The European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery: third report

By, Theo M M H de; Schoenrath, Felix; Veen, Kevin M; Mohaçsi, Paul; Stein, Julia; Alkhamees, Khalid; Anastasiadis, Kyriakos; Berhnardt, Alexander; Beyersdorf, Friedhelm; Çalışkan, Kadir; Reineke, David; Damman, Kevin; Fiane, Arnt E.; Gkouziouta, Aggeliki; Gollmann‐Tepeköylü, Can; Gustafsson, Finn; Hulman, Michal; Iacovoni, Attilio; Loforte, Antonio; Merkely, Béla; Musumeci, Francesco; Němec, Petr; Netuka, Ivan; Özbaran, Mustafa; Potapov, Evgenij; Pya, Yuriy; Juan-Áracil, Gregorio Rábago; Ramjankhan, Faiz; Reichenspurner, Hermann; Saeed, Diyar; Sandoval, Elena; Stockman, Bernard; Vanderheyden, Marc; Tops, Laurens F.; Wahlers, Thorsten; Zembala, Michael O.; Zimpfer, Daniel; Carrel, Thierry; Gummert, Jan; Meyns, Bart

doi:10.1093/ejcts/ezac032

Cited by 31 publications

(30 citation statements)

References 26 publications

(29 reference statements)

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“…A retrospective study was conducted in all patients who underwent an LVAD implantation using the EUROMACS data [2]. All patients aged > _18 years with LVAD support were included.…”

Section: Methodsmentioning

confidence: 99%

“…Given the shortage of suitable donor hearts, LVAD as destination therapy has become a viable treatment strategy in patients once all other therapeutic options have been exhausted [1]. However, long-term LVAD support has potential drawbacks, including the risk of cerebrovascular accident (CVA), bleeding and infection [1,2]. The high rate of complications hampers the long-term survival of patients supported with a continuou-flow LVAD.…”

Section: Introductionmentioning

confidence: 99%

“…Infection is the most common cause of rehospitalizations with an incidence of 4.4 per 100 patients in 3 months and 24.0 in 12 months of LVAD support and continues to increase over time [1]. Therefore, major infection is the second leading cause of death in LVAD-supported patients [2].…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular assist device-related infections and the risk of cerebrovascular accidents: a EUROMACS study

Zijderhand

Antonides

Veen

et al. 2022

European Journal of Cardio-Thoracic Surgery

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Objectives In patients supported by a durable left ventricular assist device (LVAD) infections are a frequently reported adverse event with increased morbidity and mortality. The purpose of this study was to investigate the possible association between infections and thromboembolic events, most notable cerebrovascular accidents, in LVAD patients. Methods An analysis of the multicentre European Registry for Patients Assisted with Mechanical Circulatory Support (EUROMACS) was performed. Infections were categorized as VAD-specific infections, VAD-related infections and non-VAD related infections. An extended Kaplan–Meier analysis for the risk of cerebrovascular accident with infection as a time-dependent covariate and a multivariable Cox proportional hazard model were performed. Results For this analysis 3282 patients with a LVAD were included with the majority of patients being male (83.1%). During follow-up, 1262 patients suffered from infection, and 457 patients had a cerebrovascular accident. Cox regression analysis with first infection as time-dependent covariate revealed a hazard ratio (HR) for cerebrovascular accident of 1.90 (95% CI: 1.55–2.33; P < 0.001). Multivariable analysis confirmed the association for infection and cerebrovascular accidents with a HR of 1.99 (95% CI: 1.62–2.45; P < 0.001). With infections subcategorized, VAD-specific HR was: 1.56 (95% CI: 1.18–2.08; P 0.002) and VAD-related infections HR: 1.99 (95% CI: 1.41–2.82; P < 0.001) remained associated with cerebrovascular accidents, while non-VAD related infections (P 0.102) were not. Conclusions Infection during LVAD support is associated with an increased risk of developing an ischaemic or haemorrhagic cerebrovascular accident, particularly in the setting of VAD-related or VAD-specific infections. This suggests the need of a stringent anticoagulation management and adequate antibiotic treatment during an infection in LVAD supported patients.

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“…A retrospective study was conducted in all patients who underwent an LVAD implantation using the EUROMACS data [2]. All patients aged > _18 years with LVAD support were included.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left ventricular assist device-related infections and the risk of cerebrovascular accidents: a EUROMACS study

Zijderhand

Antonides

Veen

et al. 2022

European Journal of Cardio-Thoracic Surgery

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“…In clinical trials, early RVAD support has been steady: HMII BTT trial, 6%; [27] ADVANCE trial of the HeartWare LVAD (HVAD), 2.1%; [28] MOMENTUM 3 trial of the HM3, 4.1% [9]. Registry data have shown a similar prevalence of RVAD use in patients with continuous flow LVADs: INTERMACS, 4.1%; [8] EUROMACS 2017-2020 cohort (European Registry for Patients with Mechanical Circulatory Support), 5.4%; [29] IMACS (ISHLT Mechanically Assisted Circulatory Support registry), 6.1%; [30] and MOMENTUM 3 continued access protocol (CAP) registry, 7.6% [9].…”

Section: Early Right Heart Failurementioning

confidence: 99%

Recurrent Heart Failure after Left Ventricular Assist Device Placement

Alexy¹,

Burke²

2023

Ventricular Assist Devices - Advances and Applications in Heart Failure

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A host of complications are common after left ventricular assist device (LVAD) surgery. Perhaps none is more challenging to manage than recurrent heart failure (HF). HF in an LVAD patient is associated with substantial morbidity and increased mortality. HF can occur early or late, can present abruptly or insidiously, and can be due to an array of LVAD-specific problems including pump thrombosis and cannula obstruction, or intrinsic cardiac problems such as right ventricular failure or valvular disease. These disparate etiologies require specific testing and distinct therapeutic strategies. This chapter reviews the causes of recurrent HF after LVAD surgery with particular attention to evaluation and management strategies that can identify and treat these distinct etiologies.

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“…Continuous data were expressed as mean (±standard deviation); categorical data were expressed as number (%); skewed data as median (IQR). *Other: hypertrophic cardiomyopathy (2), inflammatory myocarditis (1), and peripartum cardiomyopathy(1). †At intra-pump thrombosis.…”

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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

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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.

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The European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery: third report

Cited by 31 publications

References 26 publications

Left ventricular assist device-related infections and the risk of cerebrovascular accidents: a EUROMACS study

Left ventricular assist device-related infections and the risk of cerebrovascular accidents: a EUROMACS study

Recurrent Heart Failure after Left Ventricular Assist Device Placement

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

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