Reliable long-term non-pulsatile circulatory support without anticoagulation

Saito, Satoshi; Westaby, Stephen; Piggott, D.; Katsumata, Takahiro; Dudnikov, S.; Robson, D.; Catarino, Pedro; Nojiri, Chisato

doi:10.1016/s1010-7940(01)00640-6

Cited by 51 publications

(24 citation statements)

References 5 publications

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“…Similar to the study by Kihara et al, 14 there were no differences in BUN, creatinine, total bilirubin, or liver transaminases between the 2 groups. 15 Finally, in a similar study with a different device, Saito et al 16 found no change in liver and renal function in 6 sheep.…”

Section: Discussionmentioning

confidence: 86%

Renal and Hepatic Function Improve in Advanced Heart Failure Patients During Continuous-Flow Support With the HeartMate II Left Ventricular Assist Device

et al. 2009

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Background-The effects of continuous blood flow and reduced pulsatility on major organ function have not been studied in detail. Methods and Results-We evaluated renal (creatinine and blood urea nitrogen) and hepatic (aspartate transaminase, alanine transaminase, and total bilirubin) function in 309 (235 male, 74 female) advanced heart failure patients who had been supported with the HeartMate II continuous-flow left ventricular assist device for bridge to transplantation. To determine whether patients with impaired renal and hepatic function improve over time with continuous-flow left ventricular assist device support or whether there are any detrimental effects in patients with normal organ function, we divided patients into those with above-normal and normal laboratory values before implantation and measured blood chemistry over time during left ventricular assist device support. There were significant improvements over 6 months in all parameters in the above-normal groups, with values in the normal groups remaining in the normal range over time.Mean blood urea nitrogen and serum creatinine in the above-normal groups decreased significantly from 37Ϯ14 to 23Ϯ10 mg/dL (PϽ0.0001) and from 1.8Ϯ0.4 to 1.4Ϯ0.8 mg/dL (PϽ0.01), respectively. There were decreases in aspartate transaminase and alanine transaminase in the above-normal groups from 121Ϯ206 and 171Ϯ348 to 36Ϯ19 and 31Ϯ22 IU (PϽ0.001), respectively. Total bilirubin for the above-normal group was 2.1Ϯ0.9 mg/dL at baseline; after an acute increase at week 1, it decreased to 0.9Ϯ0.5 mg/dL by 6 months (PϽ0.0001). Both renal and liver values from patients in the normal groups remained normal during support with the left ventricular assist device. Conclusions-The HeartMate II continuous-flow left ventricular assist device improves renal and hepatic function in advanced heart failure patients who are being bridged to transplantation, without evidence of detrimental effects from reduced pulsatility over a 6-month time period. Clinical Trial Registration Information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00121472.

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Section: Discussionmentioning

confidence: 86%

Renal and Hepatic Function Improve in Advanced Heart Failure Patients During Continuous-Flow Support With the HeartMate II Left Ventricular Assist Device

et al. 2009

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“…In order to minimize the risk of thrombus formation, all the surfaces within the pump coming into blood contact are coated with covalently bonded heparin previously used in cardiopulmonary bypass circuits [11], vascular grafts [12] or assist devices [13] (Carmeda w BioActive Surface).…”

Section: Discussionmentioning

confidence: 99%

No drive line, no seal, no bearing and no wear: magnetics for impeller suspension and flow assessment in a new VAD

Huber

Tozzi

Hurni

et al. 2004

Interactive Cardiovascular and Thoracic Surgery

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The new magnetically suspended axial pump is free of seals, bearings, mechanical friction and wear. In the absence of a drive shaft or flow meter, pump flow assessment is made with an algorithm based on currents required for impeller rotation and stabilization. The aim of this study is to validate pump performance, algorithm-based flow and effective flow. A series of bovine experiments was realized after equipment with pressure transducers, continuous-cardiac-output-catheter, intracardiac ultrasound (AcuNav) over 6 h. Pump implantation was through a median sternotomy (LV-->VAD-->calibrated transonic-flow-probe-->aorta). A transonic-HT311-flow-probe was fixed onto the outflow cannula for flow comparison. Animals were electively sacrificed and at necropsy systematic pump inspection and renal embolus score was realized. Observation period was 340+/-62.4 min. The axial pump generated a mean arterial pressure of 58.8+/-14.3 mmHg (max 117 mmHg) running at a speed of 6591.3+/-1395.4 rev./min (min 5000/max 8500 rev./min) and generating 2.5+/-1.0 l/min (min 1.4/max 6.0 l/min) of flow. Correlation between the results of the pump flow algorithm and measured pump flow was linear (y=1.0339x, R2=0.9357). VAD explants were free of macroscopic thrombi. Renal embolus score was 0+/-0. The magnetically suspended axial flow pump provides excellent left ventricular support. The pump flow algorithm used is accurate and reliable. Therefore, there is no need for direct flow measurement.

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“…If bleeding stops, goal INR can be slowly increased while continuing to withhold aspirin. Patients have managed without anticoagulation for more than a year without thrombotic complications (62,67,81,82). After an intracerebral hemorrhage event, retrospective analysis indicates that aspirin can be resumed after 1 week and warfarin after 10 days without expansion of the hemorrhage or thrombotic events (77).…”

Section: Hematologic Concernsmentioning

confidence: 99%

Left Ventricular Assist Device Management in the ICU

Pratt

Shah

Boyce

2014

Critical Care Medicine

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Intensivists are increasingly likely to encounter patients requiring mechanical circulatory support with left ventricular assist devices at various points in the trajectory of their disease, from the immediate postimplant period to subsequent admissions for complications, and at end of life. A basic understanding of left ventricular assist device physiology is essential to the safe and effective care of these patients.

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Reliable long-term non-pulsatile circulatory support without anticoagulation

Abstract: The T-ILVAS successfully supported the systemic circulation without anticoagulation for up to 210 days. Mechanical reliability and biocompatibility were demonstrated. Organ function remained within normal limits during continuous non-pulsatile flow.

Cited by 51 publications

References 5 publications

Renal and Hepatic Function Improve in Advanced Heart Failure Patients During Continuous-Flow Support With the HeartMate II Left Ventricular Assist Device

Renal and Hepatic Function Improve in Advanced Heart Failure Patients During Continuous-Flow Support With the HeartMate II Left Ventricular Assist Device

No drive line, no seal, no bearing and no wear: magnetics for impeller suspension and flow assessment in a new VAD

Left Ventricular Assist Device Management in the ICU

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