Initial Clinical Experience Of Total Cardiac Replacement With Dual Heartmate-II<sup>®</sup>Axial Flow Pumps For Severe Biventricular Heart Failure

Loebe, Matthias; Bruckner, Brian A.; Reardon, Michael J.; Doorn, Erika van; Estep, Jerry D.; Gregorič, Igor D.; Masud, Faisel; Cohn, William E.; Motomura, Tadashi; Torre‐Amione, Guillermo; Frazier, O.H.

doi:10.14797/mdcj-7-1-40

Cited by 34 publications

(28 citation statements)

References 7 publications

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“…6 In contrast, intrapericardial placement of a HeartWare HVAD for RV support avoids interference with the outflow path of the left-sided pump. Thus, despite the logistical complexities in their management, nonidentical CF device pairings can provide successful long-term biventricular support.…”

Section: Discussionmentioning

confidence: 99%

Nonidentical Continuous-Flow Devices For Biventricular Support

Baldwin¹,

Sandoval²,

Cohn³

et al. 2017

Texas Heart Institute Journal

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Although biventricular heart failure has been successfully managed with dual continuousflow ventricular assist devices, the long-term use of 2 mechanically dissimilar pumps has traditionally been discouraged. We present the case of a 52-year-old T he success of continuous-flow (CF) left ventricular assist devices (LVADs) has revolutionized the surgical management of end-stage heart failure. However, studies have shown that up to 10% of LVAD candidates need biventricular support. 1 In the absence of a long-awaited CF total artificial heart, some patients with biventricular failure have received long-term support from dual, identical CF pumps. 2 Here, we present a case in which 2 separate devices-a left-sided HeartMate II ® LVAD (Thoratec Corporation; Pleasanton, Calif ) and a right-sided HeartWare ® HVAD (HeartWare International, Inc., part of Medtronic, Inc.; Framingham, Mass)-were used simultaneously in the successful long-term treatment of a patient with biventricular heart failure. Case ReportA 52-year-old man with a long-standing history of ischemic cardiomyopathy was referred to our institution when his condition precipitously declined despite the administration of home milrinone therapy. The patient's clinical history was further complicated by chronic renal insufficiency (baseline creatinine level, 2-2.5 mg/dL) and the placement of a mechanical aortic valve (St. Jude Medical, Inc., part of Abbott Laboratories; St. Paul, Minn) 17 years earlier. Echocardiographic results showed that the patient had a left ventricular (LV) ejection fraction of <0.20, an LV end-diastolic dimension of 5.9 cm, and normal right ventricular (RV) size and function. Subsequent test results indicated that the patient had a pulmonary capillary wedge pressure of 21 mmHg, a pulmonary vascular resistance of 5.2 Wood units, and a cardiac index of 1.47 L/min/m 2 .After stabilizing the patient by administering multiple inotropic infusions, we implanted a HeartMate II LVAD, positioning the device along the diaphragmatic surface of the LV. To decrease the risk of thromboembolic complications, we used a felt plug "sandwich" technique to close the patient's mechanical aortic valve. 3 The patient had evidence of severe RV dysfunction, and after multiple failed attempts to wean him from cardiopulmonary bypass, we placed a temporary CentriMag ® device (Abbott Laboratories; Abbott Park, Ill) to provide right-sided support, by cannulating the right atrium and pulmonary artery. During the subsequent 48 hours, no improvement was seen in the patient's RV functional dynamics, so we decided to implant a right-sided pump in anticipation of the need for long-term RV support. We chose a HeartWare HVAD to enable positioning of the device along the acute margin of the RV and to minimize the geometric complexity of accommodating a second HeartMate II pump housing. Transdiaphragmatic placement of the left-sided pump-standard

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Section: Discussionmentioning

confidence: 99%

Nonidentical Continuous-Flow Devices For Biventricular Support

Baldwin¹,

Sandoval²,

Cohn³

et al. 2017

Texas Heart Institute Journal

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“…[23][24][25][26][27] Although such devices have been designed and optimized (anatomically and physiologically) for LV assist, investigators have been able to adapt them for use on the right side. The adaptations include spacers to adjust inflow cannula depth of penetration into the RV and constrictors on the outflow graft to decrease output to the low-pressure, low-resistance pulmonary circuit.…”

Section: Discussionmentioning

confidence: 99%

“…22 Recently, encouraging results have been obtained with miniaturized LVADs used for RV support. [23][24][25][26][27] However, these devices are not ideally suited for implantation in the right heart, and therefore, research on VADs remains necessary. [28][29][30][31][32][33][34][35][36][37][38][39][40] The Synergy Micro-Pump (CircuLite Inc, Saddle Brook, NJ) is the size of an AA battery, connects to the heart via an 8-mm-diameter by 20-cm-long inflow cannula, has a pumping capacity of up to ϳ4.25 liters/min, and is small enough to be placed in a subcutaneous pocket.…”

mentioning

confidence: 99%

Two axial-flow Synergy Micro-Pumps as a biventricular assist device in an ovine animal model

Schmitto

Burkhoff

Avşar

et al. 2012

The Journal of Heart and Lung Transplantation

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“…Newer-generation long-term LVADs (including the Jarvik 2000 [86 ] and the HeartWare [88 ]) have been used as RVADs (for biventricular support). Dual HeartMate II continuous-flow VADs have been used for total cardiac replacement (complete heart resection) [89]. The superiority of a continuous-flow long-term LVAD over its predecessor pulsatile LVAD (HeartMate II vs. HeartMate I) for destination therapy was shown in a randomized study: improved probability of survival free from stroke and device failure at 2 years (composite end-point), better actuarial survival, better estimated 1 and 2-year survival, significant reductions in major adverse events [91].…”

Section: Risk Factors For Mortality In Short-term Mechanical Circulatmentioning

confidence: 99%

“…FDA approval for DT. Applied as continuous-flow total cardiac replacement (dual pumps -heart resection)[89]. Jarvik 2000 (Jarvik Heart Inc., New York, NY)Newer-generation, long-term, intracardiac, continuous axial flow LVAD.…”

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confidence: 99%

Mechanical assistance of the circulation during cardiogenic shock

Pitsis

Visouli

2011

Current Opinion in Critical Care

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Although MCS can be life saving in cardiogenic shock, the results are still suboptimal. Mortality is associated with the critical presupport state and the adverse events during MCS. Early initiation of support that meets the patient's requirements, potent support in the early phase, adverse event prevention, global combined management (surgical, interventional, medical), balanced support duration, bridging to further therapeutic modalities including heart transplantation or longer-term support, and advanced technology could offer improved results.

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Initial Clinical Experience Of Total Cardiac Replacement With Dual Heartmate-II^®Axial Flow Pumps For Severe Biventricular Heart Failure

Cited by 34 publications

References 7 publications

Nonidentical Continuous-Flow Devices For Biventricular Support

Nonidentical Continuous-Flow Devices For Biventricular Support

Two axial-flow Synergy Micro-Pumps as a biventricular assist device in an ovine animal model

Mechanical assistance of the circulation during cardiogenic shock

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Initial Clinical Experience Of Total Cardiac Replacement With Dual Heartmate-II®Axial Flow Pumps For Severe Biventricular Heart Failure

Cited by 34 publications

References 7 publications

Nonidentical Continuous-Flow Devices For Biventricular Support

Nonidentical Continuous-Flow Devices For Biventricular Support

Two axial-flow Synergy Micro-Pumps as a biventricular assist device in an ovine animal model

Mechanical assistance of the circulation during cardiogenic shock

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Product

Resources

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Initial Clinical Experience Of Total Cardiac Replacement With Dual Heartmate-II^®Axial Flow Pumps For Severe Biventricular Heart Failure