Mechanisms of Bleeding and Approach to Patients With Axial-Flow Left Ventricular Assist Devices

Suárez, Jorge; Patel, Chetan B.; Felker, G. Michael; Becker, Richard C.; Hernandez, Adrian F.; Rogers, Joseph G.

doi:10.1161/circheartfailure.111.962613

Cited by 239 publications

(146 citation statements)

References 30 publications

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“…81 Furthermore, the reduced pulse pressure imparted by the VAD may lead to intestinal hypoperfusion, regional hypoxia and vascular dilation. 82 Finally, platelet aggregation is also impaired in many patients and can be measured by a ristocetin cofactor assay. 83, 84 Impaired platelet function and/or hemostasis caused by acquired vWD, the presence of angioectasias and compromised platelet aggregation account for an increased predilection for bleeding.…”

Section: Indications and Patient Selectionmentioning

confidence: 99%

Challenges in Long-Term Mechanical Circulatory Support and Biological Replacement of the Failing Heart

Joyce

Groarke

Mehra

2014

Circ J

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Section: Indications and Patient Selectionmentioning

confidence: 99%

Challenges in Long-Term Mechanical Circulatory Support and Biological Replacement of the Failing Heart

Joyce

Groarke

Mehra

2014

Circ J

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“…Despite the presence of adverse events, the outcome of end-stage heart failure patients receiving implantable LVAD therapy remains superior to optimal maximal medical therapy (OMM) (Figure 3) [16]. Clinical measures, including survival and quality measures, continue to favor LVAD therapy with results that continue to trend in a favorable direction [17] (Figure 4).…”

Section: The Second Generation Implantable Lvadsmentioning

confidence: 99%

The Implantable Left Ventricular Assist Device: A Bridge to a Destination

Samuels¹

2013

J Clin Exp Cardiolog

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The Implantable Left Ventricular Assist Device (LVAD) has been in clinical use for several decades, serving originally as a therapy for bridging patients to heart transplantation (BTT). For the past fifteen years, the implantable LVAD has also served as a permanent device in patients who are not eligible for cardiac transplantationDestination Therapy (DT). Although early results were markedly superior to optimal medical management (OMM), device durability was limited. In response, improvements in patient selection and pump design have translated into improved outcomes. As such, a broader acceptance of LVAD therapy for end-stage heart failure has been observed.

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“…Continuous-flow devices are associated with the development of acquired von Willebrand disease and an increased incidence of mucosal arteriovenous malformations. 26 In combination, these 2 phenomena can lead to an increased risk of bleeding that is not readily amenable to therapy. 26 In cases such as this, the general approach is to modify anticoagulants/ antiplatelet therapy and to perform endoscopy with the hope of finding lesions that can be treated with thermoablation.…”

Section: The Patient Was Listed As United Network For Organmentioning

confidence: 99%

“…26 In combination, these 2 phenomena can lead to an increased risk of bleeding that is not readily amenable to therapy. 26 In cases such as this, the general approach is to modify anticoagulants/ antiplatelet therapy and to perform endoscopy with the hope of finding lesions that can be treated with thermoablation. If bleeding persists, it is appropriate to revisit urgent cardiac transplantation as a rescue therapy from BTT support.…”

Section: The Patient Was Listed As United Network For Organmentioning

confidence: 99%

When the Heart Runs Out of Heartbeats

et al. 2012

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A 50-year-old man was referred to the Advanced Heart Failure clinic at our institution for consideration of additional treatment options. He was diagnosed with heart failure (HF) 4 years earlier. Transthoracic echocardiography revealed a dilated left ventricle (LV) with an LV end-diastolic dimension of 5.5 cm, globally depressed ejection fraction (EF; estimated at 30%), and moderate mitral regurgitation. Complete blood cell count, urinalysis, and liver function tests were normal. Screening for hemochromatosis, human immunodeficiency virus, rheumatologic disease, and amyloidosis was performed and was negative. He did not have a family history of cardiomyopathy or sudden cardiac death. Coronary angiography revealed no evidence of obstructive coronary artery disease. Right heart catheterization demonstrated a right atrial pressure of 15 mm Hg, pulmonary artery pressure of 41/21 mm Hg, pulmonary capillary wedge pressure of 20 mm Hg, and cardiac index of 2.3 L ⅐ min ؊1 ⅐ m ؊2 . He was started on evidence-based therapies for HF. An implantable cardioverter-defibrillator was placed for primary prevention of sudden cardiac death after no improvement in his EF. He was not considered a candidate for cardiac resynchronization therapy because his QRS duration was 100 milliseconds. He had progressive HF symptoms despite maximal medical therapy and was hospitalized 3 times during the 6 months before referral for acute decompensated HF. The doses of angiotensin-converting enzyme inhibitor and ␤-blocker had been recently reduced by his cardiologist secondary to lightheadedness and fatigue accompanied by hypotension. His medical history was remarkable for hypertension and dyslipidemia. He reported adherence to his prescribed medications that included carvedilol 6.25 mg twice daily, lisinopril 5 mg daily, spironolactone 25 mg daily, and furosemide 40 mg daily.Dr Rogers: It is timely to refer this patient for advanced HF therapies because these therapies improve functional status and long-term prognosis of patients with refractory HF. 1 Referral is appropriate not only for potential heart transplantation or mechanical circulatory support (MCS) but also for medical management of persistent functional class III and IV symptoms. 2 The clinical history suggests that this patient has an idiopathic nonischemic cardiomyopathy with persistent symptomatic HF. He has been treated with angiotensinconverting enzyme inhibitors and ␤-blockers, therapies that form the cornerstone of treatment to delay or halt the progression of cardiac dysfunction and improve mortality. Aldosterone antagonists are also recommended for patients with New York Heart Association class III to IV HF secondary to reduced LVEF (Ͻ35%). Diuretic therapy, although not associated with improvement in outcomes, is recommended to restore and maintain normal volume status. 3 In this case, the history of frequent hospitalizations and reductions in neurohormonal antagonists doses for hypotension are markers of poor prognosis and suggest that the illness is progressing despite opt...

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Mechanisms of Bleeding and Approach to Patients With Axial-Flow Left Ventricular Assist Devices

Cited by 239 publications

References 30 publications

Challenges in Long-Term Mechanical Circulatory Support and Biological Replacement of the Failing Heart

Challenges in Long-Term Mechanical Circulatory Support and Biological Replacement of the Failing Heart

The Implantable Left Ventricular Assist Device: A Bridge to a Destination

When the Heart Runs Out of Heartbeats

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