How to establish a successful destination therapy ventricular assist device program

Makdisi, George; Makdisi, Peter B.; Bittner, Hartmuth B.

doi:10.21037/jtd.2017.03.139

Cited by 13 publications

(9 citation statements)

References 13 publications

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“…By the year 2030, a projected one in 33 adults will suffer from HF [1][2][3]. The discrepancy between those in need and those transplanted has translated into the fact that the number of patients treated with LVADs today, exceeds those treated with transplantation [12]. This technology is becoming so successful that over 150 centers in the USA have established LVAD destination centers [12].…”

Section: Destination Lvad Programs In Island Statesmentioning

confidence: 99%

“…The discrepancy between those in need and those transplanted has translated into the fact that the number of patients treated with LVADs today, exceeds those treated with transplantation [12]. This technology is becoming so successful that over 150 centers in the USA have established LVAD destination centers [12]. In 2014, the cardiovascular center Health City Cayman Islands on Grand Cayman became the first island in the Caribbean to perform an LVAD placement.…”

Section: Destination Lvad Programs In Island Statesmentioning

confidence: 99%

“…Establishing an LVAD destination program requires first to determine the patient volume and need for this program. Hospital administrative support and investment is critical since an LVAD program increases hospital visibility but the financial compensation is delayed [12]. The core team should consist of the following: two cardiothoracic surgeons trained in LVAD implantation, one cardiologist experienced in HF management, perfusionists with knowledge in circulatory support, a cardiovascular anesthesiologist and intensivists with experience in HF, it is critical that those involved also be trained in extra-corporeal membrane oxygenation in case this becomes necessary.…”

Section: Establishing Destination Lvad Programsmentioning

confidence: 99%

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Destination left ventricular assist devices in island states: asking too much or the inevitable solution

et al. 2022

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Background Destination left ventricular assist device placement is increasing as a result of donor shortages and changing patient attitudes. As organ shortages become critical, LVAD programs become fundamental even in more remote regions of the world including island states. Here, we provide a look into the current state and availability of LVAD programs in island states. Main body A narrative review was performed using the World Health Organization Global Index Medicus and PubMed/MEDLINE databases to identify articles describing the island states having reported LVAD placements and programs. Additionally, INTERMACS reports were used. Data were retrieved and a review is presented describing the current state of LVADs in island states. The Caribbean region as a whole has a heart failure (HF) prevalence of 814 per 100,000 and Oceania 667 per 100,000 people. We estimate that over 3000 people in these islands need either a heart transplant or an LVAD. Short conclusion For HF patients living in island regions, special attention should be paid to the inability of having access to specialized mainland medical care. The continuous quest for a solution to HF in island regions should include the establishing of high-quality LVAD programs in a transfer-network centralized/regionalized system to care for those patients not candidates for long-distance air-bridging.

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Section: Destination Lvad Programs In Island Statesmentioning

confidence: 99%

Section: Destination Lvad Programs In Island Statesmentioning

confidence: 99%

Section: Establishing Destination Lvad Programsmentioning

confidence: 99%

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Destination left ventricular assist devices in island states: asking too much or the inevitable solution

et al. 2022

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“…9 To maintain a program, financial support, adequate staffing, long-term goals, and supportive administrative leadership are key in not only the business realm but also the humanistic domain. 10 With nearly 175 US centers and over 350 non-US centers delivering care to VAD patients, there is still insufficient data to examine the composition and how the structure of these global programs are related to each other, if at all. An international survey study from 2011 explored staffing patterns for HF and transplant clinics.…”

Section: Introductionmentioning

confidence: 99%

An International Study on Ventricular Assist Device Program Models

et al. 2020

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Background: Advanced technology and improved outcomes have led to rapid growth of ventricular assist devices (VADs) throughout the world, but little exists regarding their structure. We sought to study trends in VAD programs on a global level. Methods: We distributed a 26-question online survey to 321 individuals who work within those programs. Four categories of questions were formed: patient management, coordinator role, multidisciplinary support, and leadership. Results: Fifty-eight surveys (47 United States, 11 international) were analyzed. The majority of programs cared for 26 to 100 device-assisted patients (62%), 26% cared for ≤25 patients, and 12% cared for ≥100 patients. Advanced practice providers (APPs) were used in 69% of programs as a device coordinator. In-hospital rounding was performed equally among the APPs and registered nurses. Most programs used a social worker (90%), nutritionist (74%), pharmacist (72%), palliative care (66%), and finance coordinator (64%). Less than half (43%) included a case manager and only 33% used a pharmacist. The program leader was identified as a cardiologist (31%) or surgeon (26%) or both equally (43%). Conclusion: This study demonstrates differences and similarities between VAD program structures. Additional research is warranted to evaluate the effect of program structure on outcomes, job satisfaction, and retention regions.

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“…Improving patient satisfaction with quality of life remains critically important, particularly for patients requiring long-term LVAD support. Close cooperation of telemedicine and remote monitoring could be beneficial to improve patients' quality with life and reduce psychosocial distress (35)(36)(37). With the continuous development of LVAD and the advancement of operative approaches, complications can be further reduced, so as to reduce the mortality of LVAD as a DT.…”

mentioning

confidence: 99%

Continuous-flow left ventricular assist device versus orthotopic heart transplantation in adults with heart failure: a systematic review and meta-analysis

Zhang

Guo

Ning

et al. 2021

Ann Cardiothorac Surg

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Background: Due to the lack of donor hearts, many studies have assessed the prognosis of heart failure (HF) patients treated with a continuous-flow left ventricular assist device (CF-LVAD). However, previous results have not been consistent and minimal data is available regarding long-term outcomes. There is no consensus on whether CF-LVAD as a bridge or destination therapy (DT) can equal orthotopic heart transplantation (HTx). The purpose of our study is to compare clinical outcomes between CF-LVAD and HTx in adults.Methods: We searched controlled trials from PubMed, Cochrane Library, and Embase databases until July 1, 2020. The mortality at different time points and adverse events were analyzed among 12 included studies.Results: No significant differences were found in mortality at one-year [odds ratio (OR) =1.08; 95% CI: 0.97-1.21], two-year (OR =1.01; 95% CI: 0.91-1.12), three-year (OR =1.02; 95% CI: 0.69-1.51), and five-year (OR =1.02; 95% CI: 0.93-1.11), as well as the comparison of stroke, bleeding, and infection between CF-LVAD as a bridge versus HTx. The pooled analysis of one-year mortality (OR =2.76; 95% CI: 0.38-20.18) and two-year mortality (OR =1.64; 95% CI: 0.22-12.23) revealed no significant difference between CF-LVAD DT and HTx. Comparisons of adverse events showed no differences in bleeding or infection, but a higher risk of stroke (OR =5.09; 95% CI: 1.74-14.84) for patients treated with CF-LVAD DT than with HTx.Conclusions: CF-LVAD as a bridge results in similar outcomes as HTx within five years. CF-LVAD as a DT is associated with similar one-year and two-year mortality, but carries a higher risk of stroke, as compared with HTx.

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How to establish a successful destination therapy ventricular assist device program

Abstract: How to establish a successful destination therapy ventricular assist device program. J Thorac Dis 2017;9(4):932-935.

Cited by 13 publications

References 13 publications

Destination left ventricular assist devices in island states: asking too much or the inevitable solution

Destination left ventricular assist devices in island states: asking too much or the inevitable solution

An International Study on Ventricular Assist Device Program Models

Continuous-flow left ventricular assist device versus orthotopic heart transplantation in adults with heart failure: a systematic review and meta-analysis

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