Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation

Miller, Leslie W.; Pagani, Francis D.; Russell, Stuart D.; John, Ranjit; Boyle, Andrew; Aaronson, Keith D.; Conte, John V.; Naka, Yoshifumi; Mancini, Donna; Delgado, Reynolds M.; MacGillivray, Thomas E.; Farrar, David J.; Frazier, O.H.

doi:10.1056/nejmoa067758

Cited by 1,610 publications

(1,083 citation statements)

References 17 publications

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“…Smaller, nonpulsatile devices, such as the Jarvik 2000 FlowMaker (Jarvik Heart Inc., New York, New York) and the HeartMate II (Thoratec Corporation, Pleasanton, California) were recently introduced.These devices show favourable results with regard to survival and quality of life, but long-term results are not yet available and thromboembolic complications and percutaneous lead infection remain a potential problem. 21 …”

Section: Discussionmentioning

confidence: 99%

Left ventricular assist device: a functional comparison with heart transplantation

Pruijsten

Jonge²,

Kirkels³

et al. 2008

NHJL

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Background. A growing number of patients with end-stage heart failure undergo implantation of ventricular assist devices as a bridge to heart transplantation. Objectives. In this study we investigated whether functional and haemodynamic recovery after implantation is sufficient to warrant the use of them as long-term alternative to heart transplantation. Methods. We compared peak VO 2 of a group of patients three months after implantation of a ventricular assist device and three months after heart transplantation. Furthermore, we analysed the degree of haemodynamic recovery, by comparing plasma levels of BNP and creatinine before and after implantation of the device. Results. After implantation of a ventricular assist device, exercise capacity improved considerably; three months after implantation peak VO 2 was 20.0±4.9 ml/kg/min (52% of predicted for age and gender). After heart transplantation exercise capacity improved even further; 24.0±3.9 ml/ kg/min (62% of predicted for age and gender) (p<0.001). In the three months after implantation, BNP plasma levels decreased from 570±307 pmol/l to 31±25 pmol/l and creatinine levels decreased from 191±82 µmol/l to 82±25 µmol/l, indicating significant unloading of the ventricles and haemodynamic recovery. Conclusion. With regard to functional and haemodynamic recovery, the effect of implantation of a ventricular assist device is sufficient to justify its use as an alternative to heart transplantation. (Neth Heart J 2008;16:41-6.)

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Section: Discussionmentioning

confidence: 99%

Left ventricular assist device: a functional comparison with heart transplantation

Pruijsten

Jonge²,

Kirkels³

et al. 2008

NHJL

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“…1,2 The use of LVADs, either as bridge to transplantation or as destination therapy, has resulted in marked improvement of morbidity and mortality in these patients. [3][4][5][6][7][8] Better outcomes observed over the past decade can be attributed to greater experience of LVAD teams in the management of these devices, as well as to the introduction of newer second and third generation continuous-flow LVADs (CF-LVADs), which are smaller, more reliable, and durable. [9][10][11][12][13] relationship between pulsatility and the risk of gastrointestinal (GI) bleeding from arteriovenous malformations (AVMs).…”

mentioning

confidence: 99%

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Wever-Pinzon

Selzman

Drakos

et al. 2013

Circ: Heart Failure

214

111

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Background— Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding. Methods and Results— The Utah Transplantation Affiliated Hospitals (U.T.A.H.) heart failure and transplant program databases were queried for patients with end-stage heart failure who required support with the continuous-flow LVAD HeartMate II (Thoratec Corp, Pleasanton, CA) between 2004 and 2012. Pulsatility was evaluated by means of the LVAD parameter pulsatility index (PI) and by the echocardiographic assessment of aortic valve opening during the first 3 months of LVAD support. PI was analyzed as a continuous variable and also stratified according to tertiles of all the PI measurements during the study period (low PI: <4.6, intermediate PI: 4.6–5.2, and high PI: >5.2). Major nonsurgical bleeding associated with a decrease in hemoglobin ≥2 g/dL (in the absence of hemolysis) was the primary end point. A total of 134 patients (median age of 60 [interquartile range: 49–68] years, 78% men) were included. Major bleeding occurred in 33 (25%) patients (70% gastrointestinal, 21% epistaxis, 3% genitourinary, and 6% intracranial). In multivariable analysis, PI examined either as a categorical variable, low versus high PI (hazard ratio, 4.06; 95% confidence interval, 1.35–12.21; P =0.04), or as a continuous variable (hazard ratio, 0.60; 95% confidence interval, 0.40–0.92; P =0.02) was associated with an increased risk of bleeding. Conclusions— Reduced pulsatility in patients supported with the continuous-flow LVAD HeartMate II is associated with an increased risk of nonsurgical bleeding, as evaluated by PI.

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“…Newer devices use a continuous flow rotary pump which has been found to have multiple advantages including improved outcomes, smaller device size, longer durability, and less noise, than earlier models that used volume displacement mechanisms [2,3].…”

Section: Anticoagulation Management Of Left Ventricular Assist Devicesmentioning

confidence: 99%

Anticoagulation management of left ventricular assist devices

Connors

2014

American J Hematol

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Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation

Abstract: A continuous-flow left ventricular assist device can provide effective hemodynamic support for a period of at least 6 months in patients awaiting heart transplantation, with improved functional status and quality of life. (ClinicalTrials.gov number, NCT00121472 [ClinicalTrials.gov].).

Cited by 1,610 publications

References 17 publications

Left ventricular assist device: a functional comparison with heart transplantation

Left ventricular assist device: a functional comparison with heart transplantation

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Anticoagulation management of left ventricular assist devices

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