months after LVAD implantation ( Figure 1).…”

Section: Stroke Risk In Axial and Radial Continuous-flow Vadsmentioning

confidence: 99%

“…The Supplemental Trial demonstrated that reducing the mean blood pressure resulted in a 50% reduction in hemorrhagic stroke compared to the original ENDURANCE Trial . Other studies have also suggested that maintaining the mean arterial pressure (MAP) below 90 mm Hg in patients on LVADs reduces the incidence of hemorrhagic strokes . It is also possible that previously existing chronic hypertension can be exacerbated after LVAD implantation if the blood pressure in patients on LVADs is not actively maintained at lower levels .…”

Section: Introductionmentioning

confidence: 99%

Strokes associated with left ventricular assist devices

et al. 2018

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Ventricular assist devices (VADs) have improved dramatically over the past several decades but stroke remains a problem. There are multiple etiologies of both ischemic and hemorrhagic strokes associated with VADs. While this problem is yet to be solved, there are continuing efforts at improving the design of VADs to decrease the incidence of stroke and to improve long-term survival in patients requiring mechanical circulatory assistance. The purpose is to review the incidence and underlying causes of stroke in VAD patients.

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Comparison of in‐hospital outcomes of patients with vs. without ischaemic cardiomyopathy undergoing veno‐arterial‐extracorporeal membrane oxygenation

et al. 2021

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AimsThis study aimed to investigate differences in baseline and treatment characteristics, and in-hospital mortality according to the aetiologies of cardiogenic shock in patients undergoing veno-arterial-extracorporeal membrane oxygenation (VA-ECMO). Methods and resultsThe RESCUE registry is a multicentre, observational cohort that includes 1247 patients with cardiogenic shock from 12 centres. A total of 496 patients requiring VA-ECMO were finally selected, and the study population was stratified by cardiogenic shock aetiology [ischaemic cardiomyopathy (ICM, n = 342) and non-ICM (NICM, n = 154)]. The primary outcome of interest was in-hospital mortality. Sensitivity analyses including propensity-score matching adjustments were performed. Mean age of the entire population was 61.8 ± 14.2, and 30.8% were women. There were significant differences in baseline characteristics; notable differences included the older age of patients with ICM (65.1 ± 13.7 vs. 58.2 ± 13.8, P < 0.001), preponderance of males [258 (75.4%) vs. 85 (55.2%), P < 0.001], and higher prevalence of diabetes mellitus [140 (40.9%) vs. 39 (25.3%), P = 0.001] compared with patients in the NICM aetiology group. Patients with ischaemic cardiogenic shock were more likely to have longer shock duration before VA-ECMO implantation (518.7 ± 941.4 min vs. 292.4 ± 707.8 min, P = 0.003) and were less likely to undergo distal limb perfusion than those with NICM [108 (31.6%) vs. 79 (51.3%), P < 0.001]. In-hospital mortality in the overall cohort was 52.2%; patients with ICM had a higher unadjusted risk of in-hospital mortality [203 (59.4%) vs. 56 (36.4%); unadjusted hazard ratio, 2.295; 95% confidence interval, 1.698-3.100; P < 0.001]. There were no significant differences in the primary outcome between the two aetiologies following propensity-score matching multiple adjustments (adjusted hazard ratio, 1.265; 95% confidence interval, 0.840-1.906; P = 0.260). Conclusions Results of the current study indicated among patients with cardiogenic shock undergoing VA-ECMO, ischaemic aetiology does not seem to impact in-hospital mortality. These findings underline that early initiation and appropriate treatment strategies of VA-ECMO for patients with ICM shock are required.

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Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

Cited by 87 publications

References 64 publications

Left ventricular assist device implantation and concomitant aortic valve replacement

Left ventricular assist device implantation and concomitant aortic valve replacement

Strokes associated with left ventricular assist devices

Comparison of in‐hospital outcomes of patients with vs. without ischaemic cardiomyopathy undergoing veno‐arterial‐extracorporeal membrane oxygenation

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