Neurologic Complications in Patients With Left Ventricular Assist Devices

Shoskes, Aaron; Fan, Tracey H.; Starling, Randall C.; Cho, Sung Min

doi:10.1016/j.cjca.2022.11.004

Cited by 7 publications

(5 citation statements)

References 119 publications

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“…A better understanding of the implications of continuous circulatory flow on systemic and cerebral vasculature is necessary to reduce the common occurrence of neurological complications in this population. 25 Finally, optimization of the patient's general condition before LVAD implantation has a crucial role in the outcome of these patients. Recently, the beneficial effect of respiratory rehabilitation and administration of iron and vitamin D has been reported, [26][27][28] and this is one of the policies that have been implemented during the second time period.…”

Section: Discussionmentioning

confidence: 99%

Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study

Ondrusek,

Artemiou,

Bezak

et al. 2024

Thorac Cardiovasc Surg

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Background Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation of mechanical support devices contributed to this change. In this single-center study, we focused on two time periods that are characterized by the use of different types of mechanical support devices, different patient characteristics, and change in the indications. Methods The data were processed from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). We retrospectively defined two time intervals to reflect changes in ventricular assist device technology (period 1: 2007–2015; period 2: 2016–20222). A total of 181 patients underwent left ventricular assist device implantation. Device utilization was the following: HeartMate II = 52 (76.4%) and HeartWare = 16 (23.6%) in period 1 and HeartMate II = 2 (1.8%), HeartMate 3 = 70 (61:9%), HeartWare = 29 (25.7%), SynCardia TAH = 10 (8.8%), and BerlinHeart EXCOR = 2 (1.8%) in period 2. The outcomes of the time intervals were analyzed and evaluated. Results Survival was significantly higher during the second time period. Multivariate analysis revealed that age and bypass pump time are independent predictors of mortality. Idiopathic cardiomyopathy, bypass time, and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score are independent predictors of adverse events. Furthermore, the first period was noted to be at an increased risk of the following adverse events: pump thrombosis, gastrointestinal bleeding, and bleeding events. Conclusion Despite the higher risk profile of the patients and persistent challenges, during the second period, there was a significant decrease in mortality and morbidity. The use of the HeartMate 3 device may have contributed to this result.

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Section: Discussionmentioning

confidence: 99%

Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study

Ondrusek,

Artemiou,

Bezak

et al. 2024

Thorac Cardiovasc Surg

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“…In addition, intracranial hemorrhage and stroke are among the leading causes of mortality with LVADs [ 52 , 53 , 54 ]. A study of more than 18,000 LVADs showed that the rate of stroke 1 year after implantation is 13% for axial-flow LVADs and 20% for centrifugal-flow LVADs [ 53 ].…”

Section: Complications Associated With Bridge To Transplant Lvad Therapymentioning

confidence: 99%

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

Roesel,

Nersesian,

Neuber

et al. 2024

Rev. Cardiovasc. Med.

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Heart failure (HF) is a common disease associated with high morbidity and mortality rates despite advanced pharmacological therapies. Heart transplantation remains the gold standard therapy for end-stage heart failure; however, its application is curtailed by the persistent shortage of donor organs. Over the past two decades, mechanical circulatory support, notably Left Ventricular Assist Devices (LVADs), have been established as an option for patients waiting for a donor organ. This comprehensive review focuses on elucidating the benefits and barriers associated with this application. We provide an overview of landmark clinical trials that have evaluated the use of LVADs as a bridge to transplantation therapy, with a particular focus on post-transplant outcomes. We discuss the benefits of stabilizing patients with these systems, weighing associated complications and limitations. Further technical advancements and research on optimal implantation timing are critical to ultimately improve outcomes and securing quality of life. In a world where the availability of donor organs remains constrained, LVADs are an increasingly important piece of patient care, bridging the critical gap to transplantation in advanced heart failure management.

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“…The neurological complications post-durable MCS can be devastating. Further investigations into risk factor identification and prevention are warranted [19].…”

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence Approaches for Predicting the Risks of Durable Mechanical Circulatory Support Therapy and Cardiac Transplantation

Grzyb,

Du,

Nair

2024

JCM

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Background: The use of AI-driven technologies in probing big data to generate better risk prediction models has been an ongoing and expanding area of investigation. The AI-driven models may perform better as compared to linear models; however, more investigations are needed in this area to refine their predictability and applicability to the field of durable MCS and cardiac transplantation. Methods: A literature review was carried out using Google Scholar/PubMed from 2000 to 2023. Results: This review defines the knowledge gaps and describes different AI-driven approaches that may be used to further our understanding. Conclusions: The limitations of current models are due to missing data, data imbalances, and the uneven distribution of variables in the datasets from which the models are derived. There is an urgent need for predictive models that can integrate a large number of clinical variables from multicenter data to account for the variability in patient characteristics that influence patient selection, outcomes, and survival for both durable MCS and HT; this may be fulfilled by AI-driven risk prediction models.

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Neurologic Complications in Patients With Left Ventricular Assist Devices

Cited by 7 publications

References 119 publications

Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study

Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

Artificial Intelligence Approaches for Predicting the Risks of Durable Mechanical Circulatory Support Therapy and Cardiac Transplantation

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