Safety and feasibility of hemodynamic pulmonary artery pressure monitoring using the CardioMEMS device in LVAD management

Veenis, Jesse F.; Radhoe, Sumant P; Mieghem, Nicolas Van; Manintveld, Olivier C.; Bekkers, Jos A.; Çalışkan, Kadir; Bogers, Ad J.J.C.; Zijlstra, Felix; Brugts, Jasper J.

doi:10.1111/jocs.15767

Cited by 16 publications

(7 citation statements)

References 27 publications

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“…The indication approach used for CardioMEMS in this study is different from other studies mentioned earlier. In conclusion, this pilot study demonstrated the safety and feasibility of the approach in LVAD patients [ 65 , 66 , 67 ].…”

Section: Sensor-based Hf Monitoringmentioning

confidence: 89%

An Era of Digital Healthcare—A Comprehensive Review of Sensor Technologies and Telehealth Advancements in Chronic Heart Failure Management

Manavi,

Zafar,

Sharif

2024

Sensors

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Heart failure (HF) is a multi-faceted, complex clinical syndrome characterized by significant morbidity, high mortality rate, reduced quality of life, and rapidly increasing healthcare costs. A larger proportion of these costs comprise both ambulatory and emergency department visits, as well as hospital admissions. Despite the methods used by telehealth (TH) to improve self-care and quality of life, patient outcomes remain poor. HF management is associated with numerous challenges, such as conflicting evidence from clinical trials, heterogeneity of TH devices, variability in patient inclusion and exclusion criteria, and discrepancies between healthcare systems. A growing body of evidence suggests there is an unmet need for increased individualization of in-hospital management, continuous remote monitoring of patients pre and post-hospital admission, and continuation of treatment post-discharge in order to reduce re-hospitalizations and improve long-term outcomes. This review summarizes the current state-of-the-art for HF and associated novel technologies and advancements in the most frequently used types of TH (implantable sensors), categorizing devices in their preclinical and clinical stage, bench-to-bedside implementation challenges, and future perspectives on remote HF management to improve long-term outcomes of HF patients. The Review also highlights recent advancements in non-invasive remote monitoring technologies demonstrated by a few pilot observational prospective cohort studies.

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Section: Sensor-based Hf Monitoringmentioning

confidence: 89%

An Era of Digital Healthcare—A Comprehensive Review of Sensor Technologies and Telehealth Advancements in Chronic Heart Failure Management

Manavi,

Zafar,

Sharif

2024

Sensors

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“…This model could potentially be utilized to identify a cohort of patients at higher risk for readmission and direct additional interventions, both preoperatively and post-LVAD. Transitional care interventions [20], inpatient rehabilitation [21], monitored performance improvement [22], and remote hemodynamic monitoring [23,24] are potential targets in patients at increased readmission risk that have been previously studied.…”

Section: Discussionmentioning

confidence: 99%

Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices

Kyriakopoulos,

Selzman,

Giannouchos

et al. 2024

JCM

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Background: Centrifugal-flow left ventricular assist devices (CF-LVADs) have improved morbidity and mortality for their recipients. Hospital readmissions remain common, negatively impacting quality of life and survival. We sought to identify risk factors associated with hospital readmissions among patients with CF-LVADs. Methods: Consecutive patients receiving a CF-LVAD between February 2011 and March 2021 were retrospectively evaluated using prospectively maintained institutional databases. Hospital readmissions within three years post-LVAD implantation were dichotomized into heart failure (HF)/LVAD-related or non-HF/LVAD-related readmissions. Multivariable Cox regression models augmented using a machine learning algorithm, the least absolute shrinkage and selection operator (LASSO) method, for variable selection were used to estimate associations between HF/LVAD-related readmissions and pre-, intra- and post-operative clinical variables. Results: A total of 204 CF-LVAD recipients were included, of which 138 (67.7%) had at least one HF/LVAD-related readmission. HF/LVAD-related readmissions accounted for 74.4% (436/586) of total readmissions. The main reasons for HF/LVAD-related readmissions were major bleeding, major infection, HF exacerbation, and neurological dysfunction. Using pre-LVAD variables, HF/LVAD-related readmissions were associated with substance use, previous cardiac surgery, HF duration, pre-LVAD inotrope dependence, percutaneous LVAD/VA-ECMO support, LVAD type, and the left ventricular ejection fraction in multivariable analysis (Harrell’s concordance c-statistic; 0.629). After adding intra- and post-operative variables in the multivariable model, LVAD implant hospitalization length of stay was an additional predictor of readmission. Conclusions: Using machine learning-based techniques, we generated models identifying pre-, intra-, and post-operative variables associated with a higher likelihood of rehospitalizations among patients on CF-LVAD support. These models could provide guidance in identifying patients with increased readmission risk for whom clinical strategies to mitigate this risk may further improve LVAD recipient outcomes.

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“…A recent pilot study compared 10 consecutive patients who received CardioMEMS implant before HeartMate 3 (Abbott) LVAD with 20 historical controls. 19 The primary outcome of a 1-year composite of all-cause mortality, acute kidney injury or need for renal replacement therapy, or RV failure occurred in 50% of the CardioMEMS group compared with 60% of the historical control group patients. In the CardioMEMS group, the primary outcome occurred in 83% of patients with elevated PAP compared with no patients with normal PAP.…”

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confidence: 99%

Implantable hemodynamic monitoring and management of left ventricular assist devices: Optimal or optional?

Lampert

Teuteberg

2021

JTCVS Open

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Continuous flow left ventricular assist devices (LVADs) improve quality of life and survival in patients with advanced heart failure. [1][2][3] Despite these advances, LVADs are still limited by numerous complications, including frequent rehospitalizations, right ventricular (RV) failure, gastrointestinal bleeding, and hemocompatibility-related adverse events. 4 Although continuous-flow LVADs are responsive to preload and afterload, their set speed, and thus their ability to properly unload the LV, is determined by clinicians. Further, loading conditions are influenced by medical therapies such as diuretics and vasodilators whose use and dosages are also under the discretion of the treating physician. Although there are general recommendations about pump management and medical therapy while on mechanical support, practices, therapeutic targets, and frequency of assessments may vary considerably be-From the

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Safety and feasibility of hemodynamic pulmonary artery pressure monitoring using the CardioMEMS device in LVAD management

Cited by 16 publications

References 27 publications

An Era of Digital Healthcare—A Comprehensive Review of Sensor Technologies and Telehealth Advancements in Chronic Heart Failure Management

An Era of Digital Healthcare—A Comprehensive Review of Sensor Technologies and Telehealth Advancements in Chronic Heart Failure Management

Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices

Implantable hemodynamic monitoring and management of left ventricular assist devices: Optimal or optional?

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