Terminal heart failure

Kirklin, James K.

doi:10.1097/mot.0000000000000120

Cited by 11 publications

(8 citation statements)

References 34 publications

(17 reference statements)

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“…Several developments can accelerate the growing acceptance of implantable MCS devices for DT, including device miniaturization, development of less invasive surgical techniques and reduction of adverse event burden [123]. At present, the percutaneous driveline cable considerably limits patients’ quality of life and poses risk for infection.…”

Section: Future Outlookmentioning

confidence: 99%

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Left ventricular assist devices: a kidney’s perspective

2015

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The left ventricular assist device (LVAD) has become an established treatment option for patients with refractory heart failure. Many of these patients experience chronic kidney disease (CKD) due to chronic cardiorenal syndrome type II, which is often alleviated quickly following LVAD implantation. Nevertheless, reversibility of CKD remains difficult to predict. Interestingly, initial recovery of GFR appears to be transient, being followed by gradual but significant late decline. Nevertheless, GFR often remains elevated compared to preimplant status. Larger GFR increases are followed by a proportionally larger late decline. Several explanations for this gradual decline in renal function after LVAD therapy have been proposed, yet a definitive answer remains elusive. Mortality predictors of LVAD implantation are the occurrence of either postimplantation acute kidney injury (AKI) or preimplant CKD. However, patient outcomes continue to improve as LVAD therapy becomes more widespread, and adverse events including AKI appear to decline. In light of a growing destination therapy population, it is important to understand the cumulative effects of long-term LVAD support on kidney function. Additional research and passage of time are required to further unravel the intricate relationships between the LVAD and the kidney.

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Section: Future Outlookmentioning

confidence: 99%

“…Successful implementation of transcutaneous energy transfer systems will mark a decisive turning point for the use of LVAD technology in mainstream therapy of advanced HF [126]. However, documented reduction in adverse event burden is urgently required before a paradigm shift of MCS as true alternative to HTx can occur [123]. …”

Section: Future Outlookmentioning

confidence: 99%

Left ventricular assist devices: a kidney’s perspective

2015

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“…25–27 However, there are several adverse events associated with long-term VAD support. The incidence of coagulation dysfunction (device thrombosis, thromboembolism, hemorrhage [eg, gastro-intestinal] secondary to supratherapeutic anticoagulation), neurologic events, and infectious complications related to the power lines that traverse the skin all remain significant.…”

Section: Heart Xenotransplantationmentioning

confidence: 99%

Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation

et al. 2017

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Several groups have reported extended survival of genetically-engineered pig organs in nonhuman primates, varying from almost 10 months for life-supporting kidney grafts and >2 years for nonlife-supporting heart grafts to less than 1 month for life-supporting liver and lung grafts. We have attempted to define groups of patients who may not have an option to wait for an allograft. These include kidney, heart, and lung candidates who are highly-allosensitized. In addition, some kidney candidates (who have previously lost at least 2 allografts from rapid recurrence of native kidney disease) have a high risk of further recurrence and will not be offered a repeat allotransplant. Patients with complex congenital heart disease, who may have undergone previous palliative surgical procedures, may be unsuitable for ventricular assist device implantation. Patients dying of fulminant hepatic failure, for whom no alternative therapy is available, may be candidates for a pig liver, even if only as a bridge until an allograft becomes available. When the results of pig organ xenotransplantation in nonhuman primates suggest a realistic potential for success of a pilot clinical trial, highly-selected patients should be offered participation.

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“…2 As an alternative, the use of left ventricular assist devices (LVADs) as destination therapy was emerging due to reasonable improvement in survival, functional status, and quality of life in patients with PAD. [3][4][5][6] But due to the high rate of concomitance between risk factors for heart failure and atherosclerosis, about 7.8% of LVAD candidates often have concurrent PAD. 7 Though some recent literature has shown higher odds of in-hospital mortality and morbidity in patients with PAD requiring mechanical circulatory support devices, a largescale study on the safety of LVAD implantation in patients with PAD is lacking.…”

Section: Introductionmentioning

confidence: 99%

The impact of peripheral arterial disease on left ventricular assist device implantation: A propensity‐matched analysis of the nationwide inpatient sample database

et al. 2021

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Left ventricular assist device (LVAD) candidacy screening includes evaluation for peripheral arterial disease (PAD). However, given current evidence, the impact of PAD on post-LVAD complications remains unknown. The National Inpatient Sample (NIS) database (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) was utilized to identify all LVAD cases. The in-hospital safety endpoints included major cardiovascular adverse events and its components. A propensity-matched analysis was used to obtain adjusted odds ratios (aOR). A subgroup analysis of patients with diabetes mellitus (DM) with PAD was also performed. A total of 27 424 patients with LVAD implantation (PAD: 516 [1.8%] and no-PAD 26 908 [98.2%]) were included. There were significant intergroup differences in the demographics and baseline comorbidities. A weighted sample of 1053 (no-PAD 537, PAD 516) propensity-matched population was selected.The adjusted odds for in-hospital mortality (aOR 1.7; 95% CI, 1.2-2.44, P = .004) were found to be significantly higher for LVAD-patients with PAD. There was no significant difference in the adjusted odds of MACE (aOR 1.16, 95% CI 0.87-1.5), postprocedure bleeding (aOR 0.88, 95% CI 0.62-1.26, P = .54) and risk of pneumonia (aOR 0.67, 95% CI 0.44-1.15, P = .63) between the two groups. A selected cohort of DM-only population (7339) consistently showed a higher adjusted mortality rate in PAD patients with LVAD implantation (aOR 2.3, 95% CI 1.2-4.47, P = .01). The rate of MACE (P = .17), myocardial infarction (P = .12), stroke (P = .60), postprocedural (0.10), and major bleeding (P = .51) remained identical between patients with PAD and those with no-PAD. PAD confers an increased risk of in-hospital all-cause mortality in patients undergoing LVAD implantation. This risk increases further in patients with a concomitant diagnosis of DM.

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Terminal heart failure

Cited by 11 publications

References 34 publications

Left ventricular assist devices: a kidney’s perspective

Left ventricular assist devices: a kidney’s perspective

Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation

The impact of peripheral arterial disease on left ventricular assist device implantation: A propensity‐matched analysis of the nationwide inpatient sample database

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