Safety of Contemporary Heart Failure Therapy in Patients with Continuous-Flow Left Ventricular Assist Devices

Schnettler, Jessica; Roehrich, Luise; Just, Isabell Anna; Pergantis, Panagiotis; Stein, Julia; Mueller, Marcus; Mulzer, Johanna; Knierim, Jan; Falk, Volkmar; Potapov, F. Evgenij; Schoenrath, Felix

doi:10.1016/j.cardfail.2021.06.007

Cited by 7 publications

(9 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One-year survival was 97% in the ARNI group compared with 88% in the non-ARNI (P ¼ 0.06). There was no difference in rehospitalization rates for right ventricular failure, ventricular tachycardia or ICD discharges between the ARNI and non-ARNI groups [34] [36]. In our experience, ARNI use is a well tolerated and effective therapy for BP control especially among CF-LVAD patients in whom optimal BP is not achieved despite the use of two to three antihypertensive.…”

Section: Andandmentioning

confidence: 82%

“…More contemporary studies have evaluated the use of ARNI in the setting of CF-LVAD [34,35 & ,36]. Schnettler et al [34] performed an observational study with propensity matching utilizing ARNI as first-line therapy. Patients were predominantly men with mean age 55 years, mostly INTERMACS 2 and 3 at the time of implant with both HVAD and HM3 pumps studied as destination therapy or bridge to recovery.…”

Section: Andandmentioning

confidence: 99%

“…More contemporary studies have evaluated the use of ARNI in the setting of CF-LVAD [34,35 ▪ ,36]. Schnettler et al .…”

Section: Pharmacological Therapy For Blood Pressure Control In Left V...mentioning

confidence: 99%

See 2 more Smart Citations

Management of hypertension in patients supported with continuous flow left ventricular assist devices

Krishnarao

Krim

2023

Current Opinion in Cardiology

View full text Add to dashboard Cite

Purpose of reviewHypertension remains one of the most common clinical problems leading to devastating postleft ventricular assist device (LVAD) implant complications. This study reviews the pathophysiology of hypertension in the setting of continuous flow LVAD support and provides an update on currently available antihypertensive therapies for LVAD patients.Recent findingsThe true prevalence of hypertension in the LVAD population remains unknown. Effective blood pressure (BP) control and standardization of BP measurement are key to prevent suboptimal left ventricular unloading, pump malfunction and worsening aortic regurgitation. Angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta blockers and mineralocorticoid receptor antagonists (MRA) are the preferred antihypertensive agents because of their additional potential benefits, including optimization of haemodynamics, prevention of stroke, gastrointestinal bleed and in some patients myocardial recovery. Angiotensin receptor-neprilysin inhibition (ARNI) may be a well tolerated and effective therapy for BP control especially among CF-LVAD patients with resistant hypertension. Similarly, sodium glucose co-transporter 2 inhibitors (SGLT2i) should be considered in the absence of contraindications.SummaryHypertension is very common post-LVAD implant. Heart failure guideline directed medical therapies, including ACEI, ARB, beta blockers and MRA, are the preferred antihypertensive agents to improve post-LVAD outcomes.

show abstract

Section: Andandmentioning

confidence: 82%

Section: Andandmentioning

confidence: 99%

See 1 more Smart Citation

Management of hypertension in patients supported with continuous flow left ventricular assist devices

Krishnarao

Krim

2023

Current Opinion in Cardiology

View full text Add to dashboard Cite

show abstract

“…Another limitation is that only 14.3% of our cohort were female, which is, however, in line with the reported implantation prevalence. 1,27,28 In conclusion, an acute outflow graft occlusion after lysis therapy for intra-pump thrombosis is a severe complication in patients on HVAD support. Despite a lack of the pathophysiological understanding, we are able to identify patients at risk and consequently initiate an effective treatment rapidly.…”

Section: Discussionmentioning

confidence: 95%

“…Another limitation is that only 14.3% of our cohort were female, which is, however, in line with the reported implantation prevalence. 1,27,28…”

Section: Discussionmentioning

confidence: 99%

Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

et al. 2023

Self Cite

View full text Add to dashboard Cite

Christoph hoermandinger,* nadine riedler,* Julia stein,* philipp stawowy, † ‡ evgeniJ potapov,* † Felix sChoenrath,* † § and isabell a. Just* † Lysis therapy is an established treatment option for intrapump thrombosis of left ventricular assist devices (LVADs). In clinical routine, we observed repeated cases of acute outflow graft occlusions (OGO) associated with lysis therapy with need for urgent intervention. The aim of this investigation was to gain understanding of this observation. We screened data of 962 HeartWare ventricular assist device (HVAD) patients. One hundred twenty (13.8%) had intra-pump thromboses; 58 were treated with recombinant tissue-type plasminogen activator (rtPA). Mean age was 53.0 ± 11.1 years; 84.9% were male. In 13 (24.5%) patients, OGO occurred following rtPA-lysis. These patients showed an increase in left ventricular function (18.45% ± 12.62% to 27.73% ± 10.57%; p = 0.056), more frequent 1:1 aortic valve opening (OGO+: +36.4%; OGO−: +7.4%; p = 0.026), a decrease in LVAD pulsatility within 12 months prior intrapump thrombosis (OGO+: -0.8 L/min [interquartile range {IQR}, -1.4 to -0.4 L/min]; OGO−: -0.3 L/min [IQR, -0.9 to 0.1 L/min]; p = 0.038) and lower HVAD flows at admission (OGO+: 6.7 L/min [IQR, 6.1-7.4 L/min]; OGO−: 8.3 L/ min [IQR, 6.9-9.3 L/min]; p = 0.013), indicating a subclinical OGO prior intra-pump thrombosis. There were no differences in implantation techniques, blood parameters, and lysis strategy. Subclinical OGO represented a major risk factor for acute OGO following rtPA lysis therapy. We here propose an algorithm for risk stratification and dealing with patients presenting this first-described complication. Further research is required to confirm our results and decipher the underlying pathomechanism.

show abstract

Artificial intelligence‐based analysis of body composition predicts outcome in patients receiving long‐term mechanical circulatory support

Just,

Schoenrath,

Roehrich

et al. 2023

J cachexia sarcopenia muscle

Self Cite

View full text Add to dashboard Cite

BackgroundObesity is a known cardiovascular risk factor and associated with higher postoperative complication rates in patients undergoing cardiac surgery. In heart failure (HF), conflicting evidence in terms of survival has been reported, whereas sarcopenia is associated with poor prognosis. An increasing number of HF patients require left ventricular assist device (LVAD) implantations. The postoperative mortality has improved in recent years but is still relatively high. The impact of body composition on outcome in this population remains unclear. The aim of this investigation was to examine the preoperative computed tomography (CT) body composition as a predictor of the postoperative outcome in advanced HF patients, who receive LVAD implantations.MethodsPreoperative CT scans of 137 patients who received LVADs between 2015 and 2020 were retrospectively analysed using an artificial intelligence (AI)‐powered automated software tool based on a convolutional neural network, U‐net, developed for image segmentation (Visage Version 7.1, Visage Imaging GmbH, Berlin, Germany). Assessment of body composition included visceral and subcutaneous adipose tissue areas (VAT and SAT), psoas and total abdominal muscle areas and sarcopenia (defined by lumbar skeletal muscle indexes). The body composition parameters were correlated with postoperative major complication rates, survival and postoperative 6‐min walk distance (6MWD) and quality of life (QoL).ResultsThe mean age of patients was 58.21 ± 11.9 years; 122 (89.1%) were male. Most patients had severe HF requiring inotropes (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile I–III, 71.9%) secondary to coronary artery diseases or dilated cardiomyopathy (96.4%). Forty‐four (32.1%) patients were obese (body mass index ≥ 30 kg/m2), 96 (70.1%) were sarcopene and 19 (13.9%) were sarcopene obese. Adipose tissue was associated with a significantly higher risk of postoperative infections (VAT 172.23 cm2 [54.96, 288.32 cm2] vs. 124.04 cm2 [56.57, 186.25 cm2], P = 0.022) and in‐hospital mortality (VAT 168.11 cm2 [134.19, 285.27 cm2] vs. 135.42 cm2 [49.44, 227.91 cm2], P = 0.033; SAT 227.28 cm2 [139.38, 304.35 cm2] vs. 173.81 cm2 [97.65, 254.16 cm2], P = 0.009). Obese patients showed no improvement of 6MWD and QoL within 6 months postoperatively (obese: +0.94 ± 161.44 months, P = 0.982; non‐obese: +166.90 ± 139.00 months, P < 0.000; obese: +0.088 ± 0.421, P = 0.376; non‐obese: +0.199 ± 0.324, P = 0.002, respectively). Sarcopenia did not influence the postoperative outcome and survival within 1 year after LVAD implantation.ConclusionsPreoperative AI‐based CT body composition identifies patients with poor outcome after LVAD implantation. Greater adipose tissue areas are associated with an increased risk for postoperative infections, in‐hospital mortality and impaired 6MWD and QoL within 6 months postoperatively.

show abstract

Safety of Contemporary Heart Failure Therapy in Patients with Continuous-Flow Left Ventricular Assist Devices

Cited by 7 publications

References 29 publications

Management of hypertension in patients supported with continuous flow left ventricular assist devices

Management of hypertension in patients supported with continuous flow left ventricular assist devices

Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

Artificial intelligence‐based analysis of body composition predicts outcome in patients receiving long‐term mechanical circulatory support

Contact Info

Product

Resources

About