Are biventricular assist devices underused as a bridge to heart transplantation in patients with a high risk of postimplant right ventricular failure?

Bartfay, Sven‐Erik; Dellgren, Göran; Lidén, Hans; Holmberg, Mikael; Gäbel, Jakob; Redfors, Bengt; Bech‐Hanssen, Odd; Karason, Kristjan

doi:10.1016/j.jtcvs.2016.09.084

Cited by 18 publications

(20 citation statements)

References 26 publications

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“…Implantable BiVAD (e.g. 2 CF-LVADs) support might be considered in patients at high risk of RV failure having bridge to transplant [81, 187–191]. Off-label use of implantable axial-flow or centrifugal LVADs has been adopted as RVAD support in conjunction with implantable LVAD support as an alternative to extracorporeal BiVAD or TAH implantation [192–196].…”

Section: System Selectionmentioning

confidence: 99%

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Potapov

Antonides

Crespo-Leiro

et al. 2019

European Journal of Cardio-Thoracic Surgery

300

446

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Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many—sometimes contradictory—observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.

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Section: System Selectionmentioning

confidence: 99%

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Potapov

Antonides

Crespo-Leiro

et al. 2019

European Journal of Cardio-Thoracic Surgery

300

446

View full text Add to dashboard Cite

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“…On the other hand, many centers avoid using BVAD support as a bridge to HTx because of a more demanding implantation technique, increased HTx risk due to a previous sternotomy and major costs including overall hospital resources utilization (31). Moreover, as confirmed in our own experience, perioperative bleeding or late cardiac tamponade might be a serious complication and require a careful patient management and monitoring.…”

Section: Discussionmentioning

confidence: 81%

Short-term mechanical circulatory support as bridge to heart transplantation: paracorporeal ventricular assist device as alternative to extracorporeal life support

Sponga

Benedetti

Livi

2019

Ann. Cardiothorac. Surg.

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Extracorporeal life support (ECLS) is generally considered to be the treatment of choice for bridging to heart transplantation (HTx) patients with cardiogenic shock; however, alternative mechanical circulatory support (MCS) devices have been proposed with satisfactory results and, among those, paracorporeal systems have demonstrated to be safe and effective. This technology has been used for decades as bridge to transplant, especially in patients with advanced right ventricular dysfunction or evidence of multiorgan failure (MOF), which could be difficult to manage with an isolated left ventricular support. Paracorporeal systems are defined by having the pump located outside of the body, with inflow and outflow cannulas that traverse the skin connecting the pump with the heart and great vessels. They can be utilised in a uni-or biventricular configuration and can provide pulsatile or continuous flow, depending on the device technology (pneumatic vs. centrifugal). In particular, pneumatic devices allow for patient mobilization and hospital discharge, improving rehabilitation and organ recovery while bridging to transplant. In our institution at the University Hospital of Udine, 34 pneumatic paracorporeal ventricular assist devices (VADs) have been implanted since 1998: in most cases (32 pts), as biventricular support for patients in INTERMACS class I-II. After a median support time of 34 (range, 0-385) days, with 19 patients (56%) supported for more than 1 month, 23 patients (68%) underwent HTx and 3 (9%) were successfully weaned to hospital discharge, resulting in an overall combined 76% survival to HTx or weaning. After transplant, the survival rate was similar to the one of the patients not bridged with MCS. In conclusion, pneumatic VADs can effectively assist patients with severe biventricular failure, especially those with contraindications to ECLS or expected long waiting times for HTx. Moreover, they can potentially result in hospital discharge, optimal organ and patient recovery and donor-recipient matching, resulting in a satisfactory transplant outcome.

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“…Sahlgrenska University Hospital, Sweden, on the other hand, has shown a similar survival rate between BiVAD and LVAD groups (86% vs. 90%) (Bartfay et al, 2017).…”

Section: Backg Rou N Dmentioning

confidence: 83%

“…Patients treated with BiVAD had a significantly worse 1‐year survival rate compared with those treated with a left ventricular assist device (LVAD) (55% vs. 80%) (Kirklin et al, ). Sahlgrenska University Hospital, Sweden, on the other hand, has shown a similar survival rate between BiVAD and LVAD groups (86% vs. 90%) (Bartfay et al, ).…”

Section: Introductionmentioning

confidence: 93%

Young adult patients’ experience of living with mechanical circulatory support: A phenomenological hermeneutical study

2019

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Aim To describe young adult patients’ experiences of living with a mechanical circulatory support (MSC) as a bridge to heart transplantation and impact of self‐efficacy. Design A qualitative and explorative interview study. Methods Eight interviews with adult participants were conducted and analysed using the phenomenological hermeneutical method. Results An overall theme, “Navigating from helplessness to feeling strong in the new reality,” and three themes were identified: “Feeling homeless in a changed reality” describes the experience of suddenly falling ill and the loneliness caused by the disease; “Finding my own inner resources” shows that the interviewees found the strength to fight for their lives and began to regain control of their situation; and “Adapting to my new reality” describes the importance of finding strength from others and being able to see MCS as a friend providing respite from the disease. Self‐efficacy beliefs play a significant role in the process that the participants went through.

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Are biventricular assist devices underused as a bridge to heart transplantation in patients with a high risk of postimplant right ventricular failure?

Cited by 18 publications

References 26 publications

2019 EACTS Expert Consensus on long-term mechanical circulatory support

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Short-term mechanical circulatory support as bridge to heart transplantation: paracorporeal ventricular assist device as alternative to extracorporeal life support

Young adult patients’ experience of living with mechanical circulatory support: A phenomenological hermeneutical study

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