41 Works

Should COVID Vaccination Be Required in Heart Transplantation & Left Ventricular Assist Device Implantation?

Mustafa M. Ahmed, Manjula Ananthram & Susan M. Joseph
No abstract available

Cardiac tamponade on ECPELLA: a case report of a unique hemodynamic picture

Naveed Akhtar, Parth Savsani, Maya Guglin & Roopa Rao
Extracorporeal membrane oxygenation is rapidly becoming a preferred therapy for short-term hemodynamic support in cardiogenic shock, along with the use of devices such as Impella (Abiomed, Andover, MA). The two together can create unique hemodynamics resulting in altered presentation of common hemodynamic conditions such as tamponade. We present a case of a patient with fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation and Impella support. The patient later developed a pericardial effusion with atypical tamponade physiology,...

Off-pump HeartMate II Exchange in a Patient with Severe Lower Extremity Peripheral Artery Disease: A Case Report

Mehmet Akay, Ismael Salas De Armas, Manish K. Patel, Rajko Radovancevic & Igor D. Gregoric
Thrombosis of left ventricular assist device (LVAD) pumps is a serious complication that often requires exchange of the device. A 66-year-old man with severe peripheral vascular disease presented with pump thrombosis of the HeartMate II (HMII) LVAD 1.5 years after implantation. The HMII was exchanged to another HMII through a subcostal incision and without the use of cardiopulmonary bypass. For safety, the patient was prepared for cardiopulmonary bypass by exposing the right subclavian artery and...

Impact of Atrial Fibrillation on Outcomes after Left Ventricular Assist Device Implantation: Systematic Review and Meta-Analysis

Chandan Buttar, Sofia Lakhdar, Mahmood Nassar, Nso Nso, Giovina Collura & Most Sirajum Munira
Background: Atrial fibrillation (AF) is a common finding in patients with heart failure and is well-known for its deleterious effects on cardiac function and hemodynamics; however, there are gaps in knowledge regarding the impact of AF on patients with left ventricular assist devices (LVADs). Methods: In this study, we searched PubMed/Medline, Embase, and Cochrane Library databases through September 2021 to find articles that assessed the outcomes of AF in patients with LVADs. Results: A total...

Successful Percutaneous Management of LVAD Outflow Graft Stenosis: Role of Invasive Hemodynamics in Decision Making

Tarun Dalia, Amandeep Goyal, Harsh Mehta, Henedine C. Foster, Eric Hockstad, Aaron Rohr, Philip Johnson, Travis O. Abicht & Bhanu P. Gupta
Left ventricular assist device (LVAD) outflow graft stenosis (OGS) is a rare but lethal complication. We present a case of a 79-year-old male with pertinent past medical history of an LVAD implanted as destination therapy, stage III chronic kidney disease, and hypertension. He was admitted for low-flow alarms, and the echocardiogram showed stable right ventricle function and no pericardial effusion. Invasive hemodynamic assessments demonstrated a peak-to-peak gradient of 90 mm Hg in the outflow graft...

A Unique Case of Inflow Cannula Obstruction by a Tissue Membrane

Roopa A. Rao, Kashif Saleem, Bistees George & Maya Guglin
The use of a left ventricular assist device has increased and is a primary surgical treatment for heart failure. However, one major complication of left ventricular assist device support is an obstruction in the blood flow pathway. Pump thrombosis and outflow graft occlusion are some of the common causes of such obstructions. Here, we describe a unique case of HeartMate II (Abbott Laboratories) inflow cannula obstruction from a membranous structure without evidence of thrombus. The...

Predicting Left Ventricular Assist Device Outcomes Utilizing the Stanford Integrated Psychosocial Assessment for Transplant Measure

Nicholas J. Chesher, Kristina L. Greenwood, Candace Fanale, Cody Gustavenson, Brian Jaski, Hirsch S. Mehta, Peter Hoagland, Kristine Ortiz, Marc Verlasky, Robert Adamson & Walter Dembitsky
Objective: Durable mechanical circulatory support is a proven therapy to extend survival for patients with end-stage heart failure (HF). The International Society for Heart and Lung Transplantation guidelines recommend a detailed psychosocial assessment when selecting candidates for durable mechanical circulatory support. Currently, there are no formally validated psychosocial evaluation tools for left ventricular assist device (LVAD) candidacy. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) uses a multidisciplinary algorithm to evaluate the impact of pre-transplant...

Lactate Dehydrogenase Rising: Bleeding or Clotting?

Ashleigh Long, Amin Yehya & David A. Baran
Modern continuous-flow ventricular assist devices (VADs) have greatly improved the survival of patients with end stage heart failure. However, they are associated with adverse effects, including cerebrovascular accidents (CVA), bleeding, infection, and device thrombosis. Definitive measures to evaluate for pump thrombosis can be challenging; hence, multiple laboratory and imaging modalities have been studied to help guide decision making. Lactate dehydrogenase (LDH) has proven to be a reliable test when used in the appropriate clinical settings...

A “Blinking” Left Ventricular Assist Device

Maya Guglin & Roopa Rao
Guglin M, Rao R. A ”Blinking” LVAD. The VAD Journal. 2020; 6(2):e2020627. https://doi.org/10.11589/vad/e2020627

Decreased International Normalized Ratio on Left Ventricular Assist Device Support: To Bridge or Not to Bridge?

Maya Guglin
Guglin M. Decreased International Normalized ration on Left Ventricular Assist Device Support: To Bridge or Not to Bridge? The VAD Journal. 6(2):e2020629. https://doi.org/10.11589/vad/e2020629

A Case of HeartMate 3 Outflow Graft Twisting with Extraluminal Thrombosis: Is Computed Tomography Angiography Helpful?

Karim Saleb, Marianna Zagurovskaya, Michael Sekela & Maya Guglin
Twists in the outflow graft of the HeartMateTM 3 device (Abbott) have recently been described as a sporadic, late complication. We present a case with a unique combination of external compression of the HeartMate 3 outflow graft by a surgical scar compounded by thrombus formation in the space between the band relief and the outflow graft with associated twist of the outflow graft and severe flow limitation. Computed tomography angiogram (CTA) of the chest was...

What Did We Learn about VADs in 2019?

Maya Guglin
This is our 6th annual literature review on mechanical circulatory support (MCS) devices. Our previous reports for 2014, 2015, 2016, 2017, 2018 were published as open access articles and were well received by the readers (1-5). In this paper, we summarize the most interesting and important, from our standpoint, publications from 2019. As we have done for the past two years, a section on extracorporeal membrane oxygenation (ECMO) is included and primarily addresses new developments...

What is a VAD Social Worker? A National Perspective

Pamela Combs, Will Cohen, Umar Siddiqi & Valluvan Jeevanandam
Ventricular Assist Device Social Workers (VAD SWs) are mandated members of VAD care teams and contribute to the psychosocial aspect of patient care within the United States. However, the contributions and methods of the VAD SW are relatively undefined. This article reports the results of two national surveys regarding VAD SWs. One survey ascertains the VAD SW’s views of their work and their role in the VAD care team. The other survey assesses the VAD...

Removal of Impella in the Setting of Left Ventricular Thrombus: A Potential Indication for Cerebral Embolic Protection Devices

Miro Asadourian, Avinash V. Sharma, Richard Kiel, Felice Lin & Manminder Singh Bhullar
Successful percutaneous mechanical circulatory support (MCS) has been used for acute stabilization of cardiogenic shock (CS). Improved survival outcomes have been observed in patients with CS from an acute myocardial infarction (AMI) who undergo implantation of left ventricular (LV) to ascending aorta rotodynamic pumps, such as the Impella® device (Abiomed). However, thrombotic events are a known complication of such devices in poor flow states such as CS. There is limited evidence regarding the management of...

Intra-aortic Balloon Pump may Attenuate Adverse Hemodynamic Effects of Negative Intrathoracic Pressure in Cardiogenic Shock: Case Report

Faris G. Araj
High negative intrathoracic pressure (NIP), as occurs during obstructive sleep apnea or hiccups, results in adverse hemodynamic consequences, specifically decreased left ventricle (LV) performance. These untoward effects can potentially be catastrophic in the case of an already compromised LV in cardiogenic shock. The interplay of intra-aortic balloon pump counterpulsation during abrupt high NIP in cardiogenic shock is described.

Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO): Percutaneous Bi-Atrial Drainage to Avoid Pulmonary Edema in a Patient with Left Ventricular Systolic Dysfunction

Kenneth R. Dulnuan, Joseph B. Zwischenberger, John G. Gurley & Maya Guglin
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used in patients with severe cardiogenic shock refractory to medical therapy. During V-A ECMO, retrograde flow in the aorta towards the left ventricle (LV) causes increased left-sided filling pressures, which may lead to pulmonary edema. Different strategies have been proposed to decompress the left heart, including placement of an intraaortic balloon pump (IABP), Impella® (Abiomed), or TandemHeart® (Cardiac Assist).1-3 Percutaneous decompression of the left atrium via placement of...

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