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illustration of Heart Mate ii (Thoratec, Pleasanton, CA, uSA) implantation. reprinted with permission, Cleveland Clinic Center for Medical Art & Photography ©2002. All rights reserved.
Source publication
Number of left ventricular assist device (LVAD) implantations increases every year, particularly LVADs for destination therapy (DT). Right ventricular failure (RVF) has been recognized as a serious complication of LVAD implantation. Reported incidence of RVF after LVAD ranges from 6% to 44%, varying mostly due to differences in RVF definition, diff...
Contexts in source publication
Context 1
... failure is one of the most common causes of death in western world. Number of patients diagnosed with heart failure is growing and it remains a target for many pre- ventive and treatment efforts (1,2). Mechanical circulatory support (MCS) devices, including ventricular assist devices (VADs) represent an important treatment modality. Given common etiology of end stage heart failure, left ventricu- lar assist devices (LVADs) are of greater interest. Right ven- tricular assist devices (RVADs) are reserved for situations in which right ventricular failure (RVF) develops, usually as pathophysiological sequels of left ventricular failure (LVF) or LVAD implantation (Figure 1 and ...
Context 2
... and technological improvements of LVAD im- plantation, as well as perioperative medical management have led to significant reduction in complication rates, and improved survival and quality of life, all leading to out- comes approaching those achieved with heart transplant (3)(4)(5)(6)(7)(8). Therefore, it is not surprising that overall rate of LVAD implantation increases every year, especially the number of LVADs for destination therapy (9) (Figure 3). RVF has been recognized as a serious complication of LVAD implantation, and as such has been a subject of con- siderable research. The purpose of this article is to review existing literature on predictors and risk scores for RVF fol- lowing LVAD implantation. To identify studies of interest we used MEDLINE search with Boolean term "AND, " limited to Title/Abstract and English language using terms "RV fail- ure, " "LVAD, " and "predictors, " which yielded 15 articles. Cita- tion indexing on the included studies was done to screen for other relevant publications not identified by our search strategy, which yielded additional 40 articles that were re- viewed in detail. After careful review of these 55 articles, we have identified a total of 11 studies that developed original prediction models for right ventricular failure af- ter LVAD. Of these 11 studies, 7 used available preoperative and intraoperative demographic, laboratory and comor- bidity variables in their models (Supplementary table 1). The remaining 4 studies used echocardiographic variables (Supplementary table ...
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Background
There are limited data on the role of temporary mechanical circulatory support (MCS) devices for cardiogenic shock before left ventricular assist device (LVAD) surgery. This study sought to evaluate the trends of use and outcomes of MCS in cardiogenic shock before LVAD surgery.
Methods and Results
This was a retrospective cohort study f...
Implant center clinical resources are becoming taxed by the growing volume of ambulatory LVAD patients and the rapid growth of this unique population has led to the emergence of MCS shared-care centers. The successful sharing of care with local MCS providers is necessary to allow the continued expansion of this technology to a broader patient popul...
Aims
Percutaneous left ventricular assist devices (pVADs) are used to haemodynamically stabilize patients with cardiogenic shock (CS) caused by acute myocardial infarction (AMI). One out of every two patients has a non-ischaemic cause of CS, and these patients differ profoundly from patients with AMI-related CS. We assessed the usefulness of pVAD s...
Background
The prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied. Methods
We included 3,836 continuous-flow LVAD patients in the INTERMACS registry. Health status was measured pre-operatively and 3 months post-LVAD usi...
Aims
Mechanical circulatory support (MCS) results in substantial improvement of prognosis and functional capacity. Currently, duration of MCS as a bridge to transplantation (BTT) is often prolonged due to shortage of donor hearts. Because long‐term results of exercise capacity after MCS are largely unknown, we studied serial cardiopulmonary exercis...
Citations
... Immediately before surgery, patient hemodynamic parameters, electrocardiographic findings, and medications were also recorded. Finally, the Michigan RV risk score (vasopressor need: 4 ...
Background: Right ventricular (RV) failure is a serious adverse event for patients with left ventricular assist devices (LVADs). Here, we seek to identify the risk factors which may predict the development of RV failure (RVF). Methods and Results: Forty-two patients were implanted with LVADs (32 HeartWare® ventricular assist device and 10 Thoratec® HeartMate II) between March 2013 and April 2014 at the Ege University Medical School, Izmir, Turkey. Baseline clinical, demographic, and laboratory information were measured and patients prospectively fallowed after surgery. Endpoint was defined RVF development for patients. Before surgery, hemodynamic parameters, electrocardiographic findings, standard echocardiographic measurements, and medications were recorded. Multivariate regression analysis showed that the presence of ascites, prealbumin 1.5 mg/dl, RV diameter >3.2 cm, RV-fractional area change (FAC) 28 cm, 2 and RV-myocardial performance index >0.35 were the strongest predictors of RVF after LVAD implantation. Conclusions: RAA and RV-FAC are easily obtained and should be evaluated in potential LVAD patients. Risk assessment systems should also take into account the presence of ascites and low prealbumin levels which are not currently incorporated into any risk models. Validation of the relative importance of all of these parameters requires further investigation.
... Причинами ПЖН являются: -ремоделирование желудочков; -изменения в преднагрузке (диастолическое наполнение ПЖ); -уменьшение сократимости; -увеличение постнагрузки. На сократимость правого желудочка влияет функция левого [102]. Эффект взаимозависимости желудочков наиболее заметен при изменении нагрузки, например, после имплантации LVAD, и играет важную роль в патофизиологии дисфункции правого желудочка после LVAD [103]. ...
... Кроме того, имплантация RVAD, как вари-ант лечения ПЖН, приводит к увеличению заболеваемости вследствие повышенного риска инфицирования, необходимости переливания крови и риска отказа устройства. Таким образом, одним из наиболее важных вопросов с момента введения LVAD в качестве лечения сердечной недостаточности является определение необходимости и оптимального времени поддержки RVAD [102]. ...
The work is devoted to topical issues of the use of mechanical bypass of the left ventricle, in particular, the prognostic criteria of right ventricular function, which are key in the outcome of the disease. Retrospective studies of individual institutions were analyzed; patients who received pulsating LVAD were included. Various indicators and scales are presented, and different models of predictors of the development of right ventricular failure are compared. Thus, the development and implementation of reliable predictors of the development of right ventricular failure before implantation of left ventricular assistive devices is an urgent problem of modern transplantology and functional diagnostics.
... 5,12 Current risk assessment scores have limited predictive value and clinical usefulness for predicting LVAD-related complications, especially RV failure. 9,10,24 Recently, the EUROMACS-RHF risk score has been developed and aims to predict early RV failure and associated mortality after LVAD implantation. 10 At the moment, the best predictive variable for RV failure post-LVAD implantation is RV function prior to surgery as assessed by echocardiography, which largely depends on fluid status, vascular resistance, degree to which pulmonary pressures are elevated, and severity of tricuspid valve regurgitation. ...
Aims
We aim to study the feasibility and clinical value of pulmonary artery pressure monitoring with the CardioMEMS™ device in order to optimize and guide treatment in patients with a HeartMate 3 left ventricular assist device (LVAD).
Methods and results
In this single‐centre, prospective pilot study, we will include 10 consecutive patients with New York Heart Association Class IIIb or IV with Interagency Registry for Mechanically Assisted Circulatory Support Classes 2–5 scheduled for implantation of a HeartMate 3 LVAD. Prior to LVAD implantation, patients will receive a CardioMEMS sensor, for daily pulmonary pressure readings. The haemodynamic information provided by the CardioMEMS will be used to improve haemodynamic status prior to LVAD surgery and optimize the timing of LVAD implantation. Post‐LVAD implantation, the haemodynamic changes will be assessed for additive value in detecting potential complications in an earlier stage (bleeding and tamponade). During the outpatient clinic phase, we will assess whether the haemodynamic feedback can optimize pump settings, detect potential complications, and further tailor the clinical management of these patients.
Conclusions
The HEMO‐VAD study is the first prospective pilot study to explore the safety and feasibility of using CardioMEMS for optimization of LVAD therapy with additional (remote) haemodynamic information.
... This article focuses on digital channels which support VAD stakeholders in the face of emerging challenges resulting from a growing incidence of heart disease, heart failure, and VAD implantation. [6][7][8][9] Although design in this context is often technology driven, there is opportunity for these challenges to be more conscious of a user's experience. 10 Indeed, this research details a growing trend of digital channels for VAD stakeholders, which have emerged due to an increasing recognition of the need for tools to assist with the decision-making process, practitioner education, patient and caregiver education, daily maintenance and monitoring, self-care, and wellbeing management. ...
This article seeks to review and analyze the emergence of digital channels designed for ventricular assist device (VAD) patients, caregivers, and practitioners and to understand how such digital channels support the user experience of VAD implantation. Following a content analysis methodology, the authors investigated 16 digital channels designed for VAD patients, caregivers, and practitioners, with data being analyzed thematically. Competitor Positioning Matrix diagrams were created to visually represent the landscape of digital channels that support VAD stakeholders. These matrices identified opportunities and potential areas for improvement in future VAD digital channel design, with an emphasis on interactivity coupled with intelligence and focus along the various stages of the VAD patient journey. Innovation in digital channels has the potential to reduce burden on all users by enabling communication, self-management, and remote monitoring. Digital channels can be information enhanced for point of care, function as a decision support tools or be used to empower patient-caregiver pairs to be more sufficient with self-management, while enabling communication with their practitioner.
... Patient support tools should facilitate building relationships and sustaining dialogues between stakeholders in order to improve the overall VAD implantation experience for all users, and improve patient outcomes. This challenge becomes even more critical when we consider the rising number of VADs implanted in patients and the global increase in heart disease (Go et al., 2013;Heidenreich et al., 2013;Koprivanac, Kelava, Cruz, & Moazami, 2014;Mozaffarian et al., 2016). ...
... This paper focuses specifically on the digital platforms that support VAD patients, practitioners and carers because the big picture industry challenges that are emerging with a growing incidence of heart disease, heart failure and VAD implantation (Go et al., 2013;Heidenreich et al., 2013;Koprivanac et al., 2014;Mozaffarian et al., 2016) can be met with patient-centric designs that don't have to be technology-driven, but can be created with attention to the user experience (Martin et al., 2011). We can see a trend materialising as designed digital platforms for VAD users are emerging along with the VAD industry as a whole, due to an increasing recognition of the need for tools to assist with the decision-making process, practitioner education, patient and caregiver education, daily maintenance and monitoring, self-care, and wellbeing management (J. ...
... Patient support tools should facilitate building relationships and sustaining dialogues between stakeholders in order to improve the overall VAD implantation experience for all users, and improve patient outcomes. This challenge becomes even more critical when we consider the rising number of VADs implanted in patients and the global increase in heart disease (Go et al., 2013;Heidenreich et al., 2013;Koprivanac, Kelava, Cruz, & Moazami, 2014;Mozaffarian et al., 2016). ...
... This paper focuses specifically on the digital platforms that support VAD patients, practitioners and carers because the big picture industry challenges that are emerging with a growing incidence of heart disease, heart failure and VAD implantation (Go et al., 2013;Heidenreich et al., 2013;Koprivanac et al., 2014;Mozaffarian et al., 2016) can be met with patient-centric designs that don't have to be technology-driven, but can be created with attention to the user experience (Martin et al., 2011). We can see a trend materialising as designed digital platforms for VAD users are emerging along with the VAD industry as a whole, due to an increasing recognition of the need for tools to assist with the decision-making process, practitioner education, patient and caregiver education, daily maintenance and monitoring, self-care, and wellbeing management (J. ...
A ventricular assist device (VAD) is a surgically implanted mechanical pump attached to the heart to assist its function in patients with advanced heart failure. This paper investigates the current state of training being provided to VAD patients and caregivers, and whether it adequately prepares them for the VAD lifestyle. The study consisted of a literature review, a content analysis and interviews conducted with stakeholder representatives. A co-design process led to the development a holistic interactive prototype that was evaluated by one VAD caregiver, one VAD biomedical engineer, and one VAD surgeon. Four key themes emerged from the research examining the VAD patient and caregiver training experience: (i) uncertainty, (ii) misinformation, (iii) gratitude, and (iv) preparation. Five overarching themes emerged as design recommendations: (1) artificial onboarding, (2) contextual empathy, (3) ongoing support, (4) physician connectivity, and (5) emergency scenarios. Findings suggest the need to focus on not just the patient, but equally on the VAD caregiver. Design opportunities include the optimisation of both training tools and VAD communication relating to emergency scenario preparation.
... A higher ratio means that a large proportion of each cardiac cycle is spent increasing and decreasing pressure without performing stroke work, indicating a worse ventricular performance. 54) In patients with advanced HF selected to receive CRT, abnormal RIMP demonstrated to be associated with adverse outcome compared to normal RIMP (0.83 vs. 0.69, p = 0.004) and each 0.1 unit increase in RIMP was associated with a 16% increased risk (95% confidence interval: [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. 55) Analogous association was also found in patients with moderate chronic HF. 56) ...
In patients with end-stage left ventricular (LV) heart failure who receive LV assist device (LVAD) implantation, right ventricular (RV) failure represents a possible critical complication that heavily affects morbidity and mortality. Several clinical, laboratory, hemodynamic, and echocardiographic variables have been found to be associated with RV failure occurrence after surgery. Different models and risk scores have been proposed, with poor results. No accordance has ever been reached about RV pre-operative evaluation, and time has come to introduce a standardized systematic protocol for LVAD suitability assessment according to RV function. We analyzed imaging parameters associated with LVAD implantation-related RV failure, in order to identify the minimum number for pre-operative reliable prediction of post-operative RV failure. A few echocardiographic parameters have been identified as the most reliable, or promising, and reproducible tools in this field: free-wall RV longitudinal strain, RV fractional area change, RV sphericity index, and RV ejection fraction with 3D-echocardiography. We propose the Systematic LVAD Implant Eligibility with Non-invasive Assessment protocol–the SIENA protocol–as a new and simple way of pre-operative evaluation of patients candidates to LVAD implantation.
... The classification of RVF after LVAD implantation is described by The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and is associated with increased perioperative mortality, prolonged length of stay, and worse survival even after cardiac transplantation (Table 11) [23]. The definition of serious RVF after LVAD implantation must be very clear, because it needs to be treated by heart transplantation or mechanical circulatory support (Table 12) [24]. Post-implant RVF can occur beyond the immediate postoperative period or later, and it significantly impacts survival after LVAD implantation because it is a progressive condition. ...
... In this issue of the Croatian Medical Journal, multiple venues of advanced HF treatment are reviewed (3)(4)(5)(6)(7)(8)(9)(10). The issue includes scholarly articles portraying some of the fundamental facts pertaining to heart failure and its management, while also focusing on specific clinical problems. ...
... Multiple laboratory, clinical, and echocardiographic parameters have been employed in the effort to identify LVAD patients in whom right ventricular failure will occur, but an effective predictive system is still not available. Nonetheless, this issue presents a summary of available scoring systems and their individual performances (6). ...
Heart failure (HF) is a public health concern with an immense effect on the utilization of precious and finite health care resources. More than 23 million people worldwide have been affected by symptoms of HF (1). The equivocal criteria for diagnosing HF have led to variable projections of its true incidence, but its impact and frequency grant it the status of a modern-day epidemic (1). Its prevalence continues to follow an upward trend, as it parallels the economic growth and progressive aging of a community. The syndrome of HF is multifaceted in origin, and encompasses a wide range of underlying clinical entities that all result in pronounced morbidity and mortality.
Background:
Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation is associated with worse outcomes. Prediction of RVF is difficult with routine transthoracic echocardiography (TTE), while speckle-tracking echocardiography (STE) showed promising results. We performed systematic review and meta-analysis of published literature.
Methods:
We queried multiple databases to compile articles reporting preoperative or intraoperative right ventricle global longitudinal strain (RVGLS) or right ventricle free wall strain (RVFWS) in LVAD recipients. The standard mean difference (SMD) in RVGLS and RVFWS in patients with and without RVF postoperatively was pooled using random-effects model.
Results:
Seventeen studies were included. Patients with RVF had significantly lower RVGLS and RVFWS as compared to non-RVF patients; SMD: 2.79 (95% CI: -4.07 to -1.50; P: <.001) and -3.05 (95% CI: -4.11 to -1.99; P: <.001), respectively. The pooled odds ratio (OR) for RVF per percentage increase of RVGLS and RVFWS were 1.10 (95 CI: 0.98-1.25) and 1.63 (95% CI 1.07-2.47), respectively. In a subgroup analysis, TTE-derived GLS and FWS were significantly lower in RVF patients as compared to non-RVF patients; SMD of -3.97 (95% CI: -5.40 to -2.54; P: <.001) and -3.05 (95% CI: -4.11 to -1.99; P: <.001), respectively. There was no significant difference between RVF and non-RVF groups in TEE-derived RVGLS and RVFWS.
Conclusion:
RVGLS and RVFWS were lower in patients who developed RVF as compared to non-RVF patients. In a subgroup analysis, TTE-derived RVGLS and RVFWS were reduced in RVF patients as compared to non-RVF patients. This difference was not reported with TEE.
