HVAD to HeartMate 3 left ventricular assist device exchange: Best practices recommendations

Atluri, Pavan; Cowger, Jennifer; Davis, Erin; Feller, Erika; Goldstein, Daniel J.; Hall, Shelley; Hayward, Christopher; Kaczorowski, David J.; Kilic, Arman; Lorts, Angela; Mokadam, Nahush A.; Molina, Ezequiel; Pagani, Francis D.; Pham, Duc T.; Potapov, Evgenij; Saeed, Diyar; Salerno, Christopher T.; Schmitto, Jan D.; Silvestry, Scott C.; Slaughter, Mark S.; Soltesz, Edward G.; Tsui, Steven; Zimpfer, Daniel

doi:10.1016/j.jtcvs.2021.11.085

Cited by 14 publications

(9 citation statements)

References 33 publications

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“…The size and shape of apical and outflow sensors were chosen based on the diameter of a typical LVAD apical cuff and sealed outflow graft. 17,19 The iterative optimization procedure described in 20 was used to optimize the sensors in terms of turns, outer diameter, wire thickness, wire spacing, and pitch at an operating frequency of 13.56 MHz in ANSYS Electronics Desktop 2021 R2. We used copper wire for winding and polyamide as the top layer to make it biocompatible.…”

Section: Methodsmentioning

confidence: 99%

Resonantly Coupled High-Efficiency Sensors for Assessment of Ventricular Chamber Size for Autonomous Control of Left Ventricular Assist Device

Palagani

Sorkin²,

Bonde³

et al. 2022

ASAIO Journal

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Current left ventricular assist devices (LVADs) are set to a fixed rpm and are unable to adjust to physiological demands irrespective of preload or afterload. Autonomous control of LVADs has the potential to reduce septal shift, preserve right ventricle function, and meet physiological demands. A highly innovative resonantly coupled regimen is presented which can achieve this goal. We introduce sensors based on a highly sensitive relationship between transmission coefficient and spatial separation in a resonantly coupled regimen. This relationship represents a polynomial regression. A regimen of an apical sensor and multiple outflow sensors is investigated. A range of separations varying from 50-200 mm was systematically investigated. These ranges consider anatomical & physiological variation(s) in cardiac chamber size. Validation was obtained in porcine heart preparation.The polynomial regression model predicted distance between the sensors with a mean absolute percentage error of 0.77%, 1.07%, and 5.75% for the three putative positions of the outflow sensors and apical sensor when compared with experimental results. A high degree of accuracy (95%) between the predicted and observed distance was obtained. Continuous measurements were done over 90 days to examine drift, with no statistically detectable change in measurements over million sampling cycles.We have demonstrated a reliable sensor methodology without drift for assessing ventricular chamber size in an LVAD setup. This has the potential to allow autonomous control of LVAD based on ventricular chamber size to address some of the adverse events.

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Section: Methodsmentioning

confidence: 99%

Resonantly Coupled High-Efficiency Sensors for Assessment of Ventricular Chamber Size for Autonomous Control of Left Ventricular Assist Device

Palagani

Sorkin²,

Bonde³

et al. 2022

ASAIO Journal

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“…The Medtronics HeartWare HVAD (Figure 4) was approved by FDA in November of 2012 for BTT. It has been implanted in more than 20,000 heart failure patients worldwide, with one HVAD being implanted for greater than 7 years [1,22]. The HVAD functions via both passive magnetic levitation and a hydrodynamic bearing system [22].…”

Section: Hvadmentioning

confidence: 99%

“…It has been implanted in more than 20,000 heart failure patients worldwide, with one HVAD being implanted for greater than 7 years [1,22]. The HVAD functions via both passive magnetic levitation and a hydrodynamic bearing system [22]. In June of 2021, the sale and implantation of the HVAD was discontinued secondary to technical issues with the device not restarting after planned or accidental power disconnection.…”

Section: Hvadmentioning

confidence: 99%

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Kathryn¹,

Silvonek²

2023

Updates in Anesthesia - The Operating Room and Beyond

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Heart failure is poorly tolerated and end stage heart failure (classified as New York Heart Association (NYHA) class IV) has a two-year survival with medical therapy that approaches 0%. Innovation in this sphere has yielded mechanical therapies, principally the left ventricular assist device (LVAD). In the last decade one-year survival rates of Left ventricular assist device patients have increased from 52–83%. As this therapy is more commonly used to treat advanced heart failure, coupled with the increase in patient survival after implantation, patients are increasingly encountered in the peri-operative arena requiring anesthesia for non-cardiac surgeries. The goal of this chapter is to provide the non-cardiac trained anesthesia provider a primer on what an LVAD is, how it functions, the physiological changes that occur with implantation, and considerations for administering anesthesia to patients with LVADs for non-cardiac surgery. Review of articles from 2018 to 2022 found from a search on PubMed and Google Scholar using the keywords: “Left Ventricular Assist Device”, “LVAD”, “anesthesia”, “non-cardiac surgery”, “Doppler blood pressure measurement”, “VAD coordinator”. Non-cardiac trained anesthesia providers can safely administer the anesthetics to LVAD patients undergoing non-cardiac surgery as long as appropriate considerations are taken.

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“…110 Other types of implantable vascular assist devices include the Heartmate 3 LVAD, Heartware left ventricular assist device (HVAD), and Heartmate II LVAD. 111 Coyle et al demonstrated that Heartmate 3 had a lower risk of cardiac arrhythmias, pump thrombosis, and infection compared with HVAD; however, they did not differ significantly in outcomes such as survival and quality of life. 112 HVAD has also been associated with a higher risk of stroke and gastrointestinal bleeding.…”

Section: Managementmentioning

confidence: 99%

Pathophysiology and Management of Heart Failure in the Elderly

et al. 2022

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The population of elderly adults is increasing globally. It has been projected that the population of adults aged 65 years will increase by approximately 80% by 2050 in the United States. Similarly, the elderly population is rising in other countries; a notable example being Japan where approximately 30% of the population are aged above 65 years. The pathophysiology and management of heart failure (HF) in this age group tend to have more intricacies than in younger age groups owing to the presence of multiple comorbidities. The normal aging biology includes progressive disruption at cellular and genetic levels and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities. Older adults with HF secondary to ischemic or valvular heart disease may benefit from surgical therapy, valve replacement or repair for valvular heart disease and coronary artery bypass grafting for coronary artery disease. While referring these patients for surgery, patient and family expectations and life expectations should be taken into account. In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity.

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HVAD to HeartMate 3 left ventricular assist device exchange: Best practices recommendations

Cited by 14 publications

References 33 publications

Resonantly Coupled High-Efficiency Sensors for Assessment of Ventricular Chamber Size for Autonomous Control of Left Ventricular Assist Device

Resonantly Coupled High-Efficiency Sensors for Assessment of Ventricular Chamber Size for Autonomous Control of Left Ventricular Assist Device

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Pathophysiology and Management of Heart Failure in the Elderly

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