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Surgical Treatment of End Stage Heart Failure
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Surgical Treatment of End Stage Heart Failure

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (1 July 2022) | Viewed by 10240

Special Issue Editor

Prof. Dr. Piergiorgio Tozzi

E-Mail Website
Guest Editor
Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois CHUV, University of Lausanne, Lausanne, Switzerland
Interests: end stage heart failure; heart transplant; mitral valve surgery; thoracic aorta diseases

Special Issue Information

Dear Colleagues,

As specialists in treating end-stage heart failure, we are asked to provide patients with solutions able to relief symptoms, improve survival and reduce recurrent hospitalizations. However, the tolerance to pharmacological and low invasive heart failure therapies decreases with the progression of the heart failure. This creates the need for more invasive and effective treatments besides the orthotopic heart transplant which still represents the treatment of reference in terms of extend survival and improved quality of life. Long-term mechanical circulatory support fills the gap between cardioprotective drugs and heart transplant. This is the domain that is progressing faster than any other within cardiovascular medicine.  

The special issue on “Surgical Treatment of End-Stage Heart Failure” aims to collect the most updated and disruptive scientific achievements worldwide on heart transplant related techniques and the use of Ventricular Assist Devices and Total Artificial Hearts either as bridge to transplant or bridge to recovery or destination therapy.

Beyond specialists from cardiac medicine, we also welcome submissions from researcher with focus on imaging, biomedical engineering, psychosocial aspects of human / implantable device interaction or other affiliated disciplines in order to enhance the awareness of the chances of surgical treatment of heart failure in modern cardiovascular medicine.

Prof. Dr. Piergiorgio Tozzi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • heart failure
  • Ventricular Assist Devices
  • LVAD
  • artificial heart
  • heart transplant
  • mechanical circulatory support
  • quality of life
  • advance care planning
  • centrifugal blood pump
  • hemolysis
  • cardiac surgery
  • surgery for heart failure
  • cardiomyopathy

Published Papers (5 papers)

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Research

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15 pages, 3195 KiB  
Article
A Device Strategy-Matched Comparison Analysis among Different Intermacs Profiles: A Single Center Experience
by Raphael Caraffa, Jonida Bejko, Massimiliano Carrozzini, Olimpia Bifulco, Vincenzo Tarzia, Giulia Lorenzoni, Daniele Bottigliengo, Dario Gregori, Chiara Castellani, Tomaso Bottio, Annalisa Angelini and Gino Gerosa
J. Clin. Med. 2022, 11(16), 4901; https://doi.org/10.3390/jcm11164901 - 20 Aug 2022
Cited by 2 | Viewed by 1609
Abstract
Background: The present study evaluates outcomes of LVAD patients, taking into account the device strategy and the INTERMACS profile. Methods: We included 192 LVAD-patients implanted between January 2012 and May 2021. The primary and secondary end-points were survival and major adverse events [...] Read more.
Background: The present study evaluates outcomes of LVAD patients, taking into account the device strategy and the INTERMACS profile. Methods: We included 192 LVAD-patients implanted between January 2012 and May 2021. The primary and secondary end-points were survival and major adverse events between Profiles 1–3 vs. Profile 4, depending on implantation strategies (Bridge-to-transplant-BTT; Bridge-to-candidacy-BTC; Destination-Therapy-DT). Results: The overall survival was 67% (61–75) at 12 months and 61% (54–70) at 24 months. Profile 4 patients showed significantly higher survival (p = 0.018). Incidences of acute right-ventricular-failure (RVF) (p = 0.046), right-ventricular-assist-device (RVAD) implantation (p = 0.015), and continuous-venovenous-hemofiltration (CVVH) (p = 0.006) were higher in Profile 1–3 patients, as well as a longer intensive care unit stays (p = 0.050) and in-hospital-mortality (p = 0.012). Twelve-month and 24-month survival rates were higher in the BTT rather than in BTC (log-rank = 0.410; log-rank = 0.120) and in DT groups (log-rank = 0.046). In the BTT group, Profile 1–3 patients had a higher need for RVAD support (p = 0.042). Conclusions: LVAD implantation in elective patients was associated with better survival and lower complications incidence. LVAD implantation in BTC patients has to be considered before their conditions deteriorate. DT should be addressed to elective patients in order to guarantee acceptable results. Full article
(This article belongs to the Special Issue Surgical Treatment of End Stage Heart Failure)
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12 pages, 1227 KiB  
Article
How to Optimize ECLS Results beyond Ventricular Unloading: From ECMO to CentriMag® eVAD
by Vincenzo Tarzia, Lorenzo Bagozzi, Matteo Ponzoni, Giacomo Bortolussi, Giulio Folino, Roberto Bianco, Fabio Zanella, Tomaso Bottio and Gino Gerosa
J. Clin. Med. 2022, 11(15), 4605; https://doi.org/10.3390/jcm11154605 - 7 Aug 2022
Cited by 4 | Viewed by 1498
Abstract
CentriMag® extracorporeal VAD support could represent a more physiological choice than conventional ECMO in primary cardiogenic shock. We therefore evaluated the outcome of patients with primary cardiogenic shock who were supported with CentriMag® extracorporeal VAD implantation versus conventional ECMO. We retrospectively [...] Read more.
CentriMag® extracorporeal VAD support could represent a more physiological choice than conventional ECMO in primary cardiogenic shock. We therefore evaluated the outcome of patients with primary cardiogenic shock who were supported with CentriMag® extracorporeal VAD implantation versus conventional ECMO. We retrospectively reviewed all extracorporeal life supports implanted for primary cardiogenic shock between January 2009 and December 2018 at our institution. Among 212 patients, 143 cases (67%) were treated exclusively with ECMO (Group 1) and 69 cases (33%) with extracorporeal VAD implantation (Group 2, 48 of whom as conversion of ECMO). ECLS mean duration was 8.37 ± 8.43 days in Group 1 and 14.25 ± 10.84 days in Group 2 (p = 0.001), while the mean rates of the highest predicted flow were 61.21 ± 16.01% and 79.49 ± 18.42% (p = 0.001), respectively. Increasing mechanical support flow was related to in-hospital mortality and overall mortality in Group 1 (HR 11.36, CI 95%: 2.19–44.20), but not in Group 2 (HR 1.48, CI 95%: 0.32–6.80). High-flow ECMO patients had lower survival with respect to high-flow extracorporeal VAD patients (p = 0.027). In the setting of high-flow mechanical circulatory support, CentriMag® extracorporeal VAD optimized patient survival, granting long-term assistance and physiological circulation patterns. Full article
(This article belongs to the Special Issue Surgical Treatment of End Stage Heart Failure)
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13 pages, 1096 KiB  
Article
Impact of Continuous Flow Left Ventricular Assist Device on Heart Transplant Candidates: A Multi-State Survival Analysis
by Massimiliano Carrozzini, Tomaso Bottio, Raphael Caraffa, Jonida Bejko, Olimpia Bifulco, Alvise Guariento, Carlo Mario Lombardi, Marco Metra, Danila Azzolina, Dario Gregori, Marny Fedrigo, Chiara Castellani, Vincenzo Tarzia, Giuseppe Toscano, Antonio Gambino, Vjola Jorgji, Enrico Ferrari, Annalisa Angelini and Gino Gerosa
J. Clin. Med. 2022, 11(12), 3425; https://doi.org/10.3390/jcm11123425 - 14 Jun 2022
Cited by 3 | Viewed by 1439
Abstract
(1) Objectives: The aim of this study was to investigate the impact of the prolonged use of continuous-flow left ventricular assist devices (LVADs) on heart transplant (HTx) candidates. (2) Methods: Between January 2012 and December 2019, we included all consecutive patients diagnosed with [...] Read more.
(1) Objectives: The aim of this study was to investigate the impact of the prolonged use of continuous-flow left ventricular assist devices (LVADs) on heart transplant (HTx) candidates. (2) Methods: Between January 2012 and December 2019, we included all consecutive patients diagnosed with end-stage heart failure considered for HTx at our institution, who were also eligible for LVAD therapy as a bridge to transplant (BTT). Patients were divided into two groups: those who received an LVAD as BTT (LVAD group) and those who were listed without durable support (No-LVAD group). (3) Results: A total of 250 patients were analyzed. Of these, 70 patients (28%) were directly implanted with an LVAD as BTT, 11 (4.4%) received delayed LVAD implantation, and 169 (67%) were never assisted with an implantable device. The mean follow-up time was 36 ± 29 months. In the multivariate analysis of survival before HTx, LVAD implantation showed a protective effect: LVAD vs. No-LVAD HR 0.01 (p < 0.01) and LVAD vs. LVAD delayed HR 0.13 (p = 0.02). Mortality and adverse events after HTx were similar between LVAD and No-LVAD (p = 0.65 and p = 0.39, respectively). The multi-state survival analysis showed a significantly higher probability of death for No-LVAD vs. LVAD patients with (p = 0.03) or without (p = 0.04) HTx. (4) Conclusions: The use of LVAD as a bridge to transplant was associated with an overall survival benefit, compared to patients listed without LVAD support. Full article
(This article belongs to the Special Issue Surgical Treatment of End Stage Heart Failure)
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12 pages, 1329 KiB  
Article
Marginal versus Standard Donors in Heart Transplantation: Proper Selection Means Heart Transplant Benefit
by Olimpia Bifulco, Tomaso Bottio, Raphael Caraffa, Massimiliano Carrozzini, Alvise Guariento, Jonida Bejko, Marny Fedrigo, Chiara Castellani, Giuseppe Toscano, Giulia Lorenzoni, Vincenzo Tarzia, Dario Gregori, Massimo Cardillo, Francesca Puoti, Giuseppe Feltrin, Annalisa Angelini and Gino Gerosa
J. Clin. Med. 2022, 11(9), 2665; https://doi.org/10.3390/jcm11092665 - 9 May 2022
Cited by 14 | Viewed by 1657
Abstract
Background: In this study, we assessed the mid-term outcomes of patients who received a heart donation from a marginal donor (MD), and compared them with those who received an organ from a standard donor (SD). Methods: All patients who underwent HTx between January [...] Read more.
Background: In this study, we assessed the mid-term outcomes of patients who received a heart donation from a marginal donor (MD), and compared them with those who received an organ from a standard donor (SD). Methods: All patients who underwent HTx between January 2012 and December 2020 were enrolled at a single institution. The primary endpoints were early and long-term survival of MD recipients. Risk factors for primary graft failure (PGF) and mortality in MD recipients were also analyzed. The secondary endpoint was the comparison of survival of MD versus SD recipients. Results: In total, 238 patients underwent HTx, 64 (26.9%) of whom received an organ from an MD. Hospital mortality in the MD recipient cohort was 23%, with an estimated 1 and 5-year survival of 70% (59.2–82.7) and 68.1% (57.1–81), respectively. A multivariate analysis in MD recipients showed that decreased renal function and increased inotropic support of recipients were associated with higher mortality (p = 0.04 and p = 0.03). Cold ischemic time (p = 0.03) and increased donor inotropic support (p = 0.04) were independent risk factors for PGF. Overall survival was higher in SD than MD (85% vs. 68% at 5 years, log-rank = 0.008). However, risk-adjusted mortality (p = 0.2) and 5-year conditional survival (log-rank = 0.6) were comparable. Conclusions: Selected MDs are a valuable resource for expanding the cardiac donor pool, showing promising results. The use of MDs after prolonged ischemic times, increased inotropic support of the MD or the recipient and decreased renal function are associated with worse outcomes. Full article
(This article belongs to the Special Issue Surgical Treatment of End Stage Heart Failure)
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Review

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17 pages, 801 KiB  
Review
Cardiac Surgery in Advanced Heart Failure
by Roger Hullin, Philippe Meyer, Patrick Yerly and Matthias Kirsch
J. Clin. Med. 2022, 11(3), 773; https://doi.org/10.3390/jcm11030773 - 31 Jan 2022
Cited by 6 | Viewed by 3245
Abstract
Mechanical circulatory support and heart transplantation are established surgical options for treatment of advanced heart failure. Since the prevalence of advanced heart failure is progressively increasing, there is a clear need to treat more patients with mechanical circulatory support and to increase the [...] Read more.
Mechanical circulatory support and heart transplantation are established surgical options for treatment of advanced heart failure. Since the prevalence of advanced heart failure is progressively increasing, there is a clear need to treat more patients with mechanical circulatory support and to increase the number of heart transplantations. This narrative review summarizes recent progress in surgical treatment options of advanced heart failure and proposes an algorithm for treatment of the advanced heart failure patient at >65 years of age. Full article
(This article belongs to the Special Issue Surgical Treatment of End Stage Heart Failure)
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