Experience with over 1000 Implanted Ventricular Assist Devices

Potapov, Evgenij; Loforte, Antonio; Weng, Yuguo; Jurmann, M.; Pašić, Miralem; Drews, Thorsten; Loebe, Matthias; Hennig, Ewald M.; Krabatsch, Thomas; Koster, Andreas; Lehmkuhl, H.; Hetzer, Roland

doi:10.1111/j.1540-8191.2008.00606.x

Cited by 100 publications

(112 citation statements)

References 62 publications

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“…Implantation of LVAD as a bridge to recovery or transplantation is a widely accepted treatment modality [8,11]. Despite the clinical benefit of LVAD usage, RV failure after LVAD implantation continues to be a serious complication with a poor prognosis [12].…”

Section: Discussionmentioning

confidence: 99%

Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation

Haneya

Philipp

Puehler

et al. 2011

European Journal of Cardio-Thoracic Surgery

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OBJECTIVE: Acute right ventricular (RV) failure is a life-threatening condition with a poor prognosis, and sometimes the use of mechanical circulatory support is inevitable. In this article, we describe our experience using a centrifugal pump as a temporary percutaneous right ventricular assist device (RVAD) in patients with postoperative acute refractory RV failure after left ventricular assist device (LVAD) implantation. METHODS:We retrospectively reviewed eight consecutive patients with acute RV failure who underwent temporary percutaneous RVAD implantation using a centrifugal pump after LVAD implantation between April 2008 and February 2011. A Dacron graft was attached to the main pulmonary artery and passed through a subxiphoid exit, where the outflow cannula was inserted. The inflow cannula was percutaneously cannulated using Seldinger's technique in the femoral vein. The chest was definitely closed. The technique allowed bedside removal, avoiding chest re-opening. RESULTS:The median patient age was 52 years (range: 41-58). The median duration of support was 14 days (range: 12-14). RV systolic function improved; central venous pressure and mean pulmonary artery pressure decreased significantly after RVAD support. In three patients, an oxygenator was integrated into the RVAD due to impaired pulmonary function. Six patients were successfully weaned. Five patients survived to hospital discharge. Technical problems or serious complications concerning decannulation were not observed. CONCLUSION:This report suggests that implantation of temporary percutaneous RVAD using a centrifugal pump is a safe alternative in the treatment of postoperative acute refractory RV failure. Ease of device implantation, weaning, explantation, and limited number of complications justify a liberal use.

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Section: Discussionmentioning

confidence: 99%

Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation

Haneya

Philipp

Puehler

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…Thus, the majority of patients with end stage heart failure treated with mechanical circulatory support receive left ventricular assistance with a LVAD to increase end organ perfusion. However, the incidence of right heart dysfunction after LVAD insertion may vary between 10 and 50%, 12,25,30,53,55 and is considered the most serious complication within the LVAD postoperative period. 62 The management of acute right ventricular (RV) failure post LVAD is difficult, and although pharmaceutical treatment strategies including pulmonary vasodilators, inotropic agents, and phosphodiesterase agents may temporarily improve RV function, these strategies are generally short-term, expensive, and require prolonged intensive care management.…”

Section: Requirement For Biventricular Supportmentioning

confidence: 99%

Biventricular Assist Devices: A Technical Review

et al. 2011

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The optimal treatment option for end stage heart failure is transplantation; however, the shortage of donor organs necessitates alternative treatment strategies such as mechanical circulatory assistance. Ventricular assist devices (VADs) are employed to support these cases while awaiting cardiac recovery or transplantation, or in some cases as destination therapy. While left ventricular assist device (LVAD) therapy alone is effective in many instances, up to 50% of LVAD recipients demonstrate clinically significant postoperative right ventricular failure and potentially need a biventricular assist device (BiVAD). In these cases, the BiVAD can effectively support both sides of the failing heart. This article presents a technical review of BiVADs, both clinically applied and under development. The BiVADs which have been used clinically are predominantly first generation, pulsatile, and paracorporeal systems that are bulky and prone to device failure, thrombus formation, and infection. While they have saved many lives, they generally necessitate a large external pneumatic driver which inhibits normal movement and quality of life for many patients. In an attempt to alleviate these issues, several smaller, implantable second and third generation devices that use either immersed mechanical blood bearings or hydrodynamic/magnetic levitation systems to support a rotating impeller are under development or in the early stages of clinical use. Although these rotary devices may offer a longer term, completely implantable option for patients with biventricular failure, their control strategies need to be refined to compete with the inherent volume balancing ability of the first generation devices. The BiVAD systems potentially offer an improved quality of life to patients with total heart failure, and thus a viable alternative to heart transplantation is anticipated with continued development.

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“…Клиническая практика показала, что в среднем от 20 до 40% пациентов, перенесших имплантацию ЛЖО, проявляют признаки ПЖН [42,43], что мо-жет значительно влиять на успешность применения данного метода и требует как более глубокого отбо-ра пациентов, так и применения методов бивентри-кулярного обхода желудочков сердца (БВО).…”

Section: «мост» для двухэтапной трансплантации сердцаunclassified

Durable Mechanical Circulation Support as an Alternative to Heart Transplantation

Gautier

Itkin

Шевченко

et al. 2016

RJTAO

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1 ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 Московский физико-технический институт (государственный университет), кафедра физики живых систем, Москва, Российская Федерация 3 ГБОУ ВПО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России, кафедра кардиологии, Москва, Российская Федерация 4 ГБОУ ВПО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России, кафедра трансплантологии и искусственных органов, Москва, Российская Федерация В обзоре проведен сравнительный анализ лечения терминальной хронической сердечной недостаточнос-ти с помощью трансплантации сердца и длительной механической поддержки кровообращения. Показа-ны основные преимущества и ограничения трансплантации сердца и перспективы применения техноло-гии длительной механической поддержки кровообращения. Рассмотрены основные направления данной технологии, включая двухэтапную трансплантацию сердца (bridge to transplant -BTT), восстановления миокарда на фоне работы вспомогательного насоса (bridge to recovery -BTR) и имплантация вспомога-тельного насоса на постоянной основе (destination therapy -DT). In the review a comparative analysis of the treatment of end-stage chronic heart failure using heart transplantation and durable mechanical circulatory is conducted. It shows the main advantages and limitations of heart transplantation and the prospects of application of durable mechanical circulatory support technology. The main

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Experience with over 1000 Implanted Ventricular Assist Devices

Cited by 100 publications

References 62 publications

Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation

Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation

Biventricular Assist Devices: A Technical Review

Durable Mechanical Circulation Support as an Alternative to Heart Transplantation

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