Successful use of the HeartWare HVAD rotary blood pump for biventricular support

Strueber, M.; Meyer, Anna; Malehsa, D.; Haverich, Axel

doi:10.1016/j.jtcvs.2010.04.007

Cited by 115 publications

(74 citation statements)

References 2 publications

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“…According to our mock circulation analysis, in the range of possible recovery of the pulmonary circulatory bed, the reserve of the pump speed spectrum after our "banding" procedure should be sufficient to guarantee an appropriate flow within the recommended pump settings. From our measurements, we can calculate that with an outflow graft diameter of 6 mm during pulmonary vascular resistance reduction from 800 to 160 dyne ⅐ s Ϫ1 ⅐ cm Ϫ5 , a constant pump flow of 6 L/min could be assured by reduction of the pump speed from 3200 to 2400 12 Precise assessment of pulmonary pressures is difficult in the presence of a continuous-flow BVAD, because the RVAD cannot be stopped without having backward blood flow through the pump. The repeatedly necessary reduction of pump flow on the right side in the long-term patients in the present study who had elevated pulmonary artery pressures at BVAD implantation, however, can be interpreted as indirect evidence of a decline of pulmonary vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Biventricular Circulatory Support With Two Miniaturized Implantable Assist Devices

et al. 2011

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Background-Up to 30% of patients with end-stage heart failure experience biventricular failure that requires biventricular mechanical support. For these patients, only bulky extracorporeal or implantable displacement pumps or the total artificial heart have been available to date, which enables only limited quality of life for the patients. It was our goal to evaluate a method that would allow the use of 2 implantable centrifugal left ventricular assist devices as a biventricular assist system. Methods and Results-Seventeen patients have been implanted with 2 HeartWare HVAD pumps, 1 as a left ventricular assist device and 1 as a right ventricular assist device. Seventy-seven percent of the patients had idiopathic dilated or ischemic cardiomyopathy. Their age ranged from 29 to 73 years (mean 51.8Ϯ14.5 years), and 11 (64.7%) received intravenous catecholamine support preoperatively. The right ventricular assist device pump was implanted into the right ventricular free wall. The afterload of this pump was artificially increased by local reduction of the outflow graft diameter, and the effective length of its inflow cannula was reduced by the addition of two 5-mm silicon suture rings to the original HVAD implantation ring. All right ventricular assist device devices could be operated in appropriate speed ranges and delivered a flow of between 3.0 and 5.5 L/min. Thirty-day survival was 82%, and 59% of the patients could be discharged home after recovering from the operation. There was no clinically relevant hemolysis in any of the patients. Conclusions-Two HeartWare HVAD pumps can be used as a biventricular assist system. This implantable biventricular support gives the patients more comfort and mobility than usual biventricular ventricular assist devices with large and noisy displacement pumps. (Circulation. 2011;124[suppl 1]:S179 -S186.)

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Section: Discussionmentioning

confidence: 99%

Biventricular Circulatory Support With Two Miniaturized Implantable Assist Devices

et al. 2011

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“…After our first description of the use of paired Jarvik 2000 pumps, 11 the use of biventricular continuous-flow ventricular assist devices has been reported with increasing frequency for both short-and long-term support. 12 This approach appears to be well tolerated by many patients, and preservation of the ventricles theoretically enables transmission of native contractility through the pump. Patients whose native hearts are not pumping and who are discovered to be in prolonged VF closely approximate a truly nonpulsatile system, such as that provided by a continuous-flow total artificial heart.…”

Section: Discussionmentioning

confidence: 99%

Tolerance of Sustained Ventricular Fibrillation During Continuous-Flow Left Ventricular Assist Device Support

Baldwin¹,

Gemmato²,

Sandoval³

et al. 2017

Texas Heart Institute Journal

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The widespread use of continuous-flow left ventricular assist devices for mechanical circulatory support has shown that long-term hemodynamic support is possible, even when a clinical “pulse” cannot be detected. We present the incidental discovery of ventricular fibrillation in 6 alert, hemodynamically stable patients supported only by a continuous-flow device (HeartMate II, n=5; Jarvik 2000, n=1). Ventricular fibrillation was found in 3 patients during routine outpatient follow-up visits and in 3 awaiting discharge from the hospital after device placement. Diagnosis was confirmed by electrocardiographic and echocardiographic studies. The average duration of mechanical circulatory support before ventricular fibrillation occurred was 221 ± 362 days (range, 5–864 d). All patients were conscious and ambulatory at the time of the arrhythmia. Three patients reported symptoms—primarily fatigue, nausea, and exertional dyspnea—that prompted evaluation. Serum chemistry analysis of blood drawn immediately after diagnosis showed no changes that suggested end-organ dysfunction. Three patients died of unrelated complications an average of 3.9 yr (range, 360–2,270 d) after the event. Two of the remaining 3 patients eventually underwent successful pump explantation, and one is on ongoing support. Our experience shows that it is possible for patients with continuous-flow left ventricular assist devices to remain hemodynamically stable while in ventricular fibrillation. Additional investigation is needed to determine whether defibrillator settings for these patients should be adjusted to limit delivery of shock therapy.

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“…4 Since then, several institutions have successfully used biventricular CF devices to provide short-and long-term support to patients. 2,5 The HeartWare HVAD has been used in most of these cases, presumably because of the advantages provided by its relatively small profile and intrapericardial pump position.…”

Section: Discussionmentioning

confidence: 99%

Nonidentical Continuous-Flow Devices For Biventricular Support

Baldwin¹,

Sandoval²,

Cohn³

et al. 2017

Texas Heart Institute Journal

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Although biventricular heart failure has been successfully managed with dual continuousflow ventricular assist devices, the long-term use of 2 mechanically dissimilar pumps has traditionally been discouraged. We present the case of a 52-year-old T he success of continuous-flow (CF) left ventricular assist devices (LVADs) has revolutionized the surgical management of end-stage heart failure. However, studies have shown that up to 10% of LVAD candidates need biventricular support. 1 In the absence of a long-awaited CF total artificial heart, some patients with biventricular failure have received long-term support from dual, identical CF pumps. 2 Here, we present a case in which 2 separate devices-a left-sided HeartMate II ® LVAD (Thoratec Corporation; Pleasanton, Calif ) and a right-sided HeartWare ® HVAD (HeartWare International, Inc., part of Medtronic, Inc.; Framingham, Mass)-were used simultaneously in the successful long-term treatment of a patient with biventricular heart failure. Case ReportA 52-year-old man with a long-standing history of ischemic cardiomyopathy was referred to our institution when his condition precipitously declined despite the administration of home milrinone therapy. The patient's clinical history was further complicated by chronic renal insufficiency (baseline creatinine level, 2-2.5 mg/dL) and the placement of a mechanical aortic valve (St. Jude Medical, Inc., part of Abbott Laboratories; St. Paul, Minn) 17 years earlier. Echocardiographic results showed that the patient had a left ventricular (LV) ejection fraction of <0.20, an LV end-diastolic dimension of 5.9 cm, and normal right ventricular (RV) size and function. Subsequent test results indicated that the patient had a pulmonary capillary wedge pressure of 21 mmHg, a pulmonary vascular resistance of 5.2 Wood units, and a cardiac index of 1.47 L/min/m 2 .After stabilizing the patient by administering multiple inotropic infusions, we implanted a HeartMate II LVAD, positioning the device along the diaphragmatic surface of the LV. To decrease the risk of thromboembolic complications, we used a felt plug "sandwich" technique to close the patient's mechanical aortic valve. 3 The patient had evidence of severe RV dysfunction, and after multiple failed attempts to wean him from cardiopulmonary bypass, we placed a temporary CentriMag ® device (Abbott Laboratories; Abbott Park, Ill) to provide right-sided support, by cannulating the right atrium and pulmonary artery. During the subsequent 48 hours, no improvement was seen in the patient's RV functional dynamics, so we decided to implant a right-sided pump in anticipation of the need for long-term RV support. We chose a HeartWare HVAD to enable positioning of the device along the acute margin of the RV and to minimize the geometric complexity of accommodating a second HeartMate II pump housing. Transdiaphragmatic placement of the left-sided pump-standard

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Successful use of the HeartWare HVAD rotary blood pump for biventricular support

Cited by 115 publications

References 2 publications

Biventricular Circulatory Support With Two Miniaturized Implantable Assist Devices

Biventricular Circulatory Support With Two Miniaturized Implantable Assist Devices

Tolerance of Sustained Ventricular Fibrillation During Continuous-Flow Left Ventricular Assist Device Support

Nonidentical Continuous-Flow Devices For Biventricular Support

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