Left ventricular assist device implantation: short and long-term surgical complications

Piccione, William

doi:10.1016/s1053-2498(99)00110-2

Cited by 78 publications

(59 citation statements)

References 26 publications

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“…The main complication of mechanical circulatory support in these patients is bleeding. As seen with other systems the DeBakey LVAD comes with a high incidence of bleeding [4,9], our results indicate no significant differences with previously reported figures [11].…”

Section: Discussionsupporting

confidence: 62%

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Salzberg¹,

Lachat²,

Zünd³

et al. 2003

European Journal of Cardio-Thoracic Surgery

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Objective: The MicroMed DeBakey left ventricular assist device (LVAD) axial blood flow pump was used as bridge to heart transplantation (HTx) in patients with terminal heart failure. The aim was to evaluate this novel mechanical circulatory support system in regard to overall outcome. Methods: Prospective study in 15 HTx candidates (mean age 40^7 years) with terminal heart failure and maximal medical treatment due to ischemic cardiomyopathy (CMP, n ¼ 5), dilated CMP ðn ¼ 3Þ, restrictive CMP ðn ¼ 2Þ, unclassified CMP ðn ¼ 1Þ, metabolic CMP ðn ¼ 1Þ, valvular CMP ðn ¼ 1Þ and congenital CMP ðn ¼ 2Þ. All patients were implanted with a MicroMed DeBakey LVAD. A rescue procedure was necessary in eight critical patients, while seven underwent elective LVAD implantation. Procedures were performed via median sternotomy, in normotherm femoro-femoral CPB (mean duration 59^1 min). Oral Marcoumar q (INR 2.0-3.0) and Aspirin q (100 mg daily) were started as soon as possible. Patients were discharged into a specialized rehabilitation clinic from which it was possible to release them home after a few weeks. Results: Successful implantation and discharge from ICU (mean stay 10^7 days) was possible in 11 patients. Seven were transplanted (mean support 50.7 days) and one is awaiting HTx (support .310 days) in the comfort of his home (NYHA I). Survival was 100% among the transplanted patients. Of the seven elective implants, five, and of the eight rescue procedures three patients underwent successful HTx. Four patients died early, while three patients died late on pump support due to intracranial hemorrhage (n ¼ 2, 73 and 76 days) and chest infection (n ¼ 1, 124 days). All survivors were discharged from hospital, with significant decrease in NYHA class (mean 3.8-2.4 ðn ¼ 11Þ). Treadmill testing showed increased exercise tolerance, from 35 to 71 W ðn ¼ 4Þ. Plasma BNP values (mean 950-162 ng/l ðn ¼ 4Þ) and pulmonary resistance (mean 316 -194.5 dyne s/cm 5 ðn ¼ 3Þ) decreased significantly during LVAD support. Conclusions: The MicroMed DeBakey LVAD is simple to implant; outpatient treatment is safe and efficient. Patients' condition and pulmonary resistances normalize within 6 weeks, making previously considered inoperable patients amenable for HTx. HTx can be performed in low-risk situation, allowing better donor -recipient matching and improving overall outcome. q

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Section: Discussionsupporting

confidence: 62%

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Salzberg¹,

Lachat²,

Zünd³

et al. 2003

European Journal of Cardio-Thoracic Surgery

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“…Clinically these changes improve left ventricular function and patients have a dramatic increase in their exercise capacity following LVAD implantation. [44][45][46] These findings encouraged the explantation of LVADs in select patients who have demonstrated sufficient recovery of myocardial function. To date clinical results are mixed and although the large number of studies report regression or normalization of the pathological substrate following VAD treatment, the clinical evidence for recovery remains limited.…”

Section: Molecular Changes In Myocardium After Vad Implantationmentioning

confidence: 97%

Ventricular Assist Device: Emerging Modality for Long Term Cardiac Support

Shah¹,

Kommu²,

Bhuriya³

et al. 2011

New Aspects of Ventricular Assist Devices

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“…It is also important to note the significant complications and costs associated with MCS use, especially if considered in hemodynamically stable patients. Complications can vary widely based on institution and procedural proficiency, and can include air embolism, thromboembolism, hemorrhage, right ventricle failure, infection, primary device failure and increased mortality (16). Cost of hospitalization was also significantly increased by the placement of an MCS anywhere from 2.8% to 25.2% (17,18).…”

Section: Patient Selectionmentioning

confidence: 99%

When more is not better—appropriately excluding patients from mechanical circulatory support therapy

Nayyar¹,

Donovan²,

Khouzam³

2018

Ann. Transl. Med.

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Mechanical circulatory support (MCS) devices are continually evolving and are providing greater hemodynamic support. This review was conducted to evaluate the prophylactic use of MCS in hemodynamically stable patients who were awaiting future coronary artery revascularization. A thorough review of published literature was conducted to evaluate for patients and clinical scenarios that are indicated for MCS, including hemodynamically stable and unstable patients awaiting revascularization. Although there have been several studies demonstrating the benefit of MCS use in hemodynamically unstable patients, there was limited trials in patients that were hemodynamically stable. The use of prophylactic MCS was limited to intra-aortic balloon pump (IABP) in "high risk" patients awaiting coronary artery bypass grafting (CABG). This review article was conducted to evaluate for possible prophylactic MCS in patients awaiting revascularization. In hemodynamically stable patients, literature is limited to the use of IABP for "highrisk" patients awaiting CABG. A thorough review of literature suggest that hemodynamically stable patients likely would not benefit from prophylactic placement MCS while awaiting revascularization although further clinical trials are needed to identify the ideal patients and clinical scenarios for the use of MCS.

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Left ventricular assist device implantation: short and long-term surgical complications

Cited by 78 publications

References 26 publications

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Ventricular Assist Device: Emerging Modality for Long Term Cardiac Support

When more is not better—appropriately excluding patients from mechanical circulatory support therapy

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