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Heart Failure Reviews Jul 2023Historically, transplantation of a female donor heart to male recipient has been viewed with caution given evidence of suboptimal outcomes, particularly in special... (Review)
Review
Historically, transplantation of a female donor heart to male recipient has been viewed with caution given evidence of suboptimal outcomes, particularly in special populations such as patients with pulmonary hypertension or those supported by ventricular assist devices. However, the use of predicted heart mass ratio for donor-recipient size matching demonstrated that the size of the organ rather than sex of the donor was most responsible for the outcomes. With the advent of the predicted heart mass ratio, avoiding female donor hearts for male recipients is no longer justified and may result in unnecessary waste of available organs. In this review, we highlight the value of donor-recipient sizing by predicted heart mass ratio and summarize the evidence of different approaches to the donor-to-recipient size and sex matching. We conclude that the utilization of predicted heart mass is currently considered a preferred method of matching heart donors and recipients.
Topics: Humans; Male; Female; Heart Transplantation; Tissue Donors; Heart; Hypertension, Pulmonary; Heart-Assist Devices; Retrospective Studies
PubMed: 36813936
DOI: 10.1007/s10741-023-10299-1 -
Journal of the American College of... Aug 2023In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD), it is unknown how... (Clinical Trial)
Clinical Trial
BACKGROUND
In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD), it is unknown how preimplant factors and postimplant index hospitalization events influence 5-year mortality in those able to be discharged.
OBJECTIVES
The goal was to identify risk predictors of mortality through 5 years among HM3 LVAD recipients conditional on discharge from index hospitalization in the MOMENTUM 3 pivotal trial.
METHODS
This analysis evaluated 485 of 515 (94%) patients discharged after implantation of the HM3 LVAD. Preimplant (baseline), implant surgery, and index hospitalization characteristics were analyzed individually, and as multivariable predictors for mortality risk through 5 years.
RESULTS
Cumulative 5-year mortality in the cohort (median age: 62 years, 80% male, 65% White, 61% destination therapy due to transplant ineligibility) was 38%. Two preimplant characteristics (elevated blood urea nitrogen and prior coronary artery bypass graft or valve procedure) and 3 postimplant characteristics (hemocompatibility-related adverse events, ventricular arrhythmias, and estimated glomerular filtration rate <60 mL/min/1.73 m at discharge) were predictors of 5-year mortality. In 171 of 485 patients (35.3%) without any risk predictors, 5-year mortality was reduced to 22.6% (95% CI: 15.4%-32.7%). Even among those with 1 or more predictors, mortality was <50% at 5 years (45.7% [95% CI: 39.0%-52.8%]).
CONCLUSIONS
Long-term survival in successfully discharged HM3 LVAD recipients is largely influenced by clinical events experienced during the index surgical hospitalization in tandem with baseline factors, with mortality of <50% at 5 years. In patients without identified predictors of risk, long-term 5-year mortality is low and rivals that achieved with heart transplantation, even though most were implanted with destination therapy intent. (MOMENTUM 3 IDE Clinical Study Protocol, NCT02224755; MOMENTUM 3 Pivotal Cohort Extended Follow-up PAS, NCT03982979).
Topics: Female; Humans; Male; Middle Aged; Coronary Artery Bypass; Heart Failure; Heart-Assist Devices; Hospitalization; Patient Discharge
PubMed: 37612008
DOI: 10.1016/j.jacc.2023.05.066 -
ASAIO Journal (American Society For... Feb 2024Cleveland Clinic's continuous-flow total artificial heart (CFTAH) is being developed at our institution and has demonstrated system reliability and optimal performance....
Cleveland Clinic's continuous-flow total artificial heart (CFTAH) is being developed at our institution and has demonstrated system reliability and optimal performance. Based on the results from recent chronic in vivo experiments, CFTAH has been revised, especially to improve biocompatibility. The purpose of this article is to report our progress in developing CFTAH. To improve biocompatibility, the right impeller, the pump housing, and the motor were reviewed for design revision. Updated design features were based on computational fluid dynamics analysis and observations from in vitro and in vivo studies. A new version of CFTAH was created, manufactured, and tested. All hemodynamic and pump-related parameters were observed and found to be within the intended ranges, and the new CFTAH yielded acceptable biocompatibility. Cleveland Clinic's continuous-flow total artificial heart has demonstrated reliable performance, and has shown satisfactory progress in its development.
Topics: Research Report; Reproducibility of Results; Heart, Artificial; Hemodynamics; Hydrodynamics; Heart-Assist Devices
PubMed: 37851000
DOI: 10.1097/MAT.0000000000002076 -
ASAIO Journal (American Society For... Dec 2023Few studies have focused on the clinical outcomes and risk factors of left ventricular assist device (LVAD) pump infection, and no standard treatment for LVAD pump...
Few studies have focused on the clinical outcomes and risk factors of left ventricular assist device (LVAD) pump infection, and no standard treatment for LVAD pump infection has been established. Therefore, we used a therapeutic flowchart to manage LVAD pump infections. We retrospectively evaluated 220 patients who underwent continuous-flow LVAD implantation between January 2005 and March 2021 at Osaka University, Japan. First, we performed wound debridement, negative-pressure wound therapy, antibiotic treatment, and omental flap transposition. Subsequently, we administered conservative treatment, scheduled implantable LVAD exchange, or emergent removal of the implantable LVAD and exchange for extracorporeal LVAD or percutaneous LVAD (IMPELLA). Pump infections occurred in 32 patients. The survival rates of patients with pump infections during LVAD support were 93%, 74%, and 61% at 180 days, 1 year, and 2 years after LVAD pump infection, respectively. Fifteen patients underwent successful heart transplantation. Bridge-to-bridge surgery, preoperative use of venoarterial extracorporeal membrane oxygenation or percutaneous LVAD, high lactate dehydrogenase levels, and driveline infection were significantly associated with pump infection. Our study reveals that poor preoperative condition and driveline infection were significant risk factors for LVAD pump infection.
Topics: Humans; Heart Failure; Retrospective Studies; Heart-Assist Devices; Heart Transplantation; Extracorporeal Membrane Oxygenation; Treatment Outcome
PubMed: 37549664
DOI: 10.1097/MAT.0000000000002031 -
European Heart Journal. Acute... Dec 2023Short-term percutaneous mechanical circulatory support by a micro-axial flow pump is increasingly used to support the left ventricle in cardiogenic shock. After a... (Review)
Review
Short-term percutaneous mechanical circulatory support by a micro-axial flow pump is increasingly used to support the left ventricle in cardiogenic shock. After a correct indication and placement, appropriate device management in the cardiac intensive care unit is vital to ensure optimal pump function and adequate haemodynamic support. A key element hereby is a correct percutaneous ventricular assist device (pVAD) position. This review explains how an optimal left-sided pVAD position can be achieved and maintained, focusing on the correct insertion depth and rotational angle. Useful imaging techniques, placement and replacement manoeuvres, and monitoring options through the console are discussed. The frequently encountered problem of mal-rotation towards the mitral valve, which may cause suction alarms, haemolysis, aortic regurgitation, and inadequate haemodynamic support, is explained. Finally, a practical bedside approach to assess pVAD position and discern suction alarms due to mal-positioning from haemodynamic problems is proposed.
Topics: Humans; Treatment Outcome; Shock, Cardiogenic; Hemodynamics; Intra-Aortic Balloon Pumping; Heart-Assist Devices
PubMed: 37607271
DOI: 10.1093/ehjacc/zuad097 -
The Journal of Heart and Lung... Jul 2024Hemodynamic derangements are defining features of cardiogenic shock. Randomized clinical trials have examined the efficacy of various therapeutic interventions, from... (Review)
Review
Hemodynamic derangements are defining features of cardiogenic shock. Randomized clinical trials have examined the efficacy of various therapeutic interventions, from percutaneous coronary intervention to inotropes and mechanical circulatory support (MCS). However, hemodynamic management in cardiogenic shock has not been well-studied. This State-of-the-Art review will provide a framework for hemodynamic management in cardiogenic shock, including a description of the 4 therapeutic phases from initial 'Rescue' to 'Optimization', 'Stabilization' and 'de-Escalation or Exit therapy' (R-O-S-E), phenotyping and phenotype-guided tailoring of pharmacological and MCS support, to achieve hemodynamic and therapeutic goals. Finally, the premises that form the basis for clinical management and the hypotheses for randomized controlled trials will be discussed, with a view to the future direction of cardiogenic shock.
Topics: Shock, Cardiogenic; Humans; Hemodynamics; Intensive Care Units; Heart-Assist Devices
PubMed: 38518863
DOI: 10.1016/j.healun.2024.03.009 -
Critical Care Nursing QuarterlyRight ventricular failure (RVF) is a critical condition that significantly impacts morbidity and mortality in affected patients. This review article aims to provide a... (Review)
Review
Right ventricular failure (RVF) is a critical condition that significantly impacts morbidity and mortality in affected patients. This review article aims to provide a comprehensive understanding of RVF by discussing its background, etiology, pathophysiology, clinical presentation, diagnostic studies, medical treatment, and mechanical assistive devices.
Topics: Humans; Heart Failure; Risk Factors; Heart-Assist Devices; Ventricular Dysfunction, Right; Retrospective Studies
PubMed: 38031303
DOI: 10.1097/CNQ.0000000000000486 -
Medicina (Kaunas, Lithuania) Nov 2023Heart failure remains a major global burden regarding patients' morbidity and mortality and health system organization, logistics, and costs. Despite continual advances... (Review)
Review
Heart failure remains a major global burden regarding patients' morbidity and mortality and health system organization, logistics, and costs. Despite continual advances in pharmacological and resynchronization device therapy, it is currently well accepted that heart transplantation and mechanical circulatory support represent a cornerstone in the management of advanced forms of this disease, with the latter becoming an increasingly accepted treatment modality due to the ongoing shortage of available donor hearts in an ever-increasing pool of patients. Mechanical circulatory support strategies have seen tremendous advances in recent years, especially in terms of pump technology improvements, indication for use, surgical techniques for device implantation, exchange and explantation, and postoperative patient management, but not in the field of treatment of critically ill patients and those undergoing cardiac arrest. This contemporary review aims to summarize the collected knowledge of this topic with an emphasis on complications in patients with left ventricular assist devices, their treatment, and establishing a clear-cut algorithm and the latest recommendations regarding out-of-hospital or emergency department management of cardiac arrest in this patient population.
Topics: Humans; Heart Transplantation; Tissue Donors; Heart Failure; Cardiopulmonary Resuscitation; Heart-Assist Devices; Heart Arrest
PubMed: 38004030
DOI: 10.3390/medicina59111981 -
Current Opinion in Nephrology and... Sep 2023Mechanical circulatory support (MCS) is a group of evolving therapies used for indications ranging from temporary support during a cardiac procedure to permanent... (Review)
Review
PURPOSE OF REVIEW
Mechanical circulatory support (MCS) is a group of evolving therapies used for indications ranging from temporary support during a cardiac procedure to permanent treatment of advanced heart failure. MCS is primarily used to support left ventricle function, in which case the devices are termed left ventricular assist devices (LVADs). Kidney dysfunction is common in patients requiring these devices, yet the impact of MCS itself on kidney health in many settings remains uncertain.
RECENT FINDINGS
Kidney dysfunction can manifest in many different forms in patients requiring MCS. It can be because of preexisting systemic disorders, acute illness, procedural complications, device complications, and long-term LVAD support. After durable LVAD implantation, most persons have improvement in kidney function; however, individuals can have markedly different kidney outcomes, and novel phenotypes of kidney outcomes have been identified.
SUMMARY
MCS is a rapidly evolving field. Kidney health and function before, during, and after MCS is relevant to outcomes from an epidemiologic perspective, yet the pathophysiology underlying this is uncertain. Improved understanding of the relationship between MCS use and kidney health is important to improving patient outcomes.
Topics: Humans; Heart-Assist Devices; Heart Failure; Kidney; Treatment Outcome
PubMed: 37195244
DOI: 10.1097/MNH.0000000000000896 -
Artificial Organs Dec 2023Maintaining balanced left and right cardiac outputs in a total artificial heart (TAH) is challenging due to the need for continuous adaptation to changing hemodynamic... (Review)
Review
BACKGROUND
Maintaining balanced left and right cardiac outputs in a total artificial heart (TAH) is challenging due to the need for continuous adaptation to changing hemodynamic conditions. Proper balance in ventricular outputs of the left and right ventricles requires a preload-sensitive response and mechanisms to address the higher volumetric efficiency of the right ventricle.
METHODS
This review provides a comprehensive overview of various methods used to balance left and right ventricular outputs in pulsatile total artificial hearts, categorized based on their actuation mechanism.
RESULTS
Reported strategies include incorporating compliant materials and/or air cushions inside the ventricles, employing active control mechanisms to regulate ventricular filling state, and utilizing various shunts (such as hydraulic or intra-atrial shunts). Furthermore, reducing right ventricular stroke volume compared to the left often serves to balance the ventricular outputs. Individually controlled actuation of both ventricles in a pulsatile TAH seems to be the simplest and most effective way to achieve proper preload sensitivity and left-right output balance. Pneumatically actuated TAHs have the advantage to respond passively to preload changes.
CONCLUSION
Therefore, a pneumatic TAH that comprises two individually actuated ventricles appears to be a more desirable option-both in terms of simplicity and efficacy-to respond to changing hemodynamic conditions.
Topics: Heart Ventricles; Heart, Artificial; Cardiac Output; Hemodynamics; Ventricular Function, Right
PubMed: 37702086
DOI: 10.1111/aor.14641