A structured 3-step approach to evaluate cardiac recovery with continuous flow circulatory support

Formica, Philip; Murthy, Sandhya; Edwards, P.; Goldstein, Daniel J.; Maybaum, Simon

doi:10.1016/j.healun.2010.07.008

Cited by 33 publications

(40 citation statements)

References 6 publications

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“…) echocardiography, have been published by Dandel et al 5,19 To evaluate cardiac recovery under continuous axial flow pumps, a "3-step" approach (regular echocardiography, cardiopulmonary exercise testing, and right heart catheterization) has been established. 20 Nevertheless, it should be noted that these criteria have not yet been established for congenital heart diseases.…”

Section: Figurementioning

confidence: 99%

“…In contrast, in the adult population, more differentiated approaches regarding successfully weaning, with repeated by guest on May 9, 2018 http://pediatrics.aappublications.org/ Downloaded from echocardiography, have been published by Dandel et al 5,19 To evaluate cardiac recovery under continuous axial flow pumps, a "3-step" approach (regular echocardiography, cardiopulmonary exercise testing, and right heart catheterization) has been established. 20 Nevertheless, it should be noted that these criteria have not yet been established for congenital heart diseases.Once in outpatient treatment, frequent and regular ambulant visits, including physical examination, electrocardiography, and echocardiography, are necessary to assess pump settings and predictors for recovery. Thus far, no standardized protocols for the evaluation of myocardial recovery in children on LVADs have been published.…”

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confidence: 99%

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VAD as Bridge to Recovery in Anthracycline-Induced Cardiomyopathy and HHV6 Myocarditis

et al. 2014

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This report describes an 8-year-old child with acute anthracyclineinduced cardiomyopathy triggered by human herpesvirus 6 and the subsequent implantation of an intracorporeal continuous-flow left ventricular assist device (LVAD) and the process to discharge the child from the hospital. After barely 3 months on mechanical support, the device was explanted after thorough examination. Experiences regarding LVAD removal are limited, and no guidelines for echocardiographic and hemodynamic criteria for LVAD removal in children have been published thus far. We present our institutional algorithm for device selection, surveillance in an ambulatory setting, and testing for myocardial recovery, as well as our criteria for LVAD explantation in children. Pediatrics 2014;134:e894-e899 Drs Cavigelli-Brunner and Schweiger conceptualized and designed the study, drafted the initial manuscript, and were involved in the direct care of the patient described; Dr Knirsch drafted the initial manuscript and supervised and critically reviewed the manuscript; Dr Stiasny reviewed and revised the manuscript and was involved in the direct care of the patient described; Dr Klingel critically reviewed and revised the manuscript; Drs Kretschmar and Hübler supervised and critically reviewed the manuscript; and all authors approved the final manuscript as submitted. Experiences with intracorporeal left ventricular assist devices (LVADs) in children suffering from anthracyclineinduced cardiomyopathy (CMP) with subsequent myocardial recovery and LVAD explantation are rare. 1-3 Protocols for device selection, home discharge, outpatient monitoring, and adequate evaluation for myocardial recovery and decision algorithms for device explantation are missing or have to be generated for this specific patient group.We describe the use of an intracorporeal continuous-flow LVAD in a child with acute heart failure due to anthracycline-induced CMP triggered by human herpesvirus 6 (HHV6), her subsequent discharge home, and successful device explantation after 149 days on support. CASE REPORTAn 8-year-old girl (body weight: 25 kg; body surface area [BSA]: 0.97 m 2 ) was admitted to our hospital due to severe, rapid-onset heart failure. Seven months before, she had been diagnosed with a bone sarcoma of the left tibia and was treated by surgical resection and chemotherapy according to the EURAMOS-1 Trial (The European and American Osteosarcoma Study Group), including methotrexate, cisplatin and doxorubicin(cumulative doses: 450 mg/m 2 ). Ten days after the last chemotherapy course, her general condition worsened, and echocardiography showed a dilated left ventricle, a biventricular reduced contractility with an ejection fraction (EF) of 25%, and a shortening fraction of 15%. Despite maximal inotropic support and mechanical ventilation, the patient' s condition deteriorated, and an LVAD implantation with the use of an LVAD HeartWare Ventricular Assist System (HeartWare Inc, Framingham, MA) was successfully performed (Fig 1).Apart from prolonged medical sup...

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Section: Figurementioning

confidence: 99%

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confidence: 99%

VAD as Bridge to Recovery in Anthracycline-Induced Cardiomyopathy and HHV6 Myocarditis

et al. 2014

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“…Similar to the weaning protocol described by the Berlin group, 43 the approach described allows determination of the myocardial reserve and comparison of different measurements over time. 48 Some small steps to simplify the explantation of the LVAD were developed in 2010. Cheung et al reported a minimally invasive off-pump approach, 49 and our group reported the use of a specially designed and individually manufactured titanium plug to seal the apical cuff and avoid loss of viable myocardium.…”

Section: Weaningmentioning

confidence: 99%

Advances in mechanical circulatory support: Year in review

Potapov

Krabatsch

Ventura

et al. 2011

The Journal of Heart and Lung Transplantation

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“…Restoration of myocardial function was assessed 4 weeks after patients reached maximally tolerated doses of HF medicines [27]. If echocardiography at rest and with diminished support (“turn-down”) demonstrated an EF>40% (step 1), then they proceed to cardiopulmonary stress test (step 2) and right heart catheterization (step 3).…”

Section: Weaning Protocolsmentioning

confidence: 99%

Bridge to Removal: A Paradigm Shift for Left Ventricular Assist Device Therapy

Selzman

Madden

Healy

et al. 2015

The Annals of Thoracic Surgery

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Ventricular assist devices have become standard therapy for patients with advanced heart failure either as a bridge to transplantation or destination therapy. Despite the functional and biologic evidence of reverse cardiac remodeling, few patients actually proceed to myocardial recovery, and even fewer to the point of having their device explanted. An enhanced understanding of the biology and care of the mechanically supported patient has redirected focus on the possibility of using ventricular assist devices as a bridge to myocardial recovery and removal. Herein, we review the current issues and approaches to transforming myocardial recovery to a practical reality.

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A structured 3-step approach to evaluate cardiac recovery with continuous flow circulatory support

Cited by 33 publications

References 6 publications

VAD as Bridge to Recovery in Anthracycline-Induced Cardiomyopathy and HHV6 Myocarditis

VAD as Bridge to Recovery in Anthracycline-Induced Cardiomyopathy and HHV6 Myocarditis

Advances in mechanical circulatory support: Year in review

Bridge to Removal: A Paradigm Shift for Left Ventricular Assist Device Therapy

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