Mechanical circulatory support restores eligibility for heart transplant in patients with significant pulmonary hypertension

Biełka, Agnieszka; Kalinowski, Mariusz; Hawranek, Michał; Małyszek‐Tumidajewicz, Justyna; Pacholewicz, Jerzy; Kowalczuk-Wieteska, Anetta; Ratman, Katarzyna; Kubiak, Grzegorz; Król, Bogumiła; Przybyłowski, Piotr; Zembala, Marian; Zembala, Michał

doi:10.33963/kp.15518

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…LVAD therapy also decreases the pulmonary artery pressures and pulmonary capillary wedge pressure (PCWP) (6,7). This is also the case in many patients with fixed pulmonary hypertension, giving them the opportunity to be transplanted after LVAD therapy (8).…”

Section: Hemodynamics Of Lvad Patientsmentioning

confidence: 99%

Exercise physiology in left ventricular assist device patients: insights from hemodynamic simulations

Fresiello

Gross

Jacobs

2021

Ann Cardiothorac Surg

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Left ventricular assist devices (LVADs) assure longer survival to patients, but exercise capacity is limited compared to normal values. Overall, LVAD patients show high wedge pressure and low cardiac output during maximal exercise, a phenomenon hinting at the need for increased LVAD support. Clinical studies investigating the hemodynamic benefits of an LVAD speed increase during exercise, ended in inhomogeneous and sometimes contradictory results. The native ventricle-LVAD interaction changes between rest and exercise, and this evolution is complex, multifactorial and patient-specific. The aim of this paper is to provide a comprehensive overview on the patient-LVAD interaction during exercise and to delineate possible therapeutic strategies for the future. A computational cardiorespiratory model was used to simulate the hemodynamics of peak bicycle exercise in LVAD patients. The simulator included the main cardiovascular and respiratory impairments commonly observed in LVAD patients, so as to represent an average hemodynamic response to exercise. In addition, other exercise responses were simulated, by tuning the chronotropic, inotropic and vascular functions, and implementing aortic regurgitation and stenosis in the simulator. These profiles were tested under different LVAD speeds and LVAD pressure-flow characteristics.Simulations output showed consistency with clinical data from the literature. The simulator allowed the working condition of the assisted ventricle at exercise to be investigated, clarifying the reasons behind the high wedge pressure and poor cardiac output observed in the clinics. Patients with poorer inotropic, chronotropic and vascular functions, are likely to benefit more from an LVAD speed increase during exercise.Similarly, for these patients, a flatter LVAD pressure-flow characteristic can assure better hemodynamic support under physical exertion. Overall, the study evidenced the need for a patient-specific approach on supporting exercise hemodynamics. In this frame, a complex simulator can constitute a valuable tool to define and test personalized speed control algorithms and strategies.

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Section: Hemodynamics Of Lvad Patientsmentioning

confidence: 99%

Exercise physiology in left ventricular assist device patients: insights from hemodynamic simulations

Fresiello

Gross

Jacobs

2021

Ann Cardiothorac Surg

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“…6 It has even been demonstrated that LVAD can reduce PVR in patients with established PH and thereby make them suitable for transplantation. [7][8][9] The fact that LVAD support may reduce RV afterload (i.e. PVR) at time of transplantation might be beneficial for post-operative allograft RV function.…”

Section: Introductionmentioning

confidence: 99%

“…Besides increasing CO, this treatment results in reduced pulmonary arterial wedge pressure (PAWP) and PVR 6 . It has even been demonstrated that LVAD can reduce PVR in patients with established PH and thereby make them suitable for transplantation 7–9 . The fact that LVAD support may reduce RV afterload (i.e.…”

Section: Introductionmentioning

confidence: 99%

Impact of bridging with left ventricular assist device on right ventricular function following heart transplantation

et al. 2022

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Aims Patients awaiting orthotopic heart transplantation (OHT) can be bridged utilizing a left ventricular assist device (LVAD) that reduces left ventricular filling pressures, decreases pulmonary artery wedge pressure, and maintains adequate cardiac output. This study set out to examine the poorly investigated area of if and how pre-treatment with LVAD impacts right ventricular (RV) function following OHT. Methods and resultsWe prospectively evaluated 59 (LVAD n = 20) consecutive OHT patients. Transthoracic echocardiography (TTE) was performed in conjunction with right heart catheterization (RHC) at 1, 6, and 12 months after OHT. RV function TTE-parameters included tricuspid annular plane systolic excursion (TAPSE), systolic tissue velocity (S0), fractional area change, two-dimensional RV global longitudinal strain and longitudinal strain from the RV lateral wall (RVfree). At 1 month after OHT, the LVAD group had significantly better longitudinal RV function than the non-LVAD group: TAPSE (15 ± 3 mm vs. 12 ± 2 mm, P < 0.001), RV global longitudinal strain (À19.8 ± 2.1% vs. À14.3 ± 2.8%, P < 0.001), and RVfree (À19.8 ± 2.3% vs. À14.1 ± 2.9%, P < 0.001). At this time point, pulmonary vascular resistance (PVR) was also lower [1.2 ± 0.4 Wood Units (WU) vs. 1.6 ± 0.6 WU, P < 0.05] in the LVAD group compared with the non-LVAD group. At 6 and 12 months, no difference was detected in any of the TTE and RHC measured parameters between the two groups. Between 1 and 12 months, all parameters of RV function improved significantly in the non-LVAD group but remained unaltered in the LVAD group. Conclusions Our results indicate that pre-treatment with LVAD decreases PVR and is associated with significantly better RV function early following OHT. During the first year following transplantation, RV function progressively improved in the non-LVAD group such that at 6 and 12 months, no difference in RV function was detected between the groups.

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“…The success of continuous-flow left ventricular assist device (cf-LVAD) therapy is reduced by several severe complications like hemorrhagic and thromboembolic events, arrhythmias, multi-organ failure, and driveline infections [ 1 – 4 ]. Driveline infections are the most common adverse event, occurring in about 28% of all patients with an implanted cf-LVAD [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis

Juraszek

Smólski

Kołsut

et al. 2021

J Cardiothorac Surg

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Background Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. Methods Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. Results Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (±399; range, 35–1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (±506; range 32–2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. Conclusions Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infected patients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom.

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Mechanical circulatory support restores eligibility for heart transplant in patients with significant pulmonary hypertension

Cited by 5 publications

References 11 publications

Exercise physiology in left ventricular assist device patients: insights from hemodynamic simulations

Exercise physiology in left ventricular assist device patients: insights from hemodynamic simulations

Impact of bridging with left ventricular assist device on right ventricular function following heart transplantation

Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis

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