40 Works

Heart Rate Variability: A Possible Machine Learning Biomarker for Mechanical Circulatory Device Complications and Heart Recovery

Theodore Lin, Zain Khalpey & Shravan Aras
Cardiovascular disease continues to be the number one cause of death in the United States, with heart failure patients expected to increase to >8 million by 2030. Mechanical circulatory support (MCS) devices are now better able to manage acute and chronic heart failure refractory to medical therapy, both as bridge to transplant or as bridge to destination. Despite significant advances in MCS device design and surgical implantation technique, it remains difficult to predict response to...

Improved outcomes in the treatment of post-myocardial infarction ventricular septal defect with percutaneous TandemHeart® left ventricular mechanical circulatory support

Pranav Loyalka, Angelo Nascimbene, Sriram S. Nathan, Rajko Radovancevic, Ajay S. Raman, Manish Patel, Keshava Rajagopal, Biswajit Kar & Igor D. Gregoric
Background Post-myocardial infarction (MI) ventricular septal defect (VSD) is associated with 40% - 50% of peri-procedural mortalities; however, it is amenable to catheter-based therapies. We retrospectively investigated the impact of state-of-the-art bridging percutaneous left ventricular mechanical circulatory support (MCS) using the TandemHeart® (TH) ventricular assist device (VAD) on a patient with post-MI VSD. Results From July 2008 to March 2014, 23 patients were referred for treatment of post-MI VSD. Initially, 18/23 patients required MCS; 12...

Predicting Bleeding and Thrombosis Complications in Patients with Continuous Flow Left Ventricular Assist Devices

Kyle Zacholski, William Kuan, Justin McCann, Aric Schadler, Aaron Cook, Sara Parli & Adam Sieg
Background Left ventricular assist device (LVAD) therapy has been proven to relieve heart failure symptoms and improve survival, but is not devoid of bleeding and/or thrombotic complications. Risk stratification tools have been utilized in other cardiovascular disease populations to estimate the risk of bleeding and thrombosis with and without anticoagulation, including the HAS-BLED, HEMORR2HAGES, CHADS2 and CHA2DS2-VASc models. The study objective was to evaluate the predictive value of available risk models for bleeding and thrombotic...

Unusual Case of Pump Thrombosis in LVAD Patient with COVID-19 — Diagnostic Challenges

William H. Frick, Ryan D. Mallory, Maya Guglin, Eve Anderson, Erin N. Lushin, Rey P. Vivo, Kashif Saleem & Roopa A. Rao
We present the first reported case of left ventricular assist device (LVAD) pump thrombosis in the setting of the coronavirus pandemic. We describe the clinical features of the case which helped to differentiate coronavirus disease 19 (COVID-19) from LVAD pump thrombosis. The patient is 56-year-old female supported by destination LVAD therapy. She was originally implanted with a HeartMate II device in 2015 and underwent two pump exchanges in 2017 and 2019 for pump thrombosis, despite...

Pulsatility is a Predictive Marker of Improved Cardiac Function in Patients with Liquid Matrixtreated Left Ventricular Assist Devices

Philemon Mikail, Rinku S. Skaria, Marvin J. Slepian, Janny Garcia, Richard G. Smith & Zain I. Khalpey
Objective: Left ventricular assist devices (LVADs) are utilized as a bridge to transplant or as destination therapy for patients with end-stage heart failure. Although cardiac offloading from these devices rarely leads to complete remodeling and functional recovery, the use of mesenchymal cells to modulate heart failure has been explored in recent years due to its intrinsic regenerative properties. Current methods of evaluating cardiac function have too much variability, difficulty of access, or require too frequent...

My Journey with the HeartWare Ventricular Assist Device- An Obituary

Georg Wieselthaler
Wieselthaler G. My Journey with the HeartWare Ventricular Assist Device- An Obituary. The VAD Journal. 2022; 8(1):e2022813. https://doi.org/10.11589/vad/e2022813

Angiotensin Inhibition and Gastrointestinal Bleeding Prevention in Patients with Left Ventricular Assist Devices

Phillip Weeks
Gastrointestinal bleeding remains a common complication in advanced heart failure patients following implantation of continuous-flow left ventricular assist devices. While the cause is likely multifactorial, development of arterial venous malformations in the gastrointestinal mucosa are a key factor. Inhibition of angiotensin II activity has been postulated to disrupt the signaling that promotes angiogenesis in these patients. We aim to review the theoretical basis for angiotensin receptor blockade, which has been proposed and explore the published...

Modeling Hospital-Wide Extracorporeal Cardiopulmonary Resuscitation: Pros and Cons

Shiksha Joshi, Sandipan Shringi, Manpreet Sira & Maya Guglin
Background We aimed to analyze the potential benefits of implementing a hospital-wide extracorporeal cardiopulmonary resuscitation (ECPR) protocol. Methods We analyzed in-hospital cardiac arrests in a large, academic hospital for two consecutive years. For this model, we assumed that ECPR would be started in all adults, with no upper age limit, who have a full code status. We excluded codes lasting <15 minutes, arrests with asystole as an initial rhythm, and patients with hemorrhagic shock or...

Feasibility of the use of a Stereoscopic Camera In the Final Inclusion (SCI-FI) of Donor Organ Assessment Using Virtual Reality Technology

Ismael A. Salas de Armas, Juan Marcano, Jayeshkumar A. Patel, M. Hakan Akay, Manish K. Patel, Bindu Akkanti, Marwan Jumean, Sachin Kumar, Rajko Radovancevic, Sriram S. Nathan, Biswajit Kar & Igor D. Gregoric
Objective: Donor organ assessment is challenging, particularly when physicians and surgeons have to make decisions remotely. To improve communication and preparation for the transplant process, we proposed that a versatile, secure, and transportable video presence would enable a detailed assessment of donor organs. Methods: A virtual reality camera with a 360-degree visualization range was used with a smartphone receiver to enable integral assessment of the donor's heart in the operating room, with visualization of the...

What Did We Learn about VADs in 2021?

Maya Guglin
This is our 8th annual literature review on mechanical circulatory support (MCS) devices. Our previous reports were well received by the readers. The full text of the reviews for 2014, 2015, 2016, 2017, 2018, 2019, and 20201-7 were downloaded 821, 861, 701, 869, 951, 272, and 365 times, respectively. In this review, we summarized the most interesting and important, from our standpoint, publications from 2021. There may be some slight overlap with the end of...

Fondaparinux as an Alternative Anticoagulant Treatment in Patients with Left Ventricular Assist Devices and Recurrent Gastrointestinal Bleeding: Case Series

Daniela Piani, Andrea Lechiancole, Massimo Maiani Maiani, Igor Vendramin, Sandro Sponga, Elisabetta Auci & Ugolino Livi
Gastrointestinal bleeding (GIB) can occur in patients after left ventricular assist device (LVAD) implantation. In cases of recurrent GIB, the management of anticoagulation treatment represents a challenging situation in which the risk of bleeding recurrence and the need for long-term anticoagulation must be balanced. This case series describes the successful management of anticoagulation in three patients with recurrent GIB using fondaparinux. To our knowledge, these are the first reported cases of recurrent GIB in which...

Extended Cable for Left Ventricular Assist Devices for Monitoring Isolated Patients during the COVID-19 Pandemic

Neal Waxali, James M. Kenward, Yasser Varona, Laurie Loza & Arvind Bhimaraj
We present a method to create an extended cable for patients who are supported by left ventricular assist devices (LVADs) while infected with SARS-CoV-2. The arrangement described facilitates the LVAD monitor console’s positioning outside of the patient’s room to minimize exposure of the mechanical circulatory support team to the novel coronavirus.

Advantages of bridging to durable left ventricular assist device with the Impella 5.0

Manish K. Patel
The mainstay therapy for patients in critical cardiogenic shock (CS) is temporary mechanical circulatory support. Although there is a trend toward use of durable left ventricular assist devices (LVAD) in patients that are less ill, we present our experience with using the Impella 5.0 (Abiomed) to illustrate the potential benefits of supporting patients with critical CS before durable LVAD implantation. Since 2012, our use of the Impella has increased from 5 to 38 per year....

Transcutaneous Energy Transmission: Can we do it now?

Yuriy Pya
The percutaneous driveline used in contemporary LVADs presents a continuous risk of infection for the duration of support. Minimizing infection in durable mechanical circulatory support systems requires total implantation of all components and energy transfer by means other than percutaneous drivelines. A novel coplanar energy transfer (CET) system, similar to the original transcutaneous energy transfer (TET) design, is unique by incorporating two large rings with coil-within-the-coil topology to ensure strong resonance power. The CET system...

Occupational therapy’s role with ventricular assist devices and the promotion of travel protocols

Natasha Chandra & Linda Suplicki
An option for individuals diagnosed with end-stage heart failure is to receive a ventricular assist device (VAD). In 2006, Shepherd and Wilding produced an article regarding occupational therapy’s role during the VAD process as they anticipated a growing need for this area of practice. Since that time, there continues to be a lack of supporting literature on occupational therapy’s important role with this population. Therefore, the purpose of this article is to explain an occupational...

Cutting the Cord: A Case of Late Presenting Driveline Infection

Brian Laughey, Lauren Eyadiel & Barbara Pisani
Ventricular assist device (VAD) related infection, specifically driveline infection, is a common complication after VAD implantation. A 45-year old patient with a delayed skin infection at the site of the original driveline nearly one year after VAD inactivation and surgical driveline burial was treated with antibiotics and surgical debridement for approximately six months. Continued discharge at driveline site and growth of methicillin susceptible Staphylococcus aureus resulted in the recommendation of explantation of the VAD. Post-VAD...

Guideline-Directed Heart Failure Therapy in Patients after Left Ventricular Assist Device Implantation: A Review

Bailey M. Colvin, James C. Coons & Craig J. Beavers
Background: Left ventricular assist devices (LVADs) are used as an advanced therapy option for patients with stage D heart failure. These devices provide mechanical unloading of the heart as either a bridge to transplant or recovery, or as destination therapy. In patients with LVADs, there are emerging data on the use of heart failure guideline-directed medical therapy (GDMT) to improve outcomes. This review describes the current evidence available for the use of neurohormonal blocking agents...

What Did We Learn about VADs in 2020?

Maya Guglin
This is our 7th annual literature review on mechanical circulatory support (MCS) devices. Our previous reports were well received by the readers. The full text of the reviews for 2014, 2015, 2016, 2017, 2018, 2019 1-6 were downloaded 807, 843, 638, 827, 841, and 199 times, respectively. In this review, we summarized the most interesting and important, from our standpoint, publications covering MCS from 2020. There may be some slight overlap with the end of...

Left Ventricular Assist Device Thrombosis Treated with Intravenous Tissue Plasminogen Activator in a Patient with COVID-19 Infection

Simone A Jarrett, Jafar Alzubi, Savalan Babapoor-Farrokhran, Zaid Ammari, Mohammad Al Sarie, Zachary Port, Farhan Hasni, Behnam Bozorgnia & Raphael Bonita
Left ventricular assist device (LVAD) implantation is an established treatment for patients with end-stage, systolic heart failure as a bridge to heart transplantation or destination therapy. LVAD pump thrombosis is a life-threatening complication than can be triggered by prothrombotic conditions such as infection. Management of pump thrombosis presents as both a diagnostic and therapeutic challenge that is associated with a high morbidity and mortality. We report a case of pump thrombosis in a patient with...

Thyroidectomy in Mechanical Circulatory Support - A Salvage Treatment for Thyrotoxicosis-Induced Cardiogenic Shock: Case Series

Rody G. Bou Chaaya, Lauren M. Saint & Onyedika J. Ilonze
Amiodarone is frequently used to treat arrhythmias in patients supported with left ventricular assist devices. Long term amiodarone use can cause hyperthyroidism ultimately leading to cardiomyopathy and sometimes thyrotoxicosis-induced cardiogenic shock (CS). We describe two cases of thyrotoxicosis-induced CS rescued by successful thyroidectomy under mechanical circulatory support (MCS) – one with a Heartmate III (Abbott Laboratories) and another supported with venoarterial extracorporeal membrane oxygenation (V-A ECMO). In refractory CS, the initiation of V-A ECMO as...

Acute Pump Thrombosis within One Hour of a HeartMate 3 Implantation: Case Report

Zubair Shah, Noel Torres Acosta, Amandeep Goyal, Tarun Dalia, Sarah Henkel & Travis Abicht
A 39-year-old male with a history of non-ischemic cardiomyopathy underwent a HeartMate 3 (Abbott Laboratories) implantation. Within an hour of implantation, low flow alarms were noted before exiting the operating room. The alarm was secondary to acute pump thrombosis. This is the first reported case of thrombosis immediately post-implant.

Highlights of the 2021 Brano Heart Failure Forum

Rajko Radovancevic, Bojan Vrtovec & Igor D. Gregoric
Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The forum was postponed in 2020 due to the COVID-19 pandemic and then resumed in September of 2021 in Graz, Austria. It was...

Evaluation of Outpatient Anticoagulation Bridging After Left Ventricular Assist Device Implantation

Rebecca A. Rainess, Laren Alderman, Teresa Cicci, Monty Yoder, Barbara Pisani, Thomas O’Neill & Diego Malaver
Objective: The aim of this study is to evaluate the safety of outpatient anticoagulation bridging following left ventricular assist device (LVAD) implantation. Methods: This study is a retrospective, single-center cohort of adult patients who underwent LVAD implantation (HeartMate II™ or HeartMate 3™) and received warfarin and at least one dose of therapeutic enoxaparin or fondaparinux for outpatient anticoagulation bridging. The primary endpoint was the incidence of bleeding complications within one week of completing the bridging...

Cangrelor: Safe and Effective for Left Ventricular Assist Device Thrombosis

Roopa Rao, Eve Anderson, Mark Jones, Muhamed Safiia & Maya Guglin
Pump thrombosis is a devastating complication of left ventricular assist device implantation as it increases the risk of mortality and morbidity. Early and effective treatment is important to prevent the progression of the clot and to avoid the surgical need for pump exchange or heart transplant. The current strategies of intensifying anticoagulation therapy are not consistently effective and carry significant bleeding risks. Cangrelor is a new pharmacological agent that has been utilized as an antiplatelet...

Successful pregnancy with centrifugal flow left ventricular assist device: A case report and review of the literature

Seyed Hamed Hosseini Dehkordi, Matthew R. Lippmann, Travis Abicht, Andrew J. Sauer, Nicholas A. Haglund, Marc R. Parrish Parrish, Jared Staab & Bhanu Gupta
Succesful deliveries from patients supported by axial flow left ventricular devices have been previously reported. We present the first case of a successful pregnancy and birth in a patient with a centrifugal-flow left ventricular assist device. A 24-year-old female with methamphetamine-induced cardiomyopathy and end-stage congestive heart failure supported by a HeartWare™ ventricular assist device (Medtronic) presented two years after device implantation with an unplanned pregnancy at 11-weeks of gestation. Following a multidisciplinary evaluation by experts...

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