Outcomes after implantation of partial-support left ventricular assist devices in inotropic-dependent patients: Do we still need full-support assist devices?

Sabashnikov, Anton; Popov, Aron‐Frederik; Bowles, Christopher; Mohite, Prashant N.; Weymann, Alexander; Hards, Rachel; Hedger, M.; Wittwer, Thorsten; Wippermann, Jens; Wahlers, Thorsten; Schoendube, Friedrich A.; Simón, A.

doi:10.1016/j.jtcvs.2014.05.063

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…The LVAD has an additive contribution to the arterial system that provides a constant blood flow that complements the LV ejection output while reducing LV physical diastolic loading. In these simulations, output from the LVAD was set at 2.0 L/min and again at 4.5 L/min, indicative of the range of realistic output from the miniaturized newer-generation LVADs ( 8 , 12 ). Aside from the LVAD, all other fluid exchanges are pressure-driven by the realistic mechanical model of the 4-chamber heart.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, roughly 5% of LVAD-treated patients experience a full recovery, allowing for reduced support and, in some cases, device explantation ( 10 , 11 ). Recent results show that miniaturized, less invasive, partial-support devices operating at low flow rates may have the potential to be used in more patients, particularly those with INTERMACS classification 4 and greater ( 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Partial LVAD Restores Ventricular Outputs and Normalizes LV but not RV Stress Distributions in the Acutely Failing Heart in Silico

et al. 2016

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Purpose Heart failure is a worldwide epidemic that is unlikely to change as the population ages and life expectancy increases. We sought to detail significant recent improvements to the Dassault Systèmes Living Heart Model (LHM) and use the LHM to compute left ventricular (LV) and right ventricular (RV) myofiber stress distributions under the following 4 conditions: (1) normal cardiac function; (2) acute left heart failure (ALHF); (3) ALHF treated using an LV assist device (LVAD) flow rate of 2 L/min; and (4) ALHF treated using an LVAD flow rate of 4.5 L/min. Methods and Results Incorporating improved systolic myocardial material properties in the LHM resulted in its ability to simulate the Frank-Starling law of the heart. We decreased myocardial contractility in the LV myocardium so that LV ejection fraction decreased from 56% to 28%. This caused mean LV end diastolic (ED) stress to increase to 508% of normal, mean LV end systolic (ES) stress to increase to 113% of normal, mean RV ED stress to decrease to 94% of normal and RV ES to increase to 570% of normal. When ALHF in the model was treated with an LVAD flow rate of 4.5 L/min, most stress results normalized. Mean LV ED stress became 85% of normal, mean LV ES stress became 109% of normal and mean RV ED stress became 95% of normal. However, mean RV ES stress improved less dramatically (to 342% of normal values). Conclusions These simulations strongly suggest that an LVAD is effective in normalizing LV stresses but not RV stresses that become elevated as a result of ALHF.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Partial LVAD Restores Ventricular Outputs and Normalizes LV but not RV Stress Distributions in the Acutely Failing Heart in Silico

et al. 2016

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“…This is supported by recent experiences with partial-support devices for long-term-support in elderly patients with chronic heart failure. 27,28 …”

Section: Discussionmentioning

confidence: 99%

Investigation of hemodynamics in an in vitro system simulating left ventricular support through the right subclavian artery using 4-dimensional flow magnetic resonance imaging

Jung

Müller

Buchenberg

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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The results indicate that, despite the massive alterations in natural hemodynamics due to the retrograde flow via the right subclavian and brachiocephalic arteries, there are no drastic consequences on the flow in the brain-feeding arteries and the flow characteristics in the ascending and descending aortas. It may be beneficial to adjust the operating condition of the left ventricular assist device to the residual function of the failing heart.

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“…newer LVAD devices, such as the Synergy Pocket micropump (HVAD, HeartWare Inc., Framingham, MA), have been used for such application. 11 Authors have used the Synergy device and have shown improved hemodynamics, end-organ perfusion, and quality of life. 10,12 The use of this partial support device has been shown to be clinically efficacious and safe in certain patient populations and is likely to be a future viable option.…”

Section: A New Implant Strategy For Bridged Patientsmentioning

confidence: 99%

“…[10][11][12] In this study, we aimed to compare early outcomes of bridge-to-transplant patients with prior sternotomy who received either conventional sternotomy or alternative outflow graft strategies.…”

mentioning

confidence: 99%

Can an Alternative Outflow Strategy be Utilized for High-Risk Bridged Patients with Previous Cardiac Surgery?

Danish

Davis

et al. 2016

ASAIO Journal

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The HeartWare ventricular assist device (HVAD) is an implantable continuous-flow centrifugal pump that has allowed the development of sternal-sparing techniques, with the use of alternative outflow strategies. We compared early outcomes for patients bridged with the conventional versus alternative outflow graft strategy. From January 2013 to October 2014, 89 patients with HVAD implantation were identified. Survival was analyzed with Kaplan-Meier methods, and a log-rank test was used to compare outcomes between groups. Thirty patients (34%) had ≥1 previous sternotomy before HVAD implantation. Eight patients (27%) were approached using an alternative outflow graft technique with outflow graft connection to the descending aorta (n = 4, 50%) or left subclavian artery (n = 4, 50%), whereas 22 (73%) were implanted via a conventional sternotomy approach with the outflow graft to the ascending aorta. Preoperative characteristics (age, Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS], and Lietz-Miller score) were comparable between groups (all p > 0.05). Median follow-up was 4.7 (2.8-9.3) months of support. Outcomes were comparable between conventional and alternative outflow groups; survival at 6 months was 74% for the conventional group and 83% in the alternative outflow group. An alternative outflow graft strategy can be utilized to support bridged patients with a history of prior sternotomy.

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Outcomes after implantation of partial-support left ventricular assist devices in inotropic-dependent patients: Do we still need full-support assist devices?

Cited by 10 publications

References 14 publications

Partial LVAD Restores Ventricular Outputs and Normalizes LV but not RV Stress Distributions in the Acutely Failing Heart in Silico

Partial LVAD Restores Ventricular Outputs and Normalizes LV but not RV Stress Distributions in the Acutely Failing Heart in Silico

Investigation of hemodynamics in an in vitro system simulating left ventricular support through the right subclavian artery using 4-dimensional flow magnetic resonance imaging

Can an Alternative Outflow Strategy be Utilized for High-Risk Bridged Patients with Previous Cardiac Surgery?

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