The first-in-human experience with a minimally invasive, ambulatory, counterpulsation heart assist system for advanced congestive heart failure

Jeevanandam, Valluvan; Song, Tae Ho; Onsager, D.; Ota, Takeyoshi; LaBuhn, C.; Lammy, T.; Sayer, Gabriel; Kim, Gene; Patel-Raman, Sonna; Uriel, Nir

doi:10.1016/j.healun.2017.10.011

Cited by 33 publications

(22 citation statements)

References 13 publications

(16 reference statements)

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“…According to the data from the ISHLT registry, approximately 50% of heart transplant recipients are treated with pretransplant MCS (7 studies showed comparable early and long-term outcomes in recipients with pre-transplant temporal MCS (16,17).…”

Section: Discussionmentioning

confidence: 99%

Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation

Попцов¹,

Спирина²,

Догонашева³

et al. 2019

J. Thorac. Dis

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Background: Mechanical circulatory support (MCS) is the only way to save a life for heart transplant candidates and to decrease of waiting list mortality. The choice between short-or long-term pretransplant MCS depends on of type and severity of CHF. One of the most frequently used methods of temporary MSC before orthotopic heart transplantation (OHTx) is veno-arterial extracorporeal membrane oxygenation (VA ECMO). The aim of this study was to analyze own experience of peripheral VA ECMO (pVA ECMO) in heart transplant candidates needed in urgent HT. Methods: This study included 182 pts [160 (87.9%) men and 22 (12.1%) female, age 43±1.2 yrs] supported with pVA ECMO in the period from 01. 01. 2013 to 31. 12. 2017 or 23.2% from all waiting list (n=786). Results: During VA ECMO, 16 (8.8%) of the 182 pts died. In most pts [n=13 (81.3%)] multiorgan failure/sepsis were the cause of death. One hundred and sixty-six (91.2%) pts were successfully bridged to OHTx or 27.9% from all heart transplant recipients (n=594) (2013-2017 yrs). The duration of pVA ECMO before OHTx (n=166) was 5.8±3.2 days. One hundred and forty-three (86.1%) from 166 pts were discharged to home. Post-transplant survival among heart transplant recipient with pre-transplant MCS by pVA ECMO was in comparison with recipients without pretransplant MCS [84.2% vs. 90.1% (6 months), 83.3% vs. 91.8% (1 years), 75.1% vs. 86.1% (2 years), 74.2% vs. 85.8% (3 years), 72.3% vs. 84.7% (4 years), 72.3% vs. 83.5% (5 years) respectively (P<0.0001)]. Conclusions: pVA ECMO is a useful tool of treatment of patients with INTERMACS profile 1/2. Results of OHTx at recipients bridged with VA ECMO are less successful that recipients without pre-transplant MCS. VA ECMO should be considered as a direct bridge to OHTx in conditions of limited financial resources of health care and high availability of donor's hearts.

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Section: Discussionmentioning

confidence: 99%

Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation

Попцов¹,

Спирина²,

Догонашева³

et al. 2019

J. Thorac. Dis

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“…46 The SID is an electromechanical and pneumatic conduit with a chimney that allows for shuttling of air between the pump and external driver and communication of the captured electrocardiogram (ECG) signals that are transmitted to the driver from three subcutaneous electrodes. 47 In the first in-human trial, 13 out of 14 patients were ambulatory within 24 h and successfully transplanted after. One patient needed escalation of support and received Impella 5.0 then CentriMag blood pump for extracorporeal membrane oxygenation (ECMO) before transplanted.…”

Section: Counter-pulsation Devicesmentioning

confidence: 99%

“…There was no pump thrombosis, stroke, and gastrointestinal bleeding in this single center study. 47 The Kantrowitz CardioVAD (research device, not in clinical use). Another attempt for long-term pulsatile balloon pump is the Kantrowitz CardioVAD (KCV), which utilizes extra-aortic placement and provides partial support for HF patient not qualified for transplant.…”

Section: Counter-pulsation Devicesmentioning

confidence: 99%

A review of implantable pulsatile blood pumps: Engineering perspectives

Khir

Kütting

et al. 2020

Int J Artif Organs

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It has been reported that long-term use of continuous-flow mechanical circulatory support devices (CF-MCSDs) may induce complications associated with diminished pulsatility. Pulsatile-flow mechanical circulatory support devices (PF-MCSDs) have the potential of overcoming these shortcomings with the advance of technology. In order to promote in-depth understanding of PF-MCSD technology and thus encourage future mechanical circulatory support device innovations, engineering perspectives of PF-MCSD systems, including mechanical designs, drive mechanisms, working principles, and implantation strategies, are reviewed in this article. Some emerging designs of PF-MCSDs are introduced, and possible elements for next-generation PF-MCSDs are identified.

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“…91 Recently a minimally invasive, transaxillary arterial IABP (Nupulse®, NuPulseCV, Raleigh, NC, USA) has been developed as a durable ambulatory option for bridging counterpulsation therapy. 92 After heart transplantation, exercise capacity improves dramatically compared with endstage heart failure, but this capacity continues to be subnormal compared to age-matched healthy individuals, and peak oxygen uptake ranges from 50-70% of the general healthy population. 93 Some of the factors which may explain this finding include chronotropic incompetence related to autonomic denervation of the transplanted heart, diastolic dysfunction, reduced stroke volume, reduced muscle strength, and reduced oxidative capacity or reduced capillary density.…”

Section: Frailty Modification Through Nutrition and Rehabilitationmentioning

confidence: 99%

Frailty in the End-Stage Lung Disease or Heart Failure Patient: Implications for the Perioperative Transplant Clinician

Bottiger

Nicoara

Snyder

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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The syndrome of frailty for patients undergoing heart or lung transplantation has been a recent focus for perioperative clinicians because of its association with postoperative complications and poor outcomes. Patients with end-stage cardiac or pulmonary failure may be under consideration for heart or lung transplantation along with bridging therapies such as ventricular assist device implantation or venovenous extracorporeal membrane oxygenation, respectively. Early identification of frail patients in an attempt to modify the risk of postoperative morbidity and mortality has become an important area of study over the last decade. Many quantification tools and risk prediction models for frailty have been developed but have not been evaluated extensively or standardized in the cardiothoracic transplant candidate population. Heightened awareness of frailty, coupled with a better understanding of distinct cellular mechanisms and biomarkers apart from end-stage organ disease, may play an important role in potentially reversing frailty related to organ failure. Furthermore, the clinical management of these critically ill patients may be enhanced by waitlist and postoperative physical rehabilitation and nutritional optimization.

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The first-in-human experience with a minimally invasive, ambulatory, counterpulsation heart assist system for advanced congestive heart failure

Cited by 33 publications

References 13 publications

Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation

Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation

A review of implantable pulsatile blood pumps: Engineering perspectives

Frailty in the End-Stage Lung Disease or Heart Failure Patient: Implications for the Perioperative Transplant Clinician

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