Vascular Function in Continuous Flow LVADs: Implications for Clinical Practice

Khalil, Fouad; Asleh, Rabea; Perue, Radha Kanneganti; Weinstein, Jean‐Marc; Solomon, Adam; Betesh-Abay, Batya; Briasoulis, Αlexandros; Alnsasra, Hilmi

doi:10.3390/biomedicines11030757

Cited by 4 publications

(2 citation statements)

References 166 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, this change in blood flow dynamics, characterised by laminar flow with reduced or absent pulsatility in CF-L-VADs, is considered a major contributing factor to endothelial dysfunction, leading to potential occurrences of bleeding or thromboembolic events. 5 Of note, in June 2021, Medtronic halted the worldwide distribution and sale of the Heartware HVAD device due to an elevated risk of neurological adverse events and mortality. 6 To prevent thrombotic events and minimise bleeding incidence, careful antithrombotic management is necessary.…”

Section: Open Accessmentioning

confidence: 99%

Antithrombotic therapy for durable left ventricular assist devices: protocol for a living systematic review with indirect comparison/network meta-analysis

Derzi,

Dewidar,

Sabri

et al. 2024

BMJ Open

View full text Add to dashboard Cite

BackgroundLeft ventricular assist devices (LVADs) have emerged as a successful treatment option for patients with end-stage heart failure. Compared with the best medical therapy, LVADs improve survival and enhance functional capacity and quality of life. However, two major complications compromise this patient population’s outcomes: thrombosis and bleeding. Despite technological innovations and better hemocompatibility, these devices alter the rheology, triggering the coagulation cascade and, therefore, require antithrombotic therapy. Anticoagulation and antiplatelet therapies represent the current standard of care. Still, inconsistency in the literature exists, especially whether antiplatelet therapy is required, whether direct oral anticoagulants can replace vitamin K antagonists and even whether phosphodiesterase type 5 inhibitors with their antithrombotic effects could be added to the regimen of anticoagulation.Methods and analysisWe will perform a living systematic review with network meta-analysis and indirect comparison between current antithrombotic therapies, which have and have not been directly compared within clinical trials and observational studies. We will systematically search the following electronic sources: Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE). We will exclusively examine studies published in English from 2016 to the present. Studies conducted before 2016 will be omitted since our primary focus is evaluating continuous flow devices. Two independent reviewers will assess the articles by title, abstract and full text; any disagreement will be resolved through discussion, and a third reviewer will be involved if necessary. The Cochrane Risk of Bias tool will be used to assess the risk of bias. We will then conduct a pairwise meta-analysis; if the assumption of transitivity is satisfied, we will proceed with network meta-analysis using Bayesian methodology.Ethics and disseminationFormal ethical approval is not required as no primary data are collected. This systematic review and network meta-analysis will delineate the risks of stroke, thromboembolic events, pump thrombosis, gastrointestinal bleeding and mortality in patients equipped with LVADs who are subjected to various antithrombotic regimens. The findings will be disseminated via a peer-reviewed publication and presented at conference meetings. This will enhance clinical practice and guide future research on anticoagulation strategies within this distinct patient cohort.PROSPERO registration numberCRD42023465288.

show abstract

Section: Open Accessmentioning

confidence: 99%

Antithrombotic therapy for durable left ventricular assist devices: protocol for a living systematic review with indirect comparison/network meta-analysis

Derzi,

Dewidar,

Sabri

et al. 2024

BMJ Open

View full text Add to dashboard Cite

show abstract

“…In the pre-allocation era, predictors of in-hospital mortality for LVAD implantation included age, hemodialysis, cerebrovascular disease, mechanical ventilation, liver disease, acute kidney injury (AKI), disseminated intravascular coagulation, sepsis, septic shock, and gastrointestinal bleeding [ 7 ]. However, HeartMate 3 (HM3; Abbott Cardiovascular, Chicago, IL, USA) has reduced complications, such as thrombosis and stroke events [ 8 ], and is the majority in the post-allocation era (47.3% versus 8.3%) [ 9 ]. This device improvement plausibly has changed predictors of in-hospital mortality and expanded the age demographic of patients receiving LVAD implantation.…”

Section: Introductionmentioning

confidence: 99%

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Akkawi,

Yamaguchi,

Shimamura

et al. 2024

JPM

Self Cite

View full text Add to dashboard Cite

The 2018 heart allocation system has significantly influenced heart transplantation and left ventricular assist device (LVAD) utilization. Our study aims to investigate age-related outcomes following LVAD implantation in the post-allocation era. Using the National Inpatient Sample, we analyzed data from 7375 patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by age categories. The age groups were 18–49, 50–59, 60–69, and over 70. These represented 26%, 26%, 31%, and 17% of patients, respectively. Patients aged 60–69 and those over 70 exhibited higher in-hospital mortality rates of 12% and 17%, respectively, compared to younger age groups (7% for 18–49 and 6% for 50–59). The age groups 60–69 and over 70 were independent predictors of mortality, with adjusted odds ratios of 1.99 (p = 0.02; 95% confidence interval [CI], 1.12–3.57) and 2.88 (p = 0.002; 95% CI, 1.45–5.71), respectively. Additionally, a higher Charlson Comorbidity Index was associated with increased in-hospital mortality risk (adjusted odds ratio 1.39; p = 0.02; 95% CI, 1.05–1.84). Additionally, patients above 70 experienced a statistically shorter length of stay. Nonhome discharge was found to be significantly high across all age categories. However, the difference in hospitalization cost was not statistically significant across the age groups. Our study highlights that patients aged 60 and above face an increased risk of in-hospital mortality following LVAD implantation in the post-allocation era. This study sheds light on age-related outcomes and emphasizes the importance of considering age in LVAD patient selection and management strategies.

show abstract

Development and validation of a mathematical model for evaluating shear-induced damage of von Willebrand factor

Wang

et al. 2023

Computers in Biology and Medicine

View full text Add to dashboard Cite

Vascular Function in Continuous Flow LVADs: Implications for Clinical Practice

Cited by 4 publications

References 166 publications

Antithrombotic therapy for durable left ventricular assist devices: protocol for a living systematic review with indirect comparison/network meta-analysis

Antithrombotic therapy for durable left ventricular assist devices: protocol for a living systematic review with indirect comparison/network meta-analysis

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Development and validation of a mathematical model for evaluating shear-induced damage of von Willebrand factor

Contact Info

Product

Resources

About