European results with a continuous-flow ventricular assist device for advanced heart-failure patients☆

Lahpor, Jaap R.; Khaghani, Asghar; Hetzer, Roland; Pavie, Alain; Friedrich, Ivar; Sander, Kaare; Strüber, Martin

doi:10.1016/j.ejcts.2009.05.043

Cited by 86 publications

(84 citation statements)

References 6 publications

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“…MCS in adults is used as a bridge to transplantation, bridge to candidacy, or as destination therapy (Class IIa recommendation). 1 These devices lead to improved functional status and quality of life in this patient population 22,23 and have shown improved outcomes compared with optimal medical therapy. 24 However, MCS is not without complications.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Birnbaum

Simpson

Boschert

et al. 2015

Circ: Heart Failure

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Background-Intravenous inotropic therapy can be used to support children awaiting heart transplantation. Although use of this therapy is discouraged in adults because of poor outcomes, its use in children, particularly outpatient, has had limited evaluation. We aimed to evaluate the safety and efficacy of this practice. Methods and Results-A retrospective analysis of an intent to treat protocol was completed on United Network for Organ Sharing status 1A patients discharged on inotropic therapy from 1999 until 2012. Intravenous inotropic therapy was initiated for cardiac symptoms not amenable to oral therapy. Patients who were not status 1A or required >1 inotrope were excluded. Efficacy was analyzed by time to first event: transplantation; readmission until transplantation; improvement leading to inotrope withdrawal; or death. Safety included analysis of infection rates, line malfunctions, temporary hospitalization, neurological events, and arrhythmias. One hundred six patients met inclusion criteria. The mean age was 10.1±6.4 years, 47% of patients had congenital heart disease, and 80% of these patients had single ventricle physiology.In patients without congenital heart disease, 53% had dilated cardiomyopathy, 91% of patients received milrinone, 85% of patients underwent transplantation, 8% of patients successfully weaned from support as outpatients, whereas 6% died. Fifty percent of patients were readmitted before transplantation or weaning from support, of which 64% required only 1 readmission. The majority of readmissions were for heart failure. Conclusions-Outpatient intravenous inotropic therapy can be safely used as a bridge to transplantation in pediatric patients.A minority of patients can discontinue inotropic therapy because of clinical improvement. (Circ Heart Fail. 2015;8:64-70.

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Section: Discussionmentioning

confidence: 99%

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Birnbaum

Simpson

Boschert

et al. 2015

Circ: Heart Failure

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“…However, the clinical introduction of second-and third-generation nonpulsatile devices suggests that these devices can be used as a long-term approach. 2 Despite this, bleeding complications and thromboembolic events still remain the most serious adverse events of this therapy. Early experience with continuous flow device-related thrombosis and thromboembolic events led to a maximum tolerable regimen of antiplatelet and anticoagulation therapies.…”

mentioning

confidence: 99%

Acquired von Willebrand Syndrome in Patients With an Axial Flow Left Ventricular Assist Device

Meyer

Malehsa²,

Bara³

et al. 2010

Circ: Heart Failure

262

149

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Background-Rotary blood pumps used as left ventricular assist devices (LVADs) allow for long-term support and may become suitable alternatives to heart transplantation. Effects of this technology on the coagulation system are not completely understood, leading to controversial anticoagulation protocols. Thus, we investigated the primary hemostasis in patients with chronic LVAD therapy. Methods and Results-Twenty-six outpatients received axial flow LVAD (HeartMate II; Thoratec) for a median support time of 4.5 months. In a cross-sectional protocol, platelet aggregation in response to ADP and epinephrine, von Willebrand antigen (vWF:AG), and collagen-binding capacity (vWF:CB) were obtained. Von Willebrand factor (vWF) multimer analyses were performed, and patients were screened for bleeding events. This analysis was repeated after removal of the device for transplantation or recovery (nϭ12) and after a median of 15.5 months in ongoing patients (nϭ11). In all patients on devices, severe impairment of platelet aggregation as well as a loss of large vWF multimers were found. In 10 patients, a decreased vWF:CB/vWF:AG ratio was observed. Bleeding episodes occurred with an incidence of 0.17 per patient-year. After removal of the device, normal patterns of platelet aggregation, multimer analysis, and vWF:CB/vWF:AG ratio were recorded. In the second analysis of ongoing patients, impairment of platelet aggregation and loss of large vWF multimers were verified. Conclusions-A diagnosis of von Willebrand syndrome type 2 was established in all patients after LVAD implantation, and bleeding events confirmed this finding. Reversibility of this condition was found after removal of the device. (Circ Heart Fail. 2010;3:675-681.)

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“…8 In our study group, LVAD was used in In a European study, outcomes after continuous flow LVAD implant showed a 1-year survival rate of 72%. 9 In the study of Teuteberg and associates, 8 the 2-year survival rate of patients supported for bridge to transplant was 78%, with rates of 70% for those with bridge to candidacy and 61% for those having the device for destination therapy. In our patient series, 8 patients (33.3%) died.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Gültekin

Ersoy²,

Özkan³

et al. 2015

Exp Clin Transplant

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Results: Patients had end-stage heart failure as a result of the following causes: 11 patients (45%) had ischemic cardiomyopathy, 12 patients (50%) had dilated cardiomyopathy, and 1 patient (4.1%) had acute myocarditis. Regarding use of the left ventricular assist device, 10 patients (41.6%) had the device as destination therapy, and the remaining 14 patients (48.6%) had it as bridge to transplant. The Interagency Registry for Mechanically Assisted Circulatory Support Profile was 1 for 3 patients (12.5%), 2 for 9 patients (37.5%), and 3 for 12 patients (50%). Mean follow-up was 239.8 days, and the mortality rate was 33.3% (8 patients died). During follow-up, we found that 3 patients (12.5%) had received a heart transplant and 1 patient (4.1%) eventually recovered, with the device extracted. Six patients had driveline infections, and 3 patients had cerebrovascular events. Conclusions: With the insufficient number of cardiac donors, use of a left ventricular assist device for patients with end-stage cardiac failure who are awaiting transplant may be the best option.

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European results with a continuous-flow ventricular assist device for advanced heart-failure patients☆

Abstract: These results support the use of the HM II continuous-flow LVAD for long-term support as a bridge to transplantation and possibly for destination therapy. Future emphasis should focus on minimising adverse events such as infections, bleeding and neurological events.

Cited by 86 publications

References 6 publications

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Acquired von Willebrand Syndrome in Patients With an Axial Flow Left Ventricular Assist Device

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