Surgical correction of aortic valve insufficiency after left ventricular assist device implantation

Atkins, B. Zane; Hashmi, Zubair A.; Ganapathi, Asvin M.; Harrison, J. Kevin; Hughes, G. Chad; Rogers, Joseph G.; Milano, Carmelo A.

doi:10.1016/j.jtcvs.2013.05.019

Cited by 67 publications

(35 citation statements)

References 26 publications

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“…A stationary analysis was carried out, keeping the same model settings for all grids: blood parameters, laminar model and boundary conditions. The error in thoracic aorta flow, expressed as e ¼ Q exact À Q computational *100= Q exact (7) where Q exact = Q vad À Q epiaortic and Q computational is the flow rate calculated by means of the simulation, and the computational time were evaluated. In case of coarse mesh e = 7% and time = 3 min-20 s, in case of normal mesh e = 0.6% and time = 7 min-5 s and in case of fine mesh e = 0.23% and time = 15 min-34 s. The normal mesh was chosen because the error was less than 1%, and the computational time is not high.…”

Section: Boundary Conditionsmentioning

confidence: 99%

A computational fluid dynamics comparison between different outflow graft anastomosis locations of Left Ventricular Assist Device (LVAD) in a patient‐specific aortic model

Caruso

Gramigna

Rossi

et al. 2015

Numer Methods Biomed Eng

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Left ventricular assist devices (LVADs) are mechanical supports used in case of heart failure. Little is known as the height of the anastomosis in aorta might influence the hemodynamic. The aim of the study was to evaluate the fluid dynamic behavior due to the outflow graft placement of a continuous flow LVAD in ascending aorta and to identify the insertion site with the best hemodynamic profile. Computational fluid dynamic studies were carried out to analyze 4 different anastomosis locations in a patient-specific aorta 3D model coupled with a lumped parameters model: 1 cm (case 1), 2 cm (case 2), 3 cm (case 3) and 4 cm (case 4) above the ST junction. In cases 1 and 2, epiaortic vessels presented a steady flow, while in cases 3 and 4 the flow was whirling. Moreover, maximum velocity occurred before: brachiocephalic trunk (case 1), brachiocephalic and left carotid arteries (case 2), left carotid and left subclavian artery (case 3) and left subclavian vessel and upper wall of aortic arch (case 4). Maximum time averaged wall shear stress (TAWSS) was located in: the ascending aorta (cases 1 and 2), the inferior curvature of the arch (case 3); at the origin of epiaortic vessels (case 4). Furthermore, a flow recirculation (cases 1 and 2), a blood stagnation and chaotic flow (cases 3 and 4) occurred above the aortic valve. The results suggested that the placement of the outflow graft at 2 cm above the ST junction gave the most favorable hemodynamic profile.

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Section: Boundary Conditionsmentioning

confidence: 99%

A computational fluid dynamics comparison between different outflow graft anastomosis locations of Left Ventricular Assist Device (LVAD) in a patient‐specific aortic model

Caruso

Gramigna

Rossi

et al. 2015

Numer Methods Biomed Eng

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“…3). Although aortic valve replacement also corrects AI, low intermittent transvalvular flow may cause thrombus on both mechanical and biological valves [26], and the bioprosthesis could also develop significant AI 4 years after LVAD implantation [27]. Transcatheter aortic valve implantation is also applied for patients who develop pure de-novo AI after implantation of continuous flow LVAD [28].…”

Section: Aortic Valvementioning

confidence: 99%

Clinical management for complications related to implantable LVAD use

Toda

Sawa

2014

Gen Thorac Cardiovasc Surg

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More than 250 continuous flow LVADs have been implanted in Japan during the last 3 years, with 1-year survival rates of 90%. These excellent results cannot be achieved without VAD teams who know the detail of surgical techniques and perioperative management. Preoperative optimization of RV function is essential and intraoperative managements are focused on adequate balance between right and left ventricle to prevent right ventricular (RV) failure. For postoperative RV failure early institution of temporary RV mechanical support improves outcomes. Immediate CT scanning is crucial if LVAD patients complain of new neurological symptoms. When CT reveals cerebral hemorrhage, INR should be reduced as soon as possible. The driveline (DL) exit site remains a significant source of LVAD-related infections, and orientation and immobilization of the DL is important. Although vacuum assisted closure is useful to facilitate drainage and healing in pump pocket as well as DL infections, urgent heart transplantation, bridging to recovery, or pump exchange may become the only options to eradicate LVAD-related infections. Patients with continuous flow LVAD are more prone to developing de novo aortic insufficiency. Although majority of them can be managed medically, some require surgical intervention. The cause of pump thrombosis is multifactorial, including lowered INR and pump speed, and implantation techniques. It is important to exchange pumps in a timely manner either through a median sternotomy or subcostal incision in highly suspected patients indicated by elevated LDH and left-sided heart failure.

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“…In addition, uncorrected aortic insufficiency (AI) at the time of LVAD implantation may progress and affect the effectiveness of the pump by limiting forward flow [2].…”

Section: Introductionmentioning

confidence: 99%

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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Surgical correction of aortic valve insufficiency after left ventricular assist device implantation

Cited by 67 publications

References 26 publications

A computational fluid dynamics comparison between different outflow graft anastomosis locations of Left Ventricular Assist Device (LVAD) in a patient‐specific aortic model

A computational fluid dynamics comparison between different outflow graft anastomosis locations of Left Ventricular Assist Device (LVAD) in a patient‐specific aortic model

Clinical management for complications related to implantable LVAD use

Left ventricular assist device implantation and concomitant aortic valve replacement

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