Ventricular Assist Devices as a Bridge to Transplant or Recovery

Kherani, Aftab R.; Maybaum, Simon; Öz, Mehmet C.

doi:10.1159/000075989

Cited by 20 publications

(7 citation statements)

References 56 publications

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“…Of note, we have previously found that modalities that improve cardiac function and reverse LV remodeling can decrease GRK2 levels in both cardiac tissue and white blood cells 6 . This was shown in severe HF patients undergoing implantation of mechanical LV assist devices (LVADs), which are an important therapeutic option for many patients needing additional hemodynamic support either as a bridge to ventricular recovery or cardiac transplantation or as destination therapy 7 . LVAD patients were followed with cardiac and blood samples taken at the time of LVAD implantation and also 2–3 months later during cardiac transplantation, and LV unloading caused a significant downregulation of cardiac GRK2 and improved βAR signaling, which was mirrored in decreased lymphocyte levels of GRK2 6 .…”

Section: Introductionmentioning

confidence: 99%

Dynamic Changes in Lymphocyte GRK2 Levels in Cardiac Transplant Patients: A Biomarker for Left Ventricular Function

Bonita

Raake

Otis

et al. 2010

Clinical Translational Sci

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BackgroundEnhancing our prognostic capabilities in terms of response to evidence-based therapies in heart failure (HF) may lead to improved patient outcomes and a more cost-eff ective approach to this complex syndrome. Biomarkers appropriately satisfy this role by providing the potential to enhance our diagnostic, therapeutic, and prognostic approach to the complex treatment of HF patients. Th ere have been many research endeavors examining various natriuretic peptides, extracellular and intracellular molecules, neurohormones, and infl ammatory mediators with the hope of providing insight into the pathophysiologic mechanism(s) of left ventricular (LV) systolic dysfunction, the volume-overload state, decompensation, and prognosis.1 Despite these discoveries, we still lack a complete understanding of the complex pathophysiology of HF and response to various therapies.Evidence-based medical therapies, including β-adrenergic receptor (βAR) antagonists (β-blockers), angiotensin-converting enzyme (ACE) inhibitors, and aldosterone receptor antagonists, are the cornerstones of pharmacologic therapy for LV systolic dysfunction and congestive HF. It is unclear as to why LV systolic function improves and sometimes even normalizes in some patients, while others show no improvement in ejection fraction or LV remodeling refl ected in ventricular dimensions.We, and others, have previously studied how these G protein-coupled receptors (GPCRs) are dysregulated in the heart.2,3 Much of this work has focused on GPCR kinases (GRKs), which are responsible for the desensitization of βARs and other receptors in the heart dampening signal transduction throughout the myocyte. G protein-coupled receptor kinase 2 (GRK2) is the most abundant GRK expressed in cardiac myocytes, and it has been known for over a decade that this kinase is elevated in failing myocardium. 4 Importantly, we have shown that human myocardial levels of GRK2 are mirrored by levels found in white blood cells.5 Moreover, levels of blood GRK2 expression were inversely correlated with LV systolic function, and higher levels of expression were seen with more advanced New York Heart Association (NYHA) functional classes of HF. 5Of note, we have previously found that modalities that improve cardiac function and reverse LV remodeling can decrease GRK2 levels in both cardiac tissue and white blood cells.6 This was shown in severe HF patients undergoing implantation of mechanical LV assist devices (LVADs), which are an important therapeutic option for many patients needing additional hemodynamic support either as a bridge to ventricular recovery or cardiac transplantation or as destination therapy. 7 LVAD patients were followed with cardiac and blood samples taken at the time of LVAD implantation and also 2-3 months later during cardiac transplantation, and LV unloading caused a signifi cant downregulation of cardiac GRK2 and improved βAR signaling, which was mirrored in decreased lymphocyte levels of GRK2.6 Th is fi nding supports our hypothesis that blood GRK2 levels may be ...

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Section: Introductionmentioning

confidence: 99%

Dynamic Changes in Lymphocyte GRK2 Levels in Cardiac Transplant Patients: A Biomarker for Left Ventricular Function

Bonita

Raake

Otis

et al. 2010

Clinical Translational Sci

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“…18 As technology continues to advance, these devices will offer a higher quality of life both in and out of the hospital setting, making them options for a broader spectrum of heart failure patients. 19 …”

mentioning

confidence: 99%

Improved Survival After Acute Myocardial Infarction Complicated by Cardiogenic Shock With Circulatory Support and Transplantation: Comparing Aggressive Intervention With Conservative Treatment

Tayara

Starling

Yamani

et al. 2006

The Journal of Heart and Lung Transplantation

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“…To assist the blood circulation in patients who suffer from serious heart disease, various types of blood pumps have been developed and used for clinical support (Schmid, et al, 2004;Thalmann, et al, 2005;Kherani, et al, 2004). In the past decade, significant progress in the research and practical use of rotary blood pumps that generate continuous flow by rotating an impeller has been made (Takatani, 2006;Chan, et al, 2015;Hijikata, et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

A bearingless motor utilizing a permanent magnet free structure for disposable centrifugal blood pumps

Rao

Hijikata

Shinshi

2015

JAMDSM

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There are a number of problems with disposable centrifugal blood pumps (DCBPs) that need to be addressed. First, there is the high cost of the disposable pump head due to the use of rare earth magnets; secondly, the large size of the reusable part due to the additional torque transmission structure; and thirdly, the complex shape of the secondary flow channel due to the space allocated to the magnetic bearing and the magnetic coupling. In this paper, we propose a bearingless motor utilizing a compact permanent magnet free structure, which can be applied to a DCBP and also satisfies the requirements of having a low cost disposable pump head and a smooth secondary flow channel. The radial motion and angular velocity of the rotor are actively controlled, and the axial and tilt motions are passively stabilized by a magnetic reluctance force. In a prototype bearingless motor, the permanent magnet free rotor could be levitated and rotated at angular velocities of up to 3400 rpm with a rotational positioning accuracy of less than ±27 μm which is sufficient for extracorporeal circulation support. The experimental results demonstrate the feasibility of using the proposed permanent magnet free bearingless motor in a DCBP.

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Ventricular Assist Devices as a Bridge to Transplant or Recovery

Cited by 20 publications

References 56 publications

Dynamic Changes in Lymphocyte GRK2 Levels in Cardiac Transplant Patients: A Biomarker for Left Ventricular Function

Dynamic Changes in Lymphocyte GRK2 Levels in Cardiac Transplant Patients: A Biomarker for Left Ventricular Function

Improved Survival After Acute Myocardial Infarction Complicated by Cardiogenic Shock With Circulatory Support and Transplantation: Comparing Aggressive Intervention With Conservative Treatment

A bearingless motor utilizing a permanent magnet free structure for disposable centrifugal blood pumps

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