Search Results (27)

Background: The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated improved clinical outcomes in patients with advanced heart failure (HF). However, the influence of underlying HF etiology—ischemic cardiomyopathy (ICM) versus dilated cardiomyopathy (DCM)—on post-implantation outcomes remains insufficiently characterized. Objectives: This paper aims to evaluate early postoperative outcomes following HM3 LVAD implantation in patients with ICM versus DCM and to identify the preoperative hemodynamic and clinical predictors of early mortality and hemodynamic instability. Methods: We conducted a retrospective single-center cohort study of 30 patients who underwent HM3 LVAD implantation between 2017 and 2024. Patients were stratified by HF etiology (ICM, n = 17; DCM, n = 13), and preoperative clinical, echocardiographic, and right heart catheterization data were analyzed. The primary endpoint was 30-day postoperative survival. Secondary endpoints included postoperative hemodynamic stability and the need for vasopressor support. Results: Non-survivors (n = 13) demonstrated elevated central venous pressure (>16.5 mmHg), mean right ventricular pressure (>31.5 mmHg), and pulmonary vascular resistance (>7.5 Wood units), in addition to higher preoperative creatinine levels and longer cardiopulmonary bypass times. Vasopressor requirement postoperatively was associated with elevated pre-implant systolic pulmonary artery pressure. Conclusions: Preoperative right-sided pressures and renal dysfunction are strong predictors of early mortality following HM3 LVAD implantation. Patients with ICM exhibit greater early left ventricular recovery compared to those with DCM. These findings underscore the importance of comprehensive and personalized preoperative risk stratification—particularly in patients with DCM and pulmonary hypertension—to optimize postoperative outcomes and guide patient selection for durable LVAD support. Full article

Background: Durable mechanical circulatory support (DMCS) infections remain a serious challenge. Ventricular assist device (VAD)-specific driveline infections (DLIs) are the most common type; however, no consensus exists on their surgical management. We aimed to define the incidence, risk factors, and microbiology of DLIs and discuss the surgical treatment modalities. Methods: We retrospectively reviewed 90 patients who underwent a left or biventricular ventricular assist device (LVAD or BiVAD) implantation with either a HeartMate 2 (Abbott), HeartWare HVAD (Medtronic), or HeartMate 3 (Abbott) in a single center between 1 March 2011 and 30 May 2023. Results: DLIs were detected in 20 (21.5%) patients during the follow-up. The mean duration of VAD support was 561.1 ± 833.2 days (1–4124 days), while it was 1277.9 ± 621.6 days in the DLI group. An extended duration of VAD support was associated with higher incidence rates of late-onset DLIs (p < 0.05). A younger age and lower plasma albumin levels were independent predictive factors for the risk of a DLI, with a hazard ratio of 9.77 (95%CI: 1.3–74.5) and 10.55 (95%CI: 1.40–79.35), respectively. The removal of the biofilm with velour and DL relocation through the rectus muscle combined with vacuum-assisted strategies (VAC) were performed in nine patients. One patient developed a recurrent infection, and another patient with a deep DLI subsequently received a heart transplant. No patient underwent a device exchange for an intractable DLI. Conclusions: Our results suggest that DLIs are common infectious complications after VAD implantation, which endanger patient autonomy, and impair their quality of life and overall survival. A DL relocation through the rectus muscles and VAC strategies have a role in controlling DLIs. Full article

Ventricular assist devices (VADs) invigorated the management of patients with advanced heart failure, providing a lifeline for patients awaiting transplantation or requiring long-term circulatory support. This article reviews recent advances in VAD technologies, focusing on key areas of progress to overcome existing challenges and the potential for future applications. The reduction or possible elimination of infection-prone components and the evolution to transcutaneous energy transfer systems are two main research fields to reach a new quality of life category for VADs patients. Miniaturization and enhanced biocompatibility have resulted in smaller, less invasive devices with a significantly reduced risk of complications and mortality. Advances in percutaneous ventricular assist devices have emerged, contributing to the creation of less invasive options with or without intracardiac pumps, and facilitating their use for both left and right ventricles. These devices have gained more and more features, including the use of artificial intelligence. Moreover, the possibility of long-term use of intracardiac pumps offers a potential bridge to transplantation, allowing ambulation and probably also long-term circulatory support. Despite considerable advances, challenges remain, particularly in terms of improving durability, reducing the risk of ischemic events, further refining materials, and more sophisticated control and synchronization between systems that adapt to changing physiological demands. Full article

Introduction: Sacubitril/valsartan is an angiotensin receptor–neprilysin inhibitor (ARNI) drug used to treat patients with heart failure and has shown improvement in outcomes. Different studies reported the use of an ARNI in patients using left ventricular assist devices (LVADs). However, there are limited data on the use of ARNIs in this population. We aimed to assess the efficacy of ARNIs in LVAD patients. Methods: A systematic search was performed in PubMed, Scopus, Web of Science, Embase, and Cochrane from inception to November 2024. We used all relevant words for “ARNI” and “LVAD” to search, and we included studies that assessed ARNIs in patients with LVAD. Efficacy and safety outcomes were extracted from the included studies. R software version 4.4.2 was used for a meta-analysis. Results: Seven studies totaling 249 patients were included. The ARNI was found to be effective in improvements from baseline in the New York Heart Association (NYHA), B-type natriuretic peptide (BNP) (mean = −630.07 pg/mL, 95% CI [−1113.13, −147.01]), diuretic dose (furosemide equivalents) (mean= −76.05 mg/day, 95% CI [−145.11, −6.99]), left ventricular end-diastolic diameter (LVEED) (mean = −7.3 mm, 95% CI [−11.4, −3.1]), and left ventricular ejection fraction (LVEF) (mean =5, 95% CI [3.52, 6.48]). No improvement was found in the creatinine (Cr) level. However, a slight increase in the potassium level was noticed (mean= 0.17 mEq/L, 95% CI [0.02, 0.34]). The overall mortality in patients using the ARNI was 5%, 95% CI [0.00, 20], and discontinuation was found in 25%, 95% CI [0, 100]. Conclusions: The ARNI improved several cardiac structural and hemodynamic parameters in patients on LVAD support. Full article

Background and Objectives: The use of temporary left ventricular assist devices (tLVADs) for patients suffering from cardiogenic shock (CS) is becoming more common. This study examines the indications and outcomes of microaxial flow pumps (Impella^®, Abiomed Inc., Danvers, MA, USA) when cannulated through the axillary artery in patients with severe CS, with a particular focus on acute phase reactions and hemolytic responses. Materials and Methods: This single-center, retrospective cohort involved patients who received microaxial Impella implantation via the axillary artery from 2020 to 2022 (n = 47). Results: Among the patients, 66% (N = 31 cases) were treated with the Impella 5.5, 25.5% (N = 12 cases) with the Impella 5.0, and 8.5% (N = 4 cases) with the Impella CP. Additionally, 28% were managed using the ECMELLA concept. The mean length of time for Impella support was 8 days. The overall 30-day survival rate was 78%, with no significant differences observed between the ECMELLA group and the various Impella types. At 30 days post-therapy, 47% of survivors no longer required mechanical support, while 26% were upgraded to a durable LVAD. Interleukin-6 (IL-6) levels were significantly lower in patients receiving Impella 5.5 (n = 17 vs. 12) immediately following implantation (p = 0.03) compared with those with smaller devices. Haptoglobin levels were significantly higher in the Impella 5.5 group (n = 17 vs. 11, p = 0.02), with overall lower rates of hemolysis (45.1%, p < 0.01). Conclusions: The mortality rate in critical CS appears reduced with axillary artery implantation of Impella devices relative to existing literature. A full-flow microaxial pump (Impella 5.5) seems advantageous regarding systemic inflammatory response syndrome (SIRS) and acute hemolysis, indicated by lower IL-6 and higher haptoglobin levels, compared with smaller Impella devices. A tailored escalation/de-escalation concept using axillary access for different mAFP types appears feasible and safe. Full article

Objectives: Patients in cardiogenic shock (CS) may be successfully bridged using intravascular micro-axial left ventricular assist devices (M-LVADs) for recovery or determination of definitive therapy. Methods: One hundred and seven CS patients implanted with M-LVADs from January 2020 to May 2024 were divided into four groups; group-1: 34 patients (transplant); group-2: 25 patients (LVAD); group-3: 42 patients (postcardiotomy CS (PCCS)); group-4: 6 patients (decision/recovery but excluded from analysis). Multivariable logistic regression and Multivariable Coxregression models identified predictors of early -hospital and late mortality, and Odds ratios (ORs) and hazard ratios (HRs) with p < 0.05, respectively, were considered statistically significant. SPSS 29.0 and Python 3.11.1. were used for analyses. Results: Complications included device-malfunction (6%), gastrointestinal bleed (9%), long-term hemodialysis (21%), axillary hematoma requiring re-exploration (10%), heparin-induced thrombocytopenia (4%) requiring heparin therapy cessation/initiation of argatroban infusion, and non-fatal stroke (11%). Early hospital mortality included 13 patients: 2 in group-1, 1 in group-2, 10 in group-3 (p = 0.02). In the Logistic-Regression model, category of CS requiring an M-LVAD was significant (OR = 4.7, p = 0.05). Patients were followed for 4.5 years (mean follow-up was 23 ± 17 months), and 23 deaths occurred; group-1: 3 patients, group-2: 5 patients, and group-3: 15 patients (p = 0.019). At 4.5 years, actuarial survival was 90.7 ± 5.1% in group-1, 79.2 ± 8.3% in group-2, 62.8 ± 7.7% in group-3 (p = 0.01). In the Cox-Regression model, M-LVAD category (HR = 3.63, p = 0.04), and long-term postoperative dialysis (HR = 3.9, p = 0.002) emerged as predictors of long-term mortality. Conclusions: In cardiogenic shock, mid-term outcomes demonstrate good survival with M-LVADs as bridge to transplant/durable LVADs and reasonable survival with M-LVADs as a bridge to recovery following cardiotomy, accompanied by reduced ECMO usage, and early ambulation/rehabilitation. Full article

Background: The use of durable left ventricular assist devices (LVADs) for advanced heart failure is increasing and a growing number of patients will require anesthesia for non-cardiac procedures (NCPs). The goal of this study was to describe our experience with NCPs for LVAD patients. Methods: All anesthetic procedures performed in LVAD patients at a single center were reviewed from 2014 to 2023. Perioperative management data and complications were assessed. Results: In total, 16 patients had an LVAD implanted and 9 (56.3%) patients underwent anesthesia for a total of 22 NCPs. Most of the procedures took place outside of the operating room, mainly in the endoscopy unit, as gastrointestinal endoscopy was the most common procedure (13, 59.2%). Sedation was provided in 17 procedures (77.3%). Standard monitoring was used in all cases, and invasive monitoring was applied just in cases of major surgeries. There were no intraoperative complications reported. Postoperative complications were recorded after eight (36.4%) of the procedures, consisting mainly of lower gastrointestinal bleeding after lower endoscopy, which increased the length of hospital stay. All procedures were performed by non-cardiac anesthesiologists. Conclusions: Our data suggest that, in most cases, adherence to standard anesthesia practices can be suitable for NCPs in LVAD patients. Full article

Background: Centrifugal-flow left ventricular assist devices (CF-LVADs) have improved morbidity and mortality for their recipients. Hospital readmissions remain common, negatively impacting quality of life and survival. We sought to identify risk factors associated with hospital readmissions among patients with CF-LVADs. Methods: Consecutive patients receiving a CF-LVAD between February 2011 and March 2021 were retrospectively evaluated using prospectively maintained institutional databases. Hospital readmissions within three years post-LVAD implantation were dichotomized into heart failure (HF)/LVAD-related or non-HF/LVAD-related readmissions. Multivariable Cox regression models augmented using a machine learning algorithm, the least absolute shrinkage and selection operator (LASSO) method, for variable selection were used to estimate associations between HF/LVAD-related readmissions and pre-, intra- and post-operative clinical variables. Results: A total of 204 CF-LVAD recipients were included, of which 138 (67.7%) had at least one HF/LVAD-related readmission. HF/LVAD-related readmissions accounted for 74.4% (436/586) of total readmissions. The main reasons for HF/LVAD-related readmissions were major bleeding, major infection, HF exacerbation, and neurological dysfunction. Using pre-LVAD variables, HF/LVAD-related readmissions were associated with substance use, previous cardiac surgery, HF duration, pre-LVAD inotrope dependence, percutaneous LVAD/VA-ECMO support, LVAD type, and the left ventricular ejection fraction in multivariable analysis (Harrell’s concordance c-statistic; 0.629). After adding intra- and post-operative variables in the multivariable model, LVAD implant hospitalization length of stay was an additional predictor of readmission. Conclusions: Using machine learning-based techniques, we generated models identifying pre-, intra-, and post-operative variables associated with a higher likelihood of rehospitalizations among patients on CF-LVAD support. These models could provide guidance in identifying patients with increased readmission risk for whom clinical strategies to mitigate this risk may further improve LVAD recipient outcomes. Full article

Heart transplantation and durable left ventricular assist devices (LVADs) represent two definitive therapies for end-stage heart failure in the modern era. Despite technological advances, both treatment modalities continue to experience unique risks that impact surgical and perioperative decision-making. Here, we review special populations and factors that impact risk in LVAD and heart transplant surgery and examine critical decisions in the management of these patients. As both heart transplantation and the use of durable LVADs as destination therapy continue to increase, these considerations will be of increasing relevance in managing advanced heart failure and improving outcomes. Full article

Background: In patients with end-stage heart failure, durable Left Ventricular Assist Devices (LVADs) can be used as a bridge to transplant or destination therapy. LVADs have been shown to improve survival for patients with heart failure (HF). HF is associated with electrolyte abnormalities and the development of sustained arrhythmias. However, data on the influence of arrhythmias and electrolyte imbalances on inpatient outcomes in LVAD patients are lacking. Furthermore, previous works assessing inpatient outcomes focused mainly on the role of chronic comorbidities in those outcomes. Methods: In this cross-sectional study, we used discharge data from the National Inpatient Sample from 2019 to 2020 to assess the influence of acute arrhythmias on inpatient mortality in patients with LVADs. We also investigated the relationship between acute medical conditions and mortality. Results: There were 9418 (not survey-adjusted) hospitalizations with LVAD, among which 2539 (27%) died during the hospitalization. Univariate analysis of arrhythmias showed that ventricular arrhythmias (VAs)—ventricular fibrillation/flutter and ventricular tachycardia—as well as complete heart block were associated with significantly higher odds of mortality. Follow-up multivariable logistic analysis showed that these arrhythmias retain their increased association with death. Hyperkalemia and acidosis had increased adjusted odds of death (1.54 (95% confidence interval: 1.28–1.85) (p < 0.001) and 2.44 (CI: 2.14–2.77) (p < 0.001), respectively). Conclusions: VAs, complete heart block, hyperkalemia, and acidosis were associated with increased odds of all-cause mortality. Females had higher odds of inpatient mortality. These findings suggest that electrolyte management, maintenance of optimal acid–base balance, and interventions to treat sustained ventricular arrhythmias may be suitable therapeutic targets to reduce mortality in hospitalized patients with LVADs. Full article

Objectives: Benefits of tricuspid valve repair (TVR) in left ventricular assist device (LVAD) patients have been questioned. High TVR failure rates have been reported. Remaining or recurring TR was found to be a risk factor for right heart failure (RHF). Therefore, we assessed our experience. Methods: Since 12/2010, 195 patients have undergone LVAD implantation in our center. Almost half (n = 94, 48%) received concomitant TVR (LVAD+TVR). These patients were included in our analysis. Echocardiographic and clinical data were assessed. Median follow-up was 2.8 years (7 days–0.6 years). Results were correlated with clinical outcomes. Results: LVAD+TVR patients were 59.8 ± 11.4 years old (89.4% male) and 37.3% were INTERMACS level 1 and 2. Preoperative TR was moderate in 28 and severe in 66 patients. RV function was severely impaired in 61 patients reflected by TAPSE-values of 11.2 ± 2.9 mm (vs. 15.7 ± 3.8 mm in n = 33; p < 0.001). Risk for RHF according to EUROMACS-RHF risk score was high (>4 points) in 60 patients, intermediate (>2–4 points) in 19 and low (0–2 points) in 15. RHF occurred in four patients (4.3%). Mean duration of echocardiographic follow-up was 2.8 ± 2.3 years. None of the patients presented with severe and only five (5.3%) with moderate TR. The vast majority (n = 63) had mild TR, and 26 patients had no/trace TR. Survival at 1, 3 and 5 years was 77.4%, 68.1% and 55.6%, 30-day mortality was 11.7% (n = 11). Heart transplantation was performed in 12 patients (12.8%). Conclusions: Contrary to expectations, concomitant TVR during LVAD implantation may result in excellent repair durability, which appears to be associated with low risk for RHF. Full article

Heart Failure is a chronic and progressively deteriorating syndrome that has reached epidemic proportions worldwide. Improved outcomes have been achieved with novel drugs and devices. However, the number of patients refractory to conventional medical therapy is growing. These advanced heart failure patients suffer from severe symptoms and frequent hospitalizations and have a dismal prognosis, with a significant socioeconomic burden in health care systems. Patients in this group may be eligible for advanced heart failure therapies, including heart transplantation and chronic mechanical circulatory support with left ventricular assist devices (LVADs). Heart transplantation remains the treatment of choice for eligible candidates, but the number of transplants worldwide has reached a plateau and is limited by the shortage of donor organs and prolonged wait times. Therefore, LVADs have emerged as an effective and durable form of therapy, and they are currently being used as a bridge to heart transplant, destination lifetime therapy, and cardiac recovery in selected patients. Although this field is evolving rapidly, LVADs are not free of complications, making appropriate patient selection and management by experienced centers imperative for successful therapy. Here, we review current LVAD technology, indications for durable MCS therapy, and strategies for timely referral to advanced heart failure centers before irreversible end-organ abnormalities. Full article

Heart transplantation is currently the most effective treatment for end-stage heart failure; however, the shortage in donor hearts constrains the undertaking of transplantation. Mechanical circulatory support (MCS) technology has made rapid progress in recent years, providing diverse therapeutic options and alleviating the dilemma of donor heart shortage. The ventricular assist device (VAD), as an important category of MCS, demonstrates promising applications in bridging heart transplantation, destination therapy, and bridge-to-decision. VADs can be categorized as durable VADs (dVADs) and temporary VADs (tVADs), according to the duration of assistance. With the technological advancement and clinical application experience accumulated, VADs have been developed in biocompatible, lightweight, bionic, and intelligent ways. In this review, we summarize the development history of VADs, focusing on the mechanism and application status of dVADs in detail, and further discuss the research progress and use of VADs in China. Full article

The demand for durable left ventricular assist devices (LVADs) has been increasing worldwide in tandem with the rising population of advanced heart failure patients. Especially in cases of destination therapy, instead of bridges to transplantation, LVADs require a lifelong commitment. With the increase in follow-up periods after implantation and given the lack of donor hearts, the need for managing concomitant tachyarrhythmias has arisen. Atrial and ventricular arrhythmias are documented in approximately 20% to 50% of LVAD recipients during long-term device support, according to previous registries. Atrial arrhythmias, primarily atrial fibrillation, generally exhibit good hemodynamic tolerance; therefore, catheter ablation cannot be easily recommended due to the risk of a residual iatrogenic atrial septal defect that may lead to a right-to-left shunt under durable LVAD supports. The clinical impacts of ventricular arrhythmias, mainly ventricular tachycardia, may vary depending on the time periods following the index implantation. Early occurrence after the operation affects the hospitalization period and mortality; however, the late onset of ventricular tachycardia causes varying prognostic impacts on a case-by-case basis. In cases of hemodynamic instability, catheter ablation utilizing a trans-septal approach is necessary to stabilize hemodynamics. Nonetheless, in some cases originating from the intramural region or the epicardium, procedural failure may occur with the endocardial ablation. Specialized complications associated with the state of LVAD support should be carefully considered when conducting procedures. In LVAD patients, electrophysiologists, circulatory support specialists, and surgeons should collaborate as an integrated team to address the multifaceted issues related to arrhythmia management. Full article

In this work, a soft-elastic pulsation pump (SEPP) has been made and investigated. Here, 3D printing was used to make casting molds and a melt-removal method using wax was employed. The SEPP was made of silicone rubber and driven by an external squeezing mechanism. A silicone one-way valve was also made which prevented backflow after the fluid was squeezed out of the pump chamber. The material characteristics of the SEPP including durability were examined. The pump operating parameters were confirmed to differential pressure of 100 mm Hg in a close flow loop. The average flow rate was 2 L/min, while yielding a peak flow of 8 L/min, and a stroke volume of 70 mL. A preliminary trial using fresh animal blood had shown that the SEPP has good protection on the blood. Therefore, within the resources available, an interesting idea for an effective SEPP has been proposed and realized in the laboratory. The technical details of the SEPP described, and the experimental results reported here form a good basis for making higher capacity SEPPs. This effort may help make its way to an effective ventricular assist device. Full article