Second annual report from the ISHLT Mechanically Assisted Circulatory Support Registry

Kirklin, James K.; Xie, Rongbing; Cowger, Jennifer; By, Theo M M H de; Nakatani, Takeshi; Schueler, Stephan; Taylor, Rhiannon; Lannon, J; Mohaçsi, Paul; Gummert, Jan; Goldstein, Daniel J.; Çalışkan, Kadir; Hannan, Margaret M.

doi:10.1016/j.healun.2018.01.1294

Cited by 122 publications

(122 citation statements)

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“…LVAD therapy is life-saving but remains an intensive complex treatment with high rehospitalization rates and outpatient clinic contacts. 4 Recently, novel LVAD designs have improved post-operative outcomes with a marked reduction in pump thrombosis and cerebrovascular accidents, 5 but bleeding, driveline infections, and long-term right ventricle (RV) failure continue to impair the long-term efficacy of this intervention. [6][7][8] Patients with long-term LVAD therapy remain particularly vulnerable for RV failure, with up to 20-40% of the patients developing early RV failure 5,9,10 and 15% late RV failure.…”

Section: Introductionmentioning

confidence: 99%

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

et al. 2019

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AimsWe aim to study the feasibility and clinical value of pulmonary artery pressure monitoring with the CardioMEMS™ device in order to optimize and guide treatment in patients with a HeartMate 3 left ventricular assist device (LVAD).Methods and resultsIn this single‐centre, prospective pilot study, we will include 10 consecutive patients with New York Heart Association Class IIIb or IV with Interagency Registry for Mechanically Assisted Circulatory Support Classes 2–5 scheduled for implantation of a HeartMate 3 LVAD. Prior to LVAD implantation, patients will receive a CardioMEMS sensor, for daily pulmonary pressure readings. The haemodynamic information provided by the CardioMEMS will be used to improve haemodynamic status prior to LVAD surgery and optimize the timing of LVAD implantation. Post‐LVAD implantation, the haemodynamic changes will be assessed for additive value in detecting potential complications in an earlier stage (bleeding and tamponade). During the outpatient clinic phase, we will assess whether the haemodynamic feedback can optimize pump settings, detect potential complications, and further tailor the clinical management of these patients.ConclusionsThe HEMO‐VAD study is the first prospective pilot study to explore the safety and feasibility of using CardioMEMS for optimization of LVAD therapy with additional (remote) haemodynamic information.

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Section: Introductionmentioning

confidence: 99%

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

et al. 2019

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“…Left ventricular assist devices (LVAD) are increasingly being used as a bridge to heart transplantation, now employed in half of those undergoing transplant . Despite significant advances in durable mechanical support survival, infectious complications remain the most common adverse event after LVAD implantation and the leading cause of early death after heart transplantation . A recent analysis from the International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support (INTERMACS) global registry found that 37% of patients supported by LVAD experienced 1 or more infections during the time supported by a device .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of patients with infection related to a ventricular assist device after heart transplantation

Moayedi

Multani

Bunce

et al. 2019

Clinical Transplantation

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Background: Despite significant advances in durable mechanical support survival, infectious complications remain the most common adverse event after ventricular assist device (VAD) implantation and the leading cause of early death after transplantation. In this study, we aim to describe our local infectious epidemiology and review short-term survival and infectious incidence rates in the post-transplantation period and assess risk factors for infectious episodes after transplantation. Methods: Retrospective single-center study of all consecutive adult heart transplant patients from 2008 to 2017. Survival data were estimated and summarized using the Kaplan-Meier method. We quantified and evaluated the difference in the incidence rate between patients with and without infection using a Fine-Gray model. The outcome of interest is the time to first infection diagnosis with post-transplant death as the competing event.Results: Among 278 heart transplant patients, 74 (26.5%) underwent LVAD implantation. Twenty-one patients (28.3%) developed an infection while supported by an LVAD.When compared to patients supported by an LVAD without a preceding infection, BMI was significantly greater (31.2 vs 27.8 kg/m 2 , P = .03). Median follow-up post-transplantation was 3.01 years. Significant risk factors for the competing risk regression for infection after heart transplantation include LVAD infection (HR 1.94, [95% CI] 1.11-3.39, P = .020) and recipient COPD (HR 2.14, [95% CI] 1.39-3.32, P = .001) when adjusted for recipient age, gender, hypertension, diabetes mellitus, and body mass index. Conclusions:Patients with LVAD-related infection had a significantly increased risk of infectious complications after heart transplantation. Further research on the avoidance of induction agents and reduced maintenance immunosuppression in this patient population is warranted. K E Y W O R D Santibiotic prophylaxis, antibiotic:antibacterial, heart (allograft) function/dysfunction, infectious complications

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“…The development and miniaturization of continuous flow devices has resulted in less invasive and shorter surgical procedures, as well as a reduction in the rate of complications and mortality . Currently, implanted left monoventricular devices are all continuous flow devices, the patients included are older, the origin of their end‐stage heart failure is predominantly ischemic, and patients may even have intermediate gravity heart failure, of INTERMACS classes 4 to 6 . Our study is therefore integrated within the evolution of implantation strategies and patients, and provides an update of the risk factors for mortality.…”

Section: Discussionmentioning

confidence: 98%

Independent risk factors for ICU mortality after left ventricular assist device implantation

Piffard

Coniat²,

Simon

et al. 2019

Artificial Organs

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Funding informationOnly departmental funds were used for this study. AbstractLeft ventricular assist devices (LVADs) are used as an alternative therapy for heart transplantation in patients with advanced heart failure. However, the mortality rate of these patients remains relatively high. A large proportion of deaths after LVAD implantation occur during intensive care unit (ICU) stay. We conducted a retrospective study to identify the risk factors for all-cause ICU mortality in patients with an implanted LVAD. Between January 1, 2008 and December 31, 2016, 70 consecutive patients who had received an LVAD were analyzed. The median ICU length of stay was 14 days (IQR: 8-31) and 16 patients (22.9% [95%CI: 13.1-32.7]) died in the ICU. The 90-day mortality rate was 25.7% (95%CI: 15.5-35.9). The main causes of ICU mortality were: multiple organ failure, stroke, and hemorrhagic events. The univariate analysis identified the following perioperative risk factors for all-cause ICU mortality: hypertension, preoperative platelet count, preoperative white cell count, inotropic support before LVAD implantation, mechanical ventilation before LVAD implantation, renal replacement therapy before LVAD implantation, shortterm mechanical support before LVAD implantation, INTERMACS class 1 to 2, low intraoperative platelet count, low early postoperative hemoglobin level, low early postoperative platelet count, low early postoperative pH, and massive perioperative blood transfusion. In the multivariate logistic regression analysis, only mechanical ventilation before LVAD implantation was retained as an independent risk factor for ICU mortality (OR = 11.96 [95%CI: 2.67-53.45], P < .01). These findings confirm that most deaths after LVAD implantation occur in the ICU. Patients that receive mechanical ventilation preoperatively have the highest risk of death. This confirms the need to actively treat respiratory failure and to wean patients from respiratory support before LVAD implantation. Such a strategy offers the best opportunity to initiate active rehabilitation. K E Y W O R D S Intensive care unit, left ventricular assist device, mortality, outcome, predictive factors, respiratory assistance 154 | PIFFARD et Al How to cite this article: Piffard M, Nubret-Le Coniat K, Simon O, et al. Independent risk factors for ICU mortality after left ventricular assist device implantation.

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Second annual report from the ISHLT Mechanically Assisted Circulatory Support Registry

Cited by 122 publications

References 5 publications

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

Outcomes of patients with infection related to a ventricular assist device after heart transplantation

Independent risk factors for ICU mortality after left ventricular assist device implantation

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